Nursing Theorist Nursing As defined by the INTERNATIONAL COUNCIL OF NURSES as written by 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, it’s recovery, or to a peaceful death the client would perform unaided if he had the necessary strength, will or knowledge. + Help the client gain independence as rapidly as possible. Nursing Theory Over the years, nursing has incorporated theories from non-nursing sources, including theories of systems, human needs, change, problem solving, and decision making. Barnum defines theory as “a construct that accounts for or organizes some phenomenon. A nursing theory, then, describes or explains nursing.” With the formulation of dit jerent theories, concepts, and ideas in nursing it: + Itguides nurses in their practice knowing whatis nursing and what is not nursing. + Ithelps in the formulations of standards, policies and laws. + twill help the people tounderstand the competencies and professional accountability of nurses. + [twill help define the role of the nurse in the multidisciplinary health care team. Four Major Concepts Nurses have developed various theories that provide different explanations of the nursing discipline. All theories, however, share four central concepts: Person refers to all human beings. People are the recipients of nursing care; they include individuals, families, communities, and groups. Environment includes factors that affect individuals internally and externally. It means not only in the everyday surroundings but all setting where nursing care is provided. Health generally addresses the person's state of well-being. The concept of Nursing is central to all nursing theories. Definitions of nursing describe what nursing is, what nurses do, and how nurses interact with clients. Most nursing theories address each of the four central concepts implicitly or explicitly, Scanned with CamScannerBetty Neuman (1972, 1982, 1989, 1992) Health Care System Model The Neuman System Model or itealth Care System Model + Stress reduction is a goal of system model of nursing practice. Nursing actions are in primary, secondary or tertiary level of prevention. + Toaddress the effects of stress and reactions to it on the development and maintenance of health. The concern of nursing is to prevent stress invasion, to protect the client's basic structure and to obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client stability. Metaparadigm Person + Aclient system that is composed of physiologic, psychological, sociocultural, and environmental variables. Environment + Internal and external forces surrounding humans at any time. Health + Health or wellness exists if all parts and subparts are in harmony with the whole person. Nursing Scanned with CamScanner‘+ Nursing is a unique profession in that it is concerned with all the variables affecting an individual's response to stressors. Dorothea Orem (1970, 1985) Self-Care Deficit Theory Self-Care Deficit Theory Defined Nursing: “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.” + Focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-being. + Hasa strong health promotion and maintenance focus. Identified 3 related concepts: 1, Self-care — activities an Individual performs independently throughout life to promote and maintain personal well-being. 2. Health — results when self-care agency (individual's ability) is not adequate to meet the known self-care needs. 3, Nursing System — nursing interventions needed when Individual is unable to perform the necessary self-care activities + Wholly compensatory — nurse provides entire self-care for the client. + Example: care of a new born, care of client recovering from surgery ina post-anesthesia care unit * Partial compensatory — nurse and client perform care; client can perform selected self-care activities, but also accepts care done by the nurse for needs the client cannot meet independently. + Example: Nurse can assist post operative client to ambulate, Nurse can bringa meal tray for client who can feed himself Scanned with CamScanner+ Supportive-educative~ nurse’s actions are to help the client develop/learn their own self-care abilities through knowledge, support and encouragement. + Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies. Scanned with CamScannerDorothy E. Johnson (1980) Behavioral System Model Behavioral System Model + Focuses on how the client adapts to illness; the goal of nursing is to reduce stress so that the client can move more easily through recovery. + Viewed the patient's behavior as a system, which Is a whole with interacting parts. + The nursing process is viewed as a major tool. * Toreduce stress so the client can recover as quickly as possible. According to Johnson, each person asa behavioral system is composed of seven subsystems namely: 1, Ingestive. Taking in nourishment in socially and culturally acceptable ways. 2. Eliminated. Riddling the body of waste in socially and culturally acceptable ways. 3, Affiliative. Security seeking behavior. Aggressive. Self — protective behavior. Dependence. Nurturance — seeking behavior. Achievement. Master of oneself and one’s environment according to internalized standards of excellence. 