2.NursingTheoriesAuthorfrom1to20theories.pptx

government college of nursing Rajnandgaon Chhattisgarh msc nursing final year

1. NURSING THEORIES Gebre Yitayih ( Asst.Prof ) Bahirdar University,2019 1

2. Synthesis of nursing theories 2

3. OBJECTIVE Overall objective is to understand about the Synthesis of Nursing theories in hospital settings, nursing educational institutions, community centers as well as in research areas of nursing 3

4. LEARNING OUTCOME Define nursing theories Explain the History nursing theories Describe the Metaparadigms of nursing theories Mention the Components of a theory Explain the Importance of nursing theories Discuss the Characteristics of theories Elaborate the Processes in the development of nursing theories List down the Classification of nursing theories Quality Criticisms of nursing theories Detail the Synthesis of nursing theories 4

5. LIST OF TOPICS Definition History Metaparadigms in nursing Components of a theory Concept Construct Proposition Conceptual model Middle range theory Variables Importance of nursing theories Characteristics of theories 5

6. LIST OF TOPICS Processes in the development of nursing theories A. General system theory B. Adaptation theory C. Developmental theory Classification of nursing theories Criticisms of nursing theories Synthesis of nursing theories Florence nightingale Faye abdellah Virginia henderson Dorothy e. Johnson Imogene king Madeleine leininger 6

7. Myra levine Betty neuman health care system model Dorothea orem the self-care theory Hildegard peplau Martha rogers Sister callista roy Ida jean orlando Ernestine weiden bach Jean watson Rosemarie rizzo parse Josephine paterson and loretta zderad Margaret newman 7

8. SYNTHESIS OF NURSING THEORIES INTRODUCTION Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr , 2008). Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Almost 90% of all Nursing theories are generated in the last 20 years.  Nursing models are conceptual models, constructed of theories and concepts A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline 8

9. DEFINITION Nursing theory  is defined as ‘a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena. It may consist of one or more relatively specific and concrete concepts and propositions that purport to account for, or organize some phenomenon (Barnum, 1988) 9

10. HISTORY Nightingale (1860):  To facilitate "the body’s reparative processes" by manipulating client’s environment Paplau 1952:  Nursing is; therapeutic interpersonal process. Henderson 1955:  The needs often called Henderson’s 14 basic needs Abdellah 1960 : This theory focus on delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family. Orlando 1962:  To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being. Johnson’s Theory 1968:  Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. 10

11. HISTORY CONT.. Rogers 1970:  to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through "humanistic science of nursing" Orem1971 : This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. King 1971:  To use communication to help client reestablish positive adaptation to environment. Neuman 1972:  Stress reduction is goal of system model of nursing practice. Roy 1979:  This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes 11

12. METAPARADIGMS IN NURSING Person Recipient of care, including physical, spiritual, psychological, and socio cultural 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. 12

13. COMPONENTS OF A THEORY Concept A mental idea of a phenomenon Concepts are the building blocks (the primary elements) of a theory. Construct A phenomena that cannot be observed and must be inferred. Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs. Proposition A statement of relationship between concepts 13

14. COMPONENTS OF A THEORY CONT…. Conceptual model Made up of concepts and propositions. They present ways of thinking about a problem or ways of representing how complex things work the way that they do. Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage , 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory. 14

15. COMPONENTS OF A THEORY CONT…. Middle range theory A testable theory that contains a limited number of variables, and is limited in scope as well, yet is of sufficient generality to be useful with a variety of clinical research questions. Variables Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation. Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program. 15

16. IMPORTANCE OF NURSING THEORIES Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978). It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964). Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). It helps to distinguish what should form the basis of practice by explicitly describing nursing. This can be seen as an attempt by the nursing profession to maintain its professional boundaries. 16

17. CHARACTERISTICS OF THEORIES Interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. Theories are logical in nature. Theories are generalizable. It is bases for hypotheses that can be tested. increase the general body of knowledge within the discipline through the research implemented to validate them. used by the practitioners to guide and improve their practice. consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated 17

18. PROCESSES IN THE DEVELOPMENT OF NURSING THEORIES Nursing theories are often based on and influenced by broadly applicable processes and theories.  A. General System Theory B. Adaptation Theory C. Developmental Theory 18

19. A. General System Theory : It describes how to break whole things into parts and then to learn how the parts work together in " systems". These concepts may be applied to different kinds of systems, e.g.. Molecules in chemistry , cultures in sociology, organs in Anatomy and health in Nursing. 19

20. B. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Adaptation is a continuously occurring process that effects change and involves interaction and response. Human adaptation occurs on three levels: --- the internal ( self ) --- the social (others) --- and the physical ( biochemical reactions ) 20

