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  1. Nursing Theories AKSHATA BANSODE
  2. A set of concepts, definitions, relationships, and assumptions that project a systematic view of a phenomena It may consist of one or more relatively specific and concrete concepts and propositions that purport to account for, or organize some phenomenon (Barnum, 1988)
  3. According to American Nursing History, Florence Nightingale is considered to be the first nursing theorist and is often called "the founder of modern nursing." The Florence Nightingale nursing theory she is perhaps best known for is her Environmental Theory that is still practiced today. This theory states that effective nursing relies on the patient's environment to assist them in recovery
  4. Concepts – ideas and mental images that help to describe phenomena (Alligood and Marriner-Tomey, 2002) Definitions – convey the general meaning of the concepts Assumptions – statements that describe concepts Phenomenon – aspect of reality that can be consciously sensed or experienced (Meleis, 1997).
  5. It guides nursing practice and generates knowledge It helps to describe or explain nursing Enables nurses to know WHY they are doing WHAT they are doing
  6. The view or perspective of the discipline It contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline
  7. A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline (Alligood and Marriner – Tomey, 2002)
  8. Nursing has identified its domain in a paradigm that includes four linkages: 1) person/client 2) health 3) environment 4) nursing
  9. 1.Person: The person is at the center of the four key concepts of nursing theory, because person refers to the patient who is being cared for. The person may also be referred to as represent a group of individuals, families or communities. Since every human being different and has unique experiences, it's important for nurses to take into account individual characteristics when making healthcare
  10. 2.Environment: A nursing environment is the setting in which nursing healthcare is provided affects both the patient and their ability to heal, as well as the nursing team due to factors nursing unit morale. A nursing environment can be affected by issues such as noise level lighting, scent, the amount of space in rooms and access to nature. In nursing, the environment also extends beyond the healthcare setting. It relates to the patient's everyday life and social experience. The environment metaparadigm in nursing includes personal, social, national and global aspects, as well as societal beliefs and customs
  11. 3.Health :Health in nursing relates to both improving a patient's immediate healthcare state and helping them maintain their overall health and well-being. Certain factors in a nursing environment can improve a patient's health, including cleanliness, preparedness and a sense caring. Basic medical needs like food and clean water can also impact a person's health. Heal impacts the entire lifespan. This metaparadigm looks at the overall life of a client, including physical as well as social, moral and aesthetic areas. Health is contextual, relating to a human's current state in their environment. For example, how health is characterized in a theory related to senior care will look different to how health is characterized in a theory related to newborn babies.
  12. Nursing: Finally, the nursing practice metaparadigm refers to nursing as a practice professional and as an academic discipline. At its core, nursing is a practice that promotes health advocates for patients. It's a professional calling that requires training and education to provide optimal direct patient care. Nurses use nursing theory to inform their decisions and to the critically to determine the best treatment in any situation. Nursing is based on scientific theory but it also takes into account the human element to apply the best evidence-based care in d settings. Nurses use logical analysis, research and nursing theories to provide care that factors in human choice and responsibility.
  13. Grand Nursing Theories Middle-Range Nursing Theories Practice-Level Nursing Theories:
  14. 1.Grand Nursing Theories: Grand nursing theories are the broadest category. They're the most abstract and complex concepts and propositions that provide a general nursing care framework. A grand nursing theory can apply to a variety of nursing care environments and situations. An example of a grand nursing theory is Ida Jean Orlando- Deliberative Nursing Process Theory. This theory examines the definition of the function of nursing and the interaction between the nurse and the patient. It explains how to use the nursing process to improve patient outcomes. Using a broad theory like this one, nurses, nurse educators and nurse researchers can apply the theory in a variety of patient settings and use it with other more specific nursing theories to determine the most optimal outcomes.
  15. 2 Middle-Range Nursing Theories: Middle-range nursing theories are more specific in focus compared to grand nursing theories, but they're broader than the more specific practice-level nursing theories. Middle-range nursing theories may derive from theories of similar disciplines, nursing research or nursing practice. Since they're less abstract than grand nursing theories, middle-range theories tend to be more verifiable through testing. These theories attempt to explain, describe or predict specific issues in clinical nursing practice. An example of a middle-range nursing theory is Imogene King's Theory of Goal Attainment. This theory focuses on the factors that affect the attainment of certain life goals and explains how a nurse and a patient can communicate, set goals together and take actions to achieve goals. The theory examines how the personal system, the interpersonal system and the social system affect goal attainment.
