Nursing theories essay examples

Nursing theories essay examples

Importance of Nursing Theory

Nursing theory was largely neglected after Florence Nightingale first defined nursing in 1860 with her writing of Notes on Nursing: What it is, What it is Not (Zborowsky, 2014). Nursing theory and models grew exponentially beginning in the 1950’s (McCrae, 2012). Early nurse theorists recognized the need to distinguish the profession from medicine and the traditional “handmaiden status”; the path to accomplish this is through theory by establishing nursing as a “thinking profession (McCrae, 2012) nursing theories essay examples. Continuing to develop nursing theory and define the nursing profession is what will protect and define nursing as a profession rather than a discipline.

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The purpose of this paper is to explore the importance of nursing theory for the nursing profession, to discuss Kristen Swanson’s Theory of Caring, how this theory meets all four recognized relationships of the nursing metaparadigm and its application to the role of nurse practitioner.

Importance of Nursing Theory for the Nursing Profession

Nursing theory is essential to the profession of nursing on many levels. Theories help to define the discipline and play an important role in research and  concept development helping to discover more facets of nursing for research (Im and Chung, 2012). Generating theory consolidates the nursing profession and ensures new roles are created and founded on “critically appraised science base” (Power, 2016, p.42) Nursing is never static; roles are expanding providing care once done by doctors. Nursing theory ensures a close linkage to research making implementation at the practice level more practical as well as providing the evidence base needed for further theoretical development (Warelow, 2013). Theory is crucial in propelling the profession of nursing and to “protect and preserve the focus and clarity of nursing’s distinct contribution to health care” (Wilson et al. 2015, p.146). In today’s multidisciplinary setting of healthcare, the nursing profession continues to strive to define and maintain its professional boundaries as well as expand its body of knowledge (Warelow, 2013).

The study of nursing theory aids in application of theory to everyday practice and patient/client interactions. Through study of nursing theory, graduate students reflect upon experiences from their practice and how application of theory aided in treatment of patients or how the lack of knowledge in theory hindered the person-nurse relationship. According to Hatlevik (2011), the teaching of nursing student in using reflective skills directly influences coherence of theoretical knowledge to practice.

Swanson’s Theory of Caring

Kristen Swanson first introduced the Theory of Caring with the introduction of Five Caring Processes in 1991 with the publishing Empirical Development of a Middle Range Theory of Caring, later expanding and reorganizing the caring processes in 1993 and 1998 (Wands, 2011;  Amendolair,2012). The five caring processes identified are maintaining belief, knowing, being with, doing for, and enabling.

The process of maintaining belief is a “fundamental belief in persons and their capacity to make it through events and transitions and face a future with meaning” (Wands, 2011 p.182). Nurses who maintain belief in their patients help patients find belief in themselves that they can get through whatever circumstance, by offering hope to them. “Knowing is the anchor that moors the beliefs of nursing/nursing to the lived realities of those served (Swanson, 1991, p.164)” (Amendolair, 2012, p.15). Knowing is learning and attempting to understand events and how they affect the person (Wands, 2011). Swanson’s third caring process is being with;  be with the patient, giving time to the patient and offering presence. Offering of one’s self and time conveys a message to the patient that they matter (Wands, 2011). Preserving life and dignity through caring actions is the fourth process of doing for (Amendolair, 2012). Doing for is not just the action, but predicting what the person would do if they could do it for themselves. Lastly, Swanson defines enabling as “to facilitate the other’s capacity to grow, heal, and/or practice self-care (p.164)” (Wands, 2011, p.184). Enabling equips the patients with the tools and empowerment to care and provide for themselves. These processes provide the foundation of Swanson’s Theory of Caring as well as the research of caring (Wands, 2011).

Theory of Caring and the Nursing Metaparadigm

The widely accepted metaparadigm concepts introduced by Fawcett are person, nurse, environment, and health (Alimohammadi, Taleghani, Mohammadi & Akbarian, 2014). Swanson’s five processes presented in the theory of caring meets all facets of the metaparadigm; person and health, person and environment, health and nurse, and person, environment and health. Maintaining belief and being with fulfills the person-environment-health metaparadigm, knowing is the person-environment, health-nurse can easily be related to doing for, and enabling fulfills the person-health concept of Fawcett’s nursing metaparadigm.

Maintaining belief and being with is a fundamental process in the person-environment-health relationship. Maintaining belief in the person is to encourage and give hope that the person can and will transition out of the current situation (Amendolair, 2012). Being with is arguably the most misunderstood process for nurses but is the most important (Wands, 2011). Spending one-on-one time by being emotionally present with the patient builds a trusting relationship encouraging the patient and nurse’s reception and giving of information from the other (Wands, 2011). These concepts lend to the metaparadigm by acknowledging the person, establishing trust, providing hope and being emotionally present helping to enhance the interaction the nurse has with the person-health-environment. These two processes are holistic in nature by maintaining belief and being with recognizing the person as a whole and all the facets of; the person, their health and their environment. This relationship is always interacting; one affects the other and so on.

