N320 - Nursing Theory

Importance of Theory

• communication

• professional distinction

• guides decision making

• art and science of nursing

• human experience

nursing process

• assessment, diagnosis, plan, implementation, evaluation

Floerence Nightingale

• founder of modern nursing

• developed environmental theory

Nightingale’s Environmental Theory

• role of the nurse is to to manipulate the patien’t environment to support the body’s natura ability to heal itself

• disease was a consequence of poor environmental conditions

• emphasis on infection control, sanitation, and holistic patient care - evidence based practice

• work during the Crimean War demonstrated her theory - reducing mortaility rates through environmental reform

Nightingale - 13 Canons (key environmental factors)

• ventilation and warming - fresh air without chilling the patient

• health of houses - pure water, drainage, clealiness, light

• light - espeically direct sunlight seen as healing

• noise - minimizing unnecessary sound to promote rest

• cleanliness of rooms and walls

• bed and bathing - clean, dry, and well aired

• personal cleanliness - of both patient and nurse

• variety - mental stimulation to aid recovery

• food - proper nutrition and timing of meals

• observation - careful, ongoing assessment of the patient

• chattering hopes and advices - avoid false reassurance

• social considerations - addressing poverty and living conditions

• petty management - ensuring care continues in the nurse’s absence

Nightingale - Four Major Concepts (metaparadigm)

• person - a patient with innate capcity to heal

• environment - the primary focus; external conditions that either support or hinder recovery

• health - not just absence of disease, but functioning at one’s highest potential

• nursing - the art of controlling the environment to faciliate healing

Dorothea Orem

• created theory of self care, theory of self-care deficity, and theory of Nursing systems

• centers on the individual’s ability to care for themselves

Orem - theory of self care

• explains how and why people care for themselves

• establishes that self-care is learned, daily beahvior is essential for maintaining life, healtlh, and well-being

Orem - theory of self-care deficit

• core framework that dictates that nursing is required when an individual’s health needs exceed their ability or capacity to care for themselves due to illness, injury, or developmental limitations

Orem - theory of nursing systems

• outlines how nurses meet the patient’s needs

  • wholly compensatory: the nurse completely takes over care for a patient who cannot move or act on their own (eg. unconscious patient)

  • partially compensatory: the nurse and patient share the responsibility of care (assisting patient recovering from surgery)

  • supportive-educative: patient can perform self-care, but the nurse provides guidance, education, or emotional support (eg. teaching a patient how to manage a new medication)

Orem - four major concepts (metaparadigm)

• person: a biopsychosocial being with the capacity and responsibility for self-care

• environment: external and internal conditions that affect one’s ability to engage in self-care

• health: a state of wholeness enabling self-care; health and self-care are deeply linked

• nursing: a helping service that compensates for or addresses self-care deficits

Medeleine Leininger - Culture Care Theory

• Theory of Culture Care Diversity and Universality

• founder of transcultural nursing - field recognizing that cultural background and profoundly shape how people experience health, illness, and care (culture care theory)

  • care is expressed through a cultural lens

  • cultural imposition - forcing one’s own beliefs onto others which can cause harm

Leininger’s - Sunrise Model

• visual framework that depicts the layers of influence on human care and health

• moving from the broadest cultural context down to specific nursing decisions

  • cultural and social structure dimensions - technology, religion, philosophy, kinship, politics, economics, education, language, environment

  • worldview - how individuals and groups percieve their world and health

  • health system influences - folk/traditional systems, professional systems, and nursing care

  • care decisions and actions - the point where cultural knowledge meets nursing practice

Leininger - 3 Nursing Care Modes

• Culture Care Preservation/Maintenace

  • support and preserve beneficial cultural practices

  • eg. allowing traditional dietary practices that support healing

• Culture Care Accommodaiton/Negotiation

  • adapt or negotiate care to fit cultural needs

  • eg. adjusting medication schedules around prayer times

• Culture Care repatterning/restructuring

  • help patients modify harmful practices while respecting culture

  • eg. gently addressing practices that conflict with recovery

leininger - culture care

• subjectively and objectively learned values and beliefs that guide how groups maitnain or face illness and death

leininger - culturally congruent care

• care that fits the patient’s cultural values and lifeways; the ultimate goal of transcultural nursing

cultural imposition

• the nurse’s unintentional deliberate projection of their own cultural beliefs onto the patient; considered ethically probematic

ethnocentrism

• the belief that one’s own cullture is superior; a significant barrier to effective care

emic knowledge

• the patient’s insider, cultural view of their own health experience

etic knowledge

the nurse’s outsider, professional view, must be balanced with emic understanding

