Chap10 nrsgfrmk

Using Nursing Theory to Guide
Professional Practice
Chapter 10
Copyright © 2014, 2009 by Mosby, Inc., an
imprint of Elsevier Inc.

Background
 Theory-based practice
 Provides a systematic, knowledgeable
approach to patient care
 Contributes to the professional growth of the
nurse and the nursing profession as a whole
 Nursing theory
 Provides a systematic, knowledgeable
approach to patient care
 Serves as a tool for critical thinking and
decision-making in nursing practice
2

Background (Cont'd)
 Philosophies
 Express beliefs about nursing and nursing-
related values
 Provide broad, global explanations of
phenomena of interest that contribute to nursing
knowledge
 Serve as guides for professional practice and
influence professional behaviors
 Nightingale, Watson, and Benner
3

Background (Cont'd)
 Concepts
 Are building blocks of a nursing theory that is
initiated based on a personal philosophy or
belief about nursing
 May be abstract or concrete
 Describe and classify a phenomenon of interest
 Thought of as an idea and must be clearly
defined
 Constructs
 Similar to concepts but more abstract
4

Background (Cont'd)
 Conceptual models or nursing frameworks
 Structures that guide the development of a
study
 Also called paradigm (detailed organizing
framework)
 Interrelated definitions and concepts organized
for viewing phenomena specific to nursing
 Levine, Orem, King, Newman, Roy, and
Johnson
5

Background (Cont'd)
 Theories
 Integrated set of concepts and statements that
can be used to explain, describe, predict, or
control a phenomenon
 May be developed using inductive or deductive
reasoning
 Deductive reasoning
 Proceeds from the general to the specific
 Inductive reasoning
 Proceeds from the specific to the general
6

Background (Cont'd)
 Middle-range nursing theories
 Answer specific nursing practice questions
 Describe phenomena, explain relationships,
and predict the effects of one phenomenon on
another
 Should be clear, simple, generalizable,
important, and accessible
 Orlando, Pender, Leininger, Newman, and
Parse
7

Theories in Support of Nursing
 Developmental or physiological theories
 Maslow’s Theory of the Hierarchy of Needs
 Erikson’s Theory of Psychosocial Development
 Systems theory
 All parts of a system are connected
 A change in one part will have an effect on
another
8

Theories in Support of Nursing
(Cont'd)
 Role theory
 Helps nurses function therapeutically in
interactions
 Helps to understand behaviors
 Adaptation theory
 Helps nurses understand adjusting or adapting
to stimuli
9

Nursing Philosophies
 Florence Nightingale
 Philosophy of Nursing
 Describes the nurse’s function as one that puts
the patient in the best condition for nature (God) to
act on him or her
 Focuses on the environment and describes in
detail the concepts of light, cleanliness,
ventilation, warmth, diet, and noise
 Three major relationships
 Environment to patient
 Nurse to environment
 Nurse to patient
10

Nursing Philosophies (Cont'd)
 Virginia Henderson
 Definition of Nursing
 Assist the individual, sick or well, in the
performance of those activities contributing to
health or its recovery (or to a peaceful death)
 Credited with integrating the view of holism into
nursing
 Identified 14 needs that can be broadly
categorized in terms of physical, psychological,
emotional, sociological, spiritual, or developmental
needs
11

 Jean Watson
 Philosophy of Science and Caring (originated
1979)
 Organized around 10 carative factors that
attempted to honor the human dimensions of
nursing’s work and the subjective experiences of
the people nurses serve
 Caring-healing paradigm
 Commitment to self-care
12

 Patricia Benner
 From Novice to Expert
 Focuses on clinical nursing practice and her belief
that nursing knowledge accrues over time
 Five levels of skill acquisition
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
13

Nursing Philosophies Question 1
A nurse is using a caring-healing paradigm with
10 carative factors to plan nursing care. Which
nurse developed this philosophy?
1. Patricia Benner
2. Jean Watson
3. Virginia Henderson
4. Nola Pender
14

ANSWER
 Jean Watson. Watson states that her original work was organized around
10 carative factors and believes that if an individual works from a caring-
healing paradigm, then it must be lived out in daily life through a
commitment to self-care.
 1. Patricia Benner's philosophy (from Novice to Expert) focuses on clinical
nursing practice and her belief that nursing knowledge accrues over time.
 3. Virginia Henderson is well known for the definition of nursing, which
states that nursing's primary responsibility is “to assist the individual, sick or
well, in the performance of those activities contributing to health or its
recovery (or to a 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” (Henderson, 1966, p.
7).
 4. Nola J. Pender developed the Health Promotion Model based on the
belief that the patient assumes an active role in managing his or her own
health.
15

Nursing Theories
 Hildegard E. Peplau
 Known as the mother of psychiatric nursing
 Theory of Interpersonal Relations (1952)
 This is grounded in practice and based on the belief
that the goal of nursing should be directed toward
reducing dependence and encouraging autonomy.
 Nurse, patient, health, and environment are
interconnected and should be viewed within the
context of the environment.
 Interpersonal relationship occurs in interlocking and
overlapping phases.
 Preorientation, orientation, working, and termination
16

Nursing Theories (Cont'd)
 Ida Jean Orlando
 Nursing Process Theory
 The goals of the nurse are to meet the immediate
needs of the patient and relieve distress or
discomfort.
 Nursing practice should be autonomous.
 Nurses must explore the patient’s thoughts, feelings,
and perceptions.
 Assessment includes verbal and nonverbal
behaviors.
 Using the nursing process in the provision of nursing
care provides an overall framework for nursing and
is effective in achieving a good outcome.
17

