Sub : Nursing Foundation

Unit:XVI

Nursing Theories
 A set of concepts,
definitions, relationships,
and assumptions that
project a systematic view of
a phenomena
 It may consist of one or
more relatively specific
and concrete concepts
and propositions that
purport to account for, or
organize some
phenomenon (Barnum,
1988)
 Concepts – ideas and mental
images that help to describe
phenomena (Alligood and
Marriner-Tomey, 2002)
 Definitions – convey the
general meaning of the
concepts
 Assumptions – statements that
describe concepts
 Phenomenon – aspect of reality
that can be consciously sensed
or experienced (Meleis, 1997).
A model that explains
the linkages of
science, philosophy,
and theory accepted
and applied by the
discipline (Alligood
and Marriner – Tomey,
2002)
 The view or
perspective of the
discipline
 It contains the

subject, central
concepts, values and
beliefs, phenomena of
interest, and the
central problems of
the discipline
 Nursinghas identified
its domain in a
paradigm that
includes four linkages:

1) person/client
2) health
3) environment
4) nursing
 It guides nursing
practice and
generates knowledge
 It helps to describe or

explain nursing
 Enables nurses to

know WHY they are

doing WHAT they are
doing
 Everyday practice enriches
theory
 Both practice and theory are
guided by values and beliefs
 Theory helps to reframe our
thinking about nursing
 Theory guides use of ideas and
techniques
 Theory can close the gap
between theory and research
 To envision potentialities
(Gordon, Parker, & Jester,
2001)
 Organize patient data
 Understand patient data
 Analyze patient data
 Make decisions about
nursing
 interventions
 Plan patient care
 Predict outcomes of
care
Evaluate patient
outcomes
(Alligood, 2001)
 Systems theory
 Basic Human Needs
theory
 Health and Wellness
Models
 Stress and

Adaptation
 Developmental
Theories
 Psychosocial

Theories
 Essential concepts common among nursing
theories:

 Man
 Health
 Environment
 Nursing
 Often considered the first
nurse theorist

 Defined nursing as “the act

of utilizing the environment of
the patient to assist him in
his recovery”.

 Nightingale’s theory remains

an integral part of nursing and
healthcare today
5 Factors for a Healthy Environment:
 Pure or fresh air
 Pure water Efficient
 drainage
 Cleanliness
 Light, especially directs unlight

Nightingale’s general concepts of Environmental Sanitation

includes:
Proper Ventilation
 Adequate Lighting
 Cleanliness
 Adequate Warmth
 Quiet
Diet
Nursing Practice :

The principles of Nursing Practice by FN are continuously used to this very

day. With the advent of technology and with it globalization, comes
threats from the environment.

➢ Global Warming

➢ Industrial Noise

➢ Air Pollution

➢ Fad Diets

➢ Vanity
 Nurses of
today still

needs
Maintain to:
Adequate Ventilation

 Promote Adequate & Appropriate Nutrition

 Maintain Normal Homeostatic Body Temperature

 Observe Basic Hygiene

 Comfort Measures including Environmental Sanitation

 Definition:-
“Assisting the individual, sick or well, in the performance
of those activities contributing to health or it’s recovery
(or to peaceful death) that an individual would perform
unaided if he had the necessary strength, will or
knowledge”.

 Identified 14 basic needs :

1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within normal range

8. Keeping the body clean and well-groomed

9. Avoiding dangers in the environment

10. Communicating with others

11. Worshipping according to one’s faith

12. Working in such a way that one feels a sense of accomplishment

13. Playing/participating in various forms of recreation

14.Learning, discovering or satisfying the curiosity that leads to

normal development and health and using available health facilities.
Bedsid
e
Nursing
pt.’s ability to perform the 14 basic needs should be assessed
before considering the kind of nursing care function you will

: DOER or a PARTNER
administer. Essential to determine if the N will be performing as
a HELPER,

 Nsg interventions are implemented according to the 14 basic

human needs of the patient. The degree of performance ,
involvement of the pt. and the level of nursing activity will be
dependent on the specific role the nurse will be playing
 Focus is on PROPER

IDENTIFICATION of

the problem
Particularly about the proper NURSING DIAGNOSIS

 Nurse-centered

 Nursing is a comprehensive service that is based on the art and science and
aims to help people, sick or well, cope with their health needs.

