Exhaustive University Study Guide on Nursing Theories, Process, and History

Professional Development and Philosophical Foundations of Nursing

Investing in one's own professional development and the advancement of the nursing profession is intrinsically linked to several core functions. These include the functions of education, scientific research, and management. This tri-part approach ensures that nursing remains a dynamic field based on expanding knowledge and efficient organizational oversight.

At the heart of the nursing professional's interaction with the patient is empathy. Empathy is defined specifically as the ability to empathize with the patient's situation, allowing the nurse to understand the patient's perspective and needs. This distinguishes professional care from mere technical execution or burnout, which is the exhaustion of professional capacity. Furthermore, nursing as a discipline has been most deeply influenced by the philosophical and cultural movement of Humanism, which places the dignity and value of the individual at the center of practice.

Theoretical frameworks provide the necessary structure for the profession. A theory of nursing should be understood as a theoretical construct. These constructs allow for a systematic way of viewing and addressing human health needs.

The Environmental Theory of Florence Nightingale

Florence Nightingale is recognized as the primary founder of modern global nursing, beginning her transformative work around 1860. Her conception of nursing belongs to the "environment" group of theories. According to Nightingale, illness is not merely a biological event but something that arises due to various deficiencies in the environment, such as lack of hygiene or poor conditions. Consequently, the goal of nursing is to achieve favorable hygienic conditions and a state of total hygiene.

In the Nightingale model, the patient is viewed as a passive person—a recipient of care provided by the nurse. Nursing itself is viewed as an art, a domain historically attributed to women, and a service to God. It is not defined as clinical knowledge in the modern scientific sense but as a vocational commitment. Nightingale advocated for the education of secular women in the direction of care and the development of professional vocational training. Interestingly, Nightingale rejected the utility of discoveries in microbiology regarding microorganisms that cause disease, such as the principles of asepsis and disinfection, focusing instead on environmental factors.

Dorothea Orem’s Self-Care Deficit Theory

Dorothea Orem’s General Theory of Self-Care Deficit is a comprehensive model composed of three interrelated theories: the theory of self-care, the theory of self-care deficit, and the theory of nursing systems. Orem defines self-care as a learned activity undertaken by an individual to maintain health, life, and well-being. It is not an innate ability but a skill that must be practiced and developed.

Orem categorizes human needs into three types: universal needs, developmental needs, and health-deviation needs. Universal needs are associated with the maintenance of life and general health. Developmental needs refer to requirements that arise at specific ages or during particular life stages to maintain proper growth and health. An example of a universal need is maintaining the balance between solitude and social interaction. When a patient cannot meet these needs due to limitations, a self-care deficit occurs, prompting the nurse to take over or assist through different nursing systems.

Orem defines three main nursing systems based on the level of patient independence: the wholly (totally) compensatory system, the partially compensatory system, and the supportive-educative system. The wholly compensatory system is applied when the patient is completely unable to perform self-care, such as an unconscious patient in an intensive care unit (e.g., hospitalised for 5 days with bedsores) or a patient in the third stage of hepatic coma. The partially compensatory system is used when the nurse and patient share self-care tasks. The supportive-educative (or supportive-teaching) system is employed when the patient can perform self-care but needs help learning how to do it. The nurse’s role is primarily to prepare the person for self-care in a situation of deficit, often employing method such as acting "for" and "with" the patient.

Virginia Henderson: The 14 Basic Needs and the Unique Function of Nursing

Virginia Henderson defined nursing through the lens of human needs, drawing heavily from Abraham Maslow's hierarchy. She identified 14 fundamental needs that characterize a whole, independent person. These needs include physiological functions as well as psychological and spiritual facets. Henderson defined health as the individual's ability to function independently in satisfying these 14 health needs.

The unique function of the nurse, according to Henderson, is to assist the individual—sick or healthy—in performing those activities contributing to health or its recovery (or to a peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge. The term "assisting" in Henderson's definition specifically means helping the person achieve as much independence as possible in satisfying their needs. Factors such as age, intellectual capacity, emotional state, and cultural conditions all influence how these needs are realized. This definition was adopted by the International Council of Nurses (ICN).

Betty Neuman’s Systems Model

Betty Neuman introduced the concepts of stress and coping as central pillars of nursing. In her model, the human being is viewed as an open system and a basic structure. Stressors are understood as influences from the environment that act upon the person; these are not necessarily negative but require the system to adapt. Neuman categorizes stressors as intrapersonal, interpersonal, and extrapersonal (an example of an extrapersonal stressor is the loss of a job).

To protect the system, Neuman identifies "lines of defense," which function as resources for coping with stress. The model relies on three levels of prevention: primary, secondary, and tertiary. This theory is particularly applicable in community (environmental) nursing. The concept of "adaptation energy" or energy resources in this context is also reflected in the work of Hans Selye and linked to the biological adaptation theories and the feeling of coherence.

Callista Roy’s Adaptation Model

Callista Roy defines the person as a holistic adaptive system in constant interaction with a changing environment. Health is defined as a state and process of being and becoming an integrated person (integrated through adaptation). The Roy model utilizes two internal subsystems: the regulator subsystem (innate, physiological defense mechanisms) and the cognator subsystem (related to higher brain functions and learning).

