NURSING

NURSI THEORISTS
 BETTY NEUMAN NG
THEOR
 HEALTH CARE SYSTEM MODEL
ISTS
 Health Care System each person is a complete system; the goal of nursing is assist in maintaining
client system stability

 Types of stressors  Three types of prevention

o Interpersonal o Preventative
o Intrapersonal o Corrective
o Extrapersonal o Rehabilitative

 Lines of resistance – internal factors that defend stressors

 Nursing helps the person when stressors occur
 Defines environment as “the totality of the internal and external forces which surround a person
and with which they interact at any given time.”
 Neuman’s model used “GENERAL SYSTEMS THEORY” as a framework for its development
 Reconstitution – A termed for the increase in energy that occurs in relation to the degree of
reaction to the stressor
 Nursing is a unique profession, concerned with all the variables affecting an individual’s
response to stressors, which are intra, inter & extra personal in nature.
 IMOGENE KING
 GOAL – ATTAINMENT THEORY
 Goal – attainment theory is a type of interaction theories
 the goal of nursing is to use communication to help the client re-establish positive adaptation to the
environment
 grouped her theory into health concerns in three systems
o social - Family, religious groups, schools, work, peers
o personal - Individual; perception, self, growth, development, time space, body image
o interpersonal - Socialization; interaction, communication and transaction
 Theory of goal attainment: behavior>return behavior>disturbance>set goal> agree on goal>help
attain goal.
 Open systems framework
 Human beings are open systems in constant interaction with the environment
  The nurse and patient mutually communicate, establish goals and take action to attain goals
 Each individual brings a different set of values, ideas, attitudes, perceptions to exchange.
 MADELEINE LEININGER
 TRANSCULTURAL MODEL OF NURSING
 Cultural Diversity & University
 She developed Ethno – nursing research
 Caring is the essence & central unifying, a dominant domain that distinguishes nursing from
other healt disciplines. Care is an essential human need.
 Caring is a universal phenomenon but varies transculturally
o Level 1 – the worldview & Social systems
o Level 2 – the individuals, families, groups & institutions
o Level 3 – folk systems, professional systems & nursing
o Level 4 – decision & actions

