NURSING THEORIES Objectives • By the end of this lesson the learner should be able to: a) Define terms used in Theory Development. b) Explain the significance of Nursing Theories in the Nursing Practice. What is a theory? • A theory is a generalized explanation of a phenomenon. • A set of interrelated concepts, definitions, relationships, and assumptions that project a systematic view of a phenomena (an observable fact or event). • NURSING THEORY • It is an organized framework of concepts and purposes designed to guide the practice of nursing. Components of a theory • Concepts – ideas and mental images that help to describe a phenomena. • Definitions – convey the general meaning of the concepts • Assumptions – statements that describe concepts • Phenomenon – aspect of reality that can be consciously sensed or experienced. Characteristics of theories • Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. • Theories must be logical in nature. • Theories should be relatively simple yet generalizable. • Theories can be the bases for hypotheses that can be tested. • Theories can be used by the practitioners to guide and improve their practice. What are the purposes of nursing theory? • 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. Nursing theorists • Florence Nightingale (The lady with the lamp) • Born - in Florence, Italy on May 12, 1820. (1820-1910) • Background of the theorist: she is the founder of modern nursing. • She is a linguist and educated in science, mathematics, literature and arts. • In 1837 at the age of 17 she confined in her dairy, “GOD SPOKE TO ME AND CALLED TO SERVICE” • Formed ideas about organized training for nurses, took care of ill people. • During the Crimean war, Nightingale received a request to travel to Turkey, with a group of nurses to care for wounded British soldiers. Ct… • She was appalled and horrified with what she saw • Wards were crowded, dirty, poorly ventilated, with filth and no water or sanitary facilities • Food was poorly cooked. • Soldiers lay on straw mats. The floor was covered with dirt and blood. The men still wore their blood soaked uniforms. • They died of cholera and contagious disease that of wounds. • While she was there she changed their situation assumed care of the patients at night, moving about each floor comforting patients with a lamp in hand. • This intimate relationship with her patients earned her the affectionate title of "Lady with the Lamp." Ct… • she founded the Nightingale school for nurses. • Florence Nightingale transformed the profession of nursing forever. • She gave dignity and honor to Nursing. Died at age 90. • Proposed the environmental theory. • The environmental theory states that external influences and conditions can prevent, suppress or contribute to disease or death. • What is nursing – the act of utilizing the environment of the patient to assist him in his recovery. • There are three types of environment: physical, psychological and social. Physical environment Air, light, noise Patient Psychological environment Social environment • Health of houses – presence of pure air, pure water, efficient drainage, cleanliness and light. • Ventilation and warming- the nurse was to keep the air he breathes as pure as the external air. • Light – she viewed that direct sunlight was what patients wanted. • Noise- she stated that noise was not a viable environment for healing. • Bed and bedding- dirty beddings promoted ill health among patients • Cleanliness of the rooms and walls • Personal cleanliness How Florence Nightingale is used today Nurses of today still needs to: • Maintain Adequate Ventilation • Promote Adequate & Appropriate Nutrition • Maintain Normal Homeostatic Body Temperature • Observe Basic Hygiene • Comfort Measures including Environmental Sanitation Virginia Henderson • Developed the Nursing need theory. • She came up with major concepts and definitions in the nursing practice • Nursing is defined as “ the unique function of the nurse is to assist the individual, sick or well, in performance of those activities contributing to health or its recovery or peaceful death that he/she would perform unaided if he/she had necessary strength , will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.” Ct… • Health : Definition based on individual’s ability to function independently as outlined in the 14 components. • Patient: an individual requiring assistance to achieve health and independence or a peaceful death. • A nurses role is: • Substitutive : acting for the person • Supplementary: assisting a person • Complementary: working with the person Application of Virginias theory to current nursing practice • Bedside Nursing : • patient's ability to perform the 14 basic needs should be assessed before considering the kind of nursing care function you will administer. • Essential to determine if the Nursing will be performing as a HELPER, DOER or a PARTNER • Nursing interventions are implemented according to the 14 basic human needs of the patient. Dorothea Orem • She came up with the self care deficit theory. • Defined Nursing: “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.” • Identified 3 related concepts: • Self care – practice of activities that an individual initiates and performs on his/her own behalf in maintaining life, health and well being. • Self care requisites - action directed towards provision of self care. 3 categories of self care requisites are: 1. Universal self care requisites • Developmental self care requisites 2. Health deviation self care requisites 3. Universal self care requisites- these are the activities of daily living e.g. Maintenance of sufficient intake of air ,water, food, elimination needs. • Developmental self care requisites- Associated with developmental processes/ derived from a condition or associated with an event. • E.g. adjusting to a new job, adjusting to body changes. Dorothea Orem • Health deviation self care requisites- Required in conditions of illness, injury, or disease. • These include: Seeking appropriate medical assistance • Effectively carrying out medically prescribed measures • Learning to live with effects of pathologic conditions Theory of self care deficit • Specifies when nursing is needed. • Nursing is required when an adult/ child is incapable or limited in the provision of continuous effective self care. • Orem identifies 5 methods of helping: – Acting for and doing for others – Guiding others – Supporting another – Providing an environment promoting personal development in relation to meet future demands – Teaching another Nursing Systems • Orem describes how the patient’s self care needs will be met by the nurse , the patient, or both. • Wholly compensatory system- nurse should be compensating (cares) for a patient’s total inability to take care of themselves. • Partly compensatory system -both nurse and patient perform care measures • Supportive – educative system • The theory shows that when an individual’s self-care capabilities are less than the therapeutic self-care demand, the nurse compensates for the self-care or dependent care deficits. Sister Callista Roy • Came up with the adaptation theory. • According to Roy’s model, the goal of nursing is to help the person’s adaptive system. • It is to help the person adapt to change in physiological needs, self-concepts, role function and interdependent relations during health and illness . • It is role of nurse: -To find out demands which are causing problems for a client. -To assess how well the client is adapting to them. • Nursing care is then directed at helping the client to adopt. Ct… • All individual must adapt to the following demands: • 1. Meeting basic physiological needs. • 2. Developing a positive self concept. • 3. Performing social roles. • 4. Achieving a balance between dependence and interdependence. Essential concepts common among nursing theories: • Man/ patient • Health • Environment • Nursing Others… 1. Hildegard Peplau (1952) interpersonal relations model. Describes the nurse patient relationship in 4 phases:- orientation, identification, exploitation and resolution. 2. Madeleine Leininger (1978) theory of cultural care diversity and universality. The goal of nursing is to provide culturally specific care(religion, politics, culture, traditions) 26 … 3. Betty Neuman(1974) systems model. Considered internal and external factors as stressors. The goal is stress reduction thus achieving total wellness. 4. Jean Watson’s theory of transpersonal caring (1979). The practice of caring is central to nursing. Caring for patients and their families genuinely and without ego. 27 Assignments • List down the 13 canons of Florence Nightingale environmental theory. • Identify the metaparadigms used in all the theories? • Identify how the theories are relevant to nursing? • Identify the 14 fundamental needs according to Virginia Henderson? • Read more on the theories.
