Nursing and Other Related Theories

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.
CONCEPTUAL AND THEORETICAL MODELS OF NURSING PRACTICE
A. NIGHTANGLE’S THEORY ( mid-1800)
 Focuses on the patient and his environment.
 Developed the described the first theory of nursing. Notes on Nursing: What It Is, What It Is Not. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.
 She believed that in the nurturing environment, the body could repair itself. Client’s environment is manipulated to include appropriate noise, nutrition, hygiene, socialization and hope.
B. PEPLAU, HILDEGARD (1951)
Defined nursing as a therapeutic, interpersonal process which strives to develop a nurse- patient relationship in which the nurse serves as a resource person, counselor and surrogate.
Introduced the Interpersonal Model. She defined nursing as an interpersonal process of therapeutic between an individual who is sick or in need of health services and a nurse especially educated to recognize and respond to the need for help. She identified four phases of the nurse client relationship namely:
1. Orientation: the nurse and the client initially do not know each other’s goals and testing the role each will assume. The client attempts to identify difficulties and the amount of nursing help that is needed;
2. Identification: the client responds to help professionals or the significant others who can meet the identified needs. Both the client and the nurse plan together an appropriate program to foster health;
3. Exploitation: the clients utilize all available resources to move toward a goal of maximum health functionality;
4. Resolution: refers to the termination phase of the nurse-client relationship. it occurs when the client’s needs are met and he/she can move toward a new goal. Peplau further assumed that nurse-client relationship fosters growth in both the client and the nurse.
C. ABDELLAH, FAYE G. (1960)
 Defined nursing as having a problem-solving approach, with key nursing problems related to health needs of people; developed list of 21 nursing-problem areas.
 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.
D. ORLANDO, IDA
 She conceptualized The Dynamic Nurse – Patient Relationship Model.
E. LEVINE, MYRA (1973)

 Believes nursing intervention is a conservation activity, with conservation of energy as a primary concern, four conservation principles of nursing: conservation of client energy, conservation of structured integrity, conservation of personal integrity, conservation of social integrity.

 Described the Four Conversation Principles. She Advocated that nursing is a human interaction and proposed four conservation principles of nursing which are concerned with the unity and integrity of the individual. The four conservation principles are as follows:
1. Conservation of energy. The human body functions by utilizing energy. The human body needs energy producing input (food, oxygen, fluids) to allow energy utilization output.
2. Conservation of Structural Integrity. The human body has physical boundaries (skin and mucous membrane) that must be maintained to facilitate health and prevent harmful agents from entering the body.
3. Conservation of Personal Integrity. The nursing interventions are based on the conservation of the individual client’s personality. Every individual has sense of identity, self worth and self esteem, which must be preserved and enhanced by nurses.
4. Conservation of Social integrity. The social integrity of the client reflects the family and the community in which the client functions. Health care institutions may separate individuals from their family. It is important for nurses to consider the individual in the context of the family.
F. JOHNSON, DOROTHY (1960, 1980)
 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.
Conceptualized the Behavioral System Model. 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
G. ROGERS, MARTHA
 Considers man as a unitary human being co-existing with in the universe, views nursing primarily as a science and is committed to nursing research.
H. OREM, DOROTHEA (1970, 1985)

 Emphasizes the client’s self-care needs, nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental or social needs.
 Developed the Self-Care Deficit Theory. She defined self-care as “the practice of activities that individuals initiate to perform on their own behalf in maintaining life, health well-being.” She conceptualized three systems as follows:
1. Wholly Compensatory: when the nurse is expected to accomplish all the patient’s therapeutic self-care or to compensate for the patient’s inability to engage in self care or when the patient needs continuous guidance in self care;

2. Partially Compensatory: when both nurse patient engage in meeting self care needs;
3. Supportive-Educative: the system that requires assistance decision making, behavior control and acquisition knowledge and skills.
I.IMOGENE KING (1971, 1981)
 Nursing process is defined as dynamic interpersonal process between nurse, client and health care system.
 Postulated the Goal Attainment Theory. She described nursing as a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If is this not possible, nurses help individuals die with dignity.
 In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them transactions occurred and goals are achieved.