21 Nursing Problems

 To maintain good hygiene.

 To promote optimal activity; exercise, rest and sleep.
 To promote safety.
 To maintain good body mechanics
 To facilitate the maintenance of a supply of oxygen
 To facilitate maintenance of nutrition
 To facilitate

maintenance of

elimination
To facilitate the maintenance of fluid and electrolyte balance

 To recognize the physiologic response of the body to disease conditions

 To facilitate the maintenance of regulatory mechanisms and functions

 To facilitate the maintenance of sensory functions

 To identify and accept positive and negative expressions, feelings and

reactions

 To identify and accept the interrelatedness of emotions and illness.



 To facilitate the maintenance

verbal and non-verbal communiof ef
To promote the development of productive interpersonal relationship

 To facilitate progress toward achievement of personal spiritual goals

 To create and maintain a therapeutic environment

 To facilitate awareness of self as an individual with varying needs.

 To accept the optimum possible goals

 To use community resources as an aid in resolving problems arising from

illness.

 To understand the role of social problems as influencing factors

Bedside Nursing :

The N’s ability to address &effectively manage the 21 Nursing

problems will spell the patient’s state of health – whether he
fully recovers well & fast, or deteriorate further with devastating
consequences

Ns therefore, have very important role to play. By adhering to

these nursing problems, the work of a N becomes More
Definite
 Nursing is a HUMANISTIC and SCIENTIFIC mode o
through CULTURE-SPECIFIC PROCESS
Emphasizes human caring varies among cultures
-

 Culture Care Preservation and Maintenance

 Culture Care Accommodation and Negotiation

 Culture Care Restructuring and Repatterning

 Application:
Important esp because of the rapid expansion of knowledge &
increasing globalization with the advent of advances in ICT .

 Working Overseas :
Impt to learn the cultures of other people because each culture
has its own sets of patterns, expressions & values of caring .
Getting acquainted with the culture of a country you are
seeking employment as a professional nurse will be a good
steppingstone towards a more fulfilling career in nursing
 Nursing is an art and science that is humanistic and
humanitarian. It is directed toward the unitary human and
is concerned with the nature and direction of human
development. The goal of nurses is to participate in the
process of change..

 Nursing interventions seek to promote harmonious

interaction between persons and their environment,
strengthen the wholeness of the Individual and
redirect human and environmental patterns or
organization to achieve maximum health.
5 basic assumptions:
■ The human being is a unified whole, possessing individual integrity and
manifesting characteristics that are more than and different from the
sum of parts.

■ The individual and the environment are continuously exchanging matter

and energy with each other

■ The life processes of human beings evolve irreversibly and

unidirectionally along a space-time continuum

■ Patterns identify human being and reflect their innovative

wholeness

■ The individual is characterized by the capacity for abstraction and

imagery, language and thought, sensation and emotion
 Patient has

THREE 3
1.
interacting systems
Individuals /Personalsystems :
–
How the nurse views and integrates self basedfrom personal goals and
beliefs.
2. Groupsystems / Interpersonalsystems :

How the N interrelates w/ a co-workers or pt.particularly in N-Pt.

Relationship
3. Socialsystems :

how the N interacts w/ co-workers, superiors,subordinates & the

ct. environment in general
 Action :
A means of behaviour or activities that are towards the
accomplishment of certain act. It is both PHYSICAL & MENTAL
.

Mental (POA)

Action (Goal Setting w/ Ct.)

Perform Achieve Goal

 Reaction
A form of reacting or response to a certain Stimuli.
 Interaction

Any situation wherein the N relates & deals With a ct. or pt.
 Transaction

 Application:

Provides enough direction to how nurses should be able to behave

or act in the presence of pts. Since majority of nursing activities
involves direct interaction w/ pts., Ns should understand the basic
implications of the Action-Reaction-Interaction-Transaction
model of the N- Pt . Relationship.
 Peplau is a psychiatric nurse

–Focus :Therapeutic process

–Attained through: Healthy Nurse-Patient Relationship

Four (4) Phases of Nurse-Patient Interaction

1. Orientation

 Nurse and patient test therole each one assumes

 Prepares patient for termination

 Patient identifies areas of difficulty

2. Identification Phase :
•Patient identifies with the personnel who
can satisfy his needs

3. Exploitation Phase:
•Nurse maximizes all there sources to benefit
the patient

4. Resolution Phase or Termination Phase :

• Occurs when patient’s needs have been met
 Application :

 Significant in terms of the different phases of the N-Pt.

interaction & the different ROLES the N can play in giving
nursing care to pts.

