Nursing Theoriest

Nursing Theorists
Week 11 and 12
Gloria A. Hagopian, RN, EdD
04/13/12
Definitions
Theory- a set of related statements that describes or explains phenomena in a systematic way x Concept-a mental idea of a phenomenon x Construct- a phenomena that cannot be observed and must be inferred Gloria A. Hagopian, RN, EdD 04/13/12
x
Definitions
x
Proposition- a statement of relationship between concepts Conceptual model- made up of concepts and propositions
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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, Gloria A. Hagopian, RN, EdD 04/13/12 Patricia Benner
x
Concepts in the nursing metaparadigm

x Person
x Recipient
of care, including physical, spiritual, psychological, and sociocultural components x Individual, family, or community
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x Environment
x All
internal and external conditions, circumstances, and influences affecting the person
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x Health
x Degree
of wellness or illness experienced by the person
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x Nursing
x Actions,
characteristics and attributes of person giving care
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Florence Nightingale Environmental Theory x First nursing theorist

x Unsanitary
conditions posed health hazard (Notes on Nursing, 1859) ventilation, light, warmth, effluvia, noise
5 components of environment
x
External influences can prevent, suppress or

04/13/12
Nightingales Concepts x Person

x Patient
who is acted on by nurse x Affected by environment x Has reparative powers

x
Environment x Foundation of theory. Included everything, physical, psychological, and social

04/13/12
Nightingales Concepts
x
Health
x Maintaining
well-being by using a persons powers x Maintained by control of environment

x
Nursing
x
Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate persons reparative Gloria A. Hagopian, RN, EdD 04/13/12
Hildegard Peplau Interpersonal Relations Model
04/13/12
Hildegard Peplau Interpersonal Relations Model

x
Based on psychodynamic nursing

x using
an understanding of ones own behavior to help others identify their difficulties
Applies principles of human relations x Patient has a felt need

x
04/13/12
Peplaus Concepts
Person x An individual; a developing organism who tries to reduce anxiety caused by needs x Lives in instable equilibrium x Environment- Not defined
x
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Peplaus Concepts
x
Health x Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
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Peplaus Concepts
x
Nursing x A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible x Involves problem-solving
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Virginia Henderson
04/13/12
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
04/13/12
Virginia Henderson
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.
04/13/12
Virginia Henderson
She is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the young mother, the
Gloria A. Hagopian, RN, EdD 04/13/12
Fay Abdella-
Topology of 21 Nursing Problems
04/13/12
Topology of 21 Nursing Problems

x
Fay Abdella
A list of 21 nursing problems

x Condition
presented or faced by the patient or family. physical, social and emotional
Problems are in 3 categories

x
The nurse must be a good problem solver

04/13/12
Nursing x A helping profession x A comprehensive service to meet patients needs x Increases or restores self-help ability x Uses 21 problems to guide nursing care x Health x Excludes illness x No unmet needs and no actual Gloria A. Hagopian, RN, EdD 04/13/12
x
Abdellas Concepts
Person x One who has physical, emotional, or social needs x The recipient of nursing care. Environment x Did not discuss much x Includes room, home, and community
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Abdellas Concepts
Ida Jean Orlando
Deliberative Nursing Process
04/13/12

x
Ida Jean Orlando
The deliberative nursing process is set in motion by the patients behavior x All behavior may represent a cry for help. Patients behavior can be verbal or non-verbal. The nurse reacts to patients behavior and forms basis for determining nurses acts. x Perception, thought, feeling
04/13/12
Ida Jean Orlando

x
Nurses actions should be deliberative, rather than automatic x Deliberative actions explore the meaning and relevance of an action.
04/13/12
Dorothy Johnson Behavioral Systems Model
04/13/12
The person is a behavioral system comprised of a set of organized, interactive, interdependent, and integrated subsystems
x
Constancy is maintained through biological, psychological, and sociological factors.

04/13/12

x
A steady state is maintained through adjusting and adapting to internal and external forces.
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Johnsons 7 Subsystems
x
Affiliative subsystem
x social
bonds or nuturing
Dependency
x helping
Ingestive
x
food intake
Eliminative
x excretion
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Dorothy Johnson Behavioral Systems Model 7 Sub Systems

x
Sexual
x
procreation and gratification self-protection and preservation efforts to gain mastery and control
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Agressive
x
Achievement
x
Johnsons Concepts
x
Person
x
A behavioral system comprised of subsystems constantly trying to maintain a steady state Not specifically defined but does say there is an internal and external environment
Environment
x
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x
Health
x
Balance and stability. regulatory force that is indicated only when there is instability.
Nursing
x External
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Martha Rogers Unitary Human Beings
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x
Energy fields x Fundamental unity of things that are unique, dynamic, open, and infinite x Unitary man and environmental field Universe of open systems x Energy fields are open, infinite, and interactive
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Pattern x Characteristic of energy field x A wave that changes, becomes complex and diverse Four dimensionality x A nonlinear domain with out time or space
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Rogers Definitions
x
Integrality
x Continuous
and mutual interaction between man and environment change longer to shorter wave patterns in human and environmental fields
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Resonancy
x Continuous
Helicy
x Continuous,
probabilistic, increasing diversity of the human and envrionmental fields. x Characterized by nonrepeating rhymicities x Change
04/13/12
Dorothea Orem Self-Care Model
04/13/12

