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Theoretical Foundations of Nursing

-Primer-

I. Philosophy
• Specifies the definition of the metaparadigm concepts (person, environment, health, and nursing) in each of
the conceptual models of nursing.
• Sets forth meaning through analysis, reasoning, and logical argument. It provides a broad understanding and
direction.

Florence Nightingale - Modern Nursing; Environmental Theory


• Disease is a reparative process, and that the manipulation of the environment - ventilation, warmth,
light, diet, cleanliness, and noise - would contribute to the process and health of the patient
• Did not agree with the “germ theory of disease” although she accepted the ill effects of contamination
from organic materials from the patients and the environment hence found sanitation as important
• Also renowned for pioneering statistical analysis of healthcare

Ernestine Wiedenbach - Helping Art of Clinical Nursing


• “…nursing is nurturing or caring for someone in a motherly fashion.”
• Proposed that nurses identify patient’s need-for-help by:
o Observing behaviors regarding comfort
o Exploring meanings of the behavior
o Knowing the cause of discomfort
o Knowing if they can solve on their own or need help

Virginia Henderson - Definition of Nursing; 14 Basic Needs


• “The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or to recovery (or to a 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”
• 14 Basic Needs:
1. Breathe 8. Clean body and intact integument
2. Eat and drink 9. Safe environment
3. Eliminate 10. Communicate
4. Motion and position 11. Worship
5. Rest and sleep 12.Work
6. Clothing 13.Play
7. Temperature 14.Learn

Faye Glenn Abdellah - 21 Nursing Problems


• Problem solving was seen as the way of presenting nursing(patient) problems as the patient moved
towards health
• Contributed to nursing theory development through the systematic analysis of research reports to
formulate the 21 nursing problems that served as an early guide for comprehensive nursing care

Lydia Hall - Care, Core, and Cure


• The theory consists of 3 major tenets:
o The nurse functions differently in the 3 interlocking aspects of the patient:
 Cure (Disease) shared with doctors
 Core (Person) addressed by therapeutic use of self; shared with psychiatry/psychology,
religious ministry, etc.
 Care (Body) exclusive to nurses; involves intimate bodily care like feeding, bathing and
toileting
o As the patient needs less medical care, he needs more professional nursing care
o Wholly professional nursing care will hasten recovery

Jean Watson - Philosophy and Science of Caring; Carative Factors


• Caring is a universal social phenomenon that is only effective when practiced interpersonally. Nurses
should be sensitized to humanistic aspects of caring
• 10 Carative Factors
1. Form humanistic-altruistic values 6. Scientific problem-solving method for decisions
2. Instill faith-hope 7. Promote interpersonal teaching-learning
3. Cultivate sensitivity 8. Provide supportive, protective, or corrective
environment
4. Develop helping-trust relationship 9. Assist gratifying human needs
5. Promote and accept expression of positive and 10. Allowance for existential-phenomenological forces
negative

Patricia Benner - Novice to Expert


• Validated the Dreyfus Model of Skill Acquisition in nursing practice with the systematic description of
the 5 stages (Novice, Advanced beginner, Competent, Proficient, and Expert)

II. Conceptual Models


• Frameworks or paradigms that give a broad frame of reference for systematic approaches to the concerned
phenomena
• Concepts that specify their interrelationship to form an organized perspective for viewing the phenomena
Grand Theories
• Derived from models but as “theories”, they propose testable truths or outcomes based on use of the model in
practice

Dorothea Orem - Self- Care Deficit Theory


• Composed of 3 Theories:
o Theory of Self Care
o Theory of Self-Care Deficit
o Theory of Nursing Systems - 3 Types:
 Wholly Compensatory - do for the patient
 Partly Compensatory - help the patient do for himself
 Supportive Educative - help the patient learn to do for himself; nurse has important
role in designing nursing care