 Sister Calista Roy

 ADAPTATION THEORY
 Humans are adaptive systems that cope with change through adaptation
 Nursing helps patients’ adaptation during health & illness
 Basic assumption – the person is a bio – psycho – social person
 Stress is produced by the environment
 Coping behaviours have to be used the goal of nursing to promote adaptation by managing the
environment stimuli
 Roy’s adaptation model defines nursing as the science and practice that expands adaptive abilities
& enhances person & environment transformation.
 Cognator subsystem – subsystem which responds through four cognitive – emotive channels
(perceptual & information processing, learning, judgment and emotion)
 Concept related to Roy’s adaptation model
 Focal Stimuli
 Cognator Subsystem
 Role function
 She believes that adaptation & manipulation of stressors are related to foster change
 Hildegard Peplau
 INTERPERSONAL RELATIONSHIP THEORY
 “Nursing is therapeutic interpersonal process”
 orientation - patient seeks assistance from nurse
 identification - patient responds to nurse who intervenes to assist
 exploration - patient uses services offered
 resolution - therapeutic relation ends
 Based on psychodynamic nursing
 using an understanding of one's own behavior to help others identify their difficulties
 Applies principles of human relations
 Patient has a felt need
 Peplau's Concepts
 Person
– An individual; a developing organism who tries to reduce anxiety caused by needs
– Lives in instable equilibrium
 Environment
– Not defined
 Health
– Implies forward movement of the personality and human processes toward creative,
constructive, productive, personal, and community living
 Nursing
– significant, therapeutic, interpersonal process that functions cooperatively with
others to make health possible
– Involves problem-solving
 JEAN WATSON
 HUMANG CARING
 Caring is a moral ideal & entails the body [mind – soul engagement with one another]
 Carative factors:
 Cultivating sensitivity to self & others
 Forming humanistic – altruistic value system
 Instilling faith – hope
  Caring is healing, it is communicated through the consciousness of the nurse to the individual being
cared for, it allows access to higher human spirit.
 7 assumptions about the science of caring:
 It can be demonstrated and practiced
 It results in satisfying human needs
 It promotes health
 It accepts the person as is
 Gives the person choices to act on his own
 Is healthogenic
 Covers more of the person than curing; it is central to nursing
 PATRICIA BENNER
 EXPERT TO NOVICE
 She described the 5 levels of nursing experience in her theory in nursing
 Novice – has no professional experience
 Beginner – can note recurrent meaningful situational components, but not prioritize
between them
 Competent – begins to understand actions in terms of long – range goals
 Proficient – perceives situations as wholes, rather than in terms of aspects
 Expert – Has initiative grasp of the situation & zeros in the accurate region of the problem
 Caring means that person, events, projects & things matter to people. It reveals stress & copping
options. Caring creates responsibility. It is an inherent feature of nursing practice. It helps the
nurse assist clients to recover in the face of the illness.
 Dorothea Orem
 SELF – CARE DEFICIT THEORY
 theory of Self care
 theory of self – care deficit
 theory of nursing systems
 According to her, Nursing is a helping or assistive profession to persons who are wholly or
partly dependent of when those who are supposedly caring for them are no longer able to
give care.
 SELF-CARE MODEL
 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
 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
 Wholly compensatory nursing system-Patient dependent
 Partially compensatory- Patient can meet some needs but needs nursing assistance
 Supportive educative-Patient can meet self care requisites, but needs assistance with decision
making or knowledge
 Faye Glenn Abdellah
 21 NURSING PROBLEMS THEORY
 PATIENT CARE APPROACH
 Typology of twenty – one nursing problems
 21 nursing problems – promotes problem solving
 Approach to practice
 Physiological needs
 Safety needs
 Belonging & love needs
 Esteem needs
 Nursing – A helping profession; A comprehensive service to meet patient's needs; Increases or restores
self-help ability; Uses 21 problems to guide nursing care
 Health – Excludes illness; No unmet needs and no actual or anticipated impairments
 Person – One who has physical, emotional, or social needs; The recipient of nursing care.
 Environment – Did not discuss much; Includes room, home, and community
 FLORENCE NIGHTINGALE
 ENVIRONMENTAL THEORY
 The role of nursing is to facilitate “The body’s reparative processes” by manipulating client’s
environment
 She theorized the act of utilizing the environment of the patient to assist him in his recovery
 Florence trained in nursing at Germany
 Built St. Thomas School of Nursing when she was 40 years old
 Notes in nursing
 Notes in hospital
  Florence was born in Italy
 First woman to be granted the Order of Merit and the Royal Red Cross (RRC) by Queen Victoria
of Great Britain
 Person is influenced by the environment = overall theme
 Nursing = a calling to help patients in a repetitive process directly working with the patient or by
affecting the environment to improve health or recovery from illness
 First nursing theorist
 Unsanitary conditions posed health hazard (Notes on Nursing, 1859)
 5 components of environment: ventilation, light, warmth, effluvia, noise
 External influences can prevent, suppress or contribute to disease or death.
 Nightingale's Concepts
 Person
– Patient who is acted on by nurse
– Affected by environment
– Has reparative powers
 Environment – Foundation of theory. Included everything, physical, psychological, and social
 Health
– Maintaining well-being by using a person's powers
– Maintained by control of environment
 Nursing
– Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person's reparative
process
 Jean Piaget
 COGNITIVE THEORY
 Cognitive development deals on ways in which a person learn to think, reason out and use language.
 The cognitive theory by Piaget pointed out three primary abilities which are present in each phase
 Assimilation – deals with the process where an individual encounter & reacts towards new situation &
using the mechanisms that they already have
 MARTHA ROGER
 UNITARY HUMAN BEINGS
 Unitary human being are irreducible, four – dimensional, negentropic energy fields
 Energy fields have no boundaries, are open, have patterns & the patterns change
  The purpose of nursing is to help all people achieve maximum well being
 “Continuous & mutual interaction between man & environment” is termed as integrality
 Explained the “Humanistic science of nursing”
 Energy fields
 Fundamental unity of things that are unique, dynamic, open, and infinite
 Unitary man and environmental field
 Universe of open systems
 Energy fields are open, infinite, and interactive
 Pattern
 Characteristic of energy field
 A wave that changes, becomes complex and diverse
 Pandimensionality A nonlinear domain with out time or space
 Roger's Definitions
 Integrality – Continuous and mutual interaction between man and environment
 Resonancy – Continuous change longer to shorter wave patterns in human and environmental fields
 Helicy – Continuous, probabilistic, increasing diversity of the human and envrionmental fields.
Characterized by nonrepeating rhymicities.
 DOROTHY JOHNSON
 BEHAVIOURAL SYSTEMS MODEL
 Achievement, Affiliation, Dependency
 Behavioral systems
 Behavioral subsystems

