Chapter 12: Conceptual
and Philosophical Bases for
Nursing
Bonnie M. Wivell, MS, RN, CNS
Systems
System theorist—von Bertalanffy (1936)
described a system as a set of interrelated parts
that come together to form a whole that performs
a function. Each part is a necessary
component—these parts are:
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Input: raw material that enters a system and is
changed by it
Throughput: process used to convert raw material into
something useful
Output: end result or product
Evaluation: measuring the success or failure of the
output or the effectiveness of the system
Feedback: information given back into the system to
determine if purpose or end result was achieved
Systems Continued
Suprasystem: the environment outside the
system
Open: promotes the exchange of matter, energy
& information with other systems; whole is
greater than sum of parts
Closed: doesn’t interact with other systems
Synergy: subsystems collaborate
Dynamic Nature of Systems: dynamic balance
maintains homeostasis or internal stability
Application to Nursing: Nurses work in systems
every day
Person as a System
Physiological subsystems of person: circulatory,
musculoskeletal, respiratory, GI, GU, neurological
Psychological, social, cultural and spiritual subsystems also
exist
Holistic nursing care combines all these subsystems
Genes and environmental factors influence how a person
develops
Maslow Human Needs Theory
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Basic needs: food, air, water
Safety needs: physical safety and psychological security
Love and belonging: intimacy and relationships
Esteem needs: self-esteem, self-respect, self-reliance
Self-actualization: attaining maximum potential
Assumption: basic needs must be at least partially satisfied
before higher-order needs can become relevant to the
individual
Carl Rogers
Theory of personhood
People are constantly adapting, discovering and
rediscovering themselves
Human potential to grow and develop can be
used by nurses to assist patients to change
unhealthy behaviors and to reach the highest
level of wellness possible
The concept of adaptation is helpful because
when people are moved from their home
environment to the hospital, anxiety often occurs
Homeostasis
When needs are not met, it is threatened
Balance between internal and external forces
must be maintained
Balance achieved = healthy, resistant to disease
Persons attempt to adapt to change
If adaptation unsuccessful, disequilibrium occurs
and disease or illness can result
How one responds to stress is a major factor in
the development of illness
Environment
Family Systems: nuclear family (mom, dad,
children); extended family; single parent
Cultural Systems: attitudes, beliefs, & behaviors
of social & ethnic groups
Social Systems: neighborhoods, churches
schools, civic & recreational groups—Holmes &
Rahe (1967) studied social change as related to
illness; changes require social readjustment
WHO now recognizes poverty as the most
influential determinant of health
Community, National, World Systems
Health
WHO defines health as “a state of
complete physical, mental, and social wellbeing and not merely the absence of
disease or infirmity.”
Holism: Interrelationship of all parts make
up whole of the person (Smuts, 1926)
High-level Wellness: functioning at a
maximum potential in an integrated way
with the environment (Dunn, 1961)
Health Beliefs & Health Behaviors
Healthy People 2010: an effort designed to stimulate a
national disease prevention and health promotion
agenda to improve significantly the health of all
Americans
Convincing individuals to change their lifestyles,
however, even when to do so would result in improved
health, remains a challenge
Health behaviors include those choices and habitual
actions that promote or diminish health
Rosenstock’s health beliefs model:
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An evaluation of one’s vulnerability to a condition and the
seriousness of that condition
An evaluation of how effective the health maintenance behavior
might be
The presence of a trigger event that precipitates the health
maintenance behavior
Albert Bandura
Bandura’s (1997) model of self-efficacy:
high belief in one’s self-efficacy lead to
efforts to change; four components
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Information
Skill development
Skill enhancement through guided practice
and feedback
Creating social supports for change
Locus of Control
Locus of control concept proposed that
people tend to be influenced by either an
internal or external view of control
Internal: what they themselves do
External: is determined by outside factors
Influence of Internet on health—reliance
for health information; validity; see page
289 in text for ideas on how to assess
sites
Nurses and Health Beliefs Models
Health is relative, ever changing, and affected by
genetics, environment, personal beliefs and cultural
beliefs
Health affects the entire person
Individual’s health beliefs are powerful and influence how
they respond to efforts to change their behaviors
Individuals needing or desiring change may lack
knowledge, motivation, and support
Various models of health beliefs can be used to assess
individual, family, and group readiness to change
The burden of action is mutually shared by patient,
health care providers, and population-focused entities
such as public health programs
High-Level Wellness
Developing a personal plan for High-level
wellness; see page 311 in text
The personal health practices of nurses play a
direct role in their effectiveness in counseling
patients on health-related matters
Patients more likely to adopt healthy behaviors if
caregiver engages in them
Nurses have a professional responsibility to
model positive health behaviors in their own
lives, but nurses are individuals too.
Concepts Basic to Nursing
Person
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Unique
Capable of adaptation
Motivated by needs
Environment
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Promotes or interferes with well-being
Physical and Nonphysical
Health
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Dynamic
A continuum
Beliefs
A belief represents the intellectual acceptance of
something as true.
A nurse with a non-judgmental attitude makes
every effort to convey neither approval nor
disapproval of a patient’s beliefs and respects
each person’s rights to his or her beliefs.
Categories:
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Descriptive: show true or false
Evaluative: judge as good or bad
Prescriptive: judged desirable or undesirable
Values
Values are the freely chosen principles,
ideals or standards held by an individual,
class or group that give meaning and
direction to life.
Professional nursing values on page 316
Clarifying your values on page 296
Philosophies
Philosophy is defined as the study of the
principles underlying conduct, thought, and the
nature of the universe.
Branches of Philosophies:
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Epistemology: tries to determine how we know
whether our beliefs about the world are true
Logic: study of proper & improper methods of
reasoning (such as the nursing process)
Aesthetics: study of what is beautiful
Ethics: study of standards of conduct
Politics: deals with regulation & control of people
living in society
Metaphysics: ultimate nature of existence, reality,
human experience & the universe
Philosophy of Nursing
Philosophies of Nursing are statements of
beliefs and expressions of values in
nursing that are used as bases for thinking
and acting – guide practice.
Individual philosophies
Collective philosophies: hospitals, schools
of nursing
Your personal philosophy of nursing