NCM 103
FUNDAMENTALS OF NURSING
NURSING AS A PROFESSION
NURSING THEORIES AND MODELS
NURSING ETHICS AND STANDAD
A.NURSING AS A PROFESSION
1.Nursing as a profession
PROFESSION
- a paid occupation, especially one that involves prolonged training and a formal
qualification.
- Is a calling that requires special knowledge, skill and preparation.
- An occupation that requires advanced knowledge and skills and that it grows out of
society’s needs for special services.
Nursing - is a profession within the health care sector focused on the care of individuals, families, and
communities so they may attain, maintain, or recover optimal health and quality of life (includes the
promotion of health, prevention of illness, and the care of ill, disabled and dying people).
Characteristics of Nursing
• Nursing is caring.
• Nursing involves close personal contact with the recipient of care.
• Nursing is concerned with services that take humans into account as
physiological, psychological, and sociological organisms.
• Nursing is committed to promoting individual, family, community, and
national health goals in its best manner possible.
• Nursing is committed to personalized services for all persons without
regard to color, creed, social or economic status.
• Nursing is committed to involvement in ethical, legal, and political issues in
the delivery of health care.
Personal Qualities of a Nurse
• Must have a Bachelor of Science degree in nursing.
• Must be physically and mentally fit.
• Must have a license to practice nursing in the country.
• CRETERIA OF NURSING
There are 6 creteria of nursing profession that are essential concept of
nursing practice and nurse needs to remember .
1.Distinct of subculture
2.Body of knowledge
3.Altruism
4.Code of ethics
5.Autonomy
6.Professional orginization
Patricia Benner
• Developed a concept known as “From NOVICE to EXPERT”.
• This concept explains that nurses develop skills and an understanding
of patient care over time from a combination of a strong educational
foundation and personal experiances .
5 Stages Proficiency
 Novice
 Advance beginner
 Competent
 Proficient
 Expert
Professional Responsibilities
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Caregiver/Care provider
Advocate
Educator
Communicator
Manager
Expanded orole f the nurse
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Clinical specialists
Nurse practitioner
Nurse midwife
Nurse Anesthetist
Nurse entrepreneur
Nurse administrator
NURSING THEORIES AND STANDARDS
NURSING THEORIES AND MODELS
• Introduction
A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions
derived from nursing models or from other disciplines and project a purposive, systematic view
of phenomena by designing specific inter-relationships among concepts for the purposes of
describing, explaining, predicting, and /or prescribing.
DEFINITIONS
THEORY
• a set of related statements that describes or explains phenomena in a systematic way.
Nursing theory
is the term given to the body of knowledge that is used to define or explain various aspects of the
profession of nursing .
Concept- a mental idea of a phenomenon, are the
building blocks (the primary elements) of a theory.
Construct-a phenomena that cannot be observed
and must be inferred
Proposition- a statement of relationship between concept
Conceptual model: made up of concepts and propositions
Variables - variables are the operational
forms of constructs. They define the way a
construct is to be measured in a specific
situation.
TYPES OF NURSING THEORIES
1.Grand nursing theories
2.Mid-range theories
3.Nursing practice theories
Grand nursing theories -have the broadest scope and present general concepts and
propositions. Theories at this level may both reflect and provide insights useful for practice
but are not designed for empirical testing
Middle-range nursing theories -are narrower in scope than grand nursing theories and offer
an effective bridge between grand nursing theories and nursing practice
Nursing practice theories- have the most limited scope and level of abstraction and are
developed for use within a specific range of nursing situations. Nursing practice theories
provide frameworks for nursing interventions, and predict outcomes and the impact of
nursing practice
METAPARADIGMS IN NURSING
PERSON
• Recipient of care, including physical, spiritual,
psychological, and sociocultural components.
• Individual, family, or community
ENVIRONMENT
• All internal and external conditions, circumstances, and
influences affecting the person
HEALTH
• Degree of wellness or illness experienced by the person
NURSING
• Actions, characteristics and attributes of person giving care.
Florence nightingale
• Legacy of caring
• Focuses on nursing and the patient
environment relationship
Ernestine Wiedenbach
• The helping art of clinical nursing
• Helping process meets needs through the art
of individualizing care.
