Nursing theorists · 4/8/2020  · Imogene King Goal Attainment Theory The nurse and patient...

Gloria A. Hagopian, RN, EdD 4/8/2020 1

Nursing Theorists

Week 11 and 12

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Definitions

Theory- a set of related statements that describes or explains phenomena in a systematic way

Concept-a mental idea of a phenomenon

Construct- a phenomena that cannot be observed and must be inferred

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Definitions

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, Patricia Benner

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Concepts in the nursing metaparadigm

Person Recipient of care, including physical, spiritual, psychological, and sociocultural components

Individual, family, or community

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Concepts in the nursing metaparadigm

EnvironmentAll internal and external conditions, circumstances, and influences affecting the person

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Concepts in the nursing metaparadigm

HealthDegree of wellness or illness experienced by the person

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Concepts in the nursing metaparadigm

NursingActions, characteristics and attributes of person giving care

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Florence NightingaleEnvironmental Theory

First nursing theorist

Unsanitary conditions posed health hazard (Notes on Nursing, 1859)

5 components of environment

ventilation, light, warmth, effluvia, noise

External influences can prevent, suppress or contribute to disease or death

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Nightingale’s ConceptsPerson

Patient who is acted on by nurse

Affected by environment

Has reparative powers

Environment

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

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Nightingale’s Concepts

Health

Maintaining well-being by using a person’s powers

Maintained by control of environment

Nursing

Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process

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Hildegard PeplauInterpersonal Relations Model

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Hildegard PeplauInterpersonalRelations Model

Based on psychodynamic nursing

using an understanding of one’s own behavior to help others identify their difficulties

Applies principles of human relations

Patient has a felt need

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Peplau’s Concepts

Person

An individual; a developing organism who tries to reduce anxiety caused by needs

Lives in instable equilibrium

Environment- Not defined

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Peplau’s Concepts

Health

Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living

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Peplau’s Concepts

Nursing

A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible

Involves problem-solving

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Virginia Henderson

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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 strength, will, or knowledge.

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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”.

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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 mouthpiece for those too weak or withdrawn to speak, and so on.”

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Fay Abdella- Topology of 21 Nursing Problems

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Fay AbdellaTopology of 21 Nursing Problems

A list of 21 nursing problems

Condition presented or faced by the patient or family.

Problems are in 3 categories

physical, social and emotional

The nurse must be a good problem solver

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Abdella’s ConceptsNursing

A helping profession

A comprehensive service to meet patient’s needs

Increases or restores self-help ability

Uses 21 problems to guide nursing care

Health

Excludes illness

No unmet needs and no actual or anticipated impairments

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Abdella’s Concepts

Person

One who has physical, emotional, or social needs

The recipient of nursing care.

Environment

Did not discuss much

Includes room, home, and community

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Ida Jean OrlandoDeliberative Nursing Process

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Ida Jean OrlandoDeliberative Nursing Process

The deliberative nursing process is set in motion by the patient’s behavior

All behavior may represent a cry for help. Patient’s behavior can be verbal or non-verbal.

The nurse reacts to patient’s behavior and forms basis for determining nurse’s acts.

Perception, thought, feeling

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Ida Jean OrlandoDeliberative NursingProcess

Nurses’ actions should be deliberative, rather than automatic

Deliberative actions explore the meaning and relevance of an action.

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Dorothy JohnsonBehavioral Systems Model

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Dorothy JohnsonBehavioral Systems Model

The person is a behavioral system comprised of a set of organized, interactive, interdependent, and integrated subsystems

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

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Dorothy JohnsonBehavioral Systems Model

A steady state is maintained through adjusting and adapting to internal and external forces.

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Johnson’s 7 Subsystems

Affiliative subsystem

social bonds

Dependency

helping or nuturing

Ingestive

food intake

Eliminative

excretion

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Dorothy JohnsonBehavioral Systems Model 7 Sub Systems

Sexual

procreation and gratification

Agressive

self-protection and preservation

Achievement

efforts to gain mastery and control

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Johnson’s Concepts

Person

A behavioral system comprised of subsystems constantly trying to maintain a steady state

Environment

Not specifically defined but does say there is an internal and external environment

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Dorothy JohnsonBehavioral Systems Model

Health

Balance and stability.

Nursing

External regulatory force that is indicated only when there is instability.

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Martha RogersUnitary Human Beings

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Martha RogersUnitary Human Beings

Energy fields

Fundamental unity of things that are unique, dynamic, open, and infinite

Unitary man and environmental field

Universe of open systems

Energy fields are open, infinite, and interactive

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Martha RogersUnitary Human Beings

Pattern

Characteristic of energy field

A wave that changes, becomes complex and diverse

Four dimensionality

A nonlinear domain with out time or space

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Roger’s Definitions

Integrality

Continuous and mutual interaction between man and environment

Resonancy

Continuous change longer to shorter wave patterns in human and environmental fields

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Martha RogersUnitary Human Beings

Helicy

Continuous, probabilistic, increasing diversity of the human and envrionmental fields.

