Nursing Theories PDF

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A list of nursing theorist for the subject, Theoretical Foundations in nursing....

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Virginia Henderson The Principles and Practice of Nursing “I believe that the function the nurse performs is primarily an independent one – that of acting for the patient when he lacks knowledge , physical strength, or the will to act for himself as he would ordinarily act in health, or in carrying out prescribed therapy. This function is seen as complex and creative, as offering unlimited opportunity for the application of the physical, biological, and social sciences and the development of skills based on them.” (Henderson, 1960)

Major Concepts

Subconcepts

Human or Individual

14 Activities for Client Assistance

Henderson considers the biological, psychological, sociological, and spiritual components.

Physiological 1. Breathe normally

She defined the patient as someone who needs nursing care, but did not limit nursing to illness care.

2. Eat and drink adequately 3. Eliminate body wastes

Society or Environment 4. Move and maintain desirable postures She did not define environment, but maintaining a supportive environment is one of the elements of her 14 activities.

5. Sleep and rest 6. Select suitable clothes – dress and undress

She sees individuals in relation to their families but minimally discusses the impact of the community on the individual and family.

7. Maintain body temperature within normal range by adjusting clothing and modifying environment

She supports the tasks of private and public health agencies keeping people healthy.

8. Keep the body clean and well groomed and protect the integument

She believes that society wants and expects the nurse’s service of acting for individuals who are unable to function independently.

9. Avoid dangers in the environment and avoid injuring others

Health

Psychological Aspects of Communicating and Learning

Health was not explicitly defined, but it is taken to mean balance in all realms of human life.

10. Communicate with others in expressing emotions, needs, fears, or opinions

Nursing

11. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities

Henderson believed that “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 a 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, 1991)

Spiritual and Moral 12. Worship according to one’s faith Sociologically Oriented to Occupation and Recreation 13. Work in such a way that there is sense of accomplishment 14. Play or participate in various forms of recreation “It is equally important to realize that these needs are satisfied by infinitely varied pattern of living, no two of which are alike.” (Henderson, 1960)

Assumptions Nurses care for patients until patients can care for themselves once again. Patients desire to return to health. Nurses are willing to serve and that “nurses will devote themselves to the patient day and night.” (Henderson, 1991) Nurses should be educated at the university level in both arts and sciences. Henderson also believes that mind and body are inseparable. It is implied that the mind and body are interrelated. (Henderson, 1966, 1991)

Strengths/Weaknesses Henderson’s work is relatively simple yet generalizable with some limitations. Her work can be applied to the health of individuals of all ages. Limited in a way that it can generally be applied to fully functional individuals. Each of the 14 activities can be the basis for research. Although the statements are not written in testable terms, they may be reformulated into researchable questions. Strength The concept of nursing formulated by Henderson in her definition of nursing and the 14 components of basic nursing is uncomplicated and self-explanatory. Therefore, it can be used without difficulty as a guide for nursing practice by most nurses. Weakness A major shortcoming in her work is the lack of a conceptual linkage between physiological and other human characteristics.

Analysis One cannot say that every individual who has similar needs indicated in the 14 activities by Henderson are the only things that human beings need in attaining health and for survival. With the progress of today’s time, there may be added needs that humans are entitled to be provided with by nurses. The prioritization of the 14 Activities was not clearly explained whether the first one is prerequisite to the other. But still, it is remarkable that Henderson was able to specify and characterize some of the needs of individuals based on Abraham Maslow’s hierarchy of needs. Some of the activities listed in Henderson’s concepts can only be applied to fully functional individuals indicating that there would always be patients who always require aided care which is in contrary to the goal of nursing indicated in the definition of nursing by Henderson. Because of the absence of a conceptual diagram, interconnections between the concepts and subconcepts of Henderson’s principle are not clearly delineated.

Dorothea E. Orem The Self-Care Deficit Nursing Theory.

Orem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems. “The condition that validates the existence of a requirement for nursing in an adult is the absence of the ability to maintain continuously that amount and quality of self-care which is therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with their effects. With children, the condition is the inability of the pare nt (or guardian) to maintain continuously for the child the amount and quality of care that is therapeutic.” (Orem, 1991)

Major Concepts

Subconcepts

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.