Leininger Metaparadigm

• person - a cultural being whose care needs are shaped by their cultural background, values, and lifeways

• environment - the cultural, social, and physical context in which health and illness are experienced

• health - culturally defined; what constitutes wellness or illness varies across cultures

• nursing - a learned humanistic profession whose central act is culturally congruent, compassionate care

Ethnonursing Research

• qualitiative appraoch to studying nursing phenomena from the persepctive of the culture being examed

• believed that understanding patient's required immersing oneself in their cultural world, not just applying standardized clinical tools

Hildehard Peplau

• theory of interpersonal realtions in nursing

• called “Mother of Psychiatric Nursing”

• first nursing theory that shift focus from what nurses do to how nurses relate to patients

Peplau’s central premise

• nursing is fundamentally a therapeutic interpersonal process

  • nurse-patient relationship is care

  • healing occurs through the quality and intentionality of the human connection between nurse and patient

• she drew heavily from Harry Stack Sullivan’s interpersonal psychiatry and Abraham Maslow’s humanistic psychology

  • humans beings are shaped by their relationships and can grow through them

Peplau’s Theoretical Concepts

• interpersonal process - the core of nursing; every interaction has therapeutic potential

• therapeutic relationship - a professional goal-directed relationship distinct from friendship or social interaction

• roles - fluid, dynamic functions the nurse adopts in response to patient need

• anxiety - a driving force in illness and recovery; must be identified and managed therapeuticallu

• growth - the desired outcome for both patient and nurse through the relational process

• self-awareness - essential for the nurse; without it, the nurse cannot use the relationship therapeutically

Peplau metaparadigm

• person - a developing organism shaped by interpersonal experiences; capable of growth through relationships

• environment - primarily the interpersonal environment; the forces outside the person that influence behavior, including culture and relationships

• health - a dynamic process of forward movement toward creative, constructive, productive personal and community living; closely tied to personal growth

• nursing - a significant therapeutic and interpersonal process; a human relationship between a person whi is ill and a nurse specially educated to recognize and respond to the need for help

anxiety

• mild - heightens awareness; motivates learning

  • nurse - use therapeutically; patient can learn and problem-solve

• moderate - narrows perception; patient focuses on immediate concerns

  • nurse - redirect attention; help patient refocus

• severe - dramatically reduces percpetion; patient focuses on details

  • nurse - simple, direct, communication, reduce stimuli

• panic - percpetion is completely disrupted; patient may dissociate or lose control

  • nurse - ensure safety, calm presence, do nto leave patient alone

Peplau phases

• phase 1 - orientation (stranger)

  • strangers meet, build trust, identify the need

  • nurse should build rapport & assess

• phase 2 - identification (student)

  • patient settles in, tests the relationship, finds balance

  • nurse should guide and support balance

• phase 3 - exploitation (partner)

  • uses help fully, takes inititiative, gains independence

  • nurse should empower and step back

• phase 4 - resolution

  • needs meet, relationship ends

  • nurse should ease transition

Jean Watson

• Theory of Human Caring

• positions caring as the moral and philosophical foundation of nursing

  • draws from existenialism, phenomenology, and eastern philosophy

Transpersonal Caring

• transpersonal caring moment occurs when the nurse and patient connect at a deeply human level - beyond roles, tasks,

  • the nurse enter's the patient’s ubjective world with genuine presence

  • both nurse and patient transcends the physical and touches the spiritual dimension of human expereince

  • requires nurse to bring their full authentic self not just clinical skill

Watson Metaparadigm

• person - a unified being of body, mind, and spirit greater then the sum of their parts

• environment - a healing space, both physical and energetic; the nurse helps create conditons for healing

• health - unit and harmony within mind, body, and spirit, not merely absence of disease

• nursing - a sacred science and art; a moral commitment grounded in love and caring