21. C. Developmental Theory It outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. The progress and behaviors of an individual within each stage are unique. The growth and development of an individual are influenced by heredity , temperament, emotional, and physical environment, life experiences and health status. 21

22. CLASSIFICATION OF NURSING THEORIES Depending on the generalizability of their principles Meta theory : the theory of theory. Identifies specific phenomena through abstract concepts. Grand theory:  provides a conceptual framework under which the key concepts and principles of the discipline can be identified. Middle range theory:  is more precise and only analyses a particular situation with a limited number of variables. Practice theory:  explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved. 22

23. Theories can also be categorized as: "Needs "theories. "Interaction" theories. "Outcome "theories. "Humanistic theories" 23

24. Needs" theories These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. "Interaction" theories These theories revolve around the relationships nurses form with patients. Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. 24

25. "Outcome" theories These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980). Outcome theories have been criticized as too abstract and difficult to implement in practice ( Aggleton and Chalmers 1988). 25

26. Humanistic" Theories: Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life. Humanistic theories emphasize a person’s capacity for self actualization . Humanists believes that the person contains within himself the potential for healthy and creative growth. Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual. The major contribution that Rogers added to nursing practice is the understanding that each client is a unique individual, so person-centered approach now practice in Nursing. 26

27. Criticisms of nursing theories To understand why nursing theory is generally neglected on the wards. A nursing theory should have the characteristics of accessibility and clarity. It is important that the language used in the development of nursing theory be used consistently. Many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. Majority of nurses fail to understand and apply theory to practice (Miller 1985). 27

28. SYNTHESIS OF NURSING THEORIES 1.Florence Nightingale Developed and described the first theory of nursing. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act. She believed that in the nurturing environment, the body could repair itself. 28

29. 2.Faye Abdellah Identified 21 nursing problems. She defined nursing as service to individuals and families; therefore to society. Furthermore, she conceptualized nursing as an art and 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, cope with their health needs . 21 NURSING PROBLEMS To promote good hygiene and physical comfort 2. To promote optimal activity, exercise, rest, and sleep 3. To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection 29

30. Faye Abdellah 4. To maintain good body mechanics and prevent and correct deformities 5. To facilitate the maintenance of a supply of oxygen to all body cells 6. To facilitate the maintenance of nutrition of all body cells 7. To facilitate the maintenance of elimination 8. To facilitate the maintenance of fluid and electrolyte balance 9. To recognize the physiologic responses of the body to disease conditions 10. To facilitate the maintenance of regulatory mechanisms and functions 11. To facilitate the maintenance of sensory function 12. To identify and accept positive and negative expressions, feelings, and reactions 13. To identify and accept the interrelatedness of emotions and organic illness 30

31. Faye Abdellah 14. To facilitate the maintenance of effective verbal and nonverbal communication 15. To promote the development of productive interpersonal relationships 16. To facilitate progress toward achievement of personal spiritual goals 17. To create and maintain a therapeutic environment 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs 19. To accept the optimum possible goals in light of physical and emotional limitations 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 in the cause of illness 31

32. 3.Virginia Henderson (1960) Identified 14 basic needs. She postulated that the unique function of the nurse is to assist clients, sick or well in the performance of those activities contributing to health, its recovery, or peaceful death that clients would perform unaided if they had the necessary strength, will or knowledge. 14 BASIC NEEDS 1. breathe normally. 2. eat and drink adequately. 3. eliminate body wastes. 4. move and maintain desirable postures. 32

33. Virginia Henderson (1960) 5. sleep and rest. 6. select suitable clothes--dress and undress. 7. maintain body temperature within nor mal range by adjusting clothing and modifying the environment. 8. keep the body clean and well groomed and protect the integument. 9. avoid dangers in the environment and avoid injuring others. 10. communicate with others in expressing emotions, needs, fears or opinions. 11. worship according to ones faith. 12. work in such a way that there is a sense of accomplishment. 13. play or participate in various forms of recreation. 14. learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities 33

34. 4.Dorothy E. Johnson Conceptualized the Behavioral System Model for nursing which has 7 sub systems: 1. attachment/affiliation 2. dependence 3. ingestive 4. eliminative 5. sexual 6. aggressive 7. achievement 34

35. 5.Imogene king She Postulated the Goal Attainment Theory. She descried nursing as a helping profession that assist individual and group in society to attain, maintain, and restore health. If this is not possible, nurse help individual to die with dignity. In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them, transactions occur and goal are achieved. 35

36. 6.Madeleine Leininger She Developed the Trans cultural Nursing Model. She advocate that nursing is a humanistic and scientific mode of helping a client through specific cultural caring process (cultural values, beliefs and practices) to improve or maintain a health condition. 36