x
Self-care comprises those activities performed independently by an individual to promote and maintain person well-being
Self care agency is the individuals ability to perform selfRN, EdD care activities Gloria A. Hagopian, 04/13/12
x
HISTORICAL BACKGROUND
Born in Baltimore, Maryland on 1914. Died June 22, 2007 Her father is a construction worker and her mother is a homemaker. Received her diploma of Nursing in Providence Hospital School of Nursing, Washington DC, 1930. Finished B.S.N.E and M.S.N.E in Catholic University of America (CUA). 1940 to 1949 Director of School of Nursing and Department of Nursing in Providence Hospital, Detroit. 1949 to 1957 Work in Division of Hospital and Institutional Services of Indiana State Board of Health. Her goal is to upgrade the quality of nursing in general hospitals throughout the state. 1957 to 1960 US Department of Health, Education and Welfare, Office of Education 1959 Published Guidelines for developing Curricula for the Education of Practical Nurses. She subsequently served as acting dean of the School of Nursing and as an assistant professor of Nursing Education at CUA. She continued to develop her concept of Nursing and Self Care during this time. 1971 First book of Orem published was Nursing: Concept of Practice. 1976 Degree of Doctor in Science. Orem retired and resides in Sarannah, Georgia.
04/13/12

x
Self- care deficit occurs when the person cannot carry out self-care
The nurse then meets the selfcare needs by acting or doing for;guiding, teaching, supporting or providing the environment 04/13/12 to promote Gloria A. Hagopian, RN, EdD
x

x
Wholly compensatory nursing system

x Patient
dependent
Partially compensatory
x Patient
can meet some needs but needs nursing assistance can meet self care requisites, but needs assistance
04/13/12
Supportive educative
x Patient
Metaparadigm:
Nursing - the art of nursing is practiced by doing for the patient with the disability, by helping him to do for himself or helping him to learn to do for himself. The goal of nursing is to move the patient from wholly compensatory to supportive state if at all possible. Person an individual with physical and emotional requirements for development and self maintenance of their well being. Environment Clients surroundings which may affect their ability to perform their self care activities. Health Structural and functional soundness and wholeness of the individual.
Imogene King Goal Attainment Theory
04/13/12
Open systems framework

x Human
beings are open systems in constant interaction with the environment x Personal System
x
individual; perception, self, growth, development, time space, body image
x Interpersonal
x Society
04/13/12
Imogene King Goal Attainment Theory x Personal System

x Individual;
perception, self, growth, development, time space, body image interaction, communication and transaction
Interpersonal
x Socialization;
Society
x Family,
religious groups, schools, work, Gloria A. Hagopian, RN, EdDpeers 04/13/12
The nurse and patient mutually communicate, establish goals and take action to attain goals
04/13/12
Each individual brings a different set of values, ideas, attitudes, perceptions to exchange
04/13/12
Betty Neuman Systems Model
04/13/12
Betty Neuman Health Care Systems Model

x
The person is a complete system, with interrelated parts x maintains balance and harmony between internal and external environment by adjusting to stress and defending against tensionproducing stimuli
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Focuses on stress and stress reduction x Primarily concerned with effects of stress on health x Stressors are any forces that alter the systems stability
x
04/13/12
Flexible lines of resistance

Surround basic core x Internal factors that help defend against stressors
x
x x
Normal line of resistance

x
Normal adaptation state Protective barrier, changing, affected by variables

04/13/12
Flexible line of defense

x
Betty Neuman Systems Model

x
Wellness is equilibrium Nursing interventions are activites to:

x strengthen
flexible lines of
defense x strengthen resistence to stressors x maintain adaptation

04/13/12
Sister Calista Roy Adaptation Model
04/13/12

x
Five Interrelated Essential Elements x Patiency- The person receiving

care
x Goal
of nursing- Adapting to
change
x Health-Being and becoming a
whole person
x Environment
04/13/12

x
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 Gloria A. Hagopian, RN, EdD 04/13/12
x
Jean Watson Philosophy and Science of Caring
04/13/12

Caring can be demonstrated and practiced x Caring consists of carative factors x Caring promotes growth x A caring environment accepts a person as he is and looks to what the person may become Gloria A. Hagopian, RN, EdD 04/13/12
x

xA
caring environment offers development of potential x Caring promotes health better than curing x Caring is central to nursing
Watsons 10 Carative Factors

x Forming
humanisticaltruistic value system x Instilling faith-hope x Cultivating sensitivity to self and others
04/13/12

x Developing
helping-trust relationship x Promoting expression of feelings x Using problem-solving for decision making

