Overview of Nursing Theories

Appraise the component of various nursing theories; description, purpose, concepts, definition.
Discuss the application of nursing theories in nursing practice.

1. OVERVIEW OF NURSING THEORIES By Syed Yousaf Shah

2. Objectives Discuss various Nursing Theories. Appraise the component of various nursing theories; description, purpose, concepts, definition. Discuss the application of nursing theories in nursing practice. References

3. Meta-theory - the theory of theory. Identifies specific phenomena through abstract concepts. Grand theories – broad and complex Middle-range theories- address specific phenomena and reflect practice Practice theory - explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.

4. Descriptive theories – first level of theory development Prescriptive theories – address nursing interventions and predict their consequences

5. Environmental theory Pure fresh air Pure water Effective drainage Cleanliness Light(especially direct sunlight ) Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status.

6. "Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to reduce noise, to relieve patients’ anxieties, and to help them to sleep." As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care.

7. Nursing need theory Modern Nursing Nightingale /The 20th century Nightingale “ 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" (Henderson, 1966)”

8. The 14 components Breath normally. Eat and drink adequately. Eliminate body wastes. Move and maintain desirable postures. Sleep and rest. Select suitable clothes-dress and undress. Maintain body temperature within normal range by adjusting clothing and modifying environment Keep the body clean and well groomed and protect the integument Avoid dangers in the environment and avoid injuring others. Communicate with others in expressing emotions, needs, fears, or opinions. Worship according to one’s faith. Work in such a way that there is a sense of accomplishment. Play or participate in various forms of recreation. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

9. Interpersonal theory Focuses on the interpersonal processes and therapeutic relationship that develops between the nurse and client. 4 phases of Nurse- patient relationship Orientation Identification Exploitation Resolution

10. 21 Nursing Problems Theory To maintain good hygiene and physical comfort To promote optimal activity: exercise, rest, sleep To promote safety through prevention of accident, injury, or other trauma and through prevention of the spread of infection To maintain good body mechanics and prevent and correct deformity To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition for all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory

11. To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function To identify and accept positive and negative expressions, feelings, and reactions To identify and accept interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and nonverbal communication To promote the development of productive interpersonal relationships To facilitate progress toward achievement and personal spiritual goals To create or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs To accept the optimum possible goals in the light of limitations, physical and emotional To use community resources as an aid in resolving problems that arise from illness To understand the role of social problems as influencing factors in the cause of illness

12. Theory of Goal Attainment King has interrelated the concepts of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and space into a theory of goal attainment. Nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation. The nurse and client share specific goals, problems, and concerns and explore means to achieve a goal.

13. Concepts for Personal System Perception Self Growth & development Body image Space Time Concepts for Interpersonal System Interaction Communication Transaction Role Stress Concepts for Social System Organization Authority Power Status Decision making

14. Self care deficit theory People should be self-reliant and responsible for their own care and others in their family needing care. Composed of three interrelated theories: The theory of self-care The self-care deficit theory, and The theory of nursing system

15. Nursing is as art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the medical care the individual receives from the physician.

16. System model It provides a comprehensive flexible holistic and system based perspective for nursing. Human being is viewed as an open system that interacts with both internal and external environment forces or stressors. The human is in constant change, moving toward a dynamic state of system stability or toward illness of varying degrees.

17. The Conservation Model Nursing’s role in conservation is to help the person with the process of “keeping together” the total person through the least expense of effort. Levine proposed the following four principles of conservation: The conservation of energy of the individual The conservation of the structural integrity of the individual. The conservation of the personal integrity of the individual. The conservation of the social integrity of the individual.

18. Adaptation model (RAM) RAM is one of the widely applied nursing models in nursing practice, education and research. Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity.

19. Physiologic-physical mode Self-concept-group identity mode Role function mode Interdependence mode:

20. Theory of human caring Caring can be effectively demonstrated and practiced only interpersonally. Caring consists of carative factors that result in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth.

21. The formation of a humanistic- altruistic system of values. The installation of faith-hope. The cultivation of sensitivity to one’s self and to others. The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings. The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment. Assistance with the gratification of human needs. The allowance for existential-phenomenological forces.

22. The Dynamic Nurse-Patient Relationship The role of the nurse is to find out and meet the patient's immediate need for help. The patient's presenting behavior may be a plea for help, however, the help needed may not be what it appears to be. Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with patients the meaning of their behaviour.

23. The Aspects of Care, Core, Cure The theory contains of three independent but interconnected circles: The core: The person or patient to whom nursing care is directed and needed. The care : The attention given to patients by the medical professionals The cure: The attention given to patients by the medical professionals.

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

25. 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.

26. 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.

27. 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).

28. 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. 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 .

29. Need theorists I n t e r act i on Theorists Ou t c ome theorists Abdellah Henderson Orem King Orlando Peterson and Zderad Paplau Travelbee Wiedenbach Johnson Levine Rogers Roy

30. Systems model Basic Human Needs model Health and Wellness Models Stress and Adaptation Developmental Theories Psychosocial Theories

31. They are derived through two principal methods: Deductive reasoning Inductive reasoning.

32. Theory → practice → theory Theory developed in other discipline and used in nursing situations Practice → theory : theory evolved from clinical practice Research → theory or inductive method Must evolve from research findings or empirical evidence. Theory → research → theory . Original theory examined and given a new research findings.

33. 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).

34. References Johnson, M. B., Webbe , B. P. (2001). An Introduction to Theory & Reasoning in Nursing. New York: Lippincott. Kenney, W. J. (2002). Philosophical and Theoretical Perspectives for Advanced Nursing.