In this model, the goal of nursing is to prepare the patient and their loved ones to adapt to changes caused by illness. The model consists of the person, the environment, health, and nursing, but it explicitly excludes the separate category of "system" from its list of core components, as the person is the system. This theory belongs to the group of "systems" theories and draws from the general systems theory of authors like T. Parsons.

The Interpersonal Relations Model of Hildegard Peplau

Hildegard Peplau’s theory, published in 1952, emphasizes the importance of the nurse’s personality and the significance of the nurse-patient relationship. She defines health as a symbol of "moving forward" and the development of personality toward a creative, constructive, productive, and community-centered life. A person is an organism that strives to reduce tension caused by needs.

Peplau identifies four phases of the nurse-patient relationship: orientation, identification, exploitation, and resolution. In the orientation phase, the patient and nurse meet as strangers and identify the problem. The nurse takes on various roles, including that of a counselor. The counselor's role is specifically to help the patient recognize the problem and find ways to handle it independently, rather than just providing a single prescribed solution. Peplau and Orem both view "counseling" as providing various options and helping the patient find their own solution.

Transcultural Nursing and Humanistic Caring

Madeleine Leininger is the founder of transcultural nursing. Her theory emphasizes the necessity for nurses to study cultural anthropology to provide "culturally congruent" care. She distinguishes between two types of knowledge: "etic" (professional knowledge acquired through formal education) and "emic" (lay, folk, or indigenous knowledge acquired from life and culture). The primary goal is to combine universal care with cultural specificities.

Jean Watson developed the model of Humanistic Caring (or human caring). This theory focuses on high-value nurse-patient relationships and draws from the work of Carl Rogers. It emphasizes the transpersonal caring relationship as the core of nursing practice.

Nancy Roper’s Activities of Living and Martha Rogers’ Energy Fields

Nancy Roper, along with her colleagues Logan and Tierney, developed a model based on 12 activities of living. These activities include communication, expressing sexuality, and even dying. However, religious practice is not listed among those specific 12 activities in her primary list. Roper’s model assesses where a patient stands on a continuum of dependence/independence. Important factors affecting these activities include biological, psychological, socio-cultural, environmental, and politico-economic factors.

Martha Rogers proposed the Science of Unitary Human Beings, which is a theory centered on energy fields. It views humans and their environment as irreducible energy fields in a continuous process of change.

The Nursing Process: Methodology and Application

The nursing process is a scientific, rational, and human-centered method of nursing work. In Poland, it is typically described as a multi-stage process consisting of either four stages (recognition/assessment, planning, implementation, evaluation) or five stages (recognition, diagnosis, planning, implementation, evaluation). It is characterized by dynamism, logic, continuity, and a chronological sequence of stages.

The second stage of the nursing process involves setting goals and formulating a care plan. A nursing diagnosis, as defined by NANDA (North American Nursing Diagnosis Association), is the determination of a patient's reaction to a health problem that can be resolved through nursing interventions. A NANDA diagnosis consists of the diagnostic label, definition, defining characteristics, and related factors.

Specific schemas are used for data collection and assessment. The OLD CART schema is used to evaluate the dynamics of symptoms and complaints (Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment). The AMPLE schema is utilized primarily for assessing patients in life-threatening situations. When a nurse uses the Neuman model during assessment, the focus is on identifying the source, type, and range of stressors.

Organizational Systems and Polish Nursing History

One modern organizational system is Primary Nursing, which is characterized by the idea of "my patient-my nurse." In this system, a single nurse coordinates the care of a specific patient and their family throughout the entire hospital stay, ensuring continuity and individualized attention. This stands in contrast to traditional nursing, which was often subordinate to a physician's decisions and focused purely on executing medical orders.

The history of professional nursing in Poland is marked by several milestones:

The School of Professional Nurses of the Sisters of Charity of St. Vincent de Paul was established in 1911 in Kraków. Key figures in its creation included Maria Epstein and Anna Rydlówna.
The Warsaw School of Nursing was established in 1921.
The Polish Association of Professional Nurses was founded in 1925.
The professional journal "Pielęgniarka Polska" (The Polish Nurse) began publication in 1929.
Hanna Chrzanowska is credited with introducing the patient-centered (paciocentryczny) model of nursing in Poland.
Helena Radlińska is associated with bringing the concept of "helping" into the context of Polish nursing and social work.

Questions & Discussion

Question: Is the nursing process a universal method that can be used in any situation? Answer: Yes, it is a dynamic, universal method based on scientific problem-solving adapted to individual needs. It is not an unorganized or static cycle.

Question: What does the nurse respond for in individualized nursing? Answer: In individualized care, the nurse is fundamentally responsible for the nursing component of care, while collaborating with the interdisciplinary team on the overall health of the patient.

Question: According to Orem, is self-care an internal capacity? Answer: No, it is a learned activity that people undertake to maintain their own health and life.

Question: Which schema is useful for evaluating the dynamics of a symptom or ailment? Answer: The OLD CART schema is the appropriate tool for assessing the dynamics and characteristics of a symptom.