J. BETTY NEUMAN
 Stress reduction is a goal of system model of nursing practice. Nursing actions are in primary, secondary or tertiary level of prevention.
K. SIS CALLISTA ROY (Adaptation Theory) (1979, 1984)
 Views the client as an adaptive system. The goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function and interdependent relations during health and illness.
 Presented the Adaptation Model. She viewed each person as a unified biopsychosocial system in constant interaction with a changing environment. She contented that the person as an adaptive system, functions as a whole through interdependence of its part. The system consist of input, control processes, output feedback.
L.LYDIA HALL (1962)
 The client is composed of the ff. overlapping parts: person (core), pathologic state and treatment (cure) and body (care).
 Introduced the model of Nursing: What Is It?, focusing on the notion that centers around three components of CARE, CORE and CURE. Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s orders. Core and cure are shared with the other health care providers.
M. Virginia Henderson (1955)

 Introduced The Nature of Nursing Model. She identified fourteen basic needs.
 She postulated that the unique function of the nurse is to assist the clients, sick or well, in the performance of those activities contributing to health or its recovery, the clients would perform unaided if they had the necessary strength, will or knowledge.
 She further believed that nursing involves assisting the client in gaining independence as rapidly as possible, or assisting him achieves peaceful death if recovery is no longer possible.
N. Madaleine Leininger (1978, 1984)
 Developed the Transcultural Nursing Model. She advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural caring processes (cultural values, beliefs and practices) to improve or maintain a health condition.
O. Ida Jean Orlando (1961)
 Conceptualized The Dynamic Nurse – Patient Relationship Model.
 She believed that the nurse helps patients meet a perceived need that the patient cannot meet for themselves. Orlando observed that the nurse provides direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness.
 She emphasized the importance of validating the need and evaluating care based on observable outcomes.
P. Ernestine Weidanbach (1964)
 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.
Q. Jean Watson (1979-1992)
 Introduced the theory of Human Becoming. She emphasized free choice of personal meaning in relating value priorities, co – creating the rhythmical patterns, in exchange with the environment, and co transcending in many dimensions as possibilities unfold.
R. Joyce Travelbee (1966,1971)
 She postulated the Interpersonal Aspects of Nursing Model. She advocated that the goal of nursing individual or family in preventing or coping with illness, regaining health finding meaning in illness, or maintaining maximal degree of health.
 She further viewed that interpersonal process is a human-to-human relationship formed during illness and “experience of suffering”
 She believed that a person is a unique, irreplaceable individual who is in a continuous process of becoming, evolving and changing.
S. Josephine Peterson and Loretta Zderad (1976)
 Provided the Humanistic Nursing Practice Theory. This is based on their belief that nursing is an existential experience.
 Nursing is viewed as a lived dialogue that involves the coming together of the nurse and the person to be nursed.
 The essential characteristic of nursing is nurturance. Humanistic care cannot take place without the authentic commitment of the nurse to being with and the doing with the client. Humanistic nursing also presupposes responsible choices.
T. Helen Erickson, Evelyn Tomlin, and Mary Ann Swain (1983)
 Developed Modeling and Role Modeling Theory. The focus of this theory is on the person. The nurse models (assesses), role models (plans), and intervenes in this interpersonal and interactive theory.
 They asserted that each individual unique, has some self-care knowledge, needs simultaneously to be attached to the separate from others, and has adaptive potential. Nurses in this theory, facilitate, nurture and accept the person unconditionally.
U. Margaret Newman
 Focused on health as expanding consciousness. She believed that human are unitary in whom disease is a manifestation of the pattern of health.
 She defined consciousness as the information capability of the system which is influenced by time, space movement and is ever – expanding.
V. Patricia Benner and Judith Wrudel (1989)
 Proposed the Primacy and Caring Model. They believed that caring central to the essence of nursing. Caring creates the possibilities for coping and creates the possibilities for connecting with and concern for others.
W. Anne Boykin and Savina Schoenhofer
 Presented the grand theory of Nursing as Caring. They believed that all person are caring, and nursing is a response to a unique social call. The focus of nursing is on nurturing person living and growing in caring in a manner that is specific to each nurse-nursed relationship or nursing situation. Each nursing situation is original.
 They support that caring is a moral imperative. Nursing as Caring is not based on need or deficit but is egalitarian model helping.
Moral Theories
1. Freud (1961)
 Believed that the mechanism for right and wrong within the individual is the superego, or conscience. He hypnotized that a child internalizes and adopts the moral standards and character or character traits of the model parent through the process of identification.
 The strength of the superego depends on the intensity of the child’s feeling of aggression or attachment toward the model parent rather than on the actual standards of the parent.
2. Erikson (1964)
 Erikson’s theory on the development of virtues or unifying strengths of the “good man” suggest that moral development continuous throughout life. He believed that if the conflicts of each psychosocial developmental stages favorably resolved, then an ‘ego-strength” or virtue emerges.
3. Kohlberg
 Suggested three levels of moral development. He focused on the reason for the making of a decision, not on the morality of the decision itself.
1. At first level called the premolar or the preconventional level, children are responsive to cultural rules and labels of good and bad, right and wrong. However children interpret these in terms of the physical consequences of the actions, i.e., punishment or reward.
2. At the second level, the conventional level, the individual is concerned about maintaining the expectations of the family, groups or nation and sees this as right.
3. At the third level, people make postconventional, autonomous, or principal level. At this level, people make an effort to define valid values and principles without regard to outside authority or to the expectations of others. These involve respect for other human and belief that relationship are based on mutual trust.



