Models of Nursing Theories

Phenomenon

A term given to describe an idea or responses about an event, a situation, a process, a group of events or a group of situations. Phenomena may be temporary or permanent. Nursing theories focus on the phenomena of nursing

Assumptions

Assumptions are accepted as truths and are based on values and beliefs. These are statements that explain the nature of concepts, definitions, purpose, relationships and structure of a theory.

Models

interaction among and between the concepts showing patterns. They present an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice.

Concept

often called the building blocks of theories. They are primarily the vehicles of thought that involve images.

Nursing Metaparadigm

person, environment, health, nursing

Definition of Nursing Theories

-organized bodies of knowledge to define what nursing is, what nurses do and why do they do it. -provides a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). -framework of concepts and purposes intended to guide the practice of nursing at a more concrete and specific level.

Body System Model

1. Integumentary system 2. Respiratory system 3. Cardiovascular system 4. Nervous system 5. Musculoskeletal system 6. Gastrointestinal system 7. Genitourinary system 8. Reproductive system

Roy's adaptation model

1. Physiological needs - activity and rest - nutrition - elimination - fluid and electrolytes - oxygenation - protection - regulation: temperature - regulation: the senses - regulation: endocrine system 2. Self-concept - physical self - personal self 3. Role function 4. Interdependence

Orem's Self Care Theory

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 processes 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 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 human desire to be normal.

Virginia Henderson's Theory

1. breathe normally 2. eat & drink adequately 3. eliminate body wastes 4. move & maintain desirable postures 5. sleep & rest 6. select suitable clothes- dress & undress 7. maintain body temperature within normal range by adjusting clothing and modifying environment 8. keep the body clean & well groomed & protect the integument 9. avoid dangers in the environment & avoid injuring others 10. communicate with others in expressing emotions, needs, fears or opinions 11. worship according to one's faith 12. work in such a way that there is a sense of accomplishment 13. play/ participate in various forms of recreation 14. learn, discover/ satisfy the curiosity that leads to normal development & health & use the available health facilities

Concepts

Concepts are used to help describe or label a phenomenon. They are words or phrases that identify, define and establish structure and boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or concrete. •Abstract Concepts - defined as mentally constructed independent of a specific time or place. •Concrete Concepts - are directly experienced and related to a particular time or place.

Definitions

Definitions are used to convey the general meaning of the concepts of the theory. Definitions can be theoretical or operational. •Theoretical Definitions - define a particular concept based on the theorist's perspective. •Operational Definitions - states how concepts are measured

Nightingale's Environmental Theory

Did not develop a theory of nursing provide philosophical basis from which other theories have emerged and developed. •Nightingale linked health to five environmental factors: a) pure or fresh air b) pure water c) efficient drainage d) cleanliness e) light, especially sunlight

Environment

Environment (or situation) is defined as the internal and external surrounds that affect the client. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.

Components of Nursing Theories

For a theory to be a theory it has to contain a set of concepts, definitions, relational statements and assumptions that explain a phenomenon. It should also explain how these components relate to each other.

Health

Health is defined as the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider

Person

Person (also referred to as Client or Human Beings) is the recipient of nursing care and may include individuals, patients, groups, families and communities.

Relational Statements

Relational statements define the relationships between two or more concepts. They are the chains that link concepts to one another.

Nursing

The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client. The ultimate goal of nursing theories is to improve patient care.

By Goal Orientation

Theories can also be classified based on their goals, they can be descriptive or prescriptive. Explanatory Theory •describe and explain the nature of relationships of certain phenomena to other phenomena.

Classification of Nursing Theories

There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation. By Abstraction •There are three major categories when classifying nursing theories based on their level of abstraction: grand theory, middle-range theory, and practice-level theory.

Theory

a belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of general propositions used as principles of explanation. Theories are also used to describe, predict or control phenomena.

Paradigm

a pattern of shared understanding and assumptions about reality and the world; worldview or widely accepted value system.

Philosophy

beliefs and values that define a way of thinking and are generally known and understood by a group or discipline.