7. Sexual role identity behavior + Inaddition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting ae Scanned with CamScannerand adapting to environmental forces through learned pattern of response. Furthermore, She believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in waysthat support biologic imperatives; who is able to benefit to the fullest extent during illness from the health care professional's knowledge and skills; and whose behavior does not give evidence of unnecessary trauma asa consequence of illness, Metaparadigm Person ‘+ Asystem of interdependent parts with patterned, repetitive, and purposeful ways of behaving. Environment + All forces that affect the person and that influence the behavioral system. Health + Focus on person, not illness. Health is a dynamic state influenced by biologic, psychological, and social factors Nursing + Promotion of behavioral system, balance and stability. An art anda science providing external assistance before and during balance disturbances Ernestine Wiedenbach (1964) The Helping Art of Clinical Nursing Scanned with CamScannerThe Helping Art of Clinical Nursing + Developed the Clinical Nursing — A Helping Art Model. + She advocated that the nurse’s individual philosophy or central purpose lends credence to nursing care, + She believed that nurses meet the individual's need for help through the identification of the needs, administration of help, and validation that actions were helpful. Components of clinical practice: Philosophy, purpose, practice and an art. Metaparadigm Person + Any individual who is receiving help from a member of the health profession or from a worker in the field of health. En onment + Not specifically addressed Health + Concepts of nursing, client, and need for help and their relationships imply health-related concerns in the nurse—client relationship. Nursing + The nurse is a functional human being who acts, thinks, and feels. All actions, thoughts, and feelings underlie what the nurse does. Faye Glenn Abdellah (1960) Twenty One Nursing Problems Scanned with CamScannerTwenty One Nursing Problems + Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement. + Introduced Patient - Centered Approaches to Nursing Model She defined nursing as service to individual and families; therefore the society. Furthermore, she conceptualized nursing as an art and a science that molds the attitudes, intellectual competencies and technical skills of the individual nurse into the desire and ability to help people, sick or well, and cope with their health needs. 21 Nursing Problems 1. To maintain good hygiene. 2. To promote optimal activity; exercise, rest and sleep. 3. To promote safety. 4, To maintain good body mechanics 5, To facilitate the maintenance of a supply of oxygen 6. To facilitate maintenance of nutrition 7. To facilitate maintenance of elimination 8, To facilitate the maintenance of fluid and electrolyte balance 9, To recognize the physiologic response of the body to disease conditions 10, To facilitate the maintenance of regulatory mechanisms and functions 11.To facilitate the maintenance of sensory functions 12. To identify and accept positive and negative expressions, feelings and reactions 13, To identify and accept the interrelatedness of emotions and illness. 14. To facilitate the maintenance of effective verbal and non-verbal communication 15. To promote the development of productive interpersonal relationship 16. To facilitate progress toward achievement of personal spiritual goals 17. To create and maintain @ therapeutic environment 18. To facilitate awareness of self as an individual with varying needs. 19, To accept the optimum possible goals 20. To use community resources as an aid in resolving problems arising from illness, 21, To understand the role of social problems as influencing factors Metaparadigm Person + The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert. Scanned with CamScannerEnvironment + Not clearly defined. Some discussion indicates that clients interact with their environment, of which nurse is a part. Health + Astate when the individual has no unmet needs and no anticipated or actual impairment Nursing + Broadly grouped in "21 nursing problems,” which center around needs for hygiene, comfort, activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health promotion, interpersonal relationships, and development of self-awareness. Nursing care is doing something for an individual Florence Nightingale (1860) Environmental Theory Environmental Theory + Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.” + Focuses on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. + Identified 5 environmental factors: fresh air, pure water, efficient drainage, cleantiness/sanitation and light/direct sunlight. + Considered a clean, well-ventilated, quiet environment essential for recovery. + Deficiencies in these 5 factors produce illness or lack of health, but with a nurturing environment, the body could repair itself. Scanned with CamScanner+ Developed the described the first theory of nursing. Notes on Nursing: What Its What It Is Not. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. Metaparadigm Person + Anindividual with vital reparative processes to deal with disease. Environment + External conditions that affect life and individuals development. Health + Focus is on the reparative process of getting well, Nursing + Goal is to place the individual in the best condition for good healthcare Evelyn Tomlin, Helen Erickson, and Mary Ann Swain (1983 Modeling and Role Modeling Theory Modeling and Role Modeling Theory + Developed Modeling and Role Modeling Theory. The focus of this theory is on the person. The nurse models (assesses), role models (plans), and intervenes inthis interpersonal and interactive theory. + They asserted that each individual unique, has some self-care knowledge, needs simultaneously to be attached to the separate from others, and has Scanned with CamScanneradaptive potential. Nurses in this theory, facilitate, nurture and accept the person unconditionally. Metaparadigm Person + Adifferentiation is made between patients and clients in this theory. A patient isgiven treatment and instruction; a client participates in his or her own care. “Our goal is for nurses to work withclients.” “A client is one who is considered to be a legitimate member of the decision-making team, who always has some contral over the planned regimen, and who is incorporated into the planning and implementation of his or her own care as much as possible.” Environment + “Environment is not identified in the theory as an entity of its own. The theorist see environment in the social subsystems as the interaction between self and others both cultural and individual, Biophysical stressors are seen as part of the environment.” Health + "Health is a state of physical, mental and social well-being, not merely the absence of disease or infirmity. It connotates a state of dynamic equilibrium among the various subsystems [of a holistic person!”. Nursing + "The nurse is a facilitator, not an effector. Our nurse-client relationship is an interactive, interpersonal process that aids the individual to identify, mobilize, and develop his or her own strengths.” Scanned with CamScannerFaye Glenn Abdellah (1960) Twenty One Nursing Problems Scanned with CamScannerTwenty One Nursing Problems + Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement. ‘+ Introduced Patient - Centered Approaches to Nursing Model She defined nursing as service to individual and families; therefore the society. Furthermore, she conceptualized nursing as an art and a science that molds the attitudes, intellectual competencies and technical skills of the individual nurse into the desire and ability to help people, sick or well, and cope with their health needs. 21 Nursing Problems 1. Tomaintain good hygiene. 2. To promote optimal activity; exercise, rest and sleep. 3. To promote safety. 4, To maintain good body mechanics 5. To facilitate the maintenance of a supply of oxygen 6. To facilitate maintenance of nutrition 7. To facilitate maintenance of elimination 8, To facilitate the maintenance of fluid and electrolyte balance 9. To recognize the physiologic response of the body to disease conditions 10. To facilitate the maintenance of regulatory mechanisms and functions 11.To facilitate the maintenance of sensory functions 12. To identify and accept positive and negative expressions, feelings and reactions 13, To identify and accept the interrelatedness of emotions and illness. 14. To facilitate the maintenance of effective verbal and non-verbal communication 15. To promote the development of productive interpersonal relationship 16. To facilitate progress toward achievement of personal spiritual goals 17. To create and maintain 2 therapeutic environment 18. To facilitate awareness of self as an individual with varying needs. 19. To accept the optimum possible goals 20. To use community resources as an ai illness. 21, To understand the role of social problems as influencing factors in resolving problems arising from Metaparadigm Person ‘+ The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert. Scanned with CamScannerlydia Hall (1964) Core, Care and Cure Model Core, Care and Cure Model + The client is composed of the ff. overlapping parts: person (core), pathologic state and treatment (cure) and body (care), + Introduced the model of Nursing: What Is It? Focusing on the notion that centers around three components of Care, Core and Cure. + Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection, Cure focuses on nursing related to the physician’s orders. Core and cure are shared with the other health care providers. + The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core. Metaparadigm Person + Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing. Environment ‘+ Should facilitate achievement of the client's personal goals. Health + Development of a mature self-identity that assists in the conscious selection of actions that facilitate growth, Nursing Scanned with CamScannerScanned with CamScanner