 Nursing

THEORETICAL FOUNDATIONS - nurse’s attributes, characteristics, and actions

provide care on behalf of or in conjunction with
NURSING AS A SCIENCE the client
 scientific knowledge and skills in assisting individual to
achieve optimal health
CONCEPTS OF MAN
 diagnosis and treatment of human responses to
Man is
actual of potential problem
 A bio-psychosocial and spiritual being who is in constant
 include knowledge form nursing research contact with the environment
 facts and information necessary for performing
 An open system in constant interaction with a changing
technical skills
environment
 interpersonal relationships and communication is part
 A unified whole composed of parts which are
 sociocultural and developmental factors affect
interdependent and interrelated with each other
client’s behavior
 Composed of parts, which are greater than and
different from the sum of all his parts
NURSING AS AN ART  Composed of subsystems and subparasystems
 refers to the dynamic skills and methods in assisting
o Subsystem (within) – biological, psychological,
sick and well individual in their recovery and in the
emotional
promotion and maintenance of health
o Subparasystem (outside) – family, community,
 way nursing knowledge is expressed
population
 heart of nursing
 involves feeling gained by experience
EVOLUTION OF NURSING THEORY
 sensitivity and empathy is important facet of this  Dark Era (1500-1860)
definition
o Florence Nightingale – first nursing theorist
 enable the nurse to be aware of the client’s
 Curriculum Era (1900-1940)
perspective and be attentive to verbal and non-
 Research Era (1950-1970)
verbal cues to the client’s physiologic state
 Graduate Education Era (1950-1970)
 Theory Era (1980-1990)
Theory – helps explain an event by:
 Theory Utilization Era (2000-present)
 defining ideas or concepts
 explaining relationship among the concepts
CLASSIFICATION OF THEORY
 predicting outcomes
By Abstraction
- important because it helps us decide what we know
 Grand
and what we need to know
- broad in scope, complex
- foundation for the art and science of nursing - eg Leininger’s Culture Care Theory, Orem’s Self
Care Theory
Theory --- Research --- Practice (bound together in a
continuous interactive relationship)
 Middle-range
- limited in scope, less abstract
Nursing theory - eg Pender’s Health Promotion Model
- describes, explains, predicts, and/or prescribes nursing
care  Practice
- helps generate further knowledge
- Substantive theories
- indicate in which direction nursing should develop in
- narrow in scope and focus
the future
- eg Nelson’s Breastfeeding Theory