Knowing is learning and appreciating the lived experiences of the patient. Knowing relates to the person-environment through subcategories Swanson describes in 1998. These subcategories are avoiding making assumptions, thoroughly assessing, seeking cues, centering on the person who is receiving care and engaging personhood (Wands, 2011). Avoiding assumptions relies on the nurse to have a good understanding of self and their own beliefs as to not make assumptions of the person but rather “knowing the other from place of meaning and deliberate intention” (Wands, 2011). The nurse needs to thoroughly assess and seek cues that can help the nurse understand the person-environment relationship. How does the patient present? Does the body language match verbal cues? These are just a sample that can lead the nurse to examine deeper the person-environment metaparadigm and understand the patient and their life events. Through this investigation and knowing, the nurse can better understand how to empower the patient to manipulate the environment to meet their immediate health and wellness needs.

Doing for is the most recognized process by nurses (Wands, 2011). The health and nurse metaparadigm is relatable in the process of doing for. This is the tasks of nursing, the act of doing for the patient when they cannot do it for themselves leading to a better state of health. Doing for requires more than just technical skills, it requires experience and scientific evidence-based knowledge to support the decisions and actions taken. “Care that is, doing for is comforting, anticipatory, protective of the other’s needs, and performed competently and skillfully (Swanson, 1991, p.164)” (Wands, 2011).

Enabling as defined by Swanson is empowering the patient to cope with their illness by teaching, explaining, supporting, and providing feedback about the illness in turn enabling them to make decisions about their care (Amendolair, 2012). The person is then educated about resources and empowered to make changes that are necessary to improve health and promote wellness. Empowerment through enabling supports the person and helps them find meaning and strength to move forward with their decisions, no matter what that decision may be.

Caring, being the central phenomena of nursing, is supported by Swanson’s theory of caring (Ahern, Corless, Davis & Kwong, 2011). Theory can feel abstract and not easily translated to practice, leading to practitioners to experience a disconnect from caring science theory and caring practice (Ranheim, Karner & Bertero, 2012). Swanson’s theory of caring, being a middle-range theory, lends itself to easy implementation and application to the interaction of nurse practitioners and their patients.

Application of Swanson’s Theory of Caring for Nurse Practitioners

Understanding caring as the central phenomena of nursing is an integral part of becoming a successful nurse practitioner. By using Swanson’s five caring processes a nurse practitioner (NP) practices patient-centered care. Patient-centered care ultimately enables and empowers the patient to make necessary decisions and actions that will promote well-being. Establishing a trusting, respectful relationship through maintaining belief, knowing, being with, doing for, and enabling is an important part of the patient-NP relationship. The NP-patient relationship is characterized by the willingness of NPs to talk with patients and to attentively listen(knowing and being with) to create treatment regimens (doing for) while providing teaching and health promotion (enabling) all the while maintaining belief in the patient.

In my own professional experience I have used the five processes of Swanson’s theory of caring. In 2004, I was the nurse taking care of a new mother that had suffered with HELLP that ultimately led to fetal demise. She was transferred into our ICU after the birth of her stillborn baby. Knowing I had recently experienced this myself, I was assigned to the mother. I could connect with her in ways others felt they could not. I was able to offer her and her family hope through maintaining belief that she will get through this. Knowing her by learning what her fears were, her dreams for the baby were and what she wanted in the future. Being with was simply holding her hand or a hug and crying with her. Doing for her the things she could not at the time due to IV lines and weakness. Enabling her, by providing resources to help with child loss and grief and a journal to express her anger, sadness, and hopelessness. Through all of this, I was able to help her not bring closure, as I believe there is no closure when losing a child, but I rather equipped her with tools to help her to try to make sense of what happened.

Ahern et al. (2011) cared for a 38-year old Caribbean woman that had undergone several invasive and diagnostic procedures relating to a neoplasia. While suffering depression and the recent loss of her parents, she received a diagnosis of high-grade dysplasia. After missing two appointments she arrived at the clinic and expressed her fears and anxiety related to the diagnosis and pain of the procedure. The procedure was explained in depth to her hoping to ease her fears. Unfortunately, she was unable to finish the procedure. The authors surmise that if a holistic advanced nurse practice model had been utilized, there may potentially been a different clinical outcome. Swanson’s theory of caring and its five care processes: maintaining belief, knowing, being with, doing for, and enabling became part of the clinics holistic approach for their advanced practice nurse model.

Conclusion

Theory can feel abstract and not easily applied to everyday practice. The graduate prepared nurse offers patients care through full understanding of theory and its implications in caring for the person. McCrae (2012) states the ability to generate and apply theory is what lends to a legitimate profession. Swanson’s theory of caring, being middle-range, is evidence based through interactions of patients and professional nurses. Offering empirical evidence, in today’s evidence-based health care system her theory lends itself to easy application.  “Theory is central in developing nursing knowledge and to asserting nursing as a professional occupation” (Power,2016, p.45).

Nurse practitioners implement caring theory by maintaining belief, knowing, being with, doing for, and enabling resulting in a holistic approach to patient-centered care. Upon reflection and examination of the five processes of Swanson’s theory of caring and the nursing metaparadigm, the author acknowledges that all five processes are related to each of the four metaparadigms. Not unlike the nursing metaparadigm, all five processes build upon each other; no process is independent of the other.

