Chapter 7 Grand Nursing Theories Based on Human Needs Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale “For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every week, take my word for it, we are going back.” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—(cont.) • Born: Florence, Italy, 1820 • Wealthy English parents – Well educated – Parents desired her to pursue social graces. • Attended nursing school in Kaiserswerth, Germany in 1851 (program was 3 months) – Believed that nursing was her “calling” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—(cont.) • Spent most of her later life (54 years) confined to her home • Died in 1910—age 90 years Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Work • Crimean War (1854–1855) – Served at Scutari Army Hospital in Turkey – Conditions deplorable • Advocated cleanliness, pure water, good food • Cut casualties from 48% to 2% • Kept excellent statistics demonstrating changes Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Work—(cont.) • Nightingale School for Nurses – St. Thomas’ Hospital, London – In 1872, the New York Training School (Bellevue Hospital) was the first nursing school in the United States using Nightingale’s model. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Work—(cont.) • Writings – Notes on Nursing – Notes on Hospitals – Many essays and letters Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is NOT among the many accomplishments credited to Florence Nightingale? A. She wrote extensively on nursing and nursing care. B. She served during World War I, actively improving the care of British soldiers. C. She instituted a program of record keeping for government health statistics. D. She started a program for formal education for nurses in England. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. She served during World War I, actively improving the care of British soldiers. Rationale: Nightingale’s work predated WWI by about 60 years. She was active during the Crimean War in the 1850s. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Theory • Notes on Nursing: What It Is and What It Is Not • Based on providing a healthful environment – Improve cleanliness, ventilation, warming, light, noise, bedding, etc. • Believed that nursing is an art, medicine is a science • Nurses were to do what they could to provide “the best possible conditions for nature to restore or preserve health.” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Theory—(cont.) • A nurse may be any woman who had “charge of the personal health of somebody.” • Believed that nursing is a calling or “God’s work” • Nursing is based on compassion, observation, experience, statistical data, sanitation, nutrition, and administrative skills. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Theory—(cont.) • Basic tenets/issues of Nightingale’s work – Ventilation and warming – Avoidance of “petty management” – Avoidance of noise – Variety of sights, activities, foods – Taking food/selection of food – Clean and dry bedding – Light – Cleanliness of rooms and walls – Personal cleanliness – Observation of the sick – Avoidance of “chattering homes and advices” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Theory—(cont.) • Nurses performed tasks to and for the patient. • Interestingly, she rejected the “germ theory” but was a very strong advocate of cleanliness. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Metaparadigm Concepts • Nursing—Nursing is an art that serves to “put the constitution in such a state that it will have no disease, or that it can recover from disease.” • Health—“to be well and to be able to use well every power we have” • Environment—central concept • Person—not explicitly addressed Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Florence Nightingale—Resources • http://www.florence-nightingale.co.uk/ • http://clendening.kumc.edu/dc/fn/ Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson • Well-known nursing educator • Prolific author • Created basic nursing curriculum for the NLN – Nursing is “patient centered and organized around nursing problems rather than medical diagnoses.” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—(cont.) • Born 1897 in Kansas City – Large family • Education – Graduated from the Army School of Nursing in Washington, DC in 1921 – Received her BS in Nursing Education (1932) and MA in nursing education (1934) from Columbia University Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—(cont.) • Career – Taught nursing at Columbia between 1934 and 1948 – With Bertha Harmer, revised the fifth edition of The Principles and Practice of Nursing (1953); sixth edition (1966); Nature of Nursing (1966) – Yale University School of Nursing faculty 1953– 1959 Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—(cont.) • Remained very active in nursing well into her 90s • Died in 1996—99 years old Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Theory • “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery . . . that he would perform unaided if he had the necessary strength, will or knowledge.” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which theorist related her theory to the metaparadigm of nursing with a belief that the function of the nurse is to assist the individual client? A. Betty Neuman B. Virginia Henderson C. Dorothea E. Orem D. Dorothy Johnson Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Virginia Henderson Rationale: Henderson believed that nurses should care for patients until they can care for themselves. The nurse was the focus and the theory related to the nursing metaparadigm. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Theory—(cont.) 14 Basic Needs of Patients 1. Breathe normally. 2. Eat and drink adequately. 3. Eliminate body wastes. 4. Move and maintain desirable postures. 5. Sleep and rest. 6. Select suitable clothes—dress and undress. 7. Maintain body temperature within normal range. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Theory—(cont.) 14 Basic Needs of Patients—(cont.) 8. Keep the body clean and well groomed. 9. Avoid dangers in the environment. 10. Communicate with others in expressing emotions, needs, fears, or opinions. 11. Worship according to one’s faith. 12. Work to provide a sense of accomplishment. 13. Play or participate in recreation. 14. Learn, discover, or satisfy the curiosity that leads to normal development and uses health facilities. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Theory—(cont.) • The person must maintain physiological and emotional balance. • The mind and body of the person are inseparable. • Patients require help toward independence. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Metaparadigm Concepts • Nursing—“to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery . . . that he would perform unaided if he had the necessary strength, will or knowledge . . .” • Person—“patient” as someone who needs nursing care (not limited to illness care) Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Metaparadigm Concepts—(cont.) • Environment—not explicitly defined; maintaining a supportive environment is implicit in her 14 activities • Health—not explicitly defined; inferred to be a balance in all realms of human life Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—on Education • Strong advocate for university-based education for nurses • Also strong advocate for liberal education courses for nurses • Pushed library research and increasing knowledge for all nurses • Promoted research and research-based practice Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Virginia Henderson—Resources • http://www.unc.edu/~ehallora/henderson.htm • http://www.nursinglibrary.org/vhl/ • http://www.angelfire.com/ut/virginiahenderson/index.ht ml Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Dorothea Orem Self-Care Deficit Theory “Nursing is an art . . .” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Dorothea Orem—(cont.) • Born in Baltimore—1914 • Diploma in nursing—1930s from Providence Hospital School of Nursing, Washington, DC • BSN in 1939 and master’s degree in 1945 from Catholic University Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Dorothea Orem—(cont.) • Director of the School of Nursing at Detroit’s Providence Hospital in the late 1940s • Indiana Board of Health 1949–1957 • Joined Catholic University Faculty in 1959 Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory • First book on Self-Care Deficit Nursing Theory (SCDNT) in 1971; latest edition in 2001 • Three nested theories – Theory of self-care – Theory of self-care deficit – Theory of nursing system Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is NOT one of the three nested theories that comprise the SCDNT? A. Theory of self-care B. Theory of self-care deficit C. Theory of self-care interventions D. Theory of nursing system Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Theory of self-care interventions Rationale: Orem’s SCDNT is composed of the theory of nursing system as the outer/encompassing component with the theory of self-care deficit and theory of self-care being subsumed within it. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-care deficit nursing theory. (Source: Orem, D. [2001]. Nursing: Concepts of practice [6th ed.]. St. Louis: Mosby.) Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory— (cont.) Theory of SelfCare Self-care Theory of SelfCare Deficit When therapeutic self-care demand exceeds self-care Self-care agency agency, a self-care deficit exists and Self-care requisites nursing is needed. Theory of Nursing Systems Nursing agency Nursing systems Wholly compensatory Partially compensatory Supportive/educative Therapeutic selfcare demand Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory— (cont.) “Condition that validates the existence of a requirement for nursing is an adult . . . . The absence of the ability to maintain continuously the amount and quality of self-care that is therapeutic in sustaining life and health, removing from disease or injury in on coping with their effects” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory— (cont.) • Nursing—”an art through which the practitioner . . . gives specialized assistance to persons with disabilities . . . to meet needs for self-care. . . . also intelligently participates in the medical care the individual receives from the physician” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory—(cont.) • Metaparadigm