Nursing Theories and Application

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

_PERSON



_HEALTH



_NURSING



_ENVIROMENT

METAPARADIGMS

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 FLORENCE NIGHTINGALE

 HILDEGARD PEPLAU

 VIRGINIA HENDERSON

 IDA JEAN ORLANDO

 _{DOROTHY JOHNSON}  SISTER CALISTA ROY



 JEAN WATSON

 MADELEINE LEININGER

 PATRICIA BENNER

 ROPER, LOGAN and TIERNEY

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FLORENCE

NIGHTINGALE

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FLORENCE

NIGHTINGALE

 _{The first nursing theorist.}  _{Also known as "The Lady}

with the Lamp"  _{She explained her}

environmental theory in her famous book Notes on

Nursing: What it is, What it is not .



FLORENCE

NIGHTINGALE

 She was the first to propose nursing required specific education and training.  Her contribution during

Crimean war is well-known.  She was a statistician, using

bar and pie charts,

highlighting key points.  International Nurses Day,

May 12 is observed in

respect to her contribution to Nursing.

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FLORENCE

NIGHTINGALE

 Focuses on nursing and the patient

environment relationship.

 Unsanitary conditions posed health hazard (Notes on Nursing, 1859)

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 _{Patient who is acted on by} nurse

 _{Affected by environment}  _{Has reparative powers}  _{People are}

multidimensional,

composed of biological, psychological, social and spiritual components.

FLORENCE



FLORENCE

NIGHTINGALE

physical, psychological, and social

 "Poor or difficult

environments led to poor health and disease".

 _{"Environment could be} altered to improve

conditions so that the

natural laws would allow healing to occur

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 Maintaining well-being by using a person’s powers  Maintained by control of

environment

 Health is “not only to be well, but to be able to use well every power we have”.  _{Disease is considered as}

dys-ease or the absence of comfort.

FLORENCE



 Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process

 _{Nursing is different from}

medicine and the goal of nursing is to place the patient in the best possible condition for nature to act.

 Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation.

FLORENCE



Canons of Nursing

•

_{Ventilation and warming}

•

_{Light, Noise}

•

Cleanliness of rooms/walls

•

Health of houses

•

Bed and bedding

•

Personal cleanliness

•

_Variety

•

Chattering hopes and advices

•

Taking food. What food?

•

Petty management/observation

FLORENCE

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NIGHTINGALE PLEDGE

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

FLORENCE

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Application of Nightingale's theory in practice:

"Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to

reduce noise, to relieve patients’ anxieties, and to help them sleep."

As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care.

FLORENCE

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Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations

Incorporating Florence Nightingale's theory of

nursing into teaching a group of preadolescent children about negative peer pressure.

FLORENCE

“The goal of nursing is “to put the patient in the best condition for nature to act upon him”- Nightingale

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VIRGINIA

HENDERSON

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VIRGINIA

HENDERSON

 The Nightingale of Modern Nursing”

 “Modern-Day Mother of Nursing.”

 "The 20th century Florence Nightingale."

 _{Born in Kansas City, Missouri,}

in 1897.

 Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital,

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 Have basic needs that are component of health.

 Requiring assistance to achieve health and independence or a peaceful death.

 Mind and body are inseparable and interrelated.

 Considers the biological,

psychological, sociological, and spiritual components.

 The theory presents the patient as a sum of parts with biopsychosocial needs.

 2. Environment

VIRGINIA

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 Settings in which an individual learns unique pattern for living.

 _{All external conditions and}

influences that affect life and development.

 Individuals in relation to families

 _{Minimally discusses the impact}

of the community on the individual and family.

 Basic nursing care involves providing conditions under

which the patient can perform the 14 activities unaided

VIRGINIA



 Definition based on individual’s ability to function independently as outlined in the 14 components.

 Nurses need to stress promotion of health and prevention and cure of disease.

 _{Good health is a challenge}

-affected by age, cultural background, physical, and intellectual capacities, and emotional balance Is the

individual’s ability to meet these needs independently.

VIRGINIA

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 _{Temporarily assisting an} individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14 basic needs.  _{Assists and supports the}

individual in life activities and the attainment of

independence.

 Nurse serves to make

patient “complete” “whole", or "independent.”

VIRGINIA

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 The nurse is expected to carry out physician’s therapeutic plan

Individualized care is the result of the nurse’s creativity in

planning for care.

 “Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.”

 In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and supplement his strength will or knowledge according to his needs.”

VIRGINIA

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the theory are:

 "Nurses care for patients until patient can care for

themselves once again. Patients desire to return to health, but this assumption is not explicitly stated.

 Nurses are willing to serve and that “nurses will devote themselves to the patient day and night” A final assumption is that nurses should be

educated at the university

level in both arts and sciences.

VIRGINIA

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• _{Breathe normally. Eat and drink adequately.} • _{Eliminate body wastes.}

• Move and maintain desirable postures. • Sleep and rest.

• Select suitable clothes-dress and undress.

• _{Maintain body temperature within normal range} by adjusting clothing and modifying environment • Keep the body clean and well groomed and

protect the integument

• _{Avoid dangers in the environment and avoid} injuring others.