Peter (1981)
 Proposed a concept of rational morality based on principles. Moral development is usually considered to involve three separate components: moral emotion (what one feels), moral judgment (how one reasons), and moral behavior (how one acts).
 In addition, Peters believed that the development of character traits or virtues is an essential aspect or moral development. And that virtues or character traits can be learned from others and encouraged by the example of others.
 Also, Peters believed that some can be described as habits because they are in some sense automatic and therefore are performed habitually, such as politeness, chastity, tidiness, thrift and honesty.
Gilligan (1982)
 Included the concepts of caring and responsibility. She described three stages in the process of developing an “Ethic of Care” which are as follows.
1. Caring for oneself.
2. Caring for others.
3. Caring for self and others.
 She believed the human see morality in the integrity of relationships and caring. For women, what is right is taking responsibility for others as self-chosen decision. On the other hand, men consider what is right to be what is just.
Spiritual Theories
Fowler (1979)
 Described the development of faith. He believed that faith, or the spiritual dimension is a force that gives meaning to a person’s life.
 He used the term “faith” as a form of knowing a way of being in relation “to an ultimate environment.” To Fowler, faith is a relational phenomenon: it is “an active made-of-being-in-relation to others in which we invest commitment, belief, love, risk and hope.”
ROLES AND FUNCTIONS OF THE NURSE
Selected Expanded Career Roles of Nurses
1. Nurse Practitioner
 A nurse who has an advanced education and is a graduate of a nurse practitioner program.
 These nurses are in areas as adult nurse practitioner, family nurse practitioner, school nurse practitioner, pediatric nurse practitioner, or gerontology nurse practitioner.
 They are employed in health care agencies or community based settings. They usually deal with non-emergency acute or chronic illness and provide primary ambulatory care.
2. Clinical Nurse Specialist
 A nurse who has an advanced degree or expertise and is considered to be an expert in a specialized area of practice (e.g., gerontology, oncology).
 The nurse provides direct client care, educates others, consults, conducts research, and manages care.
 The American Nurses Credentialing Center provides national certification of clinical specialists.
3. Nurse Anesthetist
 A nurse who has completed advanced education in an accredited program in anesthesiology.
 The nurse anesthetist carries out pre-operative visits and assessments, and Administers general anesthetics for surgery under the supervision of a physician prepared in anesthesiology.

 The nurse anesthetist also assesses the postoperative of clients
4. Nurse Midwife
 An RN who has completed a program in midwifery.
 The nurse gives pre-natal and post-natal care and manages deliveries in normal pregnancies.
 The midwife practices the association with a health care agency and can obtain medical services if complication occurs.
 The nurse midwife may also conduct routine Papanicolaou smears, family planning, and routine breast examination.
5. Nurse Educator
 Nurse educator is employed in nursing programs, at educational institutions, and in hospital staff education.
 The nurse educator usually ha a baccalaureate degree or more advanced preparation and frequently has expertise in a particular area of practice. The nurse educator is responsible for classroom and of ten clinical teaching.
6. Nurse Entrepreneur
 A nurse who usually has an advanced degree and manages a health-related business.
 The nurse may be involved in education, consultation, or research, for example.