concepts – Nursing—an art through which the practitioner . . . gives specialized assistance to persons with disabilities . . . to meet needs for self-care. . . . also intelligently participates in the medical care the individual receives from the physician” – Humans—“men, women, and children cared for either singly or as social units” objects of nursing care Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory—(cont.) • Metaparadigm concepts—(cont.) – Environment—has physical, chemical, and biological features (includes the family, culture, and community) – Health—“being structurally and functionally whole or sound”; also a state that encompasses both the health of individuals and groups Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory— (cont.) • Self-care—“human regulatory function that is a deliberate action to supply or ensure the supply of necessary materials needed for continued life, growth, and development and maintenance of human integrity” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory— (cont.) • Self-care requirements – Maintenance of sufficient intake of air, water, and food – Provision of care associated with elimination and excrement – Maintenance of balance between activity and rest – Maintenance of balance between solitude and social interaction – Prevention of hazards to human life, functioning, and well-being – Promotion of human functioning and development Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Orem: Self-Care Deficit Nursing Theory—(cont.) • Ms. Orem died in 2007. • Her work is readily applied in nursing practice, education, and research. • Many research articles testing relationships within the theory • One of the most frequently used theories for nursing education curricular frameworks Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Dorothea Orem—Resources • http://www.nurses.info/nursing_theory_person_orem_do rothea.htm • http://www.orem-society.com/ Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Betty Neuman • Born in 1924 in Ohio • Mother was a midwife. • Graduated from Peoples’ Hospital (Akron, OH) diploma program in 1947 • BS in Public Health Nursing (1957) and an MS in Public/Mental Health Nursing (1966) from UCLA • PhD in Clinical Psychology—Pacific Western University (1985) Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model • Developed the model in 1970—UCLA graduate students introductory course that considers holistic view of humans • Model initially published in Nursing Research in 1972 Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins The Neuman systems model. (Source: Neuman, B., & Fawcett, J. [2002]. The Neuman systems model [4th ed.]. Upper Saddle River, NJ: Pearson Education, Inc. Used with permission of Betty Neuman, RN, PhD, FAAN.) Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model—(cont.) • Two major components – Stress – Reaction to stress • Client is an open system (may be individual, family, group or community). • Exchanges between the client/system and environment are reciprocal. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model—(cont.) • Nursing is provided to achieve optimal stability. • Concept of “prevention as intervention” – Combines elements of primary, secondary, and tertiary prevention • Multiple lines of resistance • Lines of defense • Client variables (physiological, psychological, sociocultural, developmental, and spiritual) are considered in care. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model—(cont.) • Stressors are stimuli that produce tensions and might cause system instability. – Intrapersonal – Interpersonal – Extrapersonal • Goal of nursing is to help the client attain, maintain, or retain system stability. – Assessment of actual and potential effect of stressors – Assisting the client make adjustments needed for wellness Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model—(cont.) • Metaparadigm concepts – Person—“human beings” as “client/client system as a composite of variables (physiological, psychological, sociocultural, developmental and spiritual), each of which is a subpart of all parts . . .” – Nursing—Major concern is to maintain client system stability through assessing environmental and other stressors and assisting the client to adjust to maintain wellness. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model—(cont.) • Metaparadigm concepts—(cont.) – Environment—“both internal and external forces surrounding the client, influencing and being influenced by the client at any point in time” – Health—“a continuum; wellness and illness are at opposite ends” Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Neuman Systems Model—(cont.) • One of most widely used of the grand nursing theories in nursing research – Many studies test relationships between variables. – Most commonly used as a framework for a study • Widely used as a curriculum framework in nursing programs throughout the world • Continual development—latest edition (5th) (with J. Fawcett) published in 2010 Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Betty Neuman—Resources • http://currentnursing.com/nursing_theory/Neuman.html/ • http://www.neumansystemsmodel.org/ Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
