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Flashcard
NURSING THEORY(Fawcett, 2016)
Became a major theme in the last half of the 20th century
Continues to stimulate phenomenal professional growth globally through quality improvement, development of nursing literature, and education around the world
Nurses in earlier eras often delivered excellent care to patients, but what was known about nursing was not used uniformly in practice or education.
UNITED STATES CONGRESS AND NURSE LEADERS (Early in the 20th century)
A major goal was put forth by them for nursing to be developed as a profession.
To gain recognition of nursing as a profession required criteria of nursing knowledge on which to base nursing practice to improve quality of care.
Alligood, 2014, 2018; Bixler & Bixler, 1959; Chinn & Kramer, 2018; Im & Chang, 2012; Judd & Sitzman, 2014; McCrae, 2012; Melesis. 2018; Shaw, 1993; Tobbell, 2018
The history of nursing clearly documents sustained efforts toward that goal of developing a specialized body of nursing knowledge to guide nursing practice.
HISTORY OF NURSING THEORY
FLORENCE NIGHTINGALE
The history of professional nursing began with her.
She envisioned nurses as a body of educated women at a time when women were neither educated nor employed in public service.
After her war time service of organizing and caring for the wounded in Scutari during the Crimean war
Her vision and establishment of a School of Nursing at St. Thomas’ Hospital in London marked the birth of modern nursing.
Her pioneering activities in nursing practice and education and her subsequent writings became a guide at the beginning of the 20th century for establishing nursing schools and hospitals in the United States (Judd & Sitzman, 2014; Kalisch & Kalisch, 2003; Nightingle, 1859/1969).
NIGHTINGALE’S (1859/1969)
Vision of nursing has been practiced for more than a century, and theory development in nursing has evolved rapidly, leading to the recognition of nursing as an academic discipline with a specialized body of knowledge (Alligood, 2014; Bixler &Bixler, 1959; Chinn &Kramer, 2018; Fawcett, 2016; Im & Chang, 2012)
DURING THE MID – 1800S
Nightingale (1859/1969) recognized the unique focus of nursing and clarified a distinction between nursing knowledge and medical knowledge.
She described a nurse’s proper function as putting patients in the best condition for nature (God) to act upon them and set forth the following: that care of the sick is based on knowledge of persons and their surroundings - a different knowledge base than that used by physicians in their practices (Nightingale, 1859/1969)
NIGHTINGALE IN THE 1850s
it was 100 years later during the 1950s, when nursing leaders began serious discussion of the need to develop nursing knowledge apart from medical knowledge to guide nursing practice.
This awareness of the need to develop nursing knowledge continues to grow (Alligood, 2014, 2018; Chinn & Kramer, 2018; Meleis, 2018; Tobbell, 2018)
Until the proposal of nursing as a science in the 1950s, nursing practice was based mainly on principles and traditions handed down through an apprenticeship model of education and hospital procedure manuals (Kalisch & Kalisch, 2003).
Although some nursing leaders aspired for nursing to be recognized as a profession and to become an academic discipline, nursing practice reflected its vocational heritage more than its professional vision.
The transition from vocation to profession is described here in successive eras of history as nurses began developing a body of specialized knowledge on which to base nursing practice.
Progress in each era toward the goal of specialized knowledge for nursing practice demonstrates the seriousness of this drive toward professional development (Alligood, 2014)
HISTORICAL ERAS
CURRICULUM ERA (1900 – 1940S)
Addressed the question of what content nurses should study to learn how to be a nurse.
Nursing education shifted from hospital - based into colleges and universities.
During this era, an emphasis was on what course nursing students should take, with the goal of arriving at a standardized curriculum (Alligood, 2014).
STANDARDIZED CURRICULUM IN THE MID – 1930S
This had been published and adopted by many diploma nursing programs where nursing was taught at the time.
The idea of moving nursing education from hospital – based diploma programs into colleges and universities began to emerge during this era (Erwin, 2015; Judd & Sitzman, 2014).
Despite this early concept of nursing education, it was the middle of the century before many states acted upon this goal, and the second half of the 20th century before diploma programs began closing and nursing education programs opened in colleges and universities (Ervin, 2015; Judd & stizman, 2014; Kalisch & Kalisch. 2003; Tobbell, 2018).
This emphasized course selection and content for nursing programs.
RESEARCH EMPHASIS ERA
Began during the mid – 20th century
In this era, more nurse leaders embraced higher education and came to an understanding of the scientific age and research path to new nursing knowledge.
Nurses began to participate in research, and research courses were included in nursing curricula in early graduate nursing programs (Alligood, 2014; Tobbell, 2018)
In the 1970s an evaluation of the first 25 years of the journal Nursing Research revealed that nursing studies lacked conceptual connections and theoretical frameworks, accentuating the necessity for the development of specialized nursing knowledge (Batey, 1977)
Awareness of the need for concept and theory development coincided with two other milestones in the evolution of nursing theory: the standardization of curricula for nursing master’s education by the National League for Nursing accreditation criteria for baccalaureate and higher – degree programs, and the decision that doctoral education for nurses should be in nursing (Alligood, 2014; Tobbell, 2018)
RESEARCH ERA AND GRADUATE ERA
Developed in tandem
Master’s degree programs in nursing emerged across the country to meet the need for nurses as specialists for clinical practice.