  16. 3. Practice-Level Nursing Theories: Practice-level nursing theories are situation-specific. They're the narrowest in scope and focus of the three levels of nursing theories. They may be based on concepts from grand nursing theories and middle-range nursing theory but provide specific frameworks for specific nursing interventions. Nurses and nurse researchers may apply a practice-level nursing theory when it relates to a defined patient population at a specific time. Since these theories are more specific and unique, they may draw upon multiple theories to create the optimal recommended practice for that particular patient group. For example, a nurse who is working with a patient who is a mother may draw upon elements of middle-range nursing theories like the Maternal Role Attainment Theory by Ramona to provide optimal maternal patient care.
  17. USE • Helps nurses understand their purpose and role in the health care setting • Guides knowledge development • Directs education, research, and practice • Recognizes what should set the foundation of practice by explicitly describing nursing • Provides the foundations of nursing practice • Indicates in which direction nursing should develop in the future
  18. • Gives nurses a sense of identity • Helps patients, managers, and other health care professionals acknowledge a understand the unique contribution nurses make to health care service Allows the nursing profession to maintain professional limits boundaries
  19. Everyday practice enriches theory Both practice and theory are guided by values and beliefs Theory helps to reframe our thinking about nursing Theory guides use of ideas and techniques Theory can close the gap between theory and research To envision potentialities (Gordon, Parker, & Jester, 2001)
  20. Organize patient data Understand patient data Analyze patient data Make decisions about nursing interventions Plan patient care Predict outcomes of care Evaluate patient outcomes (Alligood, 2001)
  21. By asking yourself two very important questions…..
  22. Essential concepts common among nursing theories: Man Health Environment Nursing
  23. Often considered the first nurse theorist Defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery”. Nightingale’s theory remains an integral part of nursing and healthcare today
  24. 1.Florence Nightingale's Environmental Theory: A British nurse who served in the Crimean War, Nightingale is considered the pioneer of nursing. She established the Nightingale Training School for Nurses in 1860. The Florence Nightingale nursing theory on the environment includes the idea that environmental factors such as fresh air, pure water, efficient drainage, cleanliness and direct sunlight affect health. Her theory suggested that deficiency in any of these factors could negatively impact patient health outcomes.
  25. 5 Factors for a Healthy Environment: Pure or fresh air Pure water Efficient drainage Cleanliness Light, especially directs unlight Nightingale’s general concepts of Environmental Sanitation includes: Proper Ventilation Adequate Lighting Cleanliness Adequate Warmth Quiet Diet
  26. Nursing Practice : The principles of Nursing Practice by FN are continuously used to this very day. With the advent of technology and with it globalization, comes threats from the environment. ➢ Global Warming ➢ Industrial Noise ➢ Air Pollution ➢ Fad Diets ➢ Vanity
  27. Nurses of today still needs to: Maintain Adequate Ventilation Promote Adequate & Appropriate Nutrition Maintain Normal Homeostatic Body Temperature Observe Basic Hygiene Comfort Measures including Environmental Sanitation
  28. 2. Dorothea Orem's Nursing Theory: Credited with creating the Nursing Need Theory C Dorothea Orem's nursing theory involves the interrelated theory of self-care, theory of self-care deficit and theory of nursing systems. The theory provides guidance for nurses on how to help their patients perform self-care to maintain their health and well-being. The theory suggests patient recovery improves when patients have some autonomy over self-care practices. If a patient is unable to perform certain self-care duties, due to mobility issues, For example, a nurse can look for ways to help while also promoting autonomy.
  29. ROY,S Adaptation Model Nursing Theory Sister Callista Roy's Adaptation Model Nursing Theory: In her theory, Sister Callista Roy's model sees the individual as a set of interrelated systems that maintain a balance between various stimuli. Roy conceptualizes the person in a holistic perspective. Individual aspects of parts act together to form a unified being. The following are Callista Roy's Adaptation Model's major concepts, including the definition of the nursing metaparadigm as defined by the theory. They are Person, Environment, Health, Nursing, Adaptation, Internal Processes, Regulator and Cognator
  30. Definition:- “Assisting the individual, sick or well, in the performance of those activities contributing to health or it’s recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”. Identified 14 basic needs : 1. Breathing normally 2. Eating and drinking adequately 3. Eliminating body wastes 4. Moving and maintaining desirable position 5. Sleeping and resting 6. Selecting suitable clothes
  31. 7. Maintaining body temperature within normal range 8. Keeping the body clean and well-groomed 9. Avoiding dangers in the environment 10. Communicating with others 11. Worshipping according to one’s faith 12. Working in such a way that one feels a sense of accomplishment 13. Playing/participating in various forms of recreation 14.Learning, discovering or satisfying the curiosity that leads to normal development and health and using available health facilities.