 Nola J. Pender
 Health Promotion Model
 Based on the belief that the patient assumes an
active role in managing his or her own health
 Focuses on wellness and clarifies the nurse’s role
in health promotion
 Focuses on 10 determinants of health promoting
behavior: (1) prior related behavior, (2) personal factors,
(3) perceived benefits to an action, (4) perceived barriers
to an action, (5) perceived self-efficacy, (6) activity-related
affect, (7) interpersonal influences, (8) situational
influences, (9) commitment to a plan of action, and (10)
intermediate competing demands and preferences
18

 Madeline Leininger
 Culture Care Theory of Diversity and Universality
 The purpose is “to provide culturally congruent
nursing care in order to improve or offer a different
kind of nursing care service to people of diverse or
similar cultures” (Leininger, 1996, p. 72).
 Distinguished the term transcultural nursing
 Leininger (1996, p. 75) stated that: “Nurses need to
realize that humans are complex beings who want
their holistic views of life, care, culture, and health to
remain together and do not want to be viewed as
fragmented organs or body parts.”
19

 Margaret A. Newman
 Theory of Health as Expanding Consciousness
 This focuses on patterns, life processes, and wholeness.
 Life process is a progression toward higher levels of
consciousness and health, and Newman believed that health
and the evolving pattern of consciousness are the same.
 Interactions that occur between the environment and the
person are key processes.
 Both health and illness can be seen as the manifestation of the
pattern of the person-environment.
 Nurses need to listen to the rhythm of another person's
interactive pattern (irregular, difficult to sense, or chaotic);
nurses need to “hang in there” with clients (patients) until a
new rhythm emerges.
20

Nursing Models
 Dorothy E. Johnson
 Behavioral Systems Model
 This focuses on human behavior.
 The goals of nursing are to assess the internal and
external environments and help the patient select
mutual goals and develop interventions.
 Persons are composed of seven interrelated
behavioral components (subsystems) that function
together to form a whole.
 Attachment, dependency, ingestive, eliminative, sexual,
aggressive, achievement, restorative behavior
21

Nursing Models (Cont'd)
 Imogene M. King
 Theory of Goal Attainment
 Humans are composed of three interacting
systems (personal, interpersonal, and social).
 Human beings are the focus of nursing care.
 “Provides a process for human interactions that
lead to transactions and to goal attainment for
individuals, families and communities .The
structure is human beings transacting with their
environment” (p. 62).
 The goal is health for individuals, groups, society,
and the world.
22

 Myra E. Levine
 Conservation Model
 It is based on three concepts: wholeness,
adaptation, and conservation.
 Conservation occurs in four areas: energy,
structural integrity, personal integrity, and social
integrity.
 Health or well-being of the patient (wholeness) is
sustained through adaptation, a process of
change in which conservation is the outcome.
23

 Betty Neuman
 Healthcare Systems Model
 A person is a complex system who responds to
stressors originating in both the internal and external
environments.
 It guides nursing practice at three levels of
prevention: primary, secondary, and tertiary.
 Nursing should treat the whole person, whereas
systems (individuals, group, family, or community)
are seen as being in constant change or motion, and
interventions are aimed at maintaining stability.
24

 Dorothea E. Orem
 Theory of Self-Care Deficit
 Composed of three theories: nursing systems, self-care
deficit, and self-care
 Outcome of all nursing actions: promote self-care in all
individuals
 Defines activities of self-care as purposeful, ordered, and
learned
 Self-care agency: the degree to which a person is able to
participate in this
 Self-care deficit: the degree to which the patient is unable
to perform self-care
 Appropriate care developed through three operations:
diagnostic, prescriptive, and regulatory
25

 Sister Callista Roy
 Roy Adaptation Model
 Based on adaptation and adaptive behaviors that
are produced by altering the environment
 Goal: promote adaptive responses through a six-
step nursing process
 Assessing behaviors, assessing stimuli, formulating a
nursing diagnosis, setting goals to promote adaptation,
implementing interventions, and evaluating whether the
goals have been met
 Person: biopsychosocial adaptive system with
physiologic, self-concept, role function, and
interdependent modes
26

Nursing Models Question 2
A nurse wants to use Imogene King’s model to plan
nursing care. Which principle should the nurse remember?
1. “The interpersonal relationship occurs in phases known as
preorientation, orientation, working, and termination.”
2. “Nursing practice will be guided towards three levels of
prevention: primary, secondary, and tertiary.”
3. “Human beings are the focus of nursing care, and the goal is
health for individuals, families, communities, and the world.”
4. “Conservation is guided in four areas: energy, structural integrity,
personal integrity, and social integrity.”
27

answer
. “Human beings are the focus of nursing care, and the
goal is health for individuals, families, communities, and
the world.” According to Imogene King (1996), human beings
are the focus of nursing care, and the goal of the framework is
health for individuals, families, communities, and the world.
 1. Peplau believed that the interpersonal relationship occurs in
interlocking and overlapping phases known as preorientation,
orientation, working, and termination.
 2. The Healthcare Systems Model by Betty Neuman guides
nursing practice at three levels of prevention: primary,
secondary, and tertiary.
 4. Conservation is guided by four principles: conservation of
energy, conservation of structural integrity, conservation of
personal integrity, and conservation of social integrity
according to Myra Levine.
28

Your Nursing Theory/Philosophy
 Personal nursing theory/philosophy
 It will be up to you to choose the nursing theory most
in line with your beliefs and appropriate to your
practice.
 This provides the rationales for why you do what you
do and serves to guide nursing practice.
 Developing a personal philosophy of nursing will
require examination of your personal beliefs and
professional practice and will reveal your growth as
a nurse.
29

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