Theoretical Foundation of Nursing

Theories and Founders

Florence Nightingale

Founder of modern nursing, author of “Notes in Nursing” nursing from vocation to profession

Curriculum Era (1900s-1940s)

Emphasizes courses included in nursing

Research Era (1950s - 1970s)

Emphasizes role of nursing and what to research

Graduation Education Era (1950s - 1970s)

Emphasizes caving out advanced roles and basis for nursing practice

Theory Era (1980s - 1990s)

Emphasizes on the many concepts about nursing

Theory Utilization Era (21st Century)

Emphasizes on using the theories into practice

Sigmund Freud’s Psychosexual model

Associated with different pleasurable zones for gratification

Erik Erikson’s Psychosocial model

Individuals need to accomplish a particular task before completing the stage

1. Oral, 2. Anal, 3. Phallic, 3. Phallic, 4. Latent, 5. Genital

Psychosexual Theory

Oral (Psychosexual model)

18 months, thumb sucking

Anal (Psychosexual model)

12-18 months, bladder control

Phallic (Psychosexual model)

3-6 yrs old, fantasized about parent of the opposite sex

Latent (Psychosexual model)

6-12 yrs old, sexual urges repressed, socially acceptable

Genital (Psychosexual model)

Puberty to Adulthood. sexual urges awaken

Trust vs Mistrust

Stage 1, 1 years old, infant

Autonomy vs Shame and Doubt

1-3 yrs, Toddler,

Initiative vs Guilt

Stage 3, 3-6yrs old, Pre-School

Industry vs Inferiority

Stage 4, 6-11yrs old, School age

Identity vs Role Confusion

5th stage, 12-18 years old, puberty

Generativity vs Self Absoption and Stagnation

Stage 7, 40-65 yrs old, Middle age,

Integrity vs Despair

Stage 8, 65+ yrs old, old age

Sensorimotor stage

1st stage, 2 years, senses and actions, Object permanence

Preoperational Stage

Stage 2, 2-7 years, Symbolic thinking, imagination, lacks logic

Concrete operational stage

Stage 3, 7-11 yrs, logical thinking, conservation, reversibility

Formal Operational Stage

Stage 4, 12 years and up, hypothetical reasoning, deductive logic

Self-Actualization, Esteem, Love and Belonging, Safety needs, Physiological needs

Maslow’s Hierarchy of Needs

Internal esteem needs

self respect

external esteem needs

social status, reputation

Florence Nightingale

May 12, 1820 - August 13, 1910, Florence Italy in a Wealthy British Family during Crimean war (1854), 1st founder of modern nursing and theories,

Nightingale Theory

First nursing theory, focused on changing and manipulating environment, nursing environment can help body repair itself, with their 13 CANONS

Health of Houses

overall health of environment

Venilation and Warming

Fresh air: essential, well ventilated comfortable temperatures (36.5-37.5)

Light

likely to face window, lack = ICU “intensive care psychosis”

Noise

a patient should never be waked intentionally, whispering = unnecessary noise

Variety

stimulating environment can improve patient well being

Bed & Bedding

patient comfort, remove soiled diapers, keep bed dry

Cleanliness of rooms and walls

to prevent infection, ex. damp cloth, keep free from dust dirt and mildew

Personal cleanliness

Good skin integrity, nurse and patient well groomed, no injuries (turn patient every 2 hours)

Nutrition Taking Food

Food, variety, diet applicable, monitored

What Food

Quality and type of food, customizing meals,

Chattering hopes and Advices

False assurance: non-therapeutic; chismis, personal talk, disclosing patient’s diagnosis

Observation of the Sick

keen observer, cephalo-caudal (head to toe assessment), vital signs

Petty Management

Attention to detail, maintaining schedules, organization and resource management, ex. ensuring supplies

Virginia Henderson (Definition and Components of Nursing)

Creator of Need Theory and 14 Basic needs of patients | Born Nov. 30, 1897 - March 19, 1996, Kansas City Missouri USA, Army School (1921), BS Columbia Uni, and Master of Arts (1932-1934)

Virginia Henderson

First Lady of Nursing, promotes Patient independence

14 Basic Needs

Assisting individuals in performance, contributing to health, recovery or peaceful death, to achieve independence

14 Basic Needs

13 Canons

Faye Glenn Abdellah (Patient-Centered Approaches)

“21 Nursing Problems” March 13, 1919 - Feb 24, 2017, New York | BSN (1945), Master of Arts (1947), Doctor of Edu Columbia Uni (1955) | Served USPHS (1949-1989)

Faye Abdellah

First nurse and first woman to serve as Deputy Surgeon General (1972) promoted ot research-based discipline | standardized nursing language,

Patricia Benner (Novice to Expert Model)

Model widely used in nursing education, recognized for practical experience | 1942, Hampton Virginia, BSN from Psadena, Master Surgical in UCSF, PhD in Stress UCSF; pionered phenomenology, “1984 Novice to Expert Book,”

Novice to Expert Model

Develop skills and knowledge through clinical experience, based from Dreyfus Model of Skill Acquisition

Novice, Adv Beginner, Competent, Proficient, Expert

Novice to Expert Model

Benner’s Theory

experience is the prerequisite for becoming an expert nurse: Situational learning Clinical Judgment

Novice

Little to no experience whatsoever, rules and guidelines, learning basics,

Advances Beginner

Some experience, rely on rules, lack ability to prioritize

Competent

able to prioritize, considers long term goals, (2-3 years experience)

Proficient

See situations as a whole, can anticipate needs, modify plans, intuitive, less rule-based | can recognize early sign of deterioration, regardless of complex and evolving parameters

Expert

intuitive grasp, perform tasks effortlessly, highly skilled in identifying patient needs, no longer relies on guidelines | based on intuition, split second decisions, notices subtle changes

Martha Rogers (Science of Unitary Human Beings)

Remembered as pioneering nursing theorist, for nursing practice and education, Developed Introduction to the Theoretical basis of nursing (1970), May 12 1914-March 13, 1994 Dallas, Texas, USA, Public Health Nurse and Educator,

Patients are whole beings, and interact with energy fields, and must advocate for non-invasive, holistic nursing practices

Theoretical basis of nursing (1970)

Science of Unitary Human Beings

Human being, integral with universe and are one,

Energy Fields

where both humans are integral and continuously interact

Opennes

No boundaries that stop flow of energy and interaction

Pattern

distinguish characteristic of energy field as a single wave (uniqueness in daily life; to give suggestions)

Pandimensionality

human beings are beyond traditional dimensions, non-linear domain (nature therapy)

Homeodynamics

replaces homeostasis whereas change and variability are norm

Resonancy

high low freq (what to hobbies to tone down and tone higher)

Helicacy

unpredictable continuous evolution of energy fields

Integrality

inseparably of human and environmental fields (foster aid in environment like wall supports)

Betty Neuman (Neuman Health Care Systems Model)

Known for nursing practices in various settings worldwide | 1924, Lowell, Ohio, RN, UCLA, Psychology

Neuman System Model

focusing on stress; and stressors, widely used in nursing education practice and research

I. Person Variables

Physiological, Developmental, Psychological, Sociocultural, Spiritual

Physiological variables

vital signs, body structure and function physical aspects

Psychological variables

Mental Emotional, self esteem

Developmental Variables

life stage and personal growth (marriage, pregnancy)

Sociocultural variables

expectations and activities, food preferences, caring of the dying and dead

Spiritual variables

Connection to transcendent, prophibiting blood transfusion ex. Jehovah’s witness,

II. Central Core

basic structure of individual crucial for survival; genetic makeup

III. Flexible line of defense

temporary shield; stronger = healthy, weaker = sick (ex. caffeine for all-nighters)

IV. Normal Line of Defense

Persona’s everyday protection against stress (ex. eating, skin)

V. Lines of Resistance

Come in play when stressors break through normal defenses (ex. immune system)

VI. Reconstitution

Process of recovering after a stressful event; (ex. physical therapy)

VII. Stressors

Ant force that can potentially affect stability of the system (positive or negative)

Intrapersonal Stressors

Stressors within a person, emotions, feelings, hypertension, illness

Interpersonal stressors

occur between individuals (role expectations, family conflict)

Extrapersonal stressor

occur outside the individual (job, finance, pressure, job loss)

Primary Prevention

Protecting normal line of defense, taken before stressor invades system

Secondary Prevention

an intervention after stressor has penetrated normal line of defense, aims to strenghten line of resistence

Tertiary Prevention

supporting the system after treatment, regain wellness and prevent further stress

Dorothea Orem (Self-care Deficit Nursing Theory)

Construction worker (F), Home maker (M), youngest among 2 daughters, Baltimor Maryland (1914) | developed Self-care deficit nursing theory in 1950s, formalized in 1970s

Self-care

what patients do to take care of themselves

self-care deficity

what they cant do because of illness

Self-care

independent maintenance of Health

Self Care Agency

human ability of engaging self care activities - conditioned by age, developmental state, life experience, etc.,

Therapeutic Self-Care Demand

specific set of self-care actions, for a particular health situation or condition

Self-Care requisites

needs of a person through self care to stay healthy (includes; Universal “ADL”, Developmental”Adjustments in Stages of life”, Health Deviation “Adaptation in Illness”)

Imogene King (Systems Frameowrk & Goal Attainment Theory)

Developed ‘Goal Attainment Theory’ | Jan 30-Dec 24, West point, Iowa, BSN Louis Columbia 1945-1961, | assistance chief,

Goal Attainment Theory

Theory that represents interaction, in order to achieve mutual health goal decisions (Personal, Interpersonal, Social) System

Personal System

self awareness, views, perception of own body, and psychological areas that surrounds the person, and understanding of perception of time (understanding condition)