these nursing theories are useful for 1st B.BSc nursing students

1. NURSING THEORIES
For1st B.BSc nursing students
By prakash kumar(Msc Nsg)

3. – THEORIES are a set of interrelated concepts that
give a systematic view of a phenomenon (an
observable fact or event) that is explanatory &
predictive in nature.
– Theory is “a creative and rigorous structuring of
ideas that projects a tentative, purposeful, and
systematic view of phenomena”. (Chinn and Kramer
1999)

4. • Theories are composed of concepts, definitions,
models, propositions & are based on
assumptions.
• They are derived through two principal
methods; deductive reasoning and inductive
reasoning.
• A theory makes it possible to “organize the
relationship among the concepts to describe,
explain, predict, and control practice”
(Torres,1986,p.21).Torres (1990,pp.6–9)

5. NURSING THEORY
Defined as a belief, policy, or procedure proposed or followed as
the basis of action. It is an organized framework of concepts
and purposes designed to guide the practice of nursing.

6. CHARACTERISTICS OF THEORIES
1. Theories can interrelate concepts in such a
way as to create a different way of looking
at a particular phenomenon.
2. Theories must be logical in nature.
3. Theories should be relatively simple yet
generalizable.
4. Theories can be the bases
for hypotheses that can be tested.

7. 5. Theories contribute to and assist in increasing the
general body of knowledge within the discipline
through the research implemented to validate them.
6. Theories can be used by the practitioners to guide
and improve their practice.
7. Theories must be consistent with other validated
theories, laws, and principles but will leave open
unanswered questions that need to be investigated.

8. TERMINOLOGY

9. CONCEPTS
– vehicles of thought that involve images.
Are words that describe objects,
properties, or events & are basic
components of theory.
• Types:
– Empirical concepts
– Inferential concepts
– Abstract concepts

10. METAPARADIGM
• Specifies the main concepts that
encompass the subject matter and the
scope of discipline.
• “There is a general agreement that
nursing’s metaparadigm consists of the
central concepts of person, environment,
health and nursing.” (Powers and Knapp)

11. METAPARADIGM CONCEPTS
THE PERSON
THE ENVIRONMENT
HEALTH
NURSING (GOALS, ROLES & FUNCTIONS)

12. • VERBAL MODELS –
worded statements, a
form of closely related
knowledge
development.
• SCHEMATIC MODELS –
diagrams, drawings,
graphs and pictures
that facilitate
understanding.

13. PROPOSITION
• statements that explain the relationship
between the concepts.
PROCESS
 a series of actions, changes or functions
intended to bring about a desired result.

14. CONCEPTUAL FRAMEWORK
• The delivery of nursing care within the nursing process is
directed by the way specific conceptual frameworks &
theories define the person (patient), the environment,
health & nursing.
• outlines possible courses of action or to present a
preferred approach to an idea or thought.

15. NURSING
THEORISTS AND
THEIR WORKS

16. FLORENCE
NIGHTINGALE
MODERN NURSING
and
ENVIRONMENTAL
THEORY
Nursing “is an act of utilizing the
environment of the patient to
assist him in his recovery.”

17. • First Nursing Theorists and
the Mother of Modern
Nursing.
• Born in May 12, 1820 in
Italy to a wealthy British
family.
• In 1853, she accepted the
position of superintendent
at the Institute for the Care
of Sick Gentlewomen in
Upper Harley Street,
London.
Biography

18. •She tended to wounded soldiers
during the Crimean War. She became
known as the "Lady with the Lamp"
because of her night rounds.
Immortalized in the poem “Santa
Filomena” by Henry Wadsworth
Longfellow
•After the Crimean War, she
established a nursing school at St.
Thomas' Hospital and King’s College
in London in 1860.

19. • Nightingale wrote Notes on Nursing (1859), which
was the foundation of the curriculum for her
nursing school and other nursing schools.
• Notes on Matters Affecting the Health, Efficiency
and Hospital Administration of the British Army
Notes on Hospitals
Report on Measures Adopted for Sanitary
Improvements in India from June 1869 to June
1870

20. • “She helped to pioneer the revolutionary notion
that social phenomena could be objectively
measured and subjected to mathematical analysis.”
(Cohen)
• Nightingale’s research skills: Recording,
Communicating, ordering, coding, conceptualizing,
inferring, analyzing and synthesizing (Palmer)
• Nightingale emphasized the concurrent use of
observation and the performance of tasks in the
education of nurses.