Promoting teaching-learning x Promoting supportive environment x Assisting with gratification of human needs x Allowing for existentialphenomenological forces
x
Watsons Concepts
x Person
x Human
being to be valued, cared for, respected, nurtured, understood and assisted
x Environment
x Society

x Health
x Complete
physical, mental and social well-being and functioning
x Nursing
with promoting and restoring health, preventing 04/13/12 illness Gloria A. Hagopian, RN, EdD
x Concerned
Human Becoming Theory includes Totality Paradigm

x
Rosemary Parse Human Becoming Theory
Man is a combination of biological, psychological, sociological and spiritual factors Man is a unitary being in continuous, mutual interaction with environment
Simultaneity Paradigm
x
04/13/12 Originally Man-Living-Health
Parses Three Principles

x
Meaning
x Mans
reality is given meaning through lived experiences x Man and environment cocreate
x
Rhythmicity
x Man
and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns

04/13/12
Parses Three Principles

x Cotranscendence
x Refers
to reaching out and beyond the limits that a person sets x One constantly transforms
04/13/12
Person
x Open
Rosemary Parse Human BecomingTheory

being who is more than and different from the sum of the parts
Environment
x Everything
in the person and his experiences x Inseparable, complimentary to and evolving with
Rosemary Parse Human BecomingTheory

x
Health
x Open
process of being and becoming. Involves synthesis of values human science and art that uses an abstract body of knowledge to serve people
04/13/12
Nursing
xA
Based on transcultural nursing, whose goal is to provide care congruent with cultural values, beliefs, and practices x Sunrise model consists of 4 levels that provide a base of knowledge for delivering Gloria A. Hagopian, RN, EdD 04/13/12 cultural congruent care
x
Madeleine Leininger Culture Care Diversity and Universality
Madeleine Leininger Culture Care Diversity x Modes of nursing action

x Cultural
x
care preservation
help maintain or preserve health, recover from illness, or face death
x Cultural
x
care accommodation
help adapt to or negotiate for a beneficial health status, or face death
x Cultural
x
care re-patterning
help restructure or change lifestyles that are culturally meaningful

04/13/12
Patricia Benner From Novice to Expert
04/13/12

x
Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level
04/13/12

x
Levels reflect:
x movement
from reliance on past abstract principles to the use of past concrete experience as paradigms x change in perception of situation as a complete whole in which certain parts are relevant

Novice x Advanced beginner x Competent x Proficient x Expert
x
04/13/12
Importance of Theoretical Frameworks

x
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
04/13/12
Next Steps
Responsibility of nurses to know and understand theorists x Critically analyze theoretical frameworks
x
04/13/12

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Nursing Theorists

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Concepts in the nursing metaparadigm

Gloria A. Hagopian, RN, EdD

Concepts in the nursing metaparadigm

Gloria A. Hagopian, RN, EdD

Concepts in the nursing metaparadigm

of wellness or illness experienced by the person

Gloria A. Hagopian, RN, EdD

Concepts in the nursing metaparadigm

characteristics and attributes of person giving care

Gloria A. Hagopian, RN, EdD

Florence Nightingale Environmental Theory x First nursing theorist

External influences can prevent, suppress or

Gloria A. Hagopian, RN, EdD

Nightingales Concepts x Person

who is acted on by nurse x Affected by environment x Has reparative powers

Environment x Foundation of theory. Included everything, physical, psychological, and social

Gloria A. Hagopian, RN, EdD

well-being by using a persons powers x Maintained by control of environment

Hildegard Peplau Interpersonal Relations Model

Gloria A. Hagopian, RN, EdD

Hildegard Peplau Interpersonal Relations Model

Based on psychodynamic nursing

an understanding of ones own behavior to help others identify their difficulties

Gloria A. Hagopian, RN, EdD

Applies principles of human relations x Patient has a felt need

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Virginia Henderson The Nature of Nursing

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Topology of 21 Nursing Problems

Gloria A. Hagopian, RN, EdD

Topology of 21 Nursing Problems

A list of 21 nursing problems

presented or faced by the patient or family. physical, social and emotional

Problems are in 3 categories

The nurse must be a good problem solver

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Ida Jean Orlando

Deliberative Nursing Process

Gloria A. Hagopian, RN, EdD

Deliberative Nursing Process

Ida Jean Orlando

Gloria A. Hagopian, RN, EdD

Ida Jean Orlando

Deliberative Nursing Process

Gloria A. Hagopian, RN, EdD

Dorothy Johnson Behavioral Systems Model

Gloria A. Hagopian, RN, EdD

Dorothy Johnson Behavioral Systems Model

Constancy is maintained through biological, psychological, and sociological factors.

Gloria A. Hagopian, RN, EdD

Dorothy Johnson Behavioral Systems Model

Gloria A. Hagopian, RN, EdD

Gloria A. Hagopian, RN, EdD

Dorothy Johnson Behavioral Systems Model 7 Sub Systems

Gloria A. Hagopian, RN, EdD