VIRGINIA

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•Communicate with others in expressing emotions, needs, fears, or opinions.

•Worship according to one’s faith.

•Work in such a way that there is a sense of accomplishment.

•_{Play or participate in various forms of recreation.} •_{Learn, discover, or satisfy the curiosity that leads to} normal development and health and use the

available health facilities.

VIRGINIA

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Application to Nursing Practice

 Henderson provides the essence of what she believes is a definition of nursing.

 Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs.

 Her definition of nursing and the 14 components of basic nursing care are uncomplicated and

self-explanatory.

VIRGINIA



VIRGINIA

HENDERSON

 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. And to do this in such a way as to help him gain independence as

rapidly as possible" (Henderson, 1966)

HILDEGARD PEPLAU

THEORY OF

INTERPERSONAL RELATIONS



from Colombia University New York in 1947.

 _{EdD in curriculum}

development in 1953.

 Professor emeritus from Rutgers university

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 A developing organism that tries to reduce

anxiety caused by needs.

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Existing forces outside the organism and in the

context of culture

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 _{A word symbol that}

implies forward movement

of personality and other

ongoing human processes in the direction

of creative, constructive, pro

ductive, personal andcomm unity living.

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process that make health possible for individuals in

communities

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 The theory explains the purpose of nursing is to help others

identify their felt difficulties.

 Nurses should apply principles of human relations to the problems that arise at all levels of

experience.

 Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process.

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 _{Nursing is therapeutic in that it is}

a healing art, assisting an

individual who is sick or in need of health care.

 _{Nursing is an interpersonal}

process because it involves

interaction between two or more individuals with a common goal.

 The attainment of goal is

achieved through the use of a series of steps following a series of pattern.

 The nurse and patient work together so both become mature and knowledgeable in the

process.

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Stranger: receives the client in the

same way one meets a stranger in other life situations provides an accepting climate that builds trust.

Teacher: who imparts knowledge in

reference to a need or interest

Resource Person : one who provides a

specific needed information that aids in the understanding of a problem or new situation

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Roles of nurse

Counselors : helps to understand and

integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes

Surrogate: helps to clarify domains of

dependence interdependence and independence and acts on clients behalf as an advocate.

Leader : helps client assume

maximum responsibility for meeting treatment goals in a mutually

satisfying way

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 Phases of interpersonal relationship

 Identified four sequential phases in the interpersonal relationship:  1. Orientation 2. Identification 3. Exploitation 4. Resolution

HILDEGARD PEPLAU

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PHASE

 Problem defining phase

 Starts when client meets nurse as stranger

 Defining problem and deciding type of service needed

 Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences

 Nurse responds, explains roles to client, helps to identify problems and to use available resources and services

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PHASE

 _{Selection of appropriate} professional assistance  _{Patient begins to have a}

feeling of belonging and a capability of dealing with the problem which

decreases the feeling of helplessness and

hopelessness

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 Use of professional assistance for problem solving

alternatives

 Advantages of services are used is based on the needs and interests of the patients

 _{Individual feels as an integral}

part of the helping environment

 _{They may make minor}

requests or attention getting techniques

 The principles of interview

techniques must be used in order to explore, understand and

adequately deal with the underlying problem

 _{Patient may fluctuates on}

independence

 _{Nurse must be aware about the}

various phases of communication

 _{Nurse aids the patient in}

exploiting all avenues of help and progress is made towards the final step

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 Termination of professional relationship

 The patients needs have already been met by the collaborative effect of patient and nurse

 Now they need to terminate their therapeutic relationship and dissolve the links between them.

 Sometimes may be difficult for both as psychological dependence persists

 Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals

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HILDEGARD PEPLAU

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and steps of experimental teaching to patients of a concept of anxiety:

Findings revealed that when taught by the

experimental method, the patients were able to

apply the concept of anxiety after the group was terminated.

 Burd .S.F. Develop and test a nursing

intervention framework for working with

anxious patients: Students developed competency in

beginning interpersonal relationship.

APPLICATION OF THE THEORY

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SISTER CALISTA ROY

THE ADAPTATION MODEL

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 _{Sr.Callista Roy- nurse theorist,}

writer, lecturer, researcher and teacher

 Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill

 Born at Los Angeles on October 14, 1939.

 Bachelor of Arts with a major in nursing - Mount St. Mary's

College, Los Angeles in 1963.

 _{Master's degree program in}

pediatric nursing - University of California ,Los Angeles in 1966.

 Master’s and PhD in Sociology in 1973 and 1977.

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 Bio-psycho-social being in constant interaction with a changing environment

 Uses innate and acquired mechanisms to adapt

 An adaptive system described as a whole comprised of parts

 Functions as a unity for some purpose

 Includes people as individuals or in groups-families, organizations, communities, and society as a whole.