Many of these graduate programs included a course that introduced the student to the research process
During this era, nursing master’s programs began to include courses in concept development and nursing models, introducing students to early nursing theorists and knowledge development processes (Alligood, 2014; Tobbell, 2018)
The baccalaureate degree began to gain wider acceptance as the educational level for professional nursing, and nursing attained recognition as an academic discipline in higher education.
NURSE RESEARCHERS
Worked to developed and clarify a specialized body of nursing knowledge, with goals of improving the quality of patient care, providing a professional style of practice, and achieving recognition as aprofession.
1960s
There were debates and discussions in this year regarding the proper direction and appropriate discipline for nursing knowledge development.
1970s
In this year nursing continued to make the transition from vocation to profession as nurse leaders debated whether nursing should be other discipline based or nursing based.
History records the outcome: that nursing practice is to be based on nursing science (Alligood, 2014; Fawcett, 1978; Nicoll, 1986)
MELEIS (2007)
Noted “theory is not a luxury in the discipline of nursing… but an integral part of the nursing lexicon in education, administration, and practice”
An important precursor to the theory era was general acceptance of nursing as a profession and an academic discipline.
THEORY ERA
Was a natural outgrowth of the research and graduate education eras (Alligood, 2014; Im & Chang, 2012)
Nicoll, 1986, 1922, 1997; Reed & Shearer, 2009, 2012; Reed et al., 2003; Tobbell, 2018
The explosive proliferation of nursing doctoral programs from the 1970s and nursing theory literature substantiated that nursing doctorates should be in nursing rather than in other disciplines
Batey, 1977; Fawcett, 1978; Hardy, 1978; Tobbell, 2018
The understanding that both research and theory were required to produce nursing science propelled nurses forward toward their goal.
DOCTORAL EDUCATION
Nursing began to develop with a strong emphasis on theory development testing.
Nurse Educator Nursing Theory Conference
New York city in 1978 presented a group of nursing theories in a program together for the first time (Alligood, 2014; Fawcett, 1984)
1980s
This is the time of major developments in nursing theory that have been characterized as a transition from a preparadigm to the paradigm period in nursing (Fawcett, 1984; Hardy, 1978; Kuhn, 1970; Tobbell, 2018)
The prevailing nursing paradigms (models) provided perspectives for education, nursing practice, research, administration, and further theory development.
Fawcett's seminal proposal of a nursing metaparadigm of four global nursing concepts as an organizing structure for existing nursing frameworks introduced a way of understanding the individual theoretical works in a meaningful relationship (Fawcett, 1978, 1984, 1993)
That is, classifying nursing models as paradigms bordered by the metaparadigm concepts of person, environment, health, and nursing systematically united nursing theoretical works for the discipline.
This systematic classification positioned theoretical works in a larger context and improved comprehension of nursing knowledge development, greatly facilitating the growth of nursing science (Fawcett, 2005)
The body of nursing science in research, education, administration, and practice continues to expand through nursing scholarship
In the last decades of the 20th century, emphasis shifted from learning about the theorists to using the theoretical works to generate research questions, guide practice, and organize curricula.
Evidence of this growth of theoretical works proliferated in podium presentations at national and international conferences, and in newsletters, journals, and books written by nurse scientists and communities of scholars for nursing models and theories.
KUHN’S (1970)
Observations of progress in nursing theory development bring description of normal science to life.
His philosophy of science clarifies the evolution of nursing theory through paradigm science.
Theory development
Emerged as a process and product of professional scholarship and growth among nurse leaders, administrators, educators, and practitioners who sought higher education.
It was as Fitzpatrick and Whall (1983) had said, “nursing is on the brick of an exciting new era”. This awareness ushered in the theory utilization era.
THEORY UTILIZATION ERA
Emphasis shifted to theory application in nursing practice, education, research, and administration (Alligood, 2014, 2018; Kuhn, 1970; Wood, 2014)
In this era, middle – rage theory and the value of a nursing framework for thought and action in nursing practice was realized.
This era gave way to new levels of development and use of nursing theory for evidence – based professional practice.
PICKLER (2018)
Stresses the importance of using theory and being explicit about the theory one is using.
THEORY
This is relevant in the history of nursing’s progress toward specialized nursing knowledge, and that knowledge contributes to recognition and appreciation of the significance of nursing as a profession and a discipline.
SIGNIFICANCE OF NURSING THEORY
At the beginning of the 20th century, nursing was not recognized as an academic discipline or a profession, but the accomplishments of the past century have led to recognition of nursing in both areas.
The terms discipline and profession are interrelated, and the meaning of each is important.
DISCIPLINE
“academic discipline” is a branch of knowledge or field of study taught and researched as a branch of higher learning.
Is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge.
PROFESSION
Refers to an occupation with preparation in specific knowledge in higher learning and the performance of a practice.