References

Ahern, R. L., Corless, I. B., Davis, S. M., & Kwong, J. J. (2011). Infusing Swanson’s Theory of caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic. The Journal Of The Association Of Nurses In AIDS Care: JANAC, 22(6), 478-488. doi:10.1016/j.jana.2011.06.010

Alimohammadi,N., Taleghani, F., Mohammadi,E., & Akbarian,R. (2014). The nursing metaparadigm concept of human being in Islamic thought. Nursing Inquiry 21(2), 121-129. doi:10.1111/nin.12040

Amendolair, D. (2012). Caring model: putting research into practice. International Journal for Human Caring 16(4), 14-21.

Im, E. & Chang, S.J. (2012). Current trends in nursing theories. Journal of Nursing Scholarship 44(2), 156-164. doi:10.1111/j.1547-5069.2012.01440.x

Hatlevik, I.K.R. (2011). The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education. Journal of Advanced Nursing 68(4), 868-877. doi:10.1111/j.1365-2648.2011.05789.x

McCrae,N. (2012). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care. Journal of Advanced Nursing 68(1), 222-229. doi:10.11111/j.1365-2648.2011.05821.x

Power, L. (2016). Nursing theory and the delivery of compassionate care. Nursing Standard 30(24), 41-46.

Ranheim, A., Karner, A. & Bertero, C. (2012). Caring theory and practice-entering a simultaneous concept analysis. Nursing Forum 47(2), 78-90. doi:10.1111/j.1744-6198.2012.00263.x

Wands, L.M. (2011). Caring for veterans returning home from middle eastern wars. Nursing Science Quarterly 24(2), 180-186. doi:10.1177/0894318411399450

Warelow, P.J. (2013). Changing philosophies: a paradigmatic nursing shift from Nightingale. Australian Journal of Advanced Nursing 31(1), 36-45.

Wilson, R., Godfrey, C.M., Sears, K., Medves, J., Ross-White, A. & Lambert, N. (2015). Exploring conceptual and theoretical frameworks for nurse practitioner education: a scoping review protocol. JBI Database of Systemic Reviews and Implementation Reports. 13(10), 146-155. doi:10.11124/jbisrir-2015-2150

Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: nursing research focusing on the impact of healthcare environments. Health Environments Research and Design Journal 7(4), 19-34.

 

 

Grand Theorist Report

There are many grand nursing theories that have helped to set the foundation for the nursing profession. Faye Abdellah was one of the first pioneers for shaping nursing as a profession using her framework for Patient-Centered Approaches to Nursing. Abdellah’s theory is easy to apply to nursing practice in a healthcare institution because her framework is readable and clear (McEwen & Wills, 2014). In addition, another rationale for implementing her theory into practice at a healthcare institution is the fact that it clearly addresses the four metaparadigms—person, environment, health, and nursing. In this paper, we will discuss the theorist Faye Abdellah, her theory on Patient-Centered Approaches to Nursing, and how this theory can be integrated into practice at a healthcare institution.

Description of Theorist

Faye Abdellah was born in New York City on March 13, 1919. Abdellah decided at a very young age she wanted to pursue a career in nursing. She received her original certification in nursing from Fitkin Memorial Hospital. She continued her study of nursing at Columbia University getting her BA in Nursing along with her doctorate degree, which focused on psychology and education (Dewey, 2016).

Abdellah was highly influential in the profession of nursing. She was the Chief Nursing Officer and Deputy United States Surgeon General until 1993, and she was ranked as a Rear Admiral. She retired in 2000 from her last position as Dean of the Graduate School of Nursing at the Uniform Services University of Health Sciences (McEwen & Wills, 2014). As a whole, throughout her career Abdellah received many academic honors for her achievements in nursing. Her main focus was to reshape nursing as a profession by encouraging nurses to look past a physical illness or diagnosis and see “patients as people with a complex of emotional and psychological needs” (Dewey, 2016, n.p.). Clearly, this concept of looking at patients as more complex beings significantly helped to influence and shape her Patient-Centered Approaches to Nursing.

Category of Theory

Abdellah’s Patient Centered Approaches to Nursing is considered a grand nursing theory that is based on human needs. She believed that patients should be seen as ‘people’ who have individual unique needs that require personalized care from nurses. Furthermore, Abdellah developed her theory based on how she practiced while providing care to patients—which is what helps to make the theory highly applicable. McEwen & Wills (2014) further explain that Abdellah’s theory is applicable not only in the hospital setting, but also in the community setting.

Assumptions Underlying the Theory

Abdellah’s original theory did not have any stated assumptions; however, as time passed she did add the following six assumptions related to: 1) change and anticipated changes that impact the nursing profession, 2) the importance of how social enterprises and social problems are related, 3) how poverty, racism, pollution, education, etc. impact health and health care delivery, 4) changes in nursing education, 5) continuing education for nurses, and 6) development of nursing leaders (McEwen & Wills, 2014).

In addition, it is important to clearly define the metaparadigm concepts/assumptions underlying the theory as well. