Nursing Theorists
Week 11 and 12
Gloria A. Hagopian, RN, EdD
3/19/2016
1
Definitions
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Theory- a set of related statements that
describes or explains phenomena in a
systematic way
Concept-a mental idea of a phenomenon
Construct- a phenomena that cannot be
observed and must be inferred
Gloria A. Hagopian, RN, EdD
3/19/2016
2
Definitions
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Proposition- a statement of
relationship between concepts
Conceptual model- made up of
concepts and propositions
Gloria A. Hagopian, RN, EdD
3/19/2016
3
Nursing Theorists
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Florence Nightingale, Hildegard
Peplau, Virginia Henderson, Fay
Abdella, Ida Jean Orlando, Dorothy
Johnson, Martha Rogers, Dorothea
Orem, Imogene King, Betty Neuman,
Sister Calista Roy, Jean Watson,
Rosemary Rizzo Parse, Madeleine
Leininger, Patricia Benner
Gloria A. Hagopian, RN, EdD
3/19/2016
4
Concepts in the
nursing metaparadigm
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Person
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Recipient of care, including physical,
spiritual, psychological, and sociocultural
components
Individual, family, or community
Gloria A. Hagopian, RN, EdD
3/19/2016
5
Concepts in the nursing
metaparadigm
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Environment
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All internal and external conditions,
circumstances, and influences affecting
the person
Gloria A. Hagopian, RN, EdD
3/19/2016
6
Concepts in the nursing
metaparadigm
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Health
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Degree of wellness or illness experienced
by the person
Gloria A. Hagopian, RN, EdD
3/19/2016
7
Concepts in the nursing
metaparadigm
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Nursing
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Actions, characteristics and attributes of
person giving care
Gloria A. Hagopian, RN, EdD
3/19/2016
8
Florence Nightingale
Environmental Theory
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First nursing theorist
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5 components of environment
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Unsanitary conditions posed health
hazard (Notes on Nursing, 1859)
ventilation, light, warmth, effluvia, noise
External influences can prevent,
suppress or contribute to disease or
death
Gloria A. Hagopian, RN, EdD
3/19/2016
9
Nightingale’s Concepts
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Person
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Patient who is acted on by nurse
Affected by environment
Has reparative powers
Environment
u Foundation of theory. Included
everything, physical, psychological, and
social
Gloria A. Hagopian, RN, EdD
3/19/2016
10
Nightingale’s Concepts
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Health
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Maintaining well-being by using a
person’s powers
Maintained by control of environment
Nursing
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Provided fresh air, warmth, cleanliness,
good diet, quiet to facilitate person’s
reparative process
Gloria A. Hagopian, RN, EdD
3/19/2016
11
Hildegard Peplau
Interpersonal Relations
Model
Gloria A. Hagopian, RN, EdD
3/19/2016
12
Hildegard Peplau
Interpersonal
Relations Model
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Based on psychodynamic nursing
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using an understanding of one’s own
behavior to help others identify their
difficulties
Applies principles of human relations
Patient has a felt need
Gloria A. Hagopian, RN, EdD
3/19/2016
13
Peplau’s Concepts
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Person
u An individual; a developing
organism who tries to reduce anxiety
caused by needs
u Lives in instable equilibrium
Environment- Not defined
Gloria A. Hagopian, RN, EdD
3/19/2016
14
Peplau’s Concepts
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Health
u Implies forward movement of the
personality and human processes
toward creative, constructive,
productive, personal, and
community living
Gloria A. Hagopian, RN, EdD
3/19/2016
15
Peplau’s Concepts
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Nursing
u A significant, therapeutic,
interpersonal process that functions
cooperatively with others to make
health possible
u Involves problem-solving
Gloria A. Hagopian, RN, EdD
3/19/2016
16
Virginia Henderson
Gloria A. Hagopian, RN, EdD
3/19/2016
17
Virginia Henderson
The Nature of Nursing
“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
(or to peaceful death) that he would
perform unaided if he had the
necessary strength, will, or knowledge.
Gloria A. Hagopian, RN, EdD
3/19/2016
18
Virginia Henderson
And to do this in such a way as to help
him gain independence as rapidly as
possible. She must in a sense, get
inside the skin of each of her patients
in order to know what he needs”.
Gloria A. Hagopian, RN, EdD
3/19/2016
19
Virginia Henderson
“She is temporarily the
consciousness of the unconscious,
the love of life for the suicidal, the
leg of the amputee, the eyes of the
newly blind, a means of locomotion
for the infant, knowledge and
confidence for the young mother, the
mouthpiece for those too weak or
withdrawn to speak, and so on.”