Myra Estrin Levine - Conservation Model


• Major Concepts:
o Wholism (Holism)
o Adaptation - process whereby patients retain integrity; establish body economy to safeguard
stability:
 Environment
 Organismic Response - (1)Fight or flight, (2)inflammatory response, (3)response to
stress, (4)perceptual awareness
 Trophicogenesis - alternative to nursing diagnosis
o Conservation - 4 principles of conservation - Nursing intervention is based on the conservation
of the patients:
 Energy
 Structural Integrity
 Personal Integrity
 Social Integrity
• Composed of 3 Theories - (1) conservation (2) redundancy (3) therapeutic intention
Martha Rogers - Unitary Human Beings
• Principles of Homeodynamics
o Helicy - spiral development in continuous, non-repeating, and innovative patterning
o Resonancy - patterning changes with development from lower to higher frequency(intensity)
o Integrality - continuous mutual process of person and environment
• Theoretical Assertions
o Energy - Man as a whole is more than the sum of his parts
o Openness - Man and environment continuously exchange matter and energy
o Helicy - Life evolves irreversibly and unidirectionally along space and time
o Pattern and organization identify man and reflect his innovative wholeness
o Sentient, thinking being - man has capacity for abstraction and imagery, language and
thought, sensation and emotion

Dorothy Johnson - Behavioral Systems Model


• Considered attachment or affiliative subsystem as cornerstone of social organizations
• Nursing problems arise because there are disturbances in the structure or function of the subsystems:
o Dependency
o Achievement
o Aggressive
o Ingestive
o Eliminative
o Sexual
Sister Callista Roy - Adaptation Model
• Proposed that humans are biophychosocial beings who exist within an environment
• Environment and self provides 3 types of stimuli: (1) focal (2) residual (3) contextual
• Human stimuli create needs in adaptation modes, such as physiological self-concept, role function, and
interdependence
• Through adaptive mechanisms, regulator and cognator, a person shows adaptive or ineffective
response that need nursing intervention

Imogene King - Interacting Systems Framework; Goal Attainment Theory


• Nursing is a process of human interaction between nurses and patients who communicate to set goals,
explore means of attaining goals, and agree on what means to use
• Perceptions, judgement and actions of nurse and patient lead to reaction, interaction and transaction
• Interacting systems:
o Personal System - perception, self, body image, growth and development
o Interpersonal System - role, interaction, communication, transaction, and stress
o Social System - organization, power-authority status, decision making

Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
• Conceptual Components
o 12 Activities of Living (AL) - complex process of living in the view of an amalgam of activities
1. Maintain safe environment 7. Temperature
2. Communicate 8. Mobility
3. Breathe 9. Work and play
4. Eat and drink 10. Express sexuality
5. Eliminate 11. Sleep
6. Personal cleansing and dressing 12. Dying

o Life span - concept of continuous change from birth to death


o Dependence-independence continuum
o 5 factors influencing AL: Biological, Psychological, Socio-cultural, Environmental,
Politicoeconomic.
• The individuality of living is the way in which the individual attends to ALs in regard to place on life
span and dependence-independence continuum and as influenced by the 5 factors

III. Theories
• Group of related concepts that proposes actions that guide practice. May be broad but limited only to
particular aspects
Middle-range Theories
• The least abstract level because they include specific details in nursing practice like population, condition and
location.

Hildegard Peplau - Psychodynamic Nursing; Mother of Psychiatric Nursing


• Stressed the importance of the nurse’s ability to understand one’s own behavior to help others identify felt
difficulties
• 4 Phases of Nurse-Patient Relationship
o Orientation
o Identification
o Exploitation
o Resolution
• 6 Nursing Roles
1. Stranger 4. Leader
2.Resource Person 5. Surrogate
3. Teacher 6. Counselor
• 4 Psychobiological Experiences that compel destructive or constructive responses
o Needs
o Frustrations
o Conflicts
o Anxieties