COMPONENTS OF A THEORY ↑ increasing capacity to change the way we think about

 Phenomenon
the world
- an observable event
 Concepts
↓ increasing restrictions in terms of general applicability
- abstract description of phenomena
- building blocks of theories
By Goal Orientation
 Definitions
 Descriptive
- meaning of the concept - describe phenomena, speculate on why
- Theoretical/conceptual; Operational
phenomena occur and describe the
 Assumptions consequences of phenomena
- statements that describe concepts
 Prescriptive
DOMAIN OF NURSING - address nursing interventions for a phenomena
 Paradigm
and predict their consequence of a specific
- conceptual framework nursing intervention
Nursing Metaparadigm
FUNDAMENTAL PATTERNS OF KNOWING
 Person
 Empirical (The Science of Nursing)
- recipient of nursing care
- based on the assumption that what is known is
- individual with physical and emotional
accessible through the physical senses: seeing,
requirements for development of self and
touching, hearing
maintenance of well-being
- most important bc knowing the client will make
 Ethics (Moral Knowledge in Nursing)
nsg care individualized, holistic, ethical, and
- matters of obligation, what ought to be done
humane
- requires consideration of all patterns of knowing
 Health
- degree of wellness or well-being that client  Aesthetic
experiences
- encompasses knowledge of the experience of
- structural and functional soundness and nursing
wholeness of the individual (Orem, 1991)
- ability to skillfully perform nursing activities
 Environment/Situation
- constantly changing as we build on knowledge
- positive/negative
with experience
- client’s surroundings
 - a nurse using moral compass to support choices
in hospice
- a nursing student uses self-reflection while
completing clinical journal
- nurse recalls knowledge of ambulatory care to
mobilize client
 Personal
- knowing what you do and doing what you know
- self-knowing that is conscious to know fully who
you are and understand your actions and
relationships being made on the job through
care
- Experiential knowing: understanding
- Interpersonal knowing: awareness
CLASSIFICATION OF THEORY ACCDG TO AFAF MELEIS
 Needs-based theories
- based on helping indivs to fulfill their physical
and mental needs
 Interaction theories
- emphasized nursing on the establishment and
maintenance of relationships
 Outcome theories
- describe the nurse as controlling and directing
patient care using their knowledge of the human
physiological and behavioral systems
CLASSIFICATION OF THEORY ACCDG TO MARTHA ALLIGOOD
 Nursing Philosophies
- most abstract type and sets forth meaning of
nursing phenomena through analysis, reasoning,
and logical presentation
- Nightingale, Watson, Ray, Benner
 Nursing Conceptual Models
- comprehensive nursing theories that are
regarded by some as pioneers in nursing
- address the nursing metaparadigm and explain
the relationship between them
- Levine, Rogers, Roy, King, Orem
 Grand Theories
- works derived from nursing philosophies,
conceptual models, and other grand theories
that are generally not as specific as middle-
range theories
- Henderson, Abdellah, Johnson, Neuman
 Middle-range Theories
NURSING THEORISTS
Florence Nightingale
- Environmental Theory
- 5 Environmental Factors:
Cleanliness and sanitation
Lighting
Air (fresh)
Water (pure)
Drainage (efficient)
- nursing: “act of utilizing the environment of the patient
to assist him in his recovery”
- Crimean war, unsanitary environment → boiled water,
changed linens, cleaned wounds, improved ventilation
- Patient-care theory: caring for pt is more important
than nsg process, relationship bet pt and nurse, or the
individual nurse
- May 12, 1830 – Aug 13, 1910
Jean Watson
- Philosophy and Theory of Transpersonal Caring
- Human Caring Theory
- caring is an innate characteristic of every use
- “nursing is concerned with promoting health,
preventing illness, caring for the sick, and restoring
health”
- mainly concerns with how nurses care for their patients
and how that caring progresses into better plans to
promote health and wellness, prevent illness and
restore health
- focuses of health promotion, as well as treatment of
diseases
- caring is central to nursing practice and promotes halth
better than a simple medical cure
- 10 carative factors:
o forming human-altruistic value systems
o instilling faith-hope
o cultivating sensitivity to self and others
o developing a helping-trust relationship
o promoting expression of feelings
o using problem-solving for decision making
o promoting teaching-learning
o promoting supportive environment
o assisting with gratification of human needs
o allowing for existential-phenomenological forces
- C’s of Caring
o Compassion
o Competence
o Confidence
o Conscience
o Commitment
Marilyn Anne Ray
- Theory of Bureaucratic Caring
- challenges participants in nursing to think beyond their
usual frame of reference and envision the world
holistically while considering the universe as a hologram
- presents a different view of how health care
organizations and nursing phenomena interrelate as
wholes and parts in the system
- Bureaucratic Caring: spiritual-ethical caring—complex,
dynamic patterns of meaning of caring emerging in
and related to the context or institution
Patricia Benner
- Novice to Expert Theory
- states that caring practices are instilled with knowledge
and skill regarding everyday human needs
o Stage 1: Novice
o Stage 2: Advance beginner
o Stage 3: Competent (2-3 years)
o Stage 4: Proficient (3-5 years)
o Stage 5: Expert
- skill acquisition
Hildegard Peplau
- Psychodynamic Theory of Nursing
- Interpersonal Process
- Phases of Nurse-patient relationship:
o Orientation (client seeks)
o Identification (independence, dependence)
o Exploitation (accept service of nurse)
o Resolution
Lydia Hall
- 3C’s:
o Core (therapeutic use of oneself – Patient
o Care (nursing function) – Nurse
o Cure (medical) - Doctor
Myra Estrine Levine
- Conservation Model
- “Nursing is human interaction”
- when a person is in a state of conservation, that
individual has been able to effectively adapt to the
health challenges with the least amount of effort
- 4 Principles of Conservation:
o Conservation of energy
o Conservation of structural integrity of the body
o Conservation of personal integrity
o Conservation of social integrity
- Trophicognosis (nsg diagnosis)
Martha Rogers Virginia Henderson
- Theory of Human Beings - Nursing Need Theory
- “Nursing as an art and science that is humanistic and - 14 fundamental needs of man