  32. Bedside Nursing : pt.’s ability to perform the 14 basic needs should be assessed before considering the kind of nursing care function you will administer. Essential to determine if the N will be performing as a HELPER, DOER or a PARTNER Nsg interventions are implemented according to the 14 basic human needs of the patient. The degree of performance , involvement of the pt. and the level of nursing activity will be dependent on the specific role the nurse will be playing
  33. Focus is on PROPER IDENTIFICATION of the problem Particularly about the proper NURSING DIAGNOSIS Nurse-centered Nursing is a comprehensive service that is based on the art and science and aims to help people, sick or well, 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
  34. 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.
  35. 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
  36. Bedside Nursing : The N’s ability to address &effectively manage the 21 Nursing problems will spell the patient’s state of health – whether he fully recovers well & fast, or deteriorate further with devastating consequences Ns therefore, have very important role to play. By adhering to these nursing problems, the work of a N becomes More Definite
  37. Nursing is a HUMANISTIC and SCIENTIFIC mode of helping through CULTURE-SPECIFIC PROCESS Emphasizes human caring varies among cultures - Culture Care Preservation and Maintenance Culture Care Accommodation and Negotiation Culture Care Restructuring and Repatterning
  38. Application: Important esp because of the rapid expansion of knowledge & increasing globalization with the advent of advances in ICT . Working Overseas : Impt to learn the cultures of other people because each culture has its own sets of patterns, expressions & values of caring . Getting acquainted with the culture of a country you are seeking employment as a professional nurse will be a good steppingstone towards a more fulfilling career in nursing
  39. 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. The goal of nurses is to participate in the process of change.. 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.
  40. 5 basic assumptions: ■ The human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts. ■ The individual and the environment are continuously exchanging matter and energy with each other ■ The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum ■ Patterns identify human being and reflect their innovative wholeness ■ The individual is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion
  41. Patient has THREE 3 interacting systems – 1. Individuals /Personalsystems : How the nurse views and integrates self basedfrom personal goals and beliefs. 2. Groupsystems / Interpersonalsystems : How the N interrelates w/ a co-workers or pt.particularly in N-Pt. Relationship 3. Socialsystems : how the N interacts w/ co-workers, superiors,subordinates & the ct. environment in general
  42. Action : A means of behaviour or activities that are towards the accomplishment of certain act. It is both PHYSICAL & MENTAL . Mental (POA) Action (Goal Setting w/ Ct.) Perform Achieve Goal
  43. Reaction A form of reacting or response to a certain Stimuli. Interaction Any situation wherein the N relates & deals With a ct. or pt. Transaction Application: Provides enough direction to how nurses should be able to behave or act in the presence of pts. Since majority of nursing activities involves direct interaction w/ pts., Ns should understand the basic implications of the Action-Reaction-Interaction-Transaction model of the N- Pt . Relationship.
  44. Peplau is a psychiatric nurse –Focus :Therapeutic process –Attained through: Healthy Nurse-Patient Relationship Four (4) Phases of Nurse-Patient Interaction 1. Orientation Nurse and patient test therole each one assumes Prepares patient for termination Patient identifies areas of difficulty
  45. 2. Identification Phase : •Patient identifies with the personnel who can satisfy his needs 3. Exploitation Phase: •Nurse maximizes all there sources to the patient benefit 4. Resolution Phase or Termination Phase : • Occurs when patient’s needs have been met
  46. Application : Significant in terms of the different phases of the N-Pt. interaction & the different ROLES the N can play in giving nursing care to pts. It thus becomes important for nurses to understand the principles behind each of these concepts so that clinical nsg will be more meaningful for the nurse. Eventually , this will translate to pt. outcomes like : Improved health Prevention of Disease pr Enhancement of care faculties
  47. 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 nurturant 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
  48. Carative Factors: ■ The promotion of a humanistic-altruistic system of values ■ Instillation of faith-hope ■ The cultivation of sensitivity to one’s self and others ■ The development and acceptance of the expression of positive and negative feelings. ■ The systemic use of the scientific problem-solving method for decision making ■ The promotion of interpersonal teaching-learning ■ The provision for supportive, protective and corrective mental, physical, socio-cultural and spiritual environment ■ Assistance with the gratification of human needs ■ The allowance for existential phenomenological forces
  49. The Nursing Process is an interaction of Three Basic Elements: 1. Patient’s Behaviour 2. Nurse’s reaction 3. Nursing Actions – designed for the patient’s benefit The Role of the Nurse is to find out & meet the Pt’s stat need for help. Ns should use his perception, thoughts about the perception or the feeling engendered from their thoughts to explore with patients the meaning of their behaviour The use of the theory keeps the N’s focus on the patient