Metaparadigm

discipline and functions as a framework in which the more restricted structures of conceptual models develop. Four major concepts: person, environment, health and nursing.

Descriptive Theories

first level of theory development. They describe the phenomena and identify its properties and components in which it occurs. It is not action oriented or attempt to produce or change a situation. There are two types of descriptive theories: Factor-Isolating Theory •describes the properties and dimensions of phenomena and also known as category-formulating or labelling theory. Explanatory Theory •describes and explain the nature of relationships of certain phenomena to other phenomena.

History of Nursing Theories

ØIn 1860, Florence Nightingale defined nursing in her "Environmental Theory" as "the act of utilizing the environment of the patient to assist him in his recovery." ØIn 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that puts emphasis on the nurse-client relationship as the foundation of nursing practice. ØIn 1955, Virginia Henderson conceptualized the nurse's role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs, thus her Nursing Need Theory was developed. ØIn 1971, Dorothea Orem states in her theory that nursing care is required if the client is unable to fulfill biological, psychological, developmental or social needs. ØIn 1979, Jean Watson developed the philosophy of caring highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.

Prescriptive Theories

•Address the nursing interventions for a phenomenon, guide practice change and predict consequences. •Includes propositions that call for change. •In nursing, prescriptive theories are used to anticipate the outcomes of nursing interventions.

Profession

•Clinical practice generates research questions and knowledge for theory. •In a clinical setting, its primary contribution has been the facilitation of reflecting, questioning and thinking about what nurses do. Because nurses and nursing practice are often subordinate to powerful institutional forces and traditions, the introduction of any framework that encourages nurses to reflect on, question and think about what they do provide an invaluable service.

Maslow's Hierarchy Needs

•Explains human behavior in terms of basic requirements for survival and growth which are arranged according to their importance for survival and their power to motivate the individual. - Physiological Needs, Safety & Security, Love & Belongings, Esteem Needs, Self Actualization

Functional Nursing

•Functional nursing divides the nursing work into functional roles that are then assigned to one of the team members. •In this model, each care provider is responsible for specific duties or tasks. •E.g. SRN in-charge of patient admission, medication, doctor's round and the AN's or WA will be in-charge of taking vital signs, intake output chart, nursing care.

Importance of Nursing Theories

•Helps to recognize what should set the foundation of practice by explicitly describing nursing. •Helps nurses to understand their purpose and role in the healthcare setting. •Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations.

Roy's adaptation model

•Identify types of demands placed on client and client's adaptation to them - physiologic, psychological, sociologic and independence •Nursing attempts to alter the environment when the client is not adapting well or has ineffective coping responses - coping mechanisms

Total Patient Care

•In total patient care, the nurse is responsible for the total care for her patient assignment for the shift she is working. •The SRN is responsible for providing care to several patients during a normal shift. •More suitable for specialized unit e.g. ICU

Middle-Range Nursing Theories

•More limited in scope (as compared to grand theories) and present concepts and propositions at a lower level of abstraction. They address a specific phenomenon in nursing. •Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory. •Most middle-range theories are based on the works of a grand theorist but they can be conceived from research, nursing practice or the theories of other disciplines.

Safety & Security

•Once the individual's basic physical needs are met, his or her needs for safety emerge. •The person tries to maintain the conditions that allow him or her to feel safe and avoid danger. e.g. health, employment, property •Patient - comfortable environment, fall prevention, protection from harm, reassurance - anxiety / fear

Patient Centered

•Patient-focused care models are designed to focus on patient needs rather than staff needs. •Necessary care and services are decentralized and brought to patients; staff is kept close to patients in decentralized workstations. •Care teams are established for a group of patients; within these teams, disciplines collaborate to ensure that patients receive the care they need.

Practice-Level Nursing Theories

•Practice nursing theories are situation specific theories that are narrow in scope and focuses on a specific patient population at a specific time. •It provide frameworks for nursing interventions and suggest outcomes or the effect of nursing practice. •Has a more direct effect on nursing practice as compared to more abstract theories. •These theories are interrelated with concepts from middle-range theories or grand theories.