Ida Jean Orlando - Nursing Process; Dynamic Nurse-Patient Relationship


• Focused on patient’s verbal and nonverbal expressions of need and the nurse’s reactions to the behavior
• 3 Elements of a Nursing Situation
o Patient behaviors
o Nurse reactions
o Nurse actions
• Used the nursing process to meet patient’s needs through deliberate action; advanced nursing beyond
automatic response to disciplined and professional response

Joyce Travelbee - Human-to-Human Relationship Model


• Nursing was accomplished through human-to-human relationship:
1. Original encounter
2. Emerging identities
3. Developing empathy
4. Developing sympathy
5. Rapport

Katherine Kolcaba - Theory of Comfort


• Defined healthcare needs as those needs for comfort including physical, psycho-spiritual, social, and
environmental needs
• Intervening factors influence client’s perception of comfort: age, attitude, emotional support, experience,
finance, prognosis

• Types of comfort:
1. Relief when specific need is fulfilled
2. Sense of ease, calm, and contentment
3. Transcendence or rising above the problems of pain

Erikson, Tomlin and Swain - Modeling and Role-Modeling


• Synthesis of multiple theories related to basic needs, developmental tasks, object attachment, and adaptive
coping potential
• Views nursing as self-care based on the person’s perception of the world and adaptation to stressors
• Promotes growth and development while recognizing individual differences according to worldview and
inherent endowment

Ramona Mercer - Maternal Role Attainment


• Focused on parenting and maternal role attainment in diverse populations
• Developed a complex theory to explain the factors impacting the maternal role over time

Kathryn Barnard - Parent-Child Interaction; Child Health Assessment Interaction Theory


• Individual characteristics of each member influence the parent-infant system and that adaptive behavior
modifies those characteristics to meet the needs of the system
• The theory is based on scales developed to measure feeding, teaching, and environment

Madeleine Leininger - Transcultural Care Theory; Ethnonursing


• Some of the major concepts are care, caring, culture, cultural values, and cultural variations
• Caring is seen as the central theme in nursing care, knowledge and practice.
• Caring includes assistive, supportive, facilitative acts towards people with actual or anticipated needs
• 3 types of Nursing Actions
o Cultural Care Preservation or Maintenance - retention of relevant care values unique to culture
o Cultural Care Accommodation or Negotiation - adapting culture with professional care providers
o Cultural Care Repatterning or Restructuring - changing life-ways while still respecting culture for a
healthier outcome

Rosemarie Rizzo Parse - Human Becoming


• A unique, humanistic approach instead of a physiological basis for nursing
• Nursing is a human science that is not dependent on medicine or any discipline for its practice
• Major concepts include:
• Imaging • Connecting-separating
• Valuing • Powering
• Languaging • Originating
• Revealing-concealing • Transforming
• Enabling-limiting

Merle Mishel - Uncertainty in Illness


• Researched into experiences with uncertainty as it relates to chronic and life-threatening illness
• Later reconceptualized to accommodate the responses to uncertainty over time in people with chronic
conditions who may not resolve the uncertainty

Margaret Newman - Model of Health


• Major concepts are movement, time, space and consciousness. “Movement is a reflection of consciousness.
Time is a function of movement. Time is a measure of consciousness.”
• The goal of nursing is not to promote wellness or to prevent illness, but to help people use the power within
them as they evolve toward a higher level of consciousness.

Evelyn Adam - Conceptual Model for Nursing


• Used a model from Dorothy Johnson and definition of nursing from Virginia Henderson
• Identified assumptions, beliefs, and values, and major units
• Included goal of the profession, beneficiary of the professional service, role of the professional, source of the
beneficiary’s difficulty, the intervention of the professional, and the consequence

Nola Pender - Health Promotion Model


• The goal of nursing care is the optimal health of the individual
• Developed the idea that promoting optimal health supersedes disease prevention
• Identifies cognitive-perceptual factors of a person, like importance of health-promotion behavior and its
perceived barriers, and these factors are modified by demographics, biology, interpersonal influences, and
situational and behavioral factors.