Nursing Theorist

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.

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.

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.

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

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.

Faye Glenn Abdellah
(1960)
Twenty One Nursing Problems

Twenty One Nursing Problems

Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement.
Introduced Patient – Centered Approaches to Nursing Model She defined nursing as service to individual and families; therefore the society. Furthermore, she conceptualized nursing as an art and a 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, and cope with their health needs.

21 Nursing Problems

To maintain good hygiene.
To promote optimal activity; exercise, rest and sleep.
To promote safety.
To maintain good body mechanics
To facilitate the maintenance of a supply of oxygen
To facilitate maintenance of nutrition
To facilitate maintenance of elimination
To facilitate the maintenance of fluid and electrolyte balance
To recognize the physiologic response of the body to disease conditions
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory functions
To identify and accept positive and negative expressions, feelings and reactions
To identify and accept the interrelatedness of emotions and illness.
To facilitate the maintenance of effective verbal and non-verbal communication
To promote the development of productive interpersonal relationship
To facilitate progress toward achievement of personal spiritual goals
To create and maintain a therapeutic environment
To facilitate awareness of self as an individual with varying needs.
To accept the optimum possible goals
To use community resources as an aid in resolving problems arising from illness.
To understand the role of social problems as influencing factors