 Attachment – Social bonds  Sexual – procreation or gratification

 Dependency – Helping or Nurturing  Aggressive – self-protection &
 Ingestive – food intake preservation
 Eliminative - excretion  Achievement – efforts to gain mastery &
control

 The nurse assesses the client's needs in these subsystems. When the client is stressed the subsystems
are disrupted. The nurse provides care to resolve problems in the subsystems to meet the patient's
needs.
 The person is a behavioral system comprised of a set of organized, interactive, interdependent, and
integrated subsystems
  Constancy is maintained through biological, psychological, and sociological factors.
 A steady state is maintained through adjusting and adapting to internal and external forces.
 Johnson's Concepts
 Person – A behavioral system comprised of subsystems constantly trying to maintain a
steady state
 Environment – Not specifically defined but does say there is an internal and external
environment
 Health – balance and stability
 Nursing – External regulatory force that is indicated only when there is instability.
 Joyce Travelbee
 HUMAN TO HUMAN MODEL
 Postulated the Interpersonal Aspect of Nursing
 Person is described as a human being; both the nurse & the patient are human beings.
 Nursing is an interpersonal process whereby the professional nurse practitioner assists an
individual, family, or community to prevent or cope with experience or illness & suffering, & if
necessary, to find meaning in these experiences.
 Virginia Henderson
 14 BASIC NEEDS
 basic nursing care involves 14 activities: physiological, spiritual and sociological. Pay attention and
listen to person
 Nature of Nursing Model
 For her, Nursing is a theoretical system of knowledge that prescribes a process of analysis & action
related to care of the ill person
 The unique function of the nurse is to assist the individual, sick or well, in the performance of
those activities contributing to health that he would perform unaided if he has the necessary
strength, will & knowledge, & do this in such a way as to help him gain independence as rapidly
as possible.
 The Nature of Nursing
 Topology Nursing Problems
 A list of 21 nursing problems
 Condition presented or faced by the patient or family.
 Problems are in 3 categories
 Physical, social and emotional
  The nurse must be a good problem solver
 Ernestine Weidenbach
 THE HELPING ART OF CLINICAL NURSING
 Developed the Clinical nursing – a helping Art Model
 Nursing theory prescriptive
 Central purpose – the philosophy, culture, individually of the patient & nurse
 Prescription – the interactive plan of care for the patient
 Realities – the patient, nurse, environment, goals etc.
 Nursing observes, ministers & validates
 Ida Jean Orlando
 DYNAMIC NURSE – PATIENT RELATIONSHIP
 A model revolving around 5 interrelated concepts
 The function of profession nursing
 The presenting behaviour of the patient
 The immediate reaction of the nurse
 The nursing process
 Improvement for the patient
 DELIBERATIVE NURSING PROCESS
– The deliberative nursing process is set in motion by the patient's behavior
– All behavior may represent a cry for help. Patient's behavior can be verbal or non-verbal.
– The nurse reacts to patient's behavior and forms basis for determining nurse's acts.
– Perception, thought, feeling
– Nurses' actions should be deliberative, rather than automatic
– Deliberative actions explore the meaning and relevance of an action.
 Myra Levine
 THEORY OF CONSERVATION = HOLISTIC
 Her idea was that we need to help the person conserve energy; structural integrity; personal
integrity & social integrity
 Believed nursing is a disciple the basis of which is the person’s dependence & relation to others.
 Health – the ability to maintain integrity
 LYDIA HALL
 NURSING IS THE CARE, CORE & CURE (3C)
  Depicted by circles
 Care Circle – explains the role of nurse
 Core Circle – the person or patient to whom nursing care is directed and needed. The core has
goals set by himself and not by any other person. The core behaved according to his feelings, and
value system.
 Cure Circle – is the attention given to patients by the medical professionals.
 Josephine Patterson and Loretta Zderad
 HUMANISTIC THEORY
 Nursing focus shifts from technical towards the humanness of both the nurse & the patient
 Nursing is a lived human act, a response to a human situation
 4 major concepts
 Person
 Environment
 Health
 Nursing
 ABRAHAM MASLOW
 HIERARCHY OF HUMAN NEEDS
 Nurse’s highest priority to which client need is Elimination
 Maslow’s hierarchy of needs clearly depicts the human needs as it is ranked based on how essential it
is for our survival.
 Self – actualized person:
 Understands poetry, music, philosophy, science etc.
 Desires privacy, autonomous
 Problem centered
 Makes decision contrary to public opinion
 Characteristics:
 It is realistic, sees life clearly, & is subjective about his or her observations
 Has superior perception, is more decisive
 It is highly effective, flexible, spontaneous, courageous, willing to make mistakes
 SWANSON
 Caring involves 5 processes, Knowing, being with, doing for, enabling & maintaining belief
 DUNN
 Developed the concept of HIGH – LEVEL WELLNESS
 ERICKSON TOMLIN, SWAIN
 developed ROLE MODELING & MODELING THEORY
 Moses
 Father of sanitation
 Boykin & Schoenhofer
 They proposed the GRAND THEORY OF NURSING AS CARING
 Laissez – Faire
 LEADERSHIP STYLE
 A leader is someone who can influence others to accomplish a specific goal. This leadership
style has a minimal leader activity level.
1. "Each human being perceives the world as
a total person in making transactions with
individuals and things in environment".
This assumption is stated by: Imogene
King's conceptual framework
2. Notes on Nursing: What it is, What it is not
was written by: Florence Nightingale
3. Ernestine Wiedenbach's conceptual model
of nursing is called: The Helping Art of
Clinical Nursing
4. A system of nursing care in which patients
are placed in units on the basis of their
needs for care as determined by the degree
of illness rather than on the basis of a
medical specialty is: Progressive patient
care
5. Which of the following terms refers to the
branch of philosophy that deals with
questions concerning the nature, scope, and
sources of knowledge? Epistemology
6. A theory of knowledge emphasizing the
role of experience, especially experience
based on perceptual observations by the
senses is: Empiricism
7. Metaphysics is a branch of philosophy
which deals with: The study of the nature
of reality
8. According to Peplau's interpersonal model,
during which phase of nursing process, the
patient participates in goal setting and has a
feeling of belonging and selectively
responds to those who can meet his or her
needs? Identification
9. Deliberative Nursing Process Theory was
explained by: Ida Jean Orlando
10. Following is the concept related to
Nightingale theory? "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”. “The goal
 of nursing is "to put the patient in the best nursing is to facilitate "the body's reparative
condition for nature to act upon him". processes" by manipulating client's
11. Self-care deficit theory was proposed by: environment.
Dorothea Orem 15. Following is a concept related to Roy's
12. Which theory defines nursing as the science Adaptation Mondel? Focal Stimuli,
and practice that expands adaptive abilities Cognator Subsystem, Role function
and enhances person and environment 16. Imogene King's "goal attainment theory" is
transformation? Roy's adaptation model a type of: Interaction theories
13. "Nursing is therapeutic interpersonal 17. Which of the following theory has used
process". This definition was stated by: A. "General Systems Theory" as a framework
Hildegard Peplau for its development? Neuman's model
14. Which of the following statements is 18. Transcultural Model of Nursing was
related to Florence Nightingale? The role of proposed by: Madeleine Leininger