Characterized by nonrepeating rhymicities

Change

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Dorothea OremSelf-Care Model

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Dorothea OremSelf-Care Model

Self-care comprises those activities performed independently by an individual to promote and maintain person well-being

Self care agency is the individual’s ability to perform self care activities

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Dorothea OremSelf-Care Model

Self- care deficit occurs when the person cannot carry out self-care

The nurse then meets the self-care needs by acting or doing for;guiding, teaching, supporting or providing the environment to promote patient’s ability

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Dorothea OremSelf-Care Model

Wholly compensatory nursing system

Patient dependent

Partially compensatory

Patient can meet some needs but needs nursing assistance

Supportive educative

Patient can meet self care requisites, but needs assistance with decision making or knowledge

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Imogene KingGoal Attainment Theory

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Imogene KingGoal Attainment Theory

Open systems framework

Human beings are open systems in constant interaction with the environment

Personal System

individual; perception, self, growth, development, time space, body image

Interpersonal

Society

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Imogene KingGoal Attainment Theory

Personal System

Individual; perception, self, growth, development, time space, body image

Interpersonal

Socialization; interaction, communication and transaction

Society

Family, religious groups, schools, work, peers

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Imogene KingGoal Attainment Theory

The nurse and patient mutually communicate, establish goals and take action to attain goals

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Imogene KingGoal Attainment Theory

Each individual brings a different set of values, ideas, attitudes, perceptions to exchange

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Betty NeumanSystems Model

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Betty NeumanHealth CareSystems Model

The person is a complete system, with interrelated parts

maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli

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Betty NeumanHealth CareSystems Model

Focuses on stress and stress reduction

Primarily concerned with effects of stress on health

Stressors are any forces that alter the system’s stability

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Betty NeumanHealth CareSystems Model

Flexible lines of resistanceSurround basic core

Internal factors that help defend against stressors

Normal line of resistanceNormal adaptation state

Flexible line of defenseProtective barrier, changing, affected by variables

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Betty NeumanSystems Model

Wellness is equilibrium

Nursing interventions are activites to:

strengthen flexible lines of defense

strengthen resistence to stressors

maintain adaptation

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Sister Calista RoyAdaptation Model

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Sister Calista RoyAdaptation Model

Five Interrelated Essential Elements

Patiency- The person receiving care

Goal of nursing- Adapting to change

Health-Being and becoming a whole

person

Environment

Direction of nursing activities-

Facilitating adaptation

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Sister Calista RoyAdaptation Model

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

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Jean WatsonPhilosophy and Science of Caring

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Jean WatsonPhilosophy and Science of Caring

Caring can be demonstrated and practiced

Caring consists of carative factors

Caring promotes growth

A caring environment accepts a person as he is and looks to what the person may become

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Jean WatsonPhilosophy and Science of Caring

A caring environment offers development of potential

Caring promotes health better than curing

Caring is central to nursing

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Watson’s 10 Carative Factors

Forming humanistic-altruistic value system

Instilling faith-hope

Cultivating sensitivity to self and others

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Watson’s 10 Carative Factors

Developing helping-trust relationship

Promoting expression of feelings

Using problem-solving for decision making

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Watson’s 10 Carative Factors

Promoting teaching-learning

Promoting supportive environment

Assisting with gratification of human needs

Allowing for existential-phenomenological forces

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Watson’s Concepts

Person

Human being to be valued, cared for, respected, nurtured, understood and assisted

Environment

Society

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Jean WatsonPhilosophy and Science of Caring

Health

Complete physical, mental and social well-being and functioning

Nursing

Concerned with promoting and restoring health, preventing illness

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Rosemary ParseHuman Becoming Theory

Human Becoming Theory includes Totality Paradigm

Man is a combination of biological, psychological, sociological and spiritual factors

Simultaneity Paradigm

Man is a unitary being in continuous, mutual interaction with environment

Originally Man-Living-Health Theory

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Parse’s Three Principles

Meaning

Man’s reality is given meaning through lived experiences

Man and environment cocreate

Rhythmicity

Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns

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Parse’s Three Principles

Cotranscendence

Refers to reaching out and beyond the limits that a person sets

One constantly transforms

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Rosemary ParseHuman BecomingTheory

Person

Open being who is more than and different from the sum of the parts

Environment

Everything in the person and his experiences

Inseparable, complimentary to and evolving with

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Rosemary Parse

Health

Open process of being and becoming. Involves synthesis of values

Nursing

A human science and art that uses an abstract body of knowledge to serve people

Human BecomingTheory

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Madeleine LeiningerCulture Care Diversity and Universality

Based on transcultural nursing, whose goal is to provide care congruent with cultural values, beliefs, and practices

Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care

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Madeleine LeiningerCulture Care Diversity

Modes of nursing action

Cultural care preservationhelp maintain or preserve health, recover from illness, or face death

Cultural care accommodation

help adapt to or negotiate for a beneficial health status, or face death

Cultural care re-patterning

help restructure or change lifestyles that are culturally meaningful

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Patricia Benner From Novice to Expert

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Patricia Benner From Novice toExpert

Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level

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Patricia Benner From Novice toExpert

Levels reflect:

movement from reliance on past abstract principles to the use of past concrete experience as paradigms

change in perception of situation as a complete whole in which certain parts are relevant

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Patricia Benner From Novice toExpert

Novice

Advanced beginner

Competent

Proficient

Expert

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Importance of Theoretical Frameworks

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

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Next Steps

Responsibility of nurses to know and understand theorists

Critically analyze theoretical frameworks