Gloria A. Hagopian, RN, EdD
3/19/2016
20
Fay Abdella- Topology of
21 Nursing Problems
Gloria A. Hagopian, RN, EdD
3/19/2016
21
Fay Abdella
Topology of 21 Nursing
Problems
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A list of 21 nursing problems
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Problems are in 3 categories
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Condition presented or faced by the
patient or family.
physical, social and emotional
The nurse must be a good problem
solver
Gloria A. Hagopian, RN, EdD
3/19/2016
22
Abdella’s Concepts
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Nursing
u A helping profession
u A comprehensive service to meet patient’s
needs
u Increases or restores self-help ability
u Uses 21 problems to guide nursing care
Health
u Excludes illness
u No unmet needs and no actual or
anticipated impairments
Gloria A. Hagopian, RN, EdD
3/19/2016
23
Abdella’s Concepts
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Person
u One who has physical, emotional, or
social needs
u The recipient of nursing care.
Environment
u Did not discuss much
u Includes room, home, and community
Gloria A. Hagopian, RN, EdD
3/19/2016
24
Ida Jean Orlando
Deliberative Nursing Process
Gloria A. Hagopian, RN, EdD
3/19/2016
25
Ida Jean Orlando
Deliberative Nursing Process
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The deliberative nursing process is set in
motion by the patient’s behavior
u All behavior may represent a cry for help.
Patient’s behavior can be verbal or nonverbal.
The nurse reacts to patient’s behavior and
forms basis for determining nurse’s acts.
u Perception, thought, feeling
Gloria A. Hagopian, RN, EdD
3/19/2016
26
Ida Jean Orlando
Deliberative Nursing
Process
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Nurses’ actions should be deliberative,
rather than automatic
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Deliberative actions explore the
meaning and relevance of an action.
Gloria A. Hagopian, RN, EdD
3/19/2016
27
Dorothy Johnson
Behavioral Systems Model
Gloria A. Hagopian, RN, EdD
3/19/2016
28
Dorothy Johnson
Behavioral Systems Model
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The person is a behavioral system
comprised of a set of organized,
interactive, interdependent, and
integrated subsystems
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Constancy is maintained through
biological, psychological, and sociological
factors.
Gloria A. Hagopian, RN, EdD
3/19/2016
29
Dorothy Johnson
Behavioral Systems
Model
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A steady state is maintained through
adjusting and adapting to internal and
external forces.
Gloria A. Hagopian, RN, EdD
3/19/2016
30
Johnson’s 7 Subsystems
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Affiliative subsystem
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Dependency
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helping or nuturing
Ingestive
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social bonds
food intake
Eliminative
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excretion
Gloria A. Hagopian, RN, EdD
3/19/2016
31
Dorothy Johnson
Behavioral Systems
Model 7 Sub Systems
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Sexual
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Agressive
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procreation and gratification
self-protection and preservation
Achievement
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efforts to gain mastery and control
Gloria A. Hagopian, RN, EdD
3/19/2016
32
Johnson’s Concepts
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Person
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A behavioral system comprised of
subsystems constantly trying to maintain
a steady state
Environment
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Not specifically defined but does say
there is an internal and external
environment
Gloria A. Hagopian, RN, EdD
3/19/2016
33
Dorothy Johnson
Behavioral Systems
Model
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Health
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Balance and stability.
Nursing
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External regulatory force that is indicated
only when there is instability.
Gloria A. Hagopian, RN, EdD
3/19/2016
34
Martha Rogers
Unitary Human Beings
Gloria A. Hagopian, RN, EdD
3/19/2016
35
Martha Rogers
Unitary Human Beings
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Energy fields
u Fundamental unity of things that are
unique, dynamic, open, and infinite
u Unitary man and environmental field
Universe of open systems
u Energy fields are open, infinite, and
interactive
Gloria A. Hagopian, RN, EdD
3/19/2016
36
Martha Rogers
Unitary Human Beings
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Pattern
u Characteristic of energy field
u A wave that changes, becomes complex
and diverse
Four dimensionality
u A nonlinear domain with out time or
space
Gloria A. Hagopian, RN, EdD
3/19/2016
37
Roger’s Definitions
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Integrality
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Continuous and mutual interaction
between man and environment
Resonancy
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Continuous change longer to shorter
wave patterns in human and
environmental fields
Gloria A. Hagopian, RN, EdD
3/19/2016
38
Martha Rogers
Unitary Human Beings
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Helicy
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Continuous, probabilistic, increasing
diversity of the human and
envrionmental fields.