21. • Defined Nursing: “The act of utilizing the environment of
the patient to assist him in his recovery.”
• Focuses on changing and manipulating the environment in
order to put the patient in the best possible conditions for
nature to act.
• Identified 5 environmental factors: fresh air, pure water,
efficient drainage, cleanliness/sanitation and light/direct
sunlight.
• Considered a clean, well-ventilated, quiet environment
essential for recovery.
• Deficiencies in these 5 factors produce illness or lack of
health, but with a nurturing environment, the body could
repair itself.

22.  Peplau’s Interpersonal Relations
Theory
 she is a psychiatric nurse,
Introduced her interpersonal
concept in 1952.
• Defined Nursing: “An
interpersonal process of
therapeutic interactions
between an Individual who is
sick or in need of health services
and a nurse especially educated
to recognize, respond to the
need for help.
• Nursing is a “maturing force
and an educative instrument”

23. • Identified 4 phases of the Nurse – Patient relationship:
– Orientation – individual/family has a “felt need” and seeks
professional assistance from a nurse (who is a stranger). This is
the problem identification phase.
– Identification – where the patient begins to have feelings of
belongingness and a capacity for dealing with the problem,
creating an optimistic attitude from which inner strength
ensues. Here happens the selection of appropriate professional
assistance.
– Exploitation – the nurse uses communication tools to offer
services to the patient, who is expected to take advantage of all
services.
– Resolution – where patient’s needs have already been met by
the collaborative efforts between the patient and the
nurse. Therapeutic relationship is terminated and the links are
dissolved, as patient drifts away from identifying with the nurse
as the helping person.

24. Virginia Henderson’s Definition
of the Unique Function of Nursing
• Defined Nursing: “Assisting
the individual, sick or well,
in the performance of those
activities contributing to
health or it’s recovery (or to
peaceful death) that an
individual would perform
unaided if he had the
necessary strength, will or
knowledge”.

25. • Identified 14 basic needs :
– Breathing normally
– Eating and drinking adequately
– Eliminating body wastes
– Moving and maintaining desirable position
– Sleeping and resting
– Selecting suitable clothes
– Maintaining body temperature within normal range
– Keeping the body clean and well-groomed
– Avoiding dangers in the environment
– Communicating with others
– Worshipping according to one’s faith
– Working in such a way that one feels a sense of accomplishment
– Playing/participating in various forms of recreation
– Learning, discovering or satisfying the curiosity that leads to normal
development and health and using available health facilities.

26. Dorothea Orem’s General Theory of Nursing
• Defined Nursing: “The act of
assisting others in the
provision and management of
self-care to maintain/improve
human functioning at home
level of effectiveness.”
• Focuses on activities that adult
individuals perform on their own
behalf to maintain life, health
and well-being.
• Has a strong health promotion
and maintenance focus.

27. Identified 3 related concepts:
1. Self-care – activities an Individual performs
independently throughout life to promote and
maintain personal well-being.
2. Self-care deficit – results when self-care agency
(Individual’s ability) is not adequate to meet the
known self-care needs.
3. Nursing System – nursing interventions needed
when Individual is unable to perform the
necessary self-care activities:

28.  Self-care theory is based on four concepts:
1. Self care- refers to those activities an individual performs independently
throughout life to promote and maintain personal well-being.
2. Self care agency- is the individual’s ability to perform self care activities.
It consists of two agents: a self-care agent(an individual who performs
self-care independently) and a dependent care agent (a person other
than the individual who provides the care)
3. Self-care requisites- are groups of needs or requirements that Orem
identified. They are classified as either:
a) Universal self-care requisites - those needs that all people have
b) Developmental self-care requisites - 1. maturational: progress toward
higher level of maturation. 2. situational: prevention of deleterious
effects related to development.
c) Health deviation requisites - those needs that arise as a result of a
patient's condition. Result from illness, injury or disease or its treatment.
They include actions such as seeking health care assistance ,carrying out
prescribed therapies, and learning to live with the effects of illness or
treatment.