Refers to a specialized field of practice, founded on the theoretical structure of the science or knowledge of that discipline and accompanying practice abilities.
SIGNIFICANCE FOR THE DISCIPLINE
Nursing had passed through eras of gradual development, and nursing leaders offered their perspectives on the development of nursing science.
They also addressed significant disciplinary questions about whether nursing was an applied science or basic science
1970s
Was a significant period of development (Tobbell, 2018)
1977
After the journal Nursing Research had been published for 25 years, studies were reviewed comprehensively and their strengths and weaknesses reported.
BATEY (1977)
Called attention to the importance of nursing conceptualization in the research process and the role of a conceptual framework in research design for the production of science.
Fawcett
Presented her double helix metaphor, now a classic publication, clarifying the interdependent relationship of theory and research.
Henderson, Nightingale, Orlando, Peplau, and Wiedenbach
They were recognized for their theoretical nature of their earlier writings.
Orlando’s (1961- 1972)
His theory was derived from the report of an early nationally funded research project that was designed to study nursing practice.
Donaldson and Crowley (1978)
Presented the keynote address at the Western Commission of Higher Education in Nursing Conference in 1977, just as the nursing doctoral program at the University of Washington was about to open.
They discussed the nature of nursing science and the nature of knowledge needed for both the discipline and profession.
The published version of their keynote address is a classic assignment for students to learn the difference between the discipline and the profession of nursing.
THEORETICAL STRUCTURES
FUNCTIONAL FOCUS
Emphasis on what nurses do
PATIENT FOCUS
Emphasis on what nurses know about human beings and their health
SIGNIFICANCE FOR THE PROFESSION
Not only is theory essential for the existence of nursing as an academic discipline, it is also vital to the practice of professional nursing (McCrae, 2012; Pickler, 2018)
Bixler and Bixler (1959)
Published a set of criteria for a profession tailored to nursing in the American Journal of Nursing.
Criteria for Development of the Professional Status of Nursing
Utilizes in its practice a well-defined and well organized body of specialized knowledge is on the intellectual level of the higher learning.
Constantly enlarges the body of knowledge it uses and improves its techniques of education and service through use of the scientific method.
Entrusts the education of its practitioners to institutions of higher education
Applies its body knowledge in practical services vital to human and social welfare.
Functions autonomously in the formulation of professional policy and thereby in the control of professional activity.
Attracts individuals with intellectual and personal qualities of exalting service above personal gain who recognize their chosen occupation as a life work.
Strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth, and economic security.
HILDEGARD E. PEPLAU
(Theory of Interpersonal Relations)
Described as the Mother of psychiatric nursing
Because her theoretical and clinical work led to the development of distinct specialty field of psychiatric nursing.
Her scope influence in nursing includes her contributions as a psychiatric nursing expert, educator, author, and nursing leader and theorist.
She provided major leadership in the professionalization of nursing.
Served as executive director and president of the American Nurses Association (ANA)
She was instrumental in the 1980 ANA definition of nursing that was nursing’s declaration of a social contract with society in Nursing: A Social Policy Statement.
She promoted professional standards and regulation through credentialing.
Peplau taught the first classes for graduate psychiatric nursing students at Teachers College, Columbia University, and she stressed the importance of nurses' ability to understand their own behavior to help others identify perceived difficulties.
Her seminal book, Interpersonal Relations in Nursing (Peplau, 1952), describes the importance of the nurse-patient relationship as a "significant, therapeutic interpersonal process"
Recognized as the first nursing theory textbook since Nightingale's work in the 1850s.
She discussed four psychobiological experiences that compel destructive or constructive patient responses, as follows: needs, frustrations, conflicts, and anxieties.
Peplau identified four phases of the nurse-patient relation-ship-orientation, identification, exploitation, and resolution diagrammed changing aspects of nurse-patient relationships
She also proposed and described six nursing roles: stranger, resource person, teacher, leader, surrogate, and counselor.
Her work was influenced by Freud's, Maslow's, and Sullivan's interpersonal relationship theories and by the contemporaneous psychoanalytical model.
She borrowed the psychological model to synthesize her Theory of Interpersonal Relations (Haber, 2000).
Her work on nurse-patient relationships is well known internationally and continues to influence nursing practice and research.
Trevizan and colleagues (2015)
observed and analyzed empathy in Brazilian nursing professionals,
Hungerford and colleagues (2015)
developed a framework to support the evaluation of Nurse Practitioner-Aged Care Models of Practice in Australia.
Liebel and colleagues (2015)
described home health care nurse therapeutic interactions with homebound geriatric patients with depression and dis-ability.
Trygstad and colleagues (2015)
developed an auditory hallucinations interview guide for psychiatric-mental health.
Evans and Bullock (2017)
examined a nurse-delivered telephone support intervention provided to low-income pregnant women in rural settings (Evans et al., 2017).
Gasior and colleagues (2018)
examined the influence of a network of service providers, perceptions of social supports, and family relations on a homeless youth's perceptions of recovery.
