NURSING THEORIES AND CONCEPTUAL FRAMEWORK

Nursing Theory Definition

                If other professions have the theories of their own, nurses also have the Nursing theories which is the term given to the body of knowledge that is used to define or explain different kinds of aspects included in the nursing profession. It was developed by many leaders in the nursing field and some of them are mentioned in this page.

 

 

Florence Nightingale (mid-1800)

Developed and 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 believe that in the nurturing environment, the body could repair itself. Client’s environment is manipulated to include appropriate noise, nutrition, hygiene, light, comfort, socialization and hope.

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, that 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.

Faye Abdellah (1960)

                Introduced Patient- Centered Approaches to Nursing Model. She identified twenty-one nursing problems. She defined nursing as service to individuals and families; therefore to 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.

Dorothy E. Johnson (1960, 1980)

                Conceptualized the Behavioral System Model. According to Johnson , each person as a behavioral system is composed of seven subsystems namely:

Ingestive. Taking in nourishment in socially and culturally acceptable ways.

Eliminative. Riddling the body of waste in socially and culturally acceptable ways.

Affiliative. Security setting behavior.

Aggressive. Self-protective behavior.

Achievement. Master of oneself and one’s environment according to internalized standards of excellence.

Sexual and role identity behavior.

In addition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting and adapting to environmental forces through learned patterns of response. Furthermore, Johnson believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in ways that support biologic imperatives; who is able to benefit to the fullest extent during illness from the health care professional’s knowledge and skills; and whose behavior does not give evidence of unnecessary trauma as a consequence of illness.

Imogene King (1971, 1981)

                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 this is 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 occur and goals are achieved.

Madeleine Leininger (1978, 1984)

                Developed the Transactional Nursing Model. She advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural caring process (cultural values, beliefs and practices) to improve or maintain a health condition.

Myra Levine (1973)

                Described the Four Conservation 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:

Conservation of energy. The human body functions by utilizing energy. The human body needs energy producing input (food, oxygen, fluids) to allow energy utilization as output.

Conservation of Structural Integrity. The human body has physical boundaries (skin and mucous membranes) that must be maintained to facilitate health and prevent harmful agents from entering the body.

Conservation of Personal Integrity. The nursing interventions are based on the conservation of the individual client’s personality. Every individual has a sense of identity, self worth and self esteem, which must be preserved and enhanced by nurses.

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.

Betty Neuman (1982, 1989, 1992)

                Proposed the Health Care System model. She asserted that nursing is a unique profession in that it is concerned with all the variables affecting an individual’s response to stresses, which are intra- ( within the individual), inter-(between one or more other people), and extra personal ( outside the individual) in nature. The concern of nursing is to prevent stress invasion, to protect the client’s basic structure and to obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client stability.

Dorothea Orem (1970, 1985)

                Developed the Self-Care and Self-Care Deficit Theory. She defined self-care as “ the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.” She conceptualized three nursing systems as follows:

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;

Partially Compensatory. When both nurse and patient engage in meeting self care needs;

Supportive- Educative: the system that requires assistance in decision making, behavior control and acquisition of knowledge and skills.

Hildegard Peplau (1952)

                Introduced the Interpersonal Model. She defined nursing as an interpersonal process of therapeutic interactions between an individual who is sick or in need for help. She identified four phases of the nurse client relationship namely:

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;

Identification: the client responds to the 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;

Exploitation: the client utilizes all available resources to move toward a goal of maximum health or functionality;

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.

Martha Rogers (1970)

                Conceptualized the Science of Unitary Human Beings. To Rogers, unitary man is an energy field in constant interaction with the environment. She asserted that human beings are more than and different from the sum of their parts; the distinctive properties of the whole are significantly different from those of its parts. Furthermore, she believed that human being is characterized by the capacity of abstraction and imagery, language and thought, sensation and emotion.

Sister Callista Roy (1979, 1984)

                Presented the Adaptation Model. She viewed each person as a unifying biopsychosocial system in constant interaction with a changing environment.  She contended that a person as an adaptive system, functions as a whole through interdependence of its parts. The system consists of input, control processes, output and feedback. In addition, she advocated that all people have certain needs which they endeavor to meet in order to maintain integrity. These needs are divided into four different modes, the physiological, self concept, role function, and interdependence. Accordingly, Roy believed that adaptive human behavior is directed as an attempt to maintain homeostasis or integrity of the individual by conserving energy and promoting the survival, growth, reproduction and mastery of human system.

Lydia Hall (1962)

                Introduced the Model on 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.

Ida Jean Orlando (1961)

                Conceptualized The Dynamic Nurse- Patient Relationship Model. She believed that the nurse helps patient 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. She also indicated that nursing actions can be automatic ( those chosen for reasons other than the immediate need for help) or deliberative ( those resulting from validating the need for help, exploring the meaning of the need, and validating effectiveness of the actions taken to meet the need). She also advocated that the three elements composing nursing situation are: client behavior, nurse reaction, and nurse action.