29. 4. Therapeutic self-care demand-refers to all
self-care activities required to meet existing
self-care requisites, or in other words,
actions to maintain health and well-being.

30. Self care deficit- results when self care agency
is not adequate to meet the known self-care
demand. This theory explains not only
nursing is needed but also how people can
be assisted through five methods of helping:
acting or doing for, guiding, teaching,
supporting, and providing an environment
that promotes individual’s abilities to meet
current and future demands.

31. Orem’s 3 types of Nursing Systems:
1. Wholly compensatory – nurse provides entire self-care for the
client.
– Example: care of a new born, care of client recovering from surgery in a
post-anesthesia care unit
2. Partial compensatory – nurse and client perform care, client can
perform selected self-care activities, but also accepts care done by
the nurse for needs the client cannot meet independently.
– Example: Nurse can assist post operative client to ambulate, Nurse can
bring a meal tray for client who can feed himself
3. Supportive-educative – nurse’s actions are to help the client
develop/learn their own self-care abilities through knowledge,
support and encouragement.
 Example: Nurse guides a mother how to breastfeed her
baby, Counseling a psychiatric client on more adaptive coping
strategies.

32. Callista Roy’s Adaptation Theory
• Sister Callista Roy defines adaptation
as the process and outcome
whereby the thinking and feeling
person uses conscious awareness
and choice to create human and
environmental integration.
• This model comprises the four
domain concepts of person, health,
environment, and nursing and
involves a six step nursing process

33. 1) Roy's models sees the person as "a
biopsychosocial being in constant interaction
with a changing environment“
• The person is an open, adaptive system who uses
coping skills to deal with stressors.
2) Roy sees the environment as "all conditions,
circumstances and influences that surround and
affect the development and behaviour of the
person".
• Roy describes stressors as stimuli and uses the
term 'residual stimuli' to describe those stressors
whose influence on the person is not clear .

34. 3) Originally, Roy wrote that health and illness are
on a continuum with many different states or
degrees possible. More recently, she states that
health is the process of being and becoming an
integrated and whole person
4) Roy's goal of nursing is "the promotion of
adaptation in each of the four modes, thereby
contributing to the person's health, quality of life
and dying with dignity". These four modes are
physiological, self-concept, role function and
interdependence.

35. A. In the Physiologic mode, adaptation involves the
maintenance of physical integrity. Basic human needs
such as nutrition, oxygen, fluids, and temperature
regulation are identified with this mode.
 In assessing a family, the nurse would ask how the family
provides for the physical and survival needs of the family
members.
B. A function of the Self-concept mode is the need for
maintenance of psychic integrity. Perceptions of one’s
physical and personal self are included in this mode.
 Families also have concepts of themselves as a family unit.
Assessment of the family in this mode would include the
amount of understanding provided to the family members,
the solidarity of the family. the values of the family, the
amount of companionship provided to the members, and
the orientation (present or future) of the family.

36. C. The need for social integrity is emphasized in the
Role function mode. When human beings adapt
to various role changes that occur throughout a
lifetime, they are adapting in this mode.
According to Hanson, the family’s role can be
assessed by observing the communication
patterns in the family.
 Assessment should include how decisions are
reached, the roles and communication patterns
of the members, how role changes are tolerated,
and the effectiveness of communication.
 For example, when a couple adjusts their lifestyle
appropriately following retirement from full-time
employment, they are adapting in this mode.

37. D.The need for social integrity is also emphasized in the
interdependence mode.
 Interdependence involves maintaining a balance between
independence and dependence in one’s relationships with
others.
 Dependent behaviors include affection seeking, help
seeking, and attention seeking.
 Independent behaviors include mastery of obstacles and
initiative taking.
 According to Hanson, when assessing this mode in families,
the nurse tries to determine how successfully the family
lives within a given community.
 The nurse would assess the interactions of the family with
the neighbors and other community groups, the support
systems of the family, and the significant others .