Convoy and colleagues (2019)
developed the concept of Concordant Actions in Suicide Assessment (CASA), a model designed to help clinicians respond to the phenomenon of suicide.
Hochberger and Lingham (2017)
promoted patient adherence and medication usage,including administration of psychiatric medications.
Several recent studies focused on nursing students. For example, Deane and Fain (2016) assisted nursing students to understand holistic communication skills during their encounters with older adults and engagement with patients in psychiatric settings (Deane et al., 2017).
Boulton and O'Connell (2017)
examined whether stress and perceived faculty support were related to substance abuse.
Ashton (2016)
taught students how to establish and terminate professional relationships and helped them navigate their use of social media in patient care.
Sibiya and colleagues (2019)
described the challenges faced by student accoucheurs/male midwifery students regarding the maternal health care services rendered to women in South Africa.
Schlairet and Rubenstein (2019)
developed a coaching model to improve NCLEX confidence/readiness and pass rates in a baccalaureate nursing program.
Hagerty and colleagues (2017)
used Peplau's middle-range theory of personal relations in research analyzing the experiences of hospitalized patients.
Delaney (2017)
developed a model for cultivating necessary skills to support the engagement process.
Hansbrough and colleagues (2018)
examined patients' trust of a nurse who represents the Muslim faith by wearing the hijab.
Peplau's work is specific to the nurse-patient relationship and is a theory for the practice of nursing.
VIRGINIA HENDERSON
(Definition of Nursing)
She viewed the patient as an individual who requires help toward achieving independence and completeness or wholeness of mind and body.
She clarified the practice of nursing as independent from the practice of physicians and acknowledged her interpretation of the nurses role as a synthesis of many influences.
Her work is based on (1) Edward L. Thorndike, an American psycholo-gist; (2) her experiences with the Henry House Visiting Nurse Agency; (3) experience in rehabilitation nursing; and (4) Orlando's conceptualization of deliberate nursing action (Henderson, 1964; Orlando, 1961).
She emphasized the art of nursing and proposed 14 basic human needs on which nursing care is based.
Her contributions include defining nursing, delineating autonomous nursing functions, stressing goals of interdependence for the patient, and creating self-help concepts.
Her self-help concepts influenced the works of Abdellah and Adam (Abdellah et al., 1960; Adam, 1980, 1991).
Henderson made extraordinary contributions to nursing during her 60 years of service as a nurse, teacher, author, and researcher, and she published extensively throughout those years.
She wrote three books that have become nursing classics: Textbook of the Principles and Practice of Nursing (1955), Basic Principles of Nursing Care(1960), and The Nature of Nursing (1966).
Her major contribution to nursing research was an 11-year Yale-sponsored Nursing Studies Index Project published as a four-volume annotated index of nursing's biographical, analytical, and historical literature from 1900 to 1959.
In 1958 the nursing service committee of the International Council of Nurses (ICN) asked Henderson to describe her concept of nursing.
This now-historical definition, published by the ICN in 1961, represented her final crystallization on the subject: "The unique function of the nurse is to assist the indi-vidual, sick or well, in the performance of those activities contributing to health or its recovery (or to 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, 1964, p. 63)
In The Nature of Nursing: A Definition and Its Implications for Practice, Research, and Education, Henderson (1966) proposed 14 basic needs upon which nursing care is based.
Henderson's Fourteen Needs
Breathe normally.
Eat and drink adequately.
Eliminate body wastes.
Move and maintain desirable postures.
Sleep and rest.
Select suitable clothes, dress and undress.
Maintain body temperature within a normal range by adjusting clothing and modifying the environment.
Keep the body clean and well groomed and protect the integument.
Avoid dangers in the environment and avoid injuring others.
Communicate with others in expressing emotions, needs, tears, or opinions,
Worship according to one's faith.
Work in such a way that there is a sense of accom-plishment.
Play or participate in various forms of recreation.
Learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities.
Henderson identified three levels of nurse-patient relationships in which the nurse acts as (1) a substitute for the patient, (2) a helper to the patient, and (3) a partner with the patient. Through the interpersonal process, the nurse must get "inside the skin" of each of her or his patients to know what help is needed.
Henderson said of her theory that "the complexity and quality of the service is limited only by the imagination and the competence of the nurse who interprets it"
Recently, her theory has been applied to evaluate home care nursing for elderly people in Cyprus (Kouta et al., 2015).
Sola Miravete and colleagues (2018)
evaluated the usefulness of comprehensive nursing assessments as a strategy for determining the risk for delirium in older in-patients.
Bimbelo-Serrano (2017)
developed a flowchart that allows the primary care professional to make decisions with the obese patient depending on the source of the problem,
Dal Molin and colleagues (2018)
explored the effect of primary nursing on nurse-sensitive patient outcomes and organization-related outcomes.
Henderson's work is viewed as a nursing philosophy of purpose and function.
FAYE GLENN ABDELLAH
(Twenty-One Nursing Problems)
She is a nurse/psychologist, was a leader in the development of nursing research and nursing as a profession within the U.S. Public Health Service (PHS) and was an international expert on health problems.
Abdellah joined the PHS in 1949 and rose to hold the highest rank of a woman and nurse in the Federal Nursing Services, achieving the rank of Rear Admiral.
A Korean War veteran, she was the recipient of five Distinguished Service Medals.
During her 40-year career as a Commissioned Officer in the U.S. PHS (1949-1989), she served as Chief Nurse Officer (1970-1987) and as the first woman and nurse Deputy Surgeon General (1981-1989).
After retirement, Abdellah founded and served as the first dean in the Graduate School of Nursing (GSN) at the Uniformed Services University of the Health Sciences (USUHS).
she was the recipient of 12 honorary degrees, over 90 major awards, authored or coauthored more than 150 scholarly publications, and authored six books, some of which were translated into six languages, that have altered nursing theory and practice (The Washington Post, March 6, 2017).
In 1994 the American Academy of Nursing honored Abdellah with the Living Legend Award, and she was inducted into the National Women's Hall of Fame in 2000 for a lifetime spent establishing and leading essential health care programs for the United States.
She received the Sigma Theta Tau Lifetime Award in 2006 and in 2012 was inducted into the ANA Hall of Fame for a lifetime of contributions to nursing and to honor her legacy of more than 60 years of accomplishments that live on nationally and globally (ANA, 2012).
Abdellah (2004) considered her greatest accomplishment being able to "play a role in establishing a foundation for nursing research as a science" (p. iii).
Her book Patient-Centered Approaches to Nursing emphasizes the science of nursing and has elicited changes throughout nursing cur-ricula.
Her work, which is based on the problem-solving method, serves as a vehicle for delineating nursing (pa-tient) problems as the patient moves toward a healthy outcome.
Abdellah viewed nursing as an art and a science that mold the attitude, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help individuals cope with their health needs, whether they are ill or well.
She formulated 21 nursing problems based on a review of nursing research studies
She used Henderson's 14 basic human needs and nursing research to establish the classification of nursing problems.
The typology of her 21 nursing problems first appeared in Patient-Centered Approaches to Nursing (Abdellah et al., 1960). It evolved into Preparing for Nursing Research in the 21st Century: Evolution, Methodol-ogies, and Challenges (Abdellah & Levine, 1994).
The 21 nursing problems progressed to a second-generation development referred to as patient problems and patient outcomes.
Abdellah educated the public on acquired immune deficiency syndrome (AIDS), drug addiction, violence, smoking, and alcoholism.
Her classification framework for identifying nursing problems was used to determine how to reduce peripheral intravenous catheter infiltration to increase the longevity of peripheral intravenous catheters (Banks, 2015) and informed the nursing decision to change from ID badges worn on a cloth lanyard that increased the risk of hospital-acquired infection to the use of clip ID badges.
ERNESTINE WIEDENBACH
(The Helping Art of Clinical Nursing)
She is known for her work in theory development and maternal infant nursing developed while teaching maternity nursing at the School of Nursing, Yale University.
Wiedenbach taught with Ida Orlando at Yale University and wrote, with philosophers Dickoff and James, a classic work on theory in a practice discipline that is used by those studying the evolution of nursing theory (Dickoff et al., 1968a, 1968b).
She directed the major curriculum in maternal and newborn health nursing when the Yale School of Nursing established a master's degree program (Kaplan & King, 2000) and authored books used widely in nursing education.
Her definition of nursing reflects her nurse-midwife background as follows: "People may differ in their concept of nursing, but few would disagree that nursing is nurturing or caring for someone in a motherly fashion" (Wiedenbach, 1964, p. 1).
Wiedenbach's orientation is a philosophy of nursing that guides the nurses action in the art of nursing.
She specified four elements of clinical nursing: philosophy, purpose, practice, and art.
In her book Clinical Nursing: A Helping Art, Wiedenbach (1964) outlines nursing steps in sequence.
Wiedenbach proposes that nurses identify patients' need for help in the following ways:
Observing behaviors consistent or inconsistent with their comfort
Exploring the meaning of their behavior
Determining the cause of their discomfort or incapability
Determining whether they can resolve their problems or have a need for help
Her framework was used to evaluate the effectiveness of foot massage on level of pain among patients with cancer (Doss, 2014) and the effectiveness of massage on respiratory status among toddlers with lower respiratory tract infections (Martina et al., 2015).
Corrigan and colleagues (2015)
studied how mothers of newborns transition into motherhood,
Jose and Sujatha (2016)
identified the factors leading to early weaning among mothers of infants in selected areas of India.
Darra (2018)
proposed a new theory to explain childbirth from the perspective of new mothers and their midwives.
Cherian and Karkada (2015)
accessed the knowledge of oral care practices of nurses before and after education on the oral care practices for ventilated patients,
Degavi and Bjupali (2015)
evaluated the effectiveness of a planned cardiac rehabilitation program among staff nurses.
Towell and colleagues (2015)
developed a model of facilitation of emotional intelligence to promote wholeness in neophyte critical care nurses in South Africa,
Ledet and colleagues (2016)
assessed the impact of screening and teaching interventions for sleep-awake disturbances on parents of childhood patients with epilepsy.