Self-care Requisites or requirements can be defined as actions directed toward the provision of self-care. It is presented in three categories:

Humans are defined as “men, women, and children cared for either singly or as social units,” and are the “material object” of nurses and others who provide direct care. Environment has physical, chemical and biological features. It includes the family, culture and community. Health is “being structurally and functionally whole or sound.” Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one’s self, to symbolize experience, and to communicate with others. Self-care is the performance or practice of activities

A. Universal self-care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning. 1. The maintenance of a sufficient intake of air 2. The maintenance of a sufficient intake of water 3. The maintenance of a sufficient intake of food 4. The provision of care associated with elimination process and excrements 5. The maintenance of a balance between activity and rest 6. The maintenance of a balance between solitude and social interaction 7. The prevention of hazards to human life, human

that individuals initiate and perform on their own behalf to maintain life, health and well-being. Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors. Basic conditioning factors are age, gender, developmental state, health state, sociocultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability. Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations.” Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective selfcare.

functioning, and human well-being 8. The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal Normalcy is used in the sense of that which is essentially human and that which is in accord with the genetic and constitutional characteristics and the talents of individuals. B. Developmental self-care requisites are “either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a condition or associated with an event.” C. Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition. 1. Seeking and securing appropriate medical assistance

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency. Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds available selfcare agency, leading to the need for nursing.

2. Being aware of and attending to the effects and results of pathologic conditions and states 3. Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures 4. Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures 5. Modifying the self-concept (and self-image) in accepting oneself as being in a particular state of health and in need of specific forms of health care 6. Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a life-style that promotes continued personal development The Three Basic Nursing Systems: (1) The wholly compensatory nursing system is represented by a situation in which the individual is unable “to engage in those self-care actions requiring self-directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity… Persons with these limitations are socially dependent on others for their continued existence and well-being.” (2) The partly compensatory nursing system is represented by a situation in which “both nurse and perform care measures or other actions involving manipulative tasks or ambulation… [Either] the patient or the nurse may have the major role in the performance of care measures.” (3) In the supportive-educative system also known as supportive-developmental system, the person “is able to perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance.”

Relationship of the major components of Orem’s self-care deficit theory

R indicates a relationship between components; < indicates a current or potential deficit where nursing would be required

Assumptions Humans engage in continuous communication and interchange among themselves and their environments to remain alive and to function. In humans, the power to act deliberately is exercised to identify needs and to make needed judgments. Mature human beings experience privations in the form of action in care of self and others involving making lifesustaining and function-regulating actions. Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for, and make inputs into, self and others. Finally, groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members who experience privations for making required deliberate decisions about self and others (Orem, 1995).

Strengths/Weaknesses Strengths: A major strength of Orem’s theory is that it is applicable for nursing by the beginning practitioner as well as the advanced clinicians. The terms self-care, nursing systems, and self-care deficit are easily understood by the beginning student nurse and can be explored in greater depth as the nurse gains more knowledge and experience. She specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects. Three identifiable nursing systems were clearly delineated and are easily understood. Weaknesses: Orem’s theory is simple yet complex. The use of self-care in multitude of terms, such as self-care agency, self-care demand, self-care deficit, self-care requisites, and universal self-care, can be very confusing to the reader. Orem’s definition of health was confined in three static conditions which she refers to a “concrete nursing system,” which connotes rigidity. Throughout her work, there is limited acknowledgement of the individual’s emotional needs.

Analysis

There is a superb focus of Orem’s work which is self-care. Even though there is a wide range of scope seen in the encompassing theory of nursing systems, Orem’s goal of letting the readers view nursing care as a way to provide assistance to people was apparent in every concept presented. From the definition of health which is sought to be rigid, it can now be refined by making it suitable to the general view of health as a dynamic and ever changing state. The role of the environment to the nurse-patient relationship, although defined by Orem was not discussed. The role of nurses in maintaining health for the patient was set by Orem with great coherence in accordance with the life-sustaining needs of every individual. Although Orem viewed the importance of the parents or guardian in providing for their dependents, t he definition of selfcare cannot be directly applied to those who needs complete care or assistance with self -care activities such as the infants and the aged.

Nola Pender The Health Promotion Model

The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting actions.

Major Concepts

Subconcepts

Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness.

Personal Factors Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered.

On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. Individual characteristics and experiences (prior related behavior and personal factors). Behavior-specific cognitions and affect(perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences). Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior).

a. Personal biological factors Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance.

b. Personal psychological factors Include variables such as self esteem self motivation personal competence perceived health status and definition of health. c. Personal socio-cultural factors Include variables such as race ethnicity, acculturation, education and socioeconomic status. Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action Anticipated, imagined or real blocks and personal costs of understanding a given behavior.

Perceived Self Efficacy Judgment of personal capability to organize and execute a health-promoting behavior. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. Activity Related Affect Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behavior itself. Activity-related affect influences perceived selfefficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect.

Interpersonal Influences Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social support (instrumental and emotional encouragement) and modeling (vicarious learning through observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and healthcare providers.

Situational Influences Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Situational influences may have direct or indirect influences on health behavior.

Commitment to Plan Of Action The concept of intention and identification of a planned strategy leads to implementation of health behavior

Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack

Assumptions Individuals seek to actively regulate their own behavior. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.

Propositions Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health -promoting behavior. Persons commit to engaging in behaviors from which they anticipate ...