Nursing Theory Lecture 15: Myra Estrin Levine

Myra Estrin Levine

(1973)

Conservation Model

Conservation Model
• Believes nursing intervention is a conservation activity, with conservation of energy as a primary concern, four conservation principles of nursing: conservation of client energy, conservation of structured integrity, conservation of personal integrity, conservation of social integrity.
• Described the Four Conversation Principles. She advocated that nursing is a human interaction and proposed four conservation principles of nursing which are concerned with the unity and integrity of the individual. The four conservation principles are as follows:
1. Conservation of energy. The human body functions by utilizing energy. The human body needs energy producing input (food, oxygen, fluids) to allow energy utilization 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.
3. Conservation of Personal Integrity. The nursing interventions are based on the conservation of the individual client’s 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.

Metaparadigm

Person
• A holistic being

Environment
• Broadly, includes all the individual’s experiences

Health
• The maintenance of the client’s unity and integrity

Nursing
• A discipline rooted in the organic dependency of the individual human being on his or her relationship with others

Nursing Theory Lecture 14: Martha Rogers

Martha Rogers

(1970)

Science of Unitary Man

Science of Unitary Man
• Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development.
• Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen the wholeness of the Individual and redirect human and environmental patterns or organization to achieve maximum health.
• 5 basic assumptions:
1. The human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts.
2. The individual and the environment are continuously exchanging matter and energy with each other.
3. The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum 4. Patterns identify human being and reflect their innovative wholeness.
5. The individual is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

Metaparadigm

Person
• Unitary man, a four-dimensional energy field.

Environment
• Encompasses all that is outside any given human field. Person exchanging matter and energy.

Health
• Not specifically addressed, but emerges out of interaction between human and environment, moves forward, and maximizes human potential.

Nursing
• A learned profession that is both science and art. The professional practice of nursing is creative and imaginative and exists to serve people.

Nursing Theory Lecture 13: Madeleine Leininger

Madeleine Leininger

(1978, 1984)

Transcultural Care Theory and Ethnonursing

Transcultural Care Theory and Ethnonursing
• Developed the Transcultural Nursing Model. She advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural caring processes (cultural values, beliefs and practices) to improve or maintain a health condition.
• Nursing is a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.
• Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.
• Focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors.
• Awareness of the differences allows the nurse to design culture-specific nursing interventions.

Nursing Theory 10: Jean Watson

Jean Watson 

(1979) 

The Philosophy and Science of Caring 

 The Philosophy and Science of Caring
• Nursing is concerned with promotion health, preventing illness, caring for the sick, and restoring health.
• Nursing is a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human care transactions
• She defined caring as a nurturing way or responding to a valued client towards whom the nurse feels a personal sense of commitment and responsibility. It is only demonstrated interpersonally that results in the satisfaction of certain human needs. Caring accepts the person as what he/she may become in a caring environment

Carative Factors:
1. The formation of a humanistic-altruistic system of values
2. Instillation of faith-hope
3. The cultivation of sensitivity to one’s self and others
4. The development of a helping- trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systemic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning
8. The provision for supportive, protective and corrective mental, physical, socio-cultural and spiritual environment
9. Assistance with the gratification of human needs
10. The allowance for existential phenomenological forces

Metaparadigm

Person
• A valued being to be cared for, respected, nurtured, understood, and assisted, a fully functional, integrated self

Environment 
• Social environment, caring and the culture of caring affect health

Health 
• Physical, mental, and social wellness

Nursing 
• A human science of people and human health; illness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions.

Nursing Theory Lecture 9: Imogene King

Imogene King 

(1971, 1981) 

Goal Attainment Theory 

 

Goal Attainment Theory 

• Nursing process is defined as dynamic interpersonal process between nurse, client and health care system.

• Postulated the Goal Attainment Theory. She described nursing as a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If is this not possible, nurses help individuals 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 occurred and goals are achieved.

Metaparadigm 

Person 

• Biopsychosocial being

Environment 

• Internal and external environment continually interacts to assist in adjustments to change.

Health 

• A dynamic life experience with continued goal attainment and adjustment to stressors.

Nursing 

• Perceiving, thinking, relating, judging, and acting with an individual who comes to a nursing situations

Nursing Theory Lecture 8: Hildegard Peplau

Hildegard Peplau 

(1951) 

Interpersonal Relations Theory 

Interpersonal Relations Theory 
• Defined Nursing: “An interpersonal process of therapeutic interactions between an Individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.
• Nursing is a “maturing force and an educative instrument”
• Identified 4 phases of the Nurse - Patient relationship:

1. Orientation - individual/family has a “felt need” and seeks professional assistance from a nurse (who is a stranger). This is the problem identification phase.

2. Identification - where the patient begins to have feelings of belongingness and a capacity for dealing with the problem, creating an optimistic attitude from which inner strength ensues. Here happens the selection of appropriate professional assistance.

3. Exploitation - the nurse uses communication tools to offer services to the patient, who is expected to take advantage of all services.

4. Resolution - where patient’s needs have already been met by the collaborative efforts between the patient and the nurse. Therapeutic relationship is terminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.


Metaparadigm 

Person 
• An organism striving to reduce tension generated by needs

Environment 
• The interpersonal process is always included, and psychodynamic milieu receives attention, with emphasis on the client’s culture and mores.

Health 
• Ongoing human process that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.

Nursing 
• Interpersonal therapeutic process that “functions cooperatively with others human processes that make health possible for individuals in communities. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality.

Nursing Theory Lecture 7: Florence Nightingale

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, cleanliness/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.
• Developed the described the first theory of nursing. Notes on Nursing: What It Is 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 
• An individual 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

Nursing Theory Lecture 5: Ernestine Wiedenbach

Ernestine Wiedenbach 

(1964) 

The Helping Art of Clinical Nursing 

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.

Environment 
• 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

Nursing Theory Lecture 4: Dorothy Johnson

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.
• To reduce stress so the client can recover as quickly as possible. According to Johnson, each person as a 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.
4.Aggressive. Self – protective behavior.
5.Dependence. Nurturance – seeking behavior.
6.Achievement. Master of oneself and one’s environment according to internalized standards of excellence.
7.Sexual role identity behavior

• In addition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting 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 ways that 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 as a consequence of illness.


Metaparadigm

Person 
•A system 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 and a science providing external assistance before and during balance disturbances

Nursing Theory Lecture 3: Dorothea Orem

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.
•Has a 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 in a 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 bring a meal tray for client who can feed himself)
          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.)

Nursing Theory Lecture 2: Betty Neuman

Betty Neuman 

(1972, 1982, 1989, 1992) 

Health Care System Model 

The Neuman System Model or Health 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.
• To address 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 
• A client 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 
• Nursing is a unique profession in that it is concerned with all the variables affecting an individual’s response to stressors.

Nursing Theory Lecture 1: Introduction

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 different theories, concepts, and ideas in nursing it:
• It guides nurses in their practice knowing what is nursing and what is not nursing.
• It helps in the formulations of standards, policies and laws.
• It will help the people to understand the competencies and professional accountability of nurses.
• It will 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.