humanitarian” - individuals have basic needs that are components of
- unitary man is an energy field in constant interaction health
with the environment - focuses on the importance of increasing patient’s
- Wholeness independence to hasten their progress in the hospital
Openness - emphasizes the basic human needs and how nurses
Unidirectionality can assist in meeting those needs
Pattern and organization - emphasizes the importance of increasing the patient’s
Sentence and thought independence and focus on the basic human needs
- Science of Unitary Human Being : 2 dimensions so that progress after hospitalization would not be
o science of nursing delayed
 knowledge that comes from scientific - person: mind and body inseparable
research
o art of nursing Faye Glenn Abdellah
 using nursing creatively to help better the - 21 Nursing Problem Theory
lives of patient - changed the focus of nursing from disease-centered to
- Levels of prevention patient-centered and began to include families and
o Primary – health promotion and disease the elderly in nursing care
prevention - can be both applied in hospital or community care
o Secondary – treatment, curative - patient-centered approach
o Tertiary – rehabilitation - has interrelated concepts of health and nursing
problems, as well as problem-solving
Sister Callista Roy - problem solving-approach
- Adaptation Model o advantage of increasing the nurse’s critical and
- “health care profession that focuses on human life analytical thinking skills since the care to be
processes and patterns and emphasizes the promotion provided would be based on sound assessment
of health for individuals, families, groups, and society as and validation of findings
a whole”
- individual as a set of interrelated systems that strives to Dorothy E. Johnson
maintain a balance between various stimuli - Behavioral System Model
- individuals cope through biophysical social adaptation - advocates to foster efficient and effective behavioral
- 4 modes of adaptation: functioning in the patient to prevent illness and stresses
o Role function the importance of research-based knowledge about
o Interdependence the effect of nursing care on patients
o Physiological - person: behavioral system with 7 subsystems
o Self-concept - nursing: “an external regulatory force which acts to
- stimuli: focal, contextual, residual preserve the organization and integration of the
patient’s behaviors at an optimum level under those
Imogene King conditions in which the behavior constitutes a threat to
- Goal Attainment Theory the physical or social health, or in which illness is found
- patient involvement - Behavioral assessment
- Interacting systems framework o Achievement
- nurses purposefully interact with the patient and o Dependency
mutually set the goal, explore, and agree to means to o Attachment-affiliative
achieve the goals o Aggressive-protective
- “Nursing is a process of action, reaction, and o Ingestive
interaction, by which nurse and client share information o Eliminative
about their perception in a nursing situation” o Sexual
- “process of human interactions between nurse and
client whereby each perceives the other and the Rosemarie Rizzo Parse
situation, and through communication, they set goals, - Human Becoming Theory
explore means, and agree on means to achieve goals” - “Nursing is a science, and the performing art of nursing
is practiced in relationships with persons (individuals,
Dorothea Orem groups, and communities) in their processes of
- Self-Care Theory becoming
- “Act of assisting others in the provision and - person: more than the sum of the parts, the
management of self-care to maintain or improve environment, and the person is inseparable and that
human functioning the home level of effectiveness nursing is a human science and art that uses an
- focuses on each individual’s ability to perform self-care abstract body of knowledge to help people
- Composed of three interrelated theories - centered around three themes:
o Theory of self-care o Meaning
o Self-care deficit theory o Rhythmicity
o Theory of nursing systems, wholly compensatory, o Transcendence
partially compensatory, and supportive- - emphasizes how individual chose and bear
educative responsibility for patterns of personal health
- patients are better able to recover when they maintain - abstract body of knowledge to serve peopel
some independence over their own self-care
- universal self-care requirement (nutrition, oxygenation) Antonia M. Nelson
developmental self-care requirement (developmental - Breastfeeding Theory
tasks) - recommends that when educating a new mother
health care deviation self-care requirement about breastfeeding, the nurse should be respectful of
- 3 Nursing systems: the mother’s right to decide, and carefully consider
o wholly compensatory how to promote breastfeeding without causing conflict
o partially compensatory - outcome is a more positive breastfeeding experience
o supportive-educative compensatory for the mother and infant
Joyce Travelbee o Enhancing competence in every skill,
- Human to Human Relationship Theory compassion to every service and empowerment
- rapport, sympathy, empathy, emerging identities, to the nursing profession
original encounter o Leading and at the same time be of service
- “caring involves the dynamic, reciprocal, interpersonal o Leader with values and committed to sustain
connection between the nurse and patient” compassionate nursing care regardless of the
different global challenges we have in today’s
Ida Jean Orland-Pelletier new generations.
- Dynamic Nurse-Patient Relationship Model
- Deliberative Nursing Process Theory Carmelita Divinagracia
- focuses on the interaction between the nurse and - Theory of COMPOSURE Behaviors
patient, perception, validation, and the use of the COM petence
nursing process to produce positive outcomes or P resence and Prayer
patient improvement O pen-mindedness
- Four practices basic to nursing S timulation
o Observation U nderstanding
o Reporting R espect and Relaxation
o Recording E mpathy
o Actions
Sister Letty G. Kuan
Madeleine Leininger - Retirement and Role Discontinuity Theory
- Transcultural Theory of Nursing - she values the effect of retirement as a phase of one’s
o Preservation/Maintenance life and its accompanying adjustments
o Accommodation/Negotiation - identified the determinants of positive perceptions in
o Repatterning/Restructuring retirement and positive reactions toward role
- Sunrise model discontinuities