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 Focal - internal or external and

immediately confronting the person

 Contextual- all stimuli present in the situation that contribute to effect of focal stimulus

 Residual-a factor whose effects in the current situation are unclear

 All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli

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 A state and a process of being and becoming

integrated and whole

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 To promote adaptation in the four adaptive modes

 To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental

interactions

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ADAPTATION

 _{Responding positively to} environmental changes.  _{The process and outcome}

of individuals and groups who use conscious

awareness, self reflection and choice to create

human and

environmental integration

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practice

 _{Clinical assessment and} intervention

 _{Research variables}

 _{To guide nursing practice}  _{To organize nursing}

education

 _{Curricular frame work for} various nursing colleges APPLICATION OF THE THEORY

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 Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences.

 She proposed that one could gain knowledge and skills ("knowing how") without ever learning the theory ("knowing that").

AGREE DISAGREE MAYBE



 She conceptualizes in her writing about

nursing skills as experience is a prerequisite for

becoming an expert



 Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of California, San Francisco.  BA in Nursing - Pasadena

College/Point Loma College  _{MS in Med/Surg nursing} from UCSF  PhD -1982 from UC Berkeley  1970s - Research at UCSF and UC Berkeley

PATRICIA BENNER



 LEVELS OF NURSING EXPERIENCE

 She described 5 levels of nursing experience as;

 Novice  Advanced beginner  _Competent  Proficient  Expert

PATRICIA BENNER



Novice

 Beginner with no experience  Taught general rules to help

perform tasks

 Rules are: context-free, independent of specific cases, and applied

universally

 Rule-governed behavior is limited and inflexible

 _{Ex. “Tell me what I need to} do and I’ll do it.”

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Advanced Beginner

 Demonstrates acceptable performance

 Has gained prior experience in actual situations to

recognize recurring

meaningful components  _{Principles, based on}

experiences, begin to be

formulated to guide actions

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Competent

 Typically a nurse with 2-3 years experience on the job in the same area or in

similar day-to-day situations  _{More aware of long-term}

goals

 Gains perspective from

planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization



 Learns from experiences what to expect in certain situations and how to modify plans



Expert

 No longer relies on principles, rules, or guidelines to connect situations and determine actions

 _{Much more background of} experience

 Has intuitive grasp of clinical situations

 Performance is now fluid, flexible, and

highly-proficient

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 Different levels of skills reflect changes in 3 aspects of skilled performance:

 Movement from relying on abstract principles to using past concrete experiences to guide actions

 Change in learner’s perception of situations as whole parts rather than in separate pieces

 Passage from a detached observer to an involved performer, no longer outside the situation but now actively engaged in participation

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 Theorists: Nancy Roper, Winifred W. Logan and Alison J. Tierney

 One of the widely used nursing model in the United Kingdom.

 Also referred as a Human Needs Model

 A model of nursing care based on activities of daily living (ADLs).  Theory Sources  Virginia Henderson

Roper–Logan–Tierney Model of

Nursing



 Activities of Living (ALs)

 There are 12 activities, some of which are essential such as breathing and others that which enhance the quality of life.

Roper–Logan–Tierney Model of

Nursing



 Maintaining a safe environment

 Communication

 Breathing

 Eating and drinking

 Elimination

 Washing and dressing

 Controlling temperature

 Mobilisation

 Working and playing

 Expressing sexuality

 Sleeping

 Death and dying

Roper–Logan–Tierney Model of

Nursing



Madeleine Leininger

 Madeleine Leininger is considered as the

founder of the theory of transcultural nursing.

 Her theory has now developed as a

discipline in nursing.

 Transcultural nursing theory is also known as Culture Care theory.



 One of the first nursing theorist and transcultural global nursing consultant.  MSN - Catholic University in Washington DC.  PhD in anthropology - University of Washington.

Madeleine Leininger



(culture-specific) across human groups (Leininger,

1991).

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 Culture

 Set of values, beliefs and traditions, that are held by a specific group of people and handed down from generation to generation.

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 Cultural awareness

 It is an in-depth self-examination of one's own background,

recognizing biases and prejudices and

assumptions about other people.

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 Culturally congruent care

 Care that fits the people's valued life patterns and set of meanings -which is generated from the people themselves, rather than based on predetermined criteria.

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 Culturally competent care

 is the ability of the practitioner to bridge cultural gaps in caring, work with cultural

differences and enable clients and families to achieve meaningful and supportive caring.



Leininger (1991) identified three nursing

decision and action modes to achieve

culturally congruent care.

•

_{Cultural preservation or maintenance.}

•

_{Cultural care accommodation or negotiation.}

•

_{Cultural care repatterning or restructuring.}

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Philosophy and Science of Caring

 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

 A caring environment offers development of potential

 Caring promotes health better than curing

 _{Caring is central to nursing}

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Watson’s 10 Carative Factors

Forming humanistic-altruistic value system Instilling faith-hope

Cultivating sensitivity to self and others Developing helping-trust relationship Promoting expression of feelings

Using problem-solving for decision making Promoting teaching-learning

Promoting supportive environment

Assisting with gratification of human needs

Allowing for existential-phenomenological forces

JEAN WATSON



Watson’s Concepts Person

Human being to be valued, cared for, respected, nurtured, understood and assisted

Environment Society Health

Complete physical, mental and social well-being and functioning

Nursing

Concerned with promoting and restoring health, preventing illness

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THANK YOU