 It thus becomes important for nurses to understand the

principles behind each of these concepts so that clinical nsg
will be more meaningful for the nurse. Eventually , this
will translate to pt. outcomes like :
Improved health
Prevention of Disease pr
Enhancement of care
faculties


Nursing is concerned with promotion health, preventing illness, caring f

 Nursing is a human science of persons and humanhealth.
restoring health-illness
experiences that are mediated by professional, personal, scientific,
esthetic and ethical human care transactions

 • She defined caring as a nurturant way or responding to a valued client towa

nurse feels a personal sense of commitment and responsibility. It is only dem
interpersonally that results in the satisfaction of certain human needs. Carin
person as what he/she may become in a caring environment
 Carative Factors:

■ The promotion of a humanistic-altruistic system of values

■ Instillation of faith-hope
■ The cultivation of sensitivity to one’s self and others
■ The development and acceptance of the expression of positive and
negative feelings.
■ The systemic use of the scientific problem-solving method for decision
making
■ The promotion of interpersonal teaching-learning
■ The provision for supportive, protective and corrective mental, physical,
socio-cultural and spiritual environment
■ Assistance with the gratification of human needs
■ The allowance for existential phenomenological forces
 The Nursing Process is an interaction of Three Basic Elements:
1. Patient’s Behaviour
2. Nurse’s reaction
3. Nursing Actions – designed for the patient’s benefit

 The Role of the Nurse is to find out & meet the Pt’s stat need for
help. Ns should use his perception, thoughts about the perception
or the feeling engendered from their thoughts to explore with
patients the meaning of their behaviour
 The use of the theory keeps the N’s focus on the patient
Application:
The Theory increases the Therapeutic Effectiveness
of nurses by the expression of Empathy, Warmth &
Genuineness esp in the light of addressing the Stat
Need of the Patient for help.
This framework will be important for Ns who
are assigned in special clinical areas that requires
quick decision making & critical thinking skills .
If the patient’s condition improved, then the
intervention is effective and the patient moves on to
new problems
 Greatly

emphasize
Therapeutic Human Relationship between the Nurse & the Patient.


d on the
Her model emphasizes:
Empathy
Sympathy
Rapport &
the
Emotional
aspects of
 4 Interlocking Phases that precedes RAPPORT And the establishment of
Nursing
N-Pt . Relationship:
Original Encounter
Emerging Identities
Empathy
Sympathy
 Application:

The theory describes the various stages of interpersonal relations that

occur bet a Patient and a N. It thus becomes important for Ns to fully
understand the phases and its effects to the patient’s welfare.

Due consideration should be given to the pt’s inherent personal

characteristics to interact w/ other people, most especially Ns & other
members of the healthcare professions.

The key concept of Empthy ,Sympathy, Rapport &

Emotional Understanding are very important for the Ns of
today
 Focuses on 10 Categories of determinants of health-
Promoting Behaviours.

 Views a person’s health-promoting behaviour in the

light of his individual characteristics &
experiences
 The10 Determinants are :

 Prior related behaviour

 Perceived benefits of action

 Perceived barriers of action

 Perceived self-efficacy

 Activity related effect

 Interpersonal Influences (family, friends, providers) norms, support & models
 Situational Influences ( options, demand characteristics, aesthetics)–
 Immediate competing demands (low control) and preferences (high demand)
 Commitment to a plan of action–
 Personal Factors ( Biological, Psychological, Sociocultural)
 Application:

Health Promotion Activities are the major Focus of Hx

Care Organizations . In order for Patients to take on the Behaviour we, Hx
care professionals , advise them to take, we should carefully looked into a
host of factors that can influence his decision to really adopt the
behaviour.