38. The goal of nursing is to promote adaptation of
the client during both health and illness in all four
of the modes.
 Actions of the nurse begin with the assessment
process, The family is assessed on two levels.
First, the nurse makes a judgment with regard to
the presence or absence of maladaptation.
Then, the nurse focuses the assessment on the
stimuli influencing the family’s maladaptive
behaviors. The nurse may need to manipulate the
environment, an element or elements of the
client system, or both in order to promote
adaptation .

39. Roy employs a six-step nursing process which
includes: assessment of behaviour,
assessment of stimuli, nursing diagnosis, goal
setting, intervention and evaluation.
In the first step, the person's behaviour in
each of the four modes is observed. This
behaviour is then compared with norms and is
deemed either adaptive or ineffective.
The second step is concerned with factors that
influence behaviour. Stimuli are classified as
focal, contextual or residual.

40.  The nursing diagnosis is the statement of the
ineffective behaviours along with the identification of
the probable cause.
 In the fourth step, goal setting is the focus. Goals need
to be realistic and attainable and are set in
collaboration with the person.
 Intervention occurs as the fifth step, and this is when
the stimuli are manipulated. It is also called the 'doing
phase'.
 In the final stage, evaluation takes place. The degree of
change as evidenced by change in behaviour, is
determined. Ineffective behaviours would be
reassessed, and the interventions would be revised

41. Betty Neuman's Systems Model
 “Health is a condition in
which all parts and
subparts are in harmony
with the whole of the
client.”
 Developed this model
based on the individual’s
relationship to stress, the
reaction to it, and
reconstitution factors
that are dynamic in
nature.
 Reconstitution is the
state of adaptation to
stress.

42.  KEY CONCEPTS
• Viewed the client as an open system consisting of a basic
structure or central core of energy resources which
represent concentric circles
• Each concentric circle or layer is made up of the five
variable areas which are considered and occur
simultaneously in each client concentric circles. These are:
1. Physiological - refers of bodily structure and function.
2. Psychological - refers to mental processes, functioning
and emotions.
3. Sociocultural - refers to relationships; and social/cultural
functions and activities.
4. Spiritual - refers to the influence of spiritual beliefs.
5. Developmental - refers to life’s developmental processes.

43.  Basic Structure Energy Resources-This is otherwise known as the
central core, which is made up of the basic survival factors common
to all organisms. These include the following:
1. Normal temperature range – body temperature regulation ability
2. Genetic structure – Hair color and bodily features
3. Response pattern – functioning of body systems homeostatically
4. Organ strength or weakness
5. Ego structure
6. Knowns or commonalities – value system
• The person's system is an open system - dynamic and constantly
changing and evolving
• Stability, or homeostasis, occurs when the amount of energy that is
available exceeds that being used by the system.
• A homeostatic body system is constantly in a dynamic process of
input, output, feedback, and compensation, which leads to a state
of balance

44. • Central core of energy resources surrounded by two concentric
boundaries or rings referred to as lines of resistance.
 Lines of Resistance
 The last boundary that protects the basic structure or it represents
the internal factors that help client defend against s stressor
 Protect the basic structure and become activated when
environmental stressors invade the normal line of defense. An
example is that when a certain bacteria enters our system, there is
an increase in leukocyte count to combat infection.
 If the lines of resistance are effective, the system can reconstitute
and if the lines of resistance are not effective, the resulting energy
loss can result in death.
 Outside the lines of resistance are two lines of defense:

45. 1. Normal Line of Defense
• Represents client’s usual wellness level.
• Can change over time in response to coping or responding to the
environment, which includes intelligence, attitudes, problem
solving and coping abilities. Example is skin which is constantly
smooth and fair will eventually form callous over times.
2. Flexible Lines of Defense
• Is the outer boundary to the normal line of defense, the line of
resistance, and the core structure.
• Keeps the system free from stressors and is dependent on the
amount of sleep, nutritional status, as well as the quality and
quantity of stress an individual experiences.
• If the flexible line of defense fails to provide adequate protection
to the normal line of defense, the lines of resistance become
activated.