• Nurses should identify patients ‘need-for –help’
by:
• Observation
• Understanding client behaviour
• Identifying cause of discomfort
• Determining if clients can resolve problems or
have a need for help
Virginia Henderson’s
• Definition of Nursing
• Patients require help towards achieving
independence.
• Derived a definition of nursing
• Identified 14 basic human needs on which
nursing care is based.
Faye G.Abedellah’
• Typology of twenty one Nursing problems
• Patient’s problems determine nursing care
Lydia E. Hall
• Care, Cure, Core model
• Nursing care is person directed towards self
love.
Patricia Benner’s
• Novice to Expert
• Described systematically five stages of skill
acquisition in nursing practice – novice,
advanced beginner, competent, proficient and
expert
Dorothea E. Orem’s
Jean Watson’s
• Philosophy and Science of caring
• Caring is a universal, social phenomenon that
is only effective when practiced interpersonally
considering humanistic aspects and caring.
• Caring is central to the essence of nursing.
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Self care deficit theory in nursing
Self–care maintains wholeness.
Three Theories:
Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing SystemsNursing Care:
Wholly compensatory (doing for the patient)
Partly compensatory (helping the patient do for
himself or herself)
Supportive- educative (Helping patient to learn self
care and emphasizing on the importance of
nurses’ role
Myra Estrin Levine’s
• The conservation model
• Proposed that the nurses use the principles of
conservation of:
• Client Energy
• Personal integrity
• Structural integrity
• Social integrity
• A conceptual model with three nursing theories
• Conservation
• Redundancy
• Therapeutic intention
Martha E.Roger’s
• Science of unitary human beingsPerson
and environment are energy fields that
evolve negentropically
• Nursing is a basic scientific discipline
• Nursing is using knowledge for human
betterment.
• The unique focus of nursing is on the
unitary or irreducible human being and the
environment (both are energy fields) rather
than health and illness
Dorothy E.Johnson’s
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Behavioural system model
Individuals maintain stability and balance through
adjustments and adaptation to the forces that impinges
them.
Individual as a behavioural system is composed of
seven subsystems: the subsystems of attachment, or
the affiliative, dependency, achievement, aggressive,
ingestive-eliminative and sexual.
Disturbances in these causes nursing problems.
Sister Callista
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Roy‘s Adaptation model
Stimuli disrupt an adaptive system
The individual is a biopsychosocial adaptive system
within an environment.
The individual and the environment provide three
classes of stimuli-the focal, residual and contextual.
Through two adaptive mechanisms, regulator and
cognator, an individual demonstrates adaptive
responses or ineffective responses requiring nursing
interventions
Betty Neuman’s
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Health care systems modelNeuman’s model includes
intrapersonal, interpersonal and extrapersonal
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stressors.
Nursing is concerned with the whole person.
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Nursing actions (Primary, Secondary, and Tertiary
levels of prevention) focuses on the variables affecting
the client’s response to stressors
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Imogene King’s
Goal attainment theoryTransactions provide a frame
of reference toward goal setting.
Major concepts (interaction, perception,
communication, transaction, role, stress, growth and
development)
Perceptions, Judgments and actions of the patient
and the nurse lead to reaction, interaction, and
transaction (process of nursing).
Nancy Roper, WW.Logan and A.J.Tierney
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A model for nursing based on a model of living
Individuality in living.
A conceptual model of nursing from which theory of
goal attainment is derived.
Living is an amalgam of activities of living (ALs).
Most individuals experience significant life events
which can affect ALs causing actual and potential
problems.
This affects dependence – independence continuum
which is bi-directional.
Nursing helps to maintain the individuality of person
by preventing potential problems, solving actual
problems and helping to cope.
Hildegard E. Peplau
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Psychodynamic Nursing Theory
Interpersonal process is maturing force for
personality.
• Stressed the importance of nurses’ ability to
understand own behaviour to help others identify
perceived difficulties.
• The four phases of nurse-patient relationships are:
1. Orientation
2. Identification
3. Exploitations
4. Resolution
• The six nursing roles are:
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor
• Interpersonal process alleviates distress.
Ida Jean Orlando’s
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Nursing Process TheoryNurses must stay connected
to patients and assure that patients get what they
need, focused on patient’s verbal and non verbal
expressions of need and nurse’s reactions to patient’s
behaviour to alleviate distress.