It is important for Ns to be ROLE MODELS for the pts.

 The model is based on the Person’s Relationship to Stress ,his
Reaction to it and Reconstitution factors that are dynamic in nature

 •The concern of nursing is to PREVENT STRESS INVASION


•Person is viewed as an Open System composed of Basic Structure of Energy
which includes:
• Physiologic
• Psychologic
• Sociocultural
• Developmental
• Spiritual
 Basic

Structure/C
entral
surrounded by 2 concentric boundaries or Rings called Lines Of
Resistance Which represents the internal factors that AID the person

Core-
Defend against a Stressor .

Lines of Resistance –
further surrounded by 2 lines of Defense

1. Normal Line of Defense

2. Flexible Line of Defense

1.Normal Line of Defense :

person’s state of equilibrium or the state of adaptation developed &
maintained over time and which is considered normal for the person
 2.Flexible Line of Defense-
dynamic and can be readily and rapidly changed over a short
period of time.- adjusts to situations that threatens the
imbalance w/in the client’s stability
Stressors:
 Intrapersonal


 Interpersonal

Extrapersonal
FOCUS of Nursing Interventions :-

keeping or maintaining the stability of the open system which

can be carried out on three levels of prevention
 APPLICATION :-
Very comprehensive model of nsg that outlines the way
how Ns provide HOLISTIC NURSING CARE to pts. Emphasis
is on the management of Stress thru adequate
understanding of the complex client system . Strong
Advocate of Prevention Interventions which is congruent to
the aims of modern-day nsg & Hx care services. It is a
MUST that Ns perform thorough &comprehensive
assessment that includes ALL aspects of the Ct.
 Man is a BIO PSYCHOSOCIAL
BEING
Four (4) modes of Adaptation –
 Physiologic Mode
 Self Concept
 Role Function
 Interdependence

Her Model is best exemplified in the Nursing Process which includes

the following steps:

1. Assessment of Behaviour
2. Assessment of Stimuli
3. Nursing Diagnosis
4. Goal Setting
5. Intervention
6. Evaluation
 APPLICATION :

 Best applied in the performance of the Nursing Process which is cyclical in

nature . The Assessment component is the Stimuli or Input The Planning
& Implementation are the Through put process .
The Evaluation which provides necessary feedback to the Goal of care is
the Output

 The N decides what necessary actions should betaken next in the light
of the patient’s response to the Nursing Interventions. This action by the N
is Adaptation in its simplest terms Patients adopt too.

The Nursing interventions we perform ultimately elicits a response from

them. Depending on the nature & extent of the nursing interventions, pts
may or may not actually adopt according to our expectations


Defined Nursing: “The act of assisting others in the provis

management of self-care to maintain/improve human functio
 Focuses on activities that adult individuals
level of perform on their own
effectiveness.”
behalf to maintain life, health and well-being.

 Has a strong health promotion and maintenance focus.

 Identified 3 related concepts:

1. Self-care - activities an Individual performs independently
throughout life to promote and maintain personal well-being.

2.Self-care deficit - results when self-care agency (Individual’s

ability) is not adequate to meet the known self-care needs.
𝗈 3.Nursing
Wholly
when nursing
System
Individual
compensatory interventions
is unable
- nurse
to n
- provides entire self-care for the client.
pe
the necessary self-care activit
● Example: care of a new born, care of client recovering from surgery
in a post-anesthesia care unit
𝗈 Partial compensatory - nurse and client perform care, client can
perform selected self-care activities, but also accepts care done by
the nurse for needs the client cannot meet independently.
● Example: Nurse can assist post operative client to ambulate, Nurse
can bring a meal tray for client who can feed himself
𝗈 Supportive-educative - nurse’s actions are to help the client
develop/learn their own self-care abilities through knowledge,
support and encouragement.
 Theory provides direction
for nursing research
 Relationships of
components in a theory help
to drive the research
questions for understanding
nursing
 Chinn and Kramer (2004),
indicate a spiral
relationship between the
two
 Medical science
 Nursing education

 Professional nursing

organizations
 Evolving research

approaches
 Global concerns

 Consumer

demands
 Technologies
Leah Curtin, RN, MS, FAAN (1989)
Former Editor, Nursing Management