46. Neuman categorizes Stressors as:
 Stressors
 Are capable of producing either a positive or negative effect on the
client system.
 Is any environmental force which can potentially affect the stability
of the system:
1. Intrapersonal - occur within person, example is infection,
thoughts and feelings
2. Interpersonal - occur between individuals, e.g. role expectations
3. Extrapersonal - occur outside the individual, e.g. job or finance
concerns
 A person’s reaction to stressors depends on the strength of the
lines of defense.
 When the lines of defense fails, the resulting reaction depends on
the strength of the lines of resistance.
 As part of the reaction, a person’s system can adapt to a stressor, an
effect known as reconstitution.

47. Reconstitution
 Is the increase in energy that occurs in relation to the
degree of reaction to the stressor which starts after
initiation of treatment for invasion of stressors.
 May expand the normal line of defense beyond its
previous level, stabilize the system at a lower level, or
return it to the level that existed before the illness.
 Nursing interventions focus on retaining or maintaining
system stability.
 By means of primary, secondary and tertiary
interventions, the person (or the nurse) attempts to
restore or maintain the stability of the system.

48. Prevention
 Is the primary nursing intervention.
 Focuses on keeping stressors and the stress response from having a detrimental
effect on the body.
1. Primary prevention -focuses on protecting the normal line of defense and
strengthening the flexible line of defense. This occur before the system reacts to a
stressor and strengthens the person (primarily the flexible line of defense) to
enable him to better deal with stressors and also manipulates the environment to
reduce or weaken stressors. Includes health promotion and maintenance of
wellness.
2. Secondary prevention- focuses on strengthening internal lines of resistance,
reducing the reaction of the stressor and increasing resistance factors in order to
prevent damage to the central core. This occurs after the system reacts to a
stressor. This includes appropriate treatment of symptoms to attain optimal client
system stability and energy conservation.
3. Tertiary prevention -focuses on readaptation and stability, and protects
reconstitution or return to wellness after treatment. This occurs after the system
has been treated through secondary prevention strategies. Tertiary prevention
offers support to the client and attempts to add energy to the system or reduce
energy needed in order to facilitate reconstitution.

49. MARTHA ROGERS' SCIENCE OF UNITARY
HUMAN BEINGS
• Described
the irreducible nature of
individuals as being different
from the sum of their parts
• She theorized that the identity
of nursing as a science arises
from the integrality of people
and the environment that
coordinates with a
multidimensional universe of
open systems

50. • Rogers' model provides the way of viewing the
unitary human being. Humans are viewed as
integral with the universe: the unitary human
being and the environment are one, not
dichotomous

51. • The basic characteristics that describe the life
process of human include energy field,
openness, pattern, and pan-dimensionality.
The basic concepts of the theory include
unitary human being, environment, and
homeodynamic principles.

52. Concepts of Rogers' mode
1. Energy field The energy field is the fundamental unit
of both the living and nonliving. This energy field
"provides a way to perceive people and environment
as irreducible wholes". The energy fields continuously
varies in intensity, density, and extent.
2. Openness The human field and the environmental
field are constantly exchanging their energy back and
forth. There are no boundaries or barriers that inhibit
energy flow between the fields.
3. Pattern Pattern is defined as the distinguishing
characteristic of an energy field. "Pattern is an
abstraction and it gives identity to the field“.

53. 4. Pan-dimensionality Pan-dimensionality is defined as "non linear
domain without spatial or temporal attributes". The parameters
that humans use in language to describe events are arbitrary. The
present is relative; there is no temporal ordering of lives.
5. Unitary Human Being (person A unitary human being is an
"irreducible, indivisible, pan-dimensional (four-dimensional)
energy field identified by pattern and manifesting characteristics
that are specific to the whole and which cannot be predicted from
knowledge of the parts" and "a unified whole having its own
distinctive characteristics which cannot be perceived by looking at,
describing, or summarizing the parts". The person has the
capacity to participate knowingly and probabilistically in the
process of change.
6. Environment The environment is an "irreducible, pan-dimensional
energy field identified by pattern and integral with the human
field". The two fields coexist and are integral. Manifestations
emerge from this field and are perceived by the person.