Orem's Self Care Theory

•Self care deficit theory - to care for and help clients with various needs attain self-care •Need for nursing care is when a self-care deficits exists.

Esteem Needs

•Self-esteem is the feeling that one is worthwhile, competent, and independent. •The esteem of others involves the feeling that other people respect and appreciate the person. e.g: A word thank you from your client or a job well done by your superior would definitely make a different in your esteem needs. •Patient - dignity, confidentiality, motivation, knowledge

Team Nursing

•Team nursing is a care delivery model that assigns staff to teams that are then responsible for a group of patients. •A unit is divided into two teams, each led by a registered nurse. •The team leader supervises and coordinates all of the care provided by those on the team. • Care is divided into the simplest components and then assigned to the care provider with the appropriate level of skills.

Purposes of Nursing Theories

•The primary purpose of theory in the profession of nursing is to improve practice by positively influence the health and quality of life of patients. •Nursing theories are also developed to define and describe nursing care, guide nursing practice and provide a basis for clinical decision making. •The accomplishments of nursing in the past led to the recognition of nursing in academic discipline, research and profession.

Physiological Needs

•These are the basic requirements for human physical survival. •They include such essentials as food, water, shelter, oxygen, and sleep. •When these needs are unmet, human beings will focus on satisfying them and will ignore higher needs. •Patient - adequate nutrition, hygienic needs, elimination, clean bed, oxygen, rest, sleep, movement

Self Actualization

•These are the needs associated with realizing one's full potential. •As these needs emerge, the person focuses on doing what he or she is meant to do in life. •Developing his or her talents and abilities to their fullest extent. •Patient - nurse assist patient to strive to achieve full potential e.g. rehabilitation period.

Models of Nursing Care Delivery

•To ensure that nursing care is provided to patient, the work must be organized. •A care delivery models organizes the work of caring for patients. •The decision of which care delivery model is used is based on the needs of the patients and the availability of competent staff.

Virginia Henderson's Theory

•Viewed basic human needs as the basis of nursing care •To help clients and families to gain independence in meeting 14 fundamental needs.

Love & Belongings

•When the individual's physiological and safety needs are met, needs for love and belongingness emerge. •These needs include longings for an intimate relationship with another person as well as the need to belong to a group and to feel accepted. •Maslow emphasized that these needs involve both giving and receiving love. e.g: children need their parents' love and care in order to have a healthy life, friendship. •Patient - caring, emotional support, nurse-patient relationship.

Grand Nursing Theories

•abstract, broad in scope and complex, therefore requiring further research for clarification. •does not provide guidance for specific nursing interventions but rather provide a general framework and ideas about nursing. •develops their work based on their own experiences and the time they were living explaining why there is so much variation among theories. •Addresses the nursing metaparadigm components of person, nursing, health, and environment.

Primary Nursing

•care delivery model that clearly delineates the responsibility and accountability of the RN and places the RN as the primary provider of care to patients. •patients are assigned a primary nurse. •the primary nurse is responsible for developing with the patient a plan of care. •other nurses caring for the patient follow this plan of care.

Research

•development of theory is fundamental to the research process where it is necessary to use theory as a framework to provide perspective and guidance to the research study. •to guide the research process by creating and testing phenomena of interest. To improve the nursing profession's ability to meet the societal duties and responsibilities, there need to be a continuous reciprocal and cyclical connection with theory, practice, and research. This will help connect the perceived "gap" between theory and practice and promote the theory-guided practice.

Theorist Assumption

•provides the foundations of nursing practice, helps generate further knowledge and indicate in which direction nursing should develop in the future (Brown, 1964). •By providing nurses a sense of identity, nursing theory can help patients, managers and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990). •prepares the nurses to reflect on the assumptions and question the values in nursing, thus further defining nursing and increasing knowledge base. •to define, predict and demonstrate the phenomenon of nursing (Chinn and Jacobs, 1978). •guide knowledge development and directs education, research and practice although each influence the others. (Fitzpatrick and Whall, 2005).