Betty Neuman Carmencita Abaquin

- Total Person Model - PREPARE ME Interventions
- 3 types of stressors: intrapersonal, extrapersonal, P resence
interpersonal Re minisce therapy
- primary, secondary, and tertiary levels of prevention P rayer
- goal of nursing: to assist individual families and groups Re laxation
in attaining and maintaining a maximal level of total Me ditation
wellness by purposeful interventions
- internal and external forces; interact with person at any Cecilia Laurente
given time - Theory of Nursing Practice and Career
- emphasized effective communication and using the
Ernstein Weidenbach family as an entry point to help a patient
- Clinical nursing: A Helping Art
Mila Delia Llanes
Nola Pender - Conceptual model of Core Competency Development
- Health Promotion Model
Ma. Irma Bustamante
- The effects of the Nursing Self-Esteem Enhancement
FILIPINO NURSING THEORISTS
(NurSe) Program to the Self-esteem of Filipino Abused
Rozzano C. Locsin Women
- Technological competency as caring in nursing
(harmonious coexistence between technologies and Synchronicity in Human-Space-Time: A Theory of Nursing
caring in nursing) Engagement in a Global Community
- focused on “knowing persons”, with key elements of - Freslyn Lim-Saco RN, MN
technological knowing, designing, and participative - Cliford Masayon Kilat RN, MA
engaging - Rozzano Locsin PhD, RN
- How tech affects nursing:
o Monitoring
o Medications
o Health records
o Communication

Carolina S. Agravante
- Transformational Leadership Theory
- CASAGRA Transformative Leadership model
- 5Cs: creative, caring, critical, contemplative, collegial
- focused on the educational and psycho-spiritual
aspect of nursing
- accdg to care complex: caring personality rests on the
possession of a care complex within a person as an
energy source of caring
- continuous formation of nursing leadership behavior in
nursing faculty that will eventually affect their teaching
function
o Servant-leader spirituality
o Self-mastery
o Special expertise
- Application of the theory
o To be always committed to bring out the best
toe very member of the team