Characterized by nonrepeating
rhymicities
Change
Gloria A. Hagopian, RN, EdD
3/19/2016
39
Dorothea Orem
Self-Care Model
Gloria A. Hagopian, RN, EdD
3/19/2016
40
Dorothea Orem
Self-Care Model
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Self-care comprises those activities
performed independently by an
individual to promote and maintain
person well-being
Self care agency is the individual’s
ability to perform self care activities
Gloria A. Hagopian, RN, EdD
3/19/2016
41
Dorothea Orem
Self-Care Model
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Self- care deficit occurs when the
person cannot carry out self-care
The nurse then meets the self-care
needs by acting or doing for;guiding,
teaching, supporting or providing the
environment to promote patient’s
ability
Gloria A. Hagopian, RN, EdD
3/19/2016
42
Dorothea Orem
Self-Care Model
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Wholly compensatory nursing system
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Partially compensatory
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Patient dependent
Patient can meet some needs but needs
nursing assistance
Supportive educative
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Patient can meet self care requisites, but
needs assistance with decision making or
knowledge
Gloria A. Hagopian, RN, EdD
3/19/2016
43
Imogene King
Goal Attainment Theory
Gloria A. Hagopian, RN, EdD
3/19/2016
44
Imogene King
Goal Attainment Theory
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Open systems framework
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Human beings are open systems in
constant interaction with the environment
u Personal System
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individual; perception, self, growth,
development, time space, body image
Interpersonal
u Society
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Gloria A. Hagopian, RN, EdD
3/19/2016
45
Imogene King
Goal Attainment Theory
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Personal System
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Interpersonal
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Individual; perception, self, growth,
development, time space, body image
Socialization; interaction, communication
and transaction
Society
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Family, religious groups, schools, work,
peers
Gloria A. Hagopian, RN, EdD
3/19/2016
46
Imogene King
Goal Attainment Theory
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The nurse and patient mutually
communicate, establish goals and take
action to attain goals
Gloria A. Hagopian, RN, EdD
3/19/2016
47
Imogene King
Goal Attainment Theory
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Each individual brings a different set
of values, ideas, attitudes, perceptions
to exchange
Gloria A. Hagopian, RN, EdD
3/19/2016
48
Betty Neuman
Systems Model
Gloria A. Hagopian, RN, EdD
3/19/2016
49
Betty Neuman
Health Care
Systems Model
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The person is a complete system, with
interrelated parts
u maintains balance and harmony
between internal and external
environment by adjusting to stress
and defending against tensionproducing stimuli
Gloria A. Hagopian, RN, EdD
3/19/2016
50
Betty Neuman
Health Care
Systems Model
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Focuses on stress and stress reduction
Primarily concerned with effects of
stress on health
Stressors are any forces that alter the
system’s stability
Gloria A. Hagopian, RN, EdD
3/19/2016
51
Betty Neuman
Health Care
Systems Model
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Flexible lines of resistance
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Normal line of resistance
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Surround basic core
Internal factors that help defend against
stressors
Normal adaptation state
Flexible line of defense
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Protective barrier, changing, affected by
variables
Gloria A. Hagopian, RN, EdD
3/19/2016
52
Betty Neuman
Systems Model
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Wellness is equilibrium
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Nursing interventions are activites to:
strengthen flexible lines of defense
u strengthen resistence to stressors
u maintain adaptation
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Gloria A. Hagopian, RN, EdD
3/19/2016
53
Sister Calista Roy
Adaptation Model
Gloria A. Hagopian, RN, EdD
3/19/2016
54
Sister Calista Roy
Adaptation Model
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Five Interrelated Essential Elements
u Patiency- The person receiving care
u Goal of nursing- Adapting to change
u Health-Being and becoming a whole
person
Environment
u Direction of nursing activitiesu
Facilitating adaptation
Gloria A. Hagopian, RN, EdD
3/19/2016
55
Sister Calista Roy
Adaptation Model
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The person is an open adaptive system
with input (stimuli), who adapts by
processes or control mechanisms
(throughput)
The output can be either adaptive
responses or ineffective responses
Gloria A. Hagopian, RN, EdD
3/19/2016
56
Jean Watson
Philosophy and Science of
Caring
Gloria A. Hagopian, RN, EdD
3/19/2016
57
Jean Watson
Philosophy and
Science of Caring
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Caring can be demonstrated and
practiced
Caring consists of carative factors
Caring promotes growth
A caring environment accepts a person
as he is and looks to what the person
may become
Gloria A. Hagopian, RN, EdD
3/19/2016
58
Jean Watson
Philosophy and
Science of Caring
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A caring environment offers
development of potential
Caring promotes health better
than curing
Caring is central to nursing