Priya (2018)
assessed the effectiveness of a labor protocol on knowledge and practice of nurses at selected hospitals in India,
Jebakumari and Santha (2019)
Assessed the effectiveness of a sexual assertiveness training program on sexual awareness and sexual assertiveness among adolescents attending selected schools in India.
Walker (2020)
suggests that nurses draw on Wiedenbach's enduring theory for the gift of dignity in nursing philosophy in shaping the future knowledge development in nursing.
She proposes that Wiedenbach's theory is relevant for developing knowledge in relation to nursing practice, research, and policy, as countries globally struggle with concerns of mi-gration, conflict, and health disparities.
Wiedenbach's work is considered a philosophy of the art of nursing.
LYDIA HALL
(Core, Care, and Cure Model)
Lydia Hall was a rehabilitation nurse who used her philosophy of nursing to establish the Loeb Center for Nursing and Rehabilitation at Montefiore Hospital in New York,
She served as administrative director of the Loeb Center from the time of its opening in 1963 until her death in 1969.
In the 1960s, she published more than 20 articles about the Loeb Center and her theories of long-term care and chronic disease control.
In 1964, Hall's work was presented in "Nursing: What Is It?" in The Canadian Nurse (Hall, 1964).
In 1969 the Loeb Center for Nursing and Rehabilitation was discussed in the International Journal of Nursing Studies (Hall, 1969).
Hall argued for the provision of hospital beds grouped into units that focus on the delivery of therapeutic nursing.
The Loeb plan has been considered to be similar to what later emerged as "primary nursing" (Wiggins, 1980).
An evaluation study of the Loeb Center for Nursing published in 1975 revealed that those admitted to the nursing unit compared with those in a traditional unit were readmitted less often, were more independent, had higher postdis-charge quality of life, and were more satisfied with their hospital experience (Hall et al., 1975).
Hall used three interlocking circles to represent aspects of the patient and nursing functions. The care circle represents the patient's body, the cure circle represents the disease that affects the patient's physical system, and the core circle represents the inner feelings and management of the person (Fig. 2.5).
The three circles change in size and overlap in relation to the patient's phase in the disease process.
A nurse functions in all three circles but to different degrees. For example, in the care phase, the nurse gives hands-on bodily care to the patient in relation to activities of daily living such as toileting and bathing. In the cure phase, the nurse applies medical knowledge to treatment of the person, and in the core phase, the nurse addresses the social and emotional needs of the patient for effective communication and a comfortable environment (Touhy & Birnbach, 2001).
Lydia Hall's theory was used to show improvement in patient-nurse communication, self-growth, and self-awareness in patients whose heart failure was managed in the home setting (McCoy et al., 2007) and for the nursing process and critical thinking linked to disaster preparedness (Bulson & Bulson, 2011), to examine the effects of music therapy on state anxiety of female breast cancer patients following a radical mastectomy in a Chinese setting (Li et al., 2012), and to describe the importance of professional values as assessed by RN to BSN students (Koomey et al., 2015).
Hall believed that professional nursing care hastened recovery, and as less medical care was needed, more professional nursing care and teaching were necessary.
She stressed the autonomous function of nurses.
Her contribution to nursing theory was the development and use of her philosophy of nursing care at the Loeb Center for Nursing and Rehabilitation in New York.
She recognized professional nurses and encouraged them to contribute to patient outcomes.
Hall's work is viewed as a philosophy of nursing.
JOYCE TRAVELBEE
(Human-to-Human Relationship Model)
She presented her Human-to-Human Relationship Theory in her book Interpersonal Aspects of Nursing (1966, 1971).
She published predominantly in the mid-1960s and died at a young age in 1973.
Travelbee proposed that the goal of nursing was to assist an individual, family, or community to prevent or cope with the experiences of illness and suffering and, if necessary, to find meaning in these experiences, with the ultimate goal being the presence of hope (Travelbee, 1966, 1971).
She discussed her theory with Victor Frankel (1963), whom she credits along with Rollo May (1953) for influencing her thinking (Meleis, 2012).
Travelbees work was conceptual, and she wrote about illness, suffering, pain, hope, communication, interaction, empathy, sympathy, rapport, and therapeutic use of self.
She proposed that nursing was accomplished through human-to-human relationships that began with
the original encounter and progressed through stages of
emerging identities
developing feelings of empathy, and, later,
sympathy, until
the nurse and the patient attained rapport in the final stage
Travel-bee believed that it was as important to sympathize as it was to empathize if the nurse and the patient were to develop a human-to-human relationship (Travelbee, 1964).
She was explicit about the patient's and the nurse's spiritu-ality, observing the following:
"It is believed the spiritual values a person holds will determine, to a great extent, his perception of illness. The spiritual values of the nurse or her philosophical beliefs about illness and suffering will determine the degree to which he or she will be able to help ill persons find meaning, or no meaning, in these situations." (Travelbee, 1971)
Travelbees emphasis on caring stressed empathy, sympathy, rapport, and the emotional aspects of nursing (Travel-bee, 1963, 1964).
