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Nursing Theories

A companion to nursing theories and models

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Nursing Theorists

This page was last updated on 16-03-09

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Definitions

Theory- a set of related statements that describes or explains phenomena in a systematic way

Concept-a mental idea of a phenomenon

Construct- a phenomena that cannot be observed and must be inferred

Proposition- a statement of relationship between concepts

Conceptual model- made up of concepts and propositions

Nursing Theorists

Florence Nightingale,
Hildegard Peplau

Virginia Henderson

Fay Abdella

Ida Jean Orlando

Dorothy Johnson

Martha Rogers

Dorothea Orem

Imogene King

Betty Neuman

Sister Calista Roy,

Jean Watson

Rosemary Rizzo Parse

Madeleine Leininger

Patricia Benner

Concepts in the nursing

Metaparadigm

Person

Recipient of care, including physical, spiritual, psychological, and sociocultural components.

Individual, family, or community

Environment

All internal and external conditions, circumstances, and influences affecting the person

Health

Degree of wellness or illness experienced by the person

Nursing

Actions, characteristics and attributes of person giving care

Florence Nightingale- Environmental Theory

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

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

Hildegard Peplau -Interpersonal Relations Model

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
- A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible
- Involves problem-solving

Virginia Henderson -The Nature of Nursing

"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. She must in a sense, get inside the skin of each of her patients in order to know what he needs".

Fay Abdella- Topology of 21 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

Abdella’s Concepts

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

Ida Jean Orlando- 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.

Dorothy Johnson-Behavioral Systems Model

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 7 Subsystems

Affiliative subsystem

Dependency

helping or nuturing

Ingestive

food intake

Eliminative

excretion

Sexual

procreation and gratification

Aggressive

self-protection and preservation

Achievement

efforts to gain mastery and control

Johnson’s Concepts

Person

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.

Martha Rogers -Unitary Human Beings

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

Resonancy

Helicy

Continuous, probabilistic, increasing diversity of the human and envrionmental fields.
Characterized by nonrepeating rhymicities
Change

Dorothea Orem- 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

Imogene King-Goal Attainment Theory

Open systems framework

Human beings are open systems in constant interaction with the environment

Personal System

individual; perception, self, growth, development, time space, body image

Interpersonal

Society

Personal System

Individual; perception, self, growth, development, time space, body image

Interpersonal

Society

Family, religious groups, schools, work, peers

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

Betty Neuman - Health Care Systems Model

The person is a complete system, with interrelated parts
maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli
Focuses on stress and stress reduction
Primarily concerned with effects of stress on health
Stressors are any forces that alter the system’s stability
Flexible lines of resistance

Surround basic core

Internal factors that help defend against stressors

Normal line of resistance

Normal adaptation state

Flexible line of defense

Protective barrier, changing, affected by variables

Wellness is equilibrium

Nursing interventions are activates to:

strengthen flexible lines of defense

strengthen resistance to stressors

maintain adaptation

Sister Calista Roy - Adaptation Model

Five Interrelated Essential Elements

Patiency- The person receiving care

Goal of nursing- Adapting to change

Health-Being and becoming a whole person

Environment

Direction of nursing activities- Facilitating adaptation

The person is an open adaptive system with input (stimuli), who adapts by processes or control mechanisms (throughput)
The output can be either adaptive responses or ineffective responses

Jean Watson - 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

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

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

Rosemary Parse - Human Becoming Theory

Human Becoming Theory includes Totality Paradigm

Simultaneity Paradigm

Man is a unitary being in continuous, mutual interaction with environment

Originally Man-Living-Health Theory

Parse’s Three Principles

Meaning

Rhythmicity

Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns

Cotranscendence

Refers to reaching out and beyond the limits that a person sets
One constantly transforms

Person

Open being who is more than and different from the sum of the parts

Environment

Everything in the person and his experiences
Inseparable, complimentary to and evolving with

Health

Open process of being and becoming. Involves synthesis of values

Nursing

A human science and art that uses an abstract body of knowledge to serve people

Madeleine Leininger - Culture Care Diversity and Universality

Based on transcultural nursing, whose goal is to provide care congruent with cultural values, beliefs, and practices

Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care

Modes of nursing action

Cultural care preservation

Cultural care accommodation

help adapt to or negotiate for a beneficial health status, or face death

Cultural care re-patterning

help restructure or change lifestyles that are culturally meaningful

Patricia Benner - From Novice to Expert

Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level

Levels reflect:
- change in perception of situation as a complete whole in which certain parts are relevant

Importance of Theoretical Frameworks

Foundation of any profession is the development of a specialized body of knowledge. Theories should be developed in nursing, not borrow theories form other disciplines
Responsibility of nurses to know and understand theorists
Critically analyze theoretical frameworks

Reference

Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.

Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002.

George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3^rd ed. Norwalk, Appleton and Lange.

Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williamsand wilkins.

Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3^rd ed. Philadelphia, Lippincott.

Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4^th ed. Philadelphia, Lippincott.

Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. London Mosby Year Book.

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