Review of Chapters 11 & 12 in Philosophies and Theories for Advanced Practice Nurses
Chapter 11 Health Behavior Theories
Without a change in health behaviors, there would be no prevention or risk reduction of
disease or illness. Central to nursing science is the idea of nursing interventions. Much of the
interventions specific to nursing involve health education, health promotion and risk reduction
for clients. The theories outlined in this chapter and in the Prezi are specifically concentrating on
what drives individuals, families, and communities towards change in their health behaviors. By
utilizing these theories, nurses are able to utilize conceptual frameworks to explain patient
behaviors, recognize barriers, motivating factors, and assist patients to move forward in
advocating for themselves and progress towards health behaviors.
The Health Belief Model began in the 1950’s when psychologists with the United States
Public Health Service questioned the rationale of the lack of participation in a community health
screening for tuberculosis (TB). They investigated the root causes of this phenomena. They
concluded six constructs influence people’s decisions. The constructs assessed the motivation of
the people to act. These constructs are able to be utilized in both short-term and long-term
strategies to change behavior (Butts & Rich, 2013).
The Theory of Planned Behavior focuses on relationships between a person’s behavior
and their beliefs, attitudes, intentions and their view of normal. This theory has been
productively applied to predict and explain health behaviors and intentions. This framework
provides nurses with a model to identify and target specific interventions to be utilized to
empower and move the patient towards health behaviors (Butts & Rich, 2013).
The Transtheoretical Model involves the constructs of the stages of change. This model
allows for individuals to be at different stages in adopting healthy behaviors. Nurses can
exercise this knowledge to assess where patients are in the readiness to make changes to promote
healthy behaviors (Butts & Rich, 2013).
Social Cognitive Theory (SCT) engages concepts from cognitive, behavioral, and
emotional models to explain human behavior. SCT combines interactions of influences from the
environment, personal factors and behaviors to effecting change in patient’s health promotion
and prevention. Nurse can encourage the self-efficacy of a patient (confidence in his/her ability
to act) set small goals, reward health promotion and disease prevention behaviors (Butts & Rich,
2013).
Social Ecological Model is similar to social cognitive theory suggesting that an
encouraging environment is imperative to effect positive health care behaviors in patients. Butts
& Rich (2013) suggest the prevalence of unhealthy lifestyles in the world today require these
environments. This suggestion is within the scope of all nurses, but particularly is important in
the scope of the advanced practice nurse.
The Representational Approach (RA) is additionally patient-centered and examines the
probability of patients embracing conceptual change. The focus of RA is considering the
patient’s knowledge and understanding of their health problem. That information is then utilized
to present education and assist patients in learning new behaviors to effect movement towards
behavior change (Butts & Rich, 2013),
Chapter 12 Theories Focused on Interpersonal Relationships
For years nurses have heard society views the profession as the most trusted.
Interpersonal relationships are at the foundation of that trust. Nursing education strives early in
the curriculum to set forth the value of the nurse-patient relationship. The theories addressed in
this chapter reflect decades of research based on interpersonal relationships.
When Hildegard Peplau first published her theory of Interpersonal Relations, nursing was
not viewed as a profession. Her book was not published for four years because she did not have
a physician as a co-author. Peplau offered three phases and six roles in the nurse-patient
relationship. She described the framework for nurses to develop this relationship, provide a
course of action and proceed in the work needed to move the patient forward, and establishing a
plan for ending the relationship (Butts & Rich, 2013).
Ida Jean Orlando brought forth her theory, Nursing Process Theory, based on her
frustration of organizational needs being put before patient needs. She believed her theory set
the stage for effective nursing practice. Orlando proposed three areas of concern for nursing;
nurse-patient relations, the professional role of nurses and identification of distinct nursing
knowledge. Additionally, she associated effective nursing care to nursing knowledge of patient
needs. Orlando advised nurses to be deliberate in their practice, focusing on the patient’s needs
as human beings, rather than the patient as a disease (Butts & Rich, 2013).
Joyce Travelbee, and her Human-to-Human Relationship Model, took an existentialist
view with her framework. She was a psychiatric nurse and observed nurses lacking compassion
toward those patients. Travelbee was adamant unless nurses became aware of caring as a basic
foundation of nursing, patients would turn towards another kind of health professional for care.
She recommended the goal of caring for an individual, family or community be based on patient
experiences of illness and suffering. Travelbee identified phases of the nurse-patient relationship
as, original encounter, emerging identities, development of feelings of empathy and sympathy,
and establishment of rapport. She is credited with influencing the development of hospice, and
calling for birthing classes, natural childbirth and rooming-in (Butts & Rich, 2013).
Paterson and Zderad developed Humanistic Nursing Theory. They proposed that
understanding peoples experiences would assist nurses in their care. The construct of “call and
response” relationship involves, the patient calling for care and the nurse responding to that call.
The patient expects the nurse to meet the need. The goal of nursing is to assist the patient to
realize their potential (Butts & Rich, 2013).
Jean Watson is well known for her Theory of Transpersonal Caring. She describes caring
behaviors of the nurse. Her framework calls for holistic caring. The nurse needs to affirm the
patient’s importance, assess and connect with the patient’s spirit, realize the patient’s state of
being in the world, and provide caring, healing comfort, wholeness and harmony to the patient
(Butts & Rich, 2013).
Margaret Newman’s Theory of Health as Expanding Consciousness. Her framework is
Rogerian in basis and she focuses on forming relationships with patients at critical points in their
lives. She proclaims the need for nurses and patients to have self-awareness in order to have a
positive nurse-patient relationship (Butts & Rich, 2013).
Rosemarie Rizzo Parse entitled her framework as Humanbecoming Theory. She focuses
on three theoretical assumptions. She postulates the goal of nursing is being present within a
mutual nurse-patient relationship. Parse considers health as intertwined with humans and the
universe. Health is the ultimate human becoming (Butts & Rich. 2013).
There are four non-nursing theories addressed in this chapter. Sullivan’s Theory of
Interpersonal Relations suggests all human processes are interrelated. Nothing occurs in
isolation. His work was foundational for identification of social, environmental and relationships
where the individual interacts with other individuals. He set up stages of interpersonal
development, and believed that without completion of each stage a person’s personality would
not develop properly (Butts & Rich, 2013).
Carl Roger’s Person Centered Theory, is a person-centered approach encompassing
individual, choice, responsibility and creativity. He was best known for his experience-oriented
therapy, which uses a person’s experience as a change agent. His theory is considered weakened
by some as he does not consider power, status, history, politics, culture or quality of human
experience (Butts & Rich, 2013).
Viktor Frankl’s Logotherapy developed out of his experience in observing those who
lived verses those who died at Nazi death camps. He proposed those who lived had a found a
meaning to their life lived, and those who did not, died. Therefore, the main premise of his
theory is the “will to meaning” (Butts & Rich, 2013).
Rollo May is the final theorist that will be discussed. He asserted humans must do things
now rather than never doing anything at all. May believed anxiety needs to be channeled to
enable a person live a meaningful life. Ultimately he proposed, knowing humans will die, is
what brings true meaning to life (Butts & Rich, 2013).
All of these theories are important frameworks for nurses to consider. They will assist
nursing to expand knowledge with in the profession. By utilizing interdisciplinary models,
nursing can bring strength and respectability to the profession and engage in collaboration with
other disciplines.