Gloria A. Hagopian, RN, EdD
3/19/2016
59
Watson’s 10 Carative
Factors
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Forming humanistic-altruistic
value system
Instilling faith-hope
Cultivating sensitivity to self and
others
Gloria A. Hagopian, RN, EdD
3/19/2016
60
Watson’s 10 Carative
Factors
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Developing helping-trust
relationship
Promoting expression of feelings
Using problem-solving for
decision making
Gloria A. Hagopian, RN, EdD
3/19/2016
61
Watson’s 10 Carative
Factors
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Promoting teaching-learning
Promoting supportive environment
Assisting with gratification of human
needs
Allowing for existentialphenomenological forces
Gloria A. Hagopian, RN, EdD
3/19/2016
62
Watson’s Concepts
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Person
u
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Human being to be valued, cared
for, respected, nurtured, understood
and assisted
Environment
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Society
Gloria A. Hagopian, RN, EdD
3/19/2016
63
Jean Watson
Philosophy and
Science of Caring
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Health
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Complete physical, mental and
social well-being and functioning
Nursing
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Concerned with promoting and
restoring health, preventing illness
Gloria A. Hagopian, RN, EdD
3/19/2016
64
Rosemary Parse
Human Becoming Theory
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Human Becoming Theory includes
Totality Paradigm
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Man is a combination of biological,
psychological, sociological and spiritual
factors
Simultaneity Paradigm
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Man is a unitary being in continuous,
mutual interaction with environment
Originally Man-Living-Health Theory
Gloria A. Hagopian, RN, EdD
3/19/2016
65
Parse’s Three Principles
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Meaning
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Man’s reality is given meaning through
lived experiences
Man and environment cocreate
Rhythmicity
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Man and environment cocreate ( imaging,
valuing, languaging) in rhythmical
patterns
Gloria A. Hagopian, RN, EdD
3/19/2016
66
Parse’s Three Principles
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Cotranscendence
Refers to reaching out and beyond
the limits that a person sets
u One constantly transforms
u
Gloria A. Hagopian, RN, EdD
3/19/2016
67
Rosemary Parse
Human BecomingTheory
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Person
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Open being who is more than and
different from the sum of the parts
Environment
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Everything in the person and his
experiences
Inseparable, complimentary to and
evolving with
Gloria A. Hagopian, RN, EdD
3/19/2016
68
Rosemary Parse
Human BecomingTheory
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Health
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Open process of being and becoming.
Involves synthesis of values
Nursing
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A human science and art that uses an
abstract body of knowledge to serve
people
Gloria A. Hagopian, RN, EdD
3/19/2016
69
Madeleine Leininger
Culture Care Diversity and
Universality
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Based on transcultural nursing, whose
goal is to provide care congruent with
cultural values, beliefs, and practices
Sunrise model consists of 4 levels that
provide a base of knowledge for
delivering cultural congruent care
Gloria A. Hagopian, RN, EdD
3/19/2016
70
Madeleine Leininger
Culture Care Diversity
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Modes of nursing action
u Cultural care preservation
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Cultural care accommodation
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help maintain or preserve health, recover
from illness, or face death
help adapt to or negotiate for a beneficial
health status, or face death
Cultural care re-patterning
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help restructure or change lifestyles that are
culturally meaningful
Gloria A. Hagopian, RN, EdD
3/19/2016
71
Patricia Benner
From Novice to Expert
Gloria A. Hagopian, RN, EdD
3/19/2016
72
Patricia Benner
From Novice to
Expert
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Described 5 levels of nursing
experience and developed exemplars
and paradigm cases to illustrate each
level
Gloria A. Hagopian, RN, EdD
3/19/2016
73
Patricia Benner
From Novice to
Expert
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Levels reflect:
u
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movement from reliance on past abstract
principles to the use of past concrete
experience as paradigms
change in perception of situation as a
complete whole in which certain parts are
relevant
Gloria A. Hagopian, RN, EdD
3/19/2016
74
Patricia Benner
From Novice to
Expert
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Novice
Advanced beginner
Competent
Proficient
Expert
Gloria A. Hagopian, RN, EdD
3/19/2016
75
Importance of Theoretical
Frameworks
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Foundation of any profession is the
development of a specialized body of
knowledge. Theories should be
developed in nursing, not borrow
theories form other disciplines
Gloria A. Hagopian, RN, EdD
3/19/2016
76
Next Steps
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Responsibility of nurses to know and
understand theorists
Critically analyze theoretical
frameworks
Gloria A. Hagopian, RN, EdD
3/19/2016
77