Ernestine Weidenbach (1964)

                Developed the Clinical Nursing- A Helping Art Model. She advocated that the nurse’s individual philosophy or central purpose lends credence 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.

Jean Watson (1979-1985)

                Conceptualized the Human Caring Model (Nursing: Human Science and Human Care). She emphasized that nursing is the application of the art and human science through transpersonal caring transactions to help persons achieve mind-body-soul harmony, which generates self- knowledge, self-control, self-care, and self- healing. She included health promotion and treatment of illness in nursing. She believed that a person is a valued being to be cared for, respected, nurtured, understood ans assisted; a fully functional integrated self.]

Rosemarie Rizzo Pars (1981, 1987, 1992)

                Introduced the theory of Human Becoming. She emphasized free choice of personal meaning in relating value priorities, co- creating of rhythmical patterns, in exchange with the environment, and co transcending in many dimension as possibilities unfold. She also believed that each choice opens certain opportunities while closing others. Thus, she referred to revealing-concealing, enabling-limiting, and connecting- separating. Since each individual makes his or her own personal choice, the role of the nurse is that of guide, not decision maker.

Joyce Travelbee (1966, 1971)

                She postulated the Interpersonal Aspects of Nursing Model. She advocated that the goal of nursing  is to assist individual or family in preventing or coping with illness, regaining health, finding meaning in illness, maintaining maximal degree of health. She further viewed that interpersonal process is a human-to- human relationship formed during illness and “experienced of suffering”. She believed that a person is a unique, irreplaceable individual who is in a continuous  process of becoming, evolving, and changing.

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.

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 is unique, has some self-care knowledge, needs simultaneously to be attached to and separate from others, and has adaptive potentials. Nurses in this theory, facilitate, nurture and accept the person unconditionally.

Margarit Newman

                Focus on health as an expanding consciousness. She believed that humans are unitary beings 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 and movement and is ever- expanding change occurs through transformation. Nursing is involved with human beings who have reached choice points and found that their old ways are no longer effective. Caring is a moral imperative for nursing. The nurse is a partner with the client rather than the goal setter and outcome predictor.

Patricia Benner and Judith SWrubel (1989)

                Proposed the Primacy of Caring Model. They believe that caring is central to the essence of nursing. Caring creates the possibilities for connecting with and concern for others.

Anne Boykin and Savina Schoenhofer

                Presented the Grand Theory of Nursing as Caring.  They believed that all persons are caring, and nursing is a response to a unique social call. The focus of nursing is on nurturing persons 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 of helping.

Moral Theories

Sigmund Freud (1961)

                Believed that the mechanism for right and wrong within the individual is the superego, or conscience. He hypothesized 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 feelings of aggression or attachment toward the model parent rather than on the actual standards of the parent.

Erikson (1964)

                Erikson’s theory on the Development of Virtues or unifying strengths of the “good man” suggests that moral development continues throughout life. He believed that if the conflicts of each psychosocial development stages are favorably resolved, then an ‘ego-strength’ or virtue emerges.

Kohlberg

                Suggested three levels of moral development. He focused on the reasons for the making of a decision, not on the morality of the decision itself. At first level called the premoral 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 their actions, i.e., punishment or reward. 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. At the third level called postconventional, autonomous, or principled 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 humans and belief that relationships are based on mutual trust.

 

Peters (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 also believed that the development of character traits or virtues is an essential aspect of moral development. And those virtues of character traits can be learned from others and encouraged by the example of others. Also, Peters believed that some virtues 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.

Schulman and Mekler (1985)

                He believed that morality is a measure of how people treat fellow humans and that a moral child is one who strives to be kind and just. They believed that morality has two components, namely: 1. The intention of the person acting must be good in the sense that the goal of the act is the well-being of the person or more people; 2. The person acting must be fair or just in the sense that the person considers the rights of others without prejudice or favoritism. Furthermore, the aforementioned authors asserted that the theory of moral development is based on three foundations, which they believed can be taught as follows:

1. Internalizing parental standards of right and wrong.
2. Developing emphatic reactions.
3. Acquiring personal standards.

Gillingan (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 that women see morality in the integrity of relationship 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 another or others in which we invest commitment, belief, love, risk and hope.”

Westerhoff

              Proposed that faith is a way of behaving. He developed a four-stage theory of faith development based largely on his life experiences and the interpretation of those experiences. These stages are as follows:

1. Experienced faith (infancy to early adolescence): experiences faith through interaction with others who are living a particular faith.
2. b.      Affiliative faith (late adolescence): actively participates in activities that characterize a particular faith tradition.
3. c.       Searching faith (young adulthood): through a process of questioning and doubting own faith, acquires a cognitive as well as affective faith.
4. d.      Owned faith (middle adulthood): puts faith into personal and social action and is willing to stand up for what he/she believes even against the nurturing community.