37. 7.Myra Levine She described the Four Conservation Principles. She advocated that nursing is a human interaction and proposed four conservation principles of nursing which are concerned with unity and integrity of the individual. The four conservation principles are as follows: (1)conservation of energy. The human body functions by using energy. The human body needs energy producing input. (food, oxygen, fluids) to allow energy utilization as an output. (2) conservation of Structural integrity. The human body has physical boundaries (skin and mucous membrane)that must be maintained to facilitate health and prevent harmful agents from entering the body. 37

38. Myra Levine (3) conservation of Personal Integrity. The nursing intervention are base on the conservation of an individual clients personality. Every individual has sense of identity, self-worth and self-esteem, which must be preserved and enhanced by nurses. (4) Conservation of Social Integrity. The social integrity of the client reflects the family and the community in which the client functions. Health care institutions may separate individuals from their family. It is important for nurses to consider the individual in the context of the family. 38

39. 8.Betty Neuman Health Care System Model She proposed the Health Care System Model. She asserted that nursing is a unique profession in that is concerned with all the variables affecting an individual’s response to stresses, which are intra- (within the individual), inter-(between one or more other people), and extra personal (outside the individual) in nature The concern of nursing is to prevent stress, to protect the client’s basic structure and 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 system stability. 39

40. 9.Dorothea Orem the Self-Care and Self-Care Deficit Theory. She define self-care as “the practice of activities that individual initiate and perform on their own behalf in maintaining life, health and well-being.” she conceptualized three nursing system as follows: (1) wholly Compensatory: when the nurse in expected to accomplish all the patient’s therapeutic self-care or to compensate for the patient’s inability to engage in self-care or when the patient need continuous guidance in self-care; (2) Partially Compensatory: when both nurse and patient engage in meeting self-care needs (3)Supportive-Educative: the system that requires assistance in decision making, behavior control and acquisition of knowledge and skills. 40

41. 10.Hildegard Peplau She Introduced that Interpersonal Model. She defined nursing as interpersonal process of therapeutic interactions between an individual who is sick or need of health services and a nurse especially educated to recognize and respond to the need for help. She identified four phases of the nurse-client relationship namely: (1)orientation: the nurse and the client initially do not now each other goals and testing the role each will assume. The client attempts to identify difficulties and the amount of nursing help that is needed; 41

42. Hildegard Peplau (2)Identification: the client respond to the professionals or the significant others who can meet the identified needs. Both the client and the nurse plan together an appropriate program to foster health; (3)exploitation the client utilized all available resources to move toward the goal of maximal health or functionality; (4)resolution: refers to the termination phase of the nurse client relationship. It occurs when the clients needs are met and he/she can move toward a new goal. Peplau further assume that nurse client relationship fosters growth in both the client and the nurse. 42

43. 11.Martha Rogers She conceptualized the Science of Unitary Human Beings. To Rogers unitary man is an energy field constant interaction with the environment. She asserted that human being are more than and different from the sum of their parts. Further more she believed that human being is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion. 43

44. 12.Sister Callista Roy She presented the Adaptation model. She views each person as a unified bio psychosocial system in constant interaction with a changing environment. She contended that the person as an adaptive system, functions as a whole through interdependence of its parts. The system consist input control process, output and feedback. In addition, she advocated that all people have certain needs which they endeavor to meet in order to maintain integrity. These need are divided into four different model, the physiological, self-concept, role function, and interdependence. Accordingly, Roy believed adaptive human behaviors is directed toward an attempt to maintain homeostasis or integrity of individual by conserving energy and promoting survival, growth , reproduction and mastery of the human system. 44

45. 13.Lydia Hall She Introduce the notion that nursing centers around three components of CARE, CORE, 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 other health care providers. 45

46. 14.Ida Jean Orlando Believe that the nurse helps patients meet a perceived need that the patients cannot meet for themselves. Orlando observed that nurse provide direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness. She emphasized the importance of validating the need and evaluating care based on observable outcomes. She also indicated that nursing actions can be automatic (those chosen for reasons other than the immediate need for help) or deliberative (those resulting from validating the need for help, exploring the meaning of the need, and validating the effectiveness of the actions taken to meet the need.) 46

47. 15.Ernestine Weiden bach The theory of clinical nursing that she is known for has four elements: 1. A nursing philosophy - a nurses attitude and belief about life is what motivates a nurse to act in a certain way. Three important components of a nurses philosophy are reverence for life, respect for the dignity and individuality of each human being, and resolving to act on personal and professional beliefs. 2. A nursing purpose - that which a nurse wants to accomplish through what s/he does. 3. A nursing practice - those (observable) nursing actions that are affected by beliefs and feelings about meeting the patients needs. 4. The art of nursing - this includes understanding a patients needs and concerns, developing goals and actions intended to enhance patients well-being, and directing the activities related to the medical plan to improve the patients condition. 47