  50. Application: The Theory increases the Therapeutic Effectiveness of nurses by the expression of Empathy, Warmth & Genuineness esp in the light of addressing the Stat Need of the Patient for help. This framework will be important for Ns who are assigned in special clinical areas that requires quick decision making & critical thinking skills . If the patient’s condition improved, then the intervention is effective and the patient moves on to new problems
  51. Greatly emphasized on the Therapeutic Human Relationship between the Nurse & the Patient. Her model emphasizes: Empathy Sympathy Rapport & the Emotional aspects of Nursing 4 Interlocking Phases that precedes RAPPORT And the establishment of N-Pt . Relationship: Original Encounter Emerging Identities Empathy Sympathy
  52. Application: The theory describes the various stages of interpersonal relations that occur bet a Patient and a N. It thus becomes important for Ns to fully understand the phases and its effects to the patient’s welfare. Due consideration should be given to the pt’s inherent personal characteristics to interact w/ other people, most especially Ns & other members of the healthcare professions. The key concept of Empthy ,Sympathy, Rapport & Emotional Understanding are very important for the Ns of today
  53. Focuses on 10 Categories of determinants of health- Promoting Behaviours. Views a person’s health-promoting behaviour in the light of his individual characteristics & experiences
  54. The10 Determinants are : Prior related behaviour Perceived benefits of action Perceived barriers of action Perceived self-efficacy Activity related effect Interpersonal Influences (family, friends, providers) norms, support & models Situational Influences ( options, demand characteristics, aesthetics)– Immediate competing demands (low control) and preferences (high demand) Commitment to a plan of action– Personal Factors ( Biological, Psychological, Sociocultural)
  55. Application: Health Promotion Activities are the major Focus of Hx Care Organizations . In order for Patients to take on the Behaviour we, Hx care professionals , advise them to take, we should carefully looked into a host of factors that can influence his decision to really adopt the behaviour. It is important for Ns to be ROLE MODELS for the pts.
  56. The model is based on the Person’s Relationship to Stress ,his Reaction to it and Reconstitution factors that are dynamic in nature The concern of nursing is to PREVENT STRESS INVASION Person is viewed as an Open System composed of Basic Structure of Energy Resources which includes: • Physiologic • Psychologic • Sociocultural • Developmental • Spiritual
  57. Basic Structure/Central Core- surrounded by 2 concentric boundaries or Rings called Lines Of Resistance Which represents the internal factors that AID the person Defend against a Stressor . Lines of Resistance – further surrounded by 2 lines of Defense 1.Normal Line of Defense 2. Flexible Line of Defense 1.Normal Line of Defense : person’s state of equilibrium or the state of adaptation developed & maintained over time and which is considered normal for the person
  58. 2.Flexible Line of Defense- dynamic and can be readily and rapidly changed over a short period of time.- adjusts to situations that threatens the imbalance w/in the client’s stability Stressors: Intrapersonal Interpersonal Extrapersonal FOCUS of Nursing Interventions :- keeping or maintaining the stability of the open system which can be carried out on three levels of prevention
  59. APPLICATION :- Very comprehensive model of nsg that outlines the way how Ns provide HOLISTIC NURSING CARE to pts. Emphasis is on the management of Stress thru adequate understanding of the complex client system . Strong Advocate of Prevention Interventions which is congruent to the aims of modern-day nsg & Hx care services. It is a MUST that Ns perform thorough &comprehensive assessment that includes ALL aspects of the Ct.
  60. Man is a BIO PSYCHOSOCIAL BEING Four (4) modes of Adaptation – Physiologic Mode Self Concept Role Function Interdependence Her Model is best exemplified in the Nursing Process which includes the following steps: 1. Assessment of Behaviour 2. Assessment of Stimuli 3. Nursing Diagnosis 4. Goal Setting 5. Intervention 6. Evaluation
  61. APPLICATION : Best applied in the performance of the Nursing Process which is cyclical in nature . The Assessment component is the Stimuli or Input The Planning & Implementation are the Through put process . The Evaluation which provides necessary feedback to the Goal of care is the Output The N decides what necessary actions should betaken next in the light of the patient’s response to the Nursing Interventions. This action by the N is Adaptation in its simplest terms Patients adopt too. The Nursing interventions we perform ultimately elicits a response from them. Depending on the nature & extent of the nursing interventions, pts may or may not actually adopt according to our expectations
  62. 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.Self-care deficit - results when self-care agency (Individual’s ability) is not adequate to meet the known self-care needs.
  63. 3.Nursing System - nursing interventions needed when Individual is unable to perform the necessary self-care activities: 𝗈 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. 𝗈 𝗈
  64. Theory provides direction for nursing research Relationships of components in a theory help to drive the research questions for understanding nursing Chinn and Kramer (2004), indicate a spiral relationship between the two
  65. Medical science Nursing education Professional nursing organizations Evolving research approaches Global concerns Consumer demands Technologies