19. Following are concepts explained in 33. Madeleine Leininger – Transcultural

Dorothy Johnson's Behavioral Systems nursing
Model? Affiliation, Dependency, 34. Patricia Benner – From Novice to Expert
Achievement 35. Lydia E. Hall – The Core, Care and Cure
20. Watson's carative factors include all the 36. Joyce Travelbee – Human-To-Human
following: Forming humanistic-altruistic Relationship Model
value system, Instilling faith-hope, 37. Margaret Newman – Health As Expanding
Cultivating sensitivity to self and others Consciousness
21. Florence Nightingale – Environment theory 38. Katharine Kolcaba – Comfort Theory
22. Hildegard Peplau – Interpersonal theory 39. Rosemarie Rizzo Parse – Human Becoming
23. Virginia Henderson – Need Theory Theory
24. Fay Abdella – Twenty One Nursing 40. Ernestine Wiedenbach – The Helping Art
Problems of Clinical Nursing
25. Ida Jean Orlando – Nursing Process theory
26. Dorothy Johnson – System model
27. Martha Rogers – Unitary Human beings
28. Dorothea Orem – Self-care theory
29. Imogene King – Goal Attainment theory
30. Betty Neuman – System Model
31. Sister Calista Roy – Adaptation theory
32. Jean Watson – Philosophy & Caring Model