48. 16.Jean Watson Conceptualized the Human Caring Model. She emphasized that nursing is the application of the art and human science through transpersonal caring transactions to help persons achieve mind- body soul harmony, which generates self- knowledge, self-control, self-care, and self-healing. She included health promotion and treatment of illness in nursing. 48

49. 17.Rosemarie Rizzo Parse Introduce the theory of Human Becoming. She emphasized free choice of personal meaning in relating value priorities, co-creating of rhythmical patterns, in exchange with the environment and co transcending in many dimensions as possibilities unfold. She also believed that each choice opens certain opportunities while closing others. Thus, she referred to revealing-concealing, enabling- limiting, and connecting-separating. Since each individual makes his or her own personal choices, the role of the nurse is that of guide, not decision maker. 49

50. 18.Josephine Paterson and Loretta Zderad She Provided a Humanistic Nursing Practice Theory. This is based on their belief that nursing is an existential experience. Nursing is viewed as a lived dialogue that involves the coming together of the nurse and the person to be nursed. The essential characteristics of nursing is nurturance. Humanistic care cannot take place without the authentic commitment of the nurse being with and doing with the client. Humanistic nursing also presupposes responsible choices 50

51. 19.Helen Erickson, Evelyn Tomlin and Mary Ann Swain Developed the Modeling and Role - Modeling Theory. The focus of this theory is on the person. The nurse model (assesses), role models (plans), and intervenes in this interpersonal and interactive theory. They asserted that each individual is unique has some self-care knowledge, needs simultaneous to be attached to and separate from others, and has adaptive potential, nurses in this theory, facilitate, nurture and accept the person unconditionally. They view nursing as a self-care model based on the clients perception of the world and adaptations to stressors. 51

52. 20.Margaret Newman She Focused on health as expanding consciousness. She believed that human are unitary beings in whom disease is a manifestation of the pattern of health. She defined consciousness as the information capability of the system which is influenced by time, space, and movement and is ever- expanding. Change occurs through transformation. Nursing is involved with human beings who have reached choice points and found that their old ways are no longer effective. Caring is a moral imperative for nursing. The nurse is a partner with the client rather than the goal setter and outcome predictor. 52

53. SUMMARY Theory and practice are related . To develop nursing as a profession the concept of theory must be addressed. If nursing theory does not drive the development of nursing, it will continue to develop in the footsteps of other disciplines such as medicine 53

54. REFERENCES George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd 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 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. London Mosby Year Book. 54

55. SUGGESTED READINGS Avolio , B., Sosik , J., Jung, D., & Berson , Y. (2003). Leadership models, methods and applications. In W. Borman , D. Ilgen & R. Klimoski (Eds.). Handbook of Psychology(vol.1, pp. 277-307), New York, Wiley. Baker, S. D. (2007). Followership: The theoretical foundation of a contemporary construct. Journal of Leadership & Organizational Studies Bass, B. M. (2005). Transformational leadership theory. In J. B. Miner. Organizational behavior I.Essential theories of motivation and leadership. Day, D., & Harrison, M. M. (2007). A multilevel, identity-based approachto leadership development, Human Resource Management Review, 17(4), 360-372. 55

56. EXTERNAL RESOURCES Fiedler, F. (1967). A theory of leadership effectiveness. New York: McGraw-Hill. Graen , G., & Uhl -Bien, M. (1995). Relationship-based approach to leadership: Development of leader–member exchange (LMX) theory of leadership over 25 years: Applying a multilevel multi-domain perspective. The Leadership Quarterly, 6(2). Liden , R. C., & Maslyn , J.M. (1998). Multidimensionality of leader-member exchange:An empirical assessment through scale development. Journal of Management. Maccoby , M. (1979). Leadership needs of the 1980’s. Current issues in highereducation . Murphy, A.J. (1941). A study of the leadership process. American SociologicalReview . 56

57. EXTERNAL RESOURCES Fiedler, F. (1967). A theory of leadership effectiveness. New York: McGraw-Hill. Graen , G., & Uhl -Bien, M. (1995). Relationship-based approach to leadership: Development of leader–member exchange (LMX) theory of leadership over 25 years: Applying a multilevel multi-domain perspective. The Leadership Quarterly, 6(2). Liden , R. C., & Maslyn , J.M. (1998). Multidimensionality of leader-member exchange:An empirical assessment through scale development. Journal of Management. Maccoby , M. (1979). Leadership needs of the 1980’s. Current issues in highereducation . Murphy, A.J. (1941). A study of the leadership process. American SociologicalReview 57

58. Thanks 58