• Elements of nursing situation:
1.Patient
2.Nurse reactions
3.Nursing action
Kathryn E. Barnard’s
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Parent Child Interaction Model
Growth and development of children and mother–
infant relationships
Individual characteristics of each member influence the
parent–infant system and adaptive behaviour modifies
those characteristics to meet the needs of the system.
Joyce Travelbee’s
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Human To Human Relationship Model
Therapeutic human relationships.
Nursing is accomplished through human to human
relationships that began with the original encounter
and then progressed through stages of emerging
identities.
Ramona T.Mercer’s
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Maternal Role Attainment
A complex theory to explain the factors impacting the
development of maternal role over time.
Katharine Kolcaba’s
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Theory of comfort
Comfort is desirable holistic outcome of care.
Health care needs are needs (physical, psycho
spiritual, social and environmental needs) for comfort,
arising from stressful health care situations that cannot
be met by recipients’ traditional support system.
Comfort measures include those nursing interventions
designed to address the specific comfort needs.
Madeleine Leininger’s
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Transcultural nursing, culture-care theory
Caring is universal and varies transculturally.
Major concepts include care, caring, culture, cultural
values and cultural variations
Caring serves to ameliorate or improve human
conditions and life base.
Care is the essence and the dominant, distinctive and
unifying feature of nursing
Nola J.Pender’s
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The Health promotion; model
Promoting optimum health supersedes disease
prevention.
Identifies cognitive, perceptual factors in clients which
are modified by demographical and biological
characteristics, interpersonal influences, situational
and behavioural factors that help predict in health
promoting behaviour
Rosemarie Rizzo Parse’s
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Theory of human becoming
Indivisible beings and environment co-create health.
A theory of nursing derived from Roger’s conceptual
model.
Clients are open, mutual and in constant interaction
with environment.
The nurse assists the client in interaction with the
environment and co creating health
NURSE ETHICS AND STANDARD
ETHICS
• Ethics deals with the rightness or
wrongness of human behavior
• concerned with the motivation behind the
behavior
• bioethics is the application of these
principle to life and death issue .
MORAL
• An individuals own code for acceptable
behavior
• they arise from an individual conscience
• they act as a guide for individual behavior
• they act are learned
Ethical principle
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Autonomy
Nonmaleficence
Justice
fidelity
Confidelity
Veracity
Accountability
Autonomy
• The freedom to make decision about
oneself
• the right to self determination
• Healthcare providers needs to repect
patient rights to makes choice about
heathcare ,even if the healthcare provider
do not agree with the patients decision .
Nonmaleficence
• Requires that no harm be caused to an
individual,either unintentionally or
deliberately
• This principle requires nurses to protect
individual who are unable to protect
themselves
Beneficence
• This principle means doing good for
others
• Nurses need to assist client in
meeting all their needs
• Biological
• Psychological
• social
Justice
• Every individual must be treated
equally
• This requires nurses to be
nonjudgement .
Fidelity
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Loyalty
The promise to fulfill all commitments
The basis of accountability
Includes the professionals faithfulness or
loyalty to agreements & responsibilities
accepted as part of the practice of the
profession
Confidentiality
• Anything stated to nurses or healthcare providers by patients must
remain confidential
• The only times this principle may be
violated are:
If patients may indicate harm to
themselves or others
If the patient gives permission for
the information to be shared
Veracity
• This principle implies “truthfulness”
• Nurses need to be truthful to their clients
• Veracity is an important component of
building trusting relationships
Accountability
• Individuals need to be responsible
for their own actions
• Nurses are accountable to
themselves and to their colleagues
Ethical Dilemmas
• Occur when a problem exists
between ethical principles
• Deciding in favor of one principle
usually violates another
• Both sides have “goodness” and
“badness” associated with them
why call an Ethics Consult?
• Ethics Consult can help:
– Discover and understand the issues
– Serves as a forum for sharing of concerns and questions
– Identifies possible treatment alternatives
– Provides guidance to the staff, patient, and family members
– Resolves conflicts
Using the Nursing Process
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Assessment
Planning
Implementation
Evaluation
THANK YOUU!!!
RAINA ABDUHASAD A.
BSN