Nursing Theorists

Nursing Theorists

1. Florence Nightingale - Environment theory
2. Hildegard Peplau - Interpersonal theory
3. Virginia Henderson - Need Theory
4. Fay Abdella - Twenty One Nursing Problems
5. Ida Jean Orlando - Nursing Process theory
6. Dorothy Johnson - System model
7. Martha Rogers -Unitary Human beings
8. Dorothea Orem - Self-care theory
9. Imogene King - Goal Attainment theory
10. Betty Neuman - System model
11. Sister Calista Roy - Adaptation theory
12. Jean Watson - Philosophy and Caring Model
13. Madeleine Leininger -Transcultural nursing
14. Patricia Benner - From Novice to Expert
15. Lydia E. Hall - The Core, Care and Cure
16. Joyce Travelbee - Human-To-Human Relationship Model
17. Margaret Newman - Health As Expanding Consciousness
18. Katharine Kolcaba - Comfort Theory
19. Rosemarie Rizzo Parse - Human Becoming Theory
20. Ernestine Wiedenbach - The Helping Art of Clinical Nursing 

1. Florence Nightingale- Environmental 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.

Nightingale’s Concepts
1. Person

• Patient who is acted on by nurse
• Affected by environment
• Has reparative powers

2. Environment

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

3. Health

• Maintaining well-being by using a person’s powers
• Maintained by control of environment

4. Nursing

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

2. Hildegard Peplau -Interpersonal Relations 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

Peplau’s Concepts
1. Person

• An individual; a developing organism who tries to reduce anxiety caused by needs
• Lives in instable equilibrium

2. Environment

• Not defined

3. Health

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

4. Nursing

• A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible
• Involves problem-solving

3. 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. 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".

4. Fay Abdella- Topology 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

Abdella’s Concepts
1. Nursing

• A helping profession
• A comprehensive service to meet patient’s needs
• Increases or restores self-help ability
• Uses 21 problems to guide nursing care

2. Health

• Excludes illness
• No unmet needs and no actual or anticipated impairments

3. Person

• One who has physical, emotional, or social needs
• The recipient of nursing care.

4. Environment

• Did not discuss much
• Includes room, home, and community

5. Ida Jean Orlando- Deliberative 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
• Nurses’ actions should be deliberative, rather than automatic
• Deliberative actions explore the meaning and relevance of an action.

6. Dorothy Johnson-Behavioral 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.
• A steady state is maintained through adjusting and adapting to internal and external forces.

Johnson’s 7 Subsystems

• Affiliative subsystem - social bonds
• Dependency - helping or nuturing
• Ingestive - food intake
• Eliminative - excretion
• Sexual - procreation and gratification
• Aggressive - self-protection and preservation
• Achievement - efforts to gain mastery and control

Johnson’s Concepts
1. Person

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

2. Environment

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

3. Health

• Balance and stability.

4. Nursing

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

7. Martha Rogers -Unitary 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

Pattern

• Characteristic of energy field
• A wave that changes, becomes complex and diverse

Pandimensionality

• A nonlinear domain with out time or space

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

Helicy

• Continuous, probabilistic, increasing diversity of the human and envrionmental fields.
• Characterized by nonrepeating rhymicities
• Change

8. Dorothea Orem- Self-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
• 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
• 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

9. Imogene King-Goal 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
• Personal System
  • Individual; perception, self, growth, development, time space, body image
• Interpersonal
  • Socialization; interaction, communication and transaction
• Society
  • Family, religious groups, schools, work, peers
• The nurse and patient mutually communicate, establish goals and take action to attain goals
• Each individual brings a different set of values, ideas, attitudes, perceptions to exchange

10. Betty Neuman - Health Care Systems 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
• Focuses on stress and stress reduction
• Primarily concerned with effects of stress on health
• Stressors are any forces that alter the system’s stability
• Flexible lines of resistance - Surround basic core
• Internal factors that help defend against stressors
• Normal line of resistance -  Normal adaptation state
• Flexible line of defense - Protective barrier, changing, affected by variables
• Wellness is equilibrium

Nursing interventions are activates to:

• strengthen flexible lines of defense
• strengthen resistance to stressors
• maintain adaptation

11. Sister Calista Roy - Adaptation Model

Five Interrelated Essential Elements

1. Patiency- The person receiving care
   
2. Goal of nursing- Adapting to change
   
3. Health-Being and becoming a whole person
   
4. Environment
   
5. Direction of nursing activities- Facilitating adaptation

• 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

12. Jean Watson - Philosophy 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
• A caring environment offers development of potential
• Caring promotes health better than curing
• Caring is central to nursing

Watson’s 10 Carative Factors

• Forming humanistic-altruistic value system
• Instilling faith-hope
• Cultivating sensitivity to self and others
• Developing helping-trust relationship
• Promoting expression of feelings
• Using problem-solving for decision making
• Promoting teaching-learning
• Promoting supportive environment
• Assisting with gratification of human needs
• Allowing for existential-phenomenological forces

Watson’s Concepts

• Person
  • Human being to be valued, cared for, respected, nurtured, understood and assisted
• Environment
  • Society
• Health
  • Complete physical, mental and social well-being and functioning
• Nursing
  • Concerned with promoting and restoring health, preventing illness

13. Rosemary Parse - Human 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

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
• Cotranscendence
  • Refers to reaching out and beyond the limits that a person sets
  • One constantly transforms
• 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
• 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

14. Madeleine Leininger - Culture Care Diversity and Universality

• According to transcultural nursing, the goal of nursing care 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.
• Cultural care preservation
  • help 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

15. Patricia Benner - From Novice to Expert

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

1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

• 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

16. Lydia E. Hall - The Core, Care and Cure

• The theory contains of three independent but interconnected circles:
  1. the core,
  2. the care and
  3. the cure
• The core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person. The core behaved according to his feelings, and value system.
  
• The care circle explains the role of nurse
• The cure is the attention given to patients by the medical professionals.

References

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