Rich (2003)
revisited Travelbees argument on the value of sympathy in nursing and updated it with a reminder that compassion is central to holistic nursing care.
Bunkers (2012)
examined her human relationship model to explore the meaning of presence.
Norlyk and colleagues (2017)
illustrated how patients have experienced hospital care organized according to evidenced-based fast-track programs.
Falkenstrom (2017)
explored nurse-patient encounters from the perspective of Home Health Care registered nurses
Freitas and colleagues (2018)
framed the implementation of the nursing process, based on the classification systems, to an individual with a herniated disk.
Elias and colleagues (2020)
discussed the intersection between being a nurse and being a therapist in mental health guided by Travelbees theoretical perspec-tive.
Travelbee's work is categorized as nursing theory.
KATHRYN E. BARNARD
(Child Health Assessment)
She was an internationally recognized pioneer in the field of infant mental health, which studied the social and emotional development of children during their first 5 years of life.
She was a renowned researcher, teacher, and innovator (Aleccia, J., 2015).
She published extensively from the mid-1960s about improving the health of infants and their families.
She remained at the University of Washington for her career where she founded The Barnard Center on Infant Mental Health and Development.
Her pioneering work to improve the physical and mental health outcomes of infants and young children earned her numerous honors, including the Gustav O.
Leinhard Award from the Institute of Medicine, the Epis-teme Award, and the Living Legend Award in 2006 from the American Academy of Nursing, and the ZERO TO THREE Lifetime Achievement Award.
Barnard began by studying mentally and physically handicapped children and adults, moved into the activities of the well child, and expanded to methods of evaluating the growth and development of children and mother-infant relationships, and finally how environment influences development for children and families (Barnard, 2004).
She was the founder of the Nursing Child Assessment Satellite Training Project (NCAST), providing health care workers around the globe with guidelines for assessing infant development and parent-child interactions.
Barnard (1978) proposed that individual characteristics of members influence the parent-infant system, and that adaptive behavior modifies those characteristics to meet the needs of the system.
Her theory borrows from psychology and human development and focuses on mother-infant interaction with the environment.
Barnard's theory is based on scales designed to measure the effects of feeding, teaching, and environment (Kelly & Barnard, 2000).
Her theory remains population specific; it was originally designed to be applicable to interactions between the caregiver and the child in the first year and has been expanded to first 3 years of life (Masters, 2015).
She modeled the role of researcher in clinical practice and engaged in theory development in practice for the advancement of nursing science.
Her sleep-activity record of the infant's sleep-wake cycle was used in research on infant and mother circadian rhythm (Tsai et al., 2011, 2012).
Barnard's model of parent-child interaction informed an Infant Sleep Development Theory (Keys & Benzies, 2018).
Barnard's work is a theory of nursing.
EVELYN ADAM
(Conceptual Model for Nursing)
Evelyn Adam is a Canadian nurse who started publishing in the mid-1970s.
Her work focuses on the development of models and theories on the concept of nursing (1983, 1987,1999).
She worked toward clarity in terminology of frame-works, theories, and models (Adam, 1985; Fig. 2.8).
She uses a model that she learned from Dorothy Johnson. In her book, To Be a Nurse (1980), she applies Virginia Hen-derson's definition of nursing to Johnson's model and identifies the assumptions, beliefs, and values, as well as major units.
In the latter category, Adam includes the goal of the profession, the beneficiary of the professional service, the role of the professional, the source of the beneficiary's dif-ficulty, the intervention of the professional, and the conse-quences.
She expanded her work in a 1991 second edition.
Her classic paper titled simply "Modèles conceptuels" argues their importance in shaping a way of thinking and providing a framework for practice (Adam, 1999).
Adam's work is a good example of using a unique basis of nursing for further expansion.
Adam's argument for an ideological framework in nursing was described in a health telematics education conference (Tallberg, 1997).
She contributed to theory development with clear explanation and use of earlier works.
Adam's work is a theory of nursing.
NANCY ROPER, WINIFRED W. LOGAN, AND ALISON J. TIERNEY
(A Model for Nursing Based on a Model of Living)
Nancy Roper is described as a practical theorist who produced a simple nursing theory, "which actually helped bedside nurses" (Dopson, 2004; Scott, 2004, p. 28).
After 15 years as a principal tutor in a school of nursing in England, Roper began her career as a full-time book writer during the 1960s and published several popular textbooks, including Principles of Nursing (Roper, 1967).
She investigated the concept of an identifiable "core" of nursing for her MPhil research study, which was published in a monograph titled Clinical Experience in Nurse Education (Roper, 1976).
This work served as the basis for her work with theorists Winifred Logan and Alison Tierney.
Roper worked with the European and Nursing and Midwifery Unit, where she was influential in developing European Standards for Nursing (Hallett & Wagner, 2011; Roper, 1977).
Roper authored The Elements of Nursing in 1985 and 1990.
The trio collaborated in the fourth and most recent edition of The Elements of Nursing: A Model for Nursing Based on a Model of Living (Roper et al., 1996).
During the 1970s, they conducted research to discover the core of nursing, based on a Model of Living.
Three decades of study of the elements of nursing by Roper evolved into a model for nursing with five main factors that influenced activities of living (ALs) .
Rather than revising the fourth edition of their text-book, these theorists prepared a monograph (Roper et al.,2000) about the model titled The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living, without application of the model.
Holland and colleagues (2008) explored the use of the Roper-Logan-Tierney Model of Nursing.
They used case studies and exercises about adult patients with a variety of health problems in acute care and community-based settings to help students develop problem-solving skills.
In the Model of Nursing, ALs include maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilizing, working and playing, expressing sexuality, sleeping, and dying.
Life span ranges from birth to death, and the dependence-indepen-dence continuum ranges from total dependence to total independence.
The five groups of factors that influence the ALs are biological, psychological, sociocultural, environ-mental, and politicoeconomic. Individuality of living is the way in which the individual attends to the ALs in regard to the individual's place in the life span; on the dependence-independence continuum; and as influenced by biological, psychological, sociocultural, environmental, and politico-economic factors.
The five components can be used to describe the individual in relation to maintaining health, preventing disease, coping during periods of sickness and rehabilitation, coping positively during periods of chronic ill health, and coping when dying.
Individualizing nursing is accomplished by using the process of nursing, which involves four phases:
assessing
planning
imple-menting
evaluating
Nursing process is a method of logical thinking that should be used with an explicit nursing model, and the patient's individuality in living must be borne in mind during all four phases of the pro-cess.
The Roper-Logan-Tierney Model was used to plan nursing care for patients receiving mechanical ventilation in complex neurological settings (Venkatesaperumal et al., 2013); to determine the prevalence of urinary incontinence among older women, risk factors, and the effect on activities of daily living (Kasikçi et al., 2015); to identify the ALs of disabled people (Moura et al., 2015); and to manage thalamic hemorrhage in the critical care setting (Chan, 2015) and care of the elderly with anemia (Beh, 2012).
This model has been used as a guide for nursing practice, re-search, and education.
IDA JEAN (ORLANDO) PELLETIER
(Nursing Process Theory)
She "developed her theory from a study conducted at the Yale University School of Nursing, integrating mental health concepts into a basic nursing curriculum.
The study was carried out by observing and participating in experiences with patients, students, nurses, and instructors and was derived inductively from field notes for this study.
Orlando analyzed the content of 2000 nurse-patient contacts and created her theory based on analysis of these data (Schmieding, 1993).
Meleis (2012) has noted, "Orlando was one of the early thinkers in nursing who proposed that patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions"
The theory was published in The Dynamic Nurse-Patient Relationship (Orlando, 1961), which was an outcome of the project.
Her book purposed a contribution to concerns about the nurse-patient relationship, the nurses professional role and identity, and the knowledge development distinct to nursing (Schmieding, 1993).
In 1990 the National League for Nursing (NLN) reprinted Orlando's 1961 publication. In the preface to the NLN edition, Orlando states, "If I had been more courageous in 1961, when this book was first written, I would have proposed it as 'nursing process theory' instead of as a theory of effective nursing practice" (Orlando, 1990, p. vi).
Orlando (1972) continued to develop and refine her work, and in her second book, The Discipline and Teaching of Nursing Process: An Evaluative Study, she redefined and renamed deliberative nursing process as nursing process discipline.
Orlando's nursing theory stresses the reciprocal relationship between patient and nurse.
What the nurse and the patient say and do affects them both.
Orlando (1961) views the professional function of nursing as finding out and meeting the patient's immediate need for help.
She was one of the first nursing leaders to identify and emphasize the elements of nursing process and the critical importance of the patient's participation in the nursing process.
Orlando's theory focuses on how to produce improvement in the patient's behavior.
Evidence of relieving the patient's distress is seen as positive changes in the patient's observ. able behavior. Orlando may have facilitated the development of nurses as logical thinkers (Nursing Theories Conference Group & George, 1980).
According to Orlando (1961), persons become patients who require nursing care when they have needs for help that cannot be met independently because they have physical limitations, have negative reactions to an environment, or have an experience that prevents them from communicating their needs.
Patients experience distress or feelings of helplessness as the result of unmet needs for help (Orlando, 1961).
Orlando proposed a positive correlation between the length of time the patient experiences unmet needs and the degree of distress.
Therefore immediacy is emphasized throughout her theory.
In Orlando's view, when individuals are able to meet their own needs, they do not feel distress and do not require care from a professional nurse.
Orlando emphasizes that it is crucial for nurses to share their perceptions, thoughts, and feelings so they can determine whether their inferences are congruent with the patient's need (Schmieding, 2006).
Boschini (2015)
used Orlando's theory as a visual representation of the experiences of nursing faculty members who provided support to psychologically distressed students.
Gaudet and Howett (2018)
proposed a model for Orlando's theory of dynamic nurse-patient relationship as a teaching tool for nurse-patient communication.
Orlando's theory remains an effective practice theory that is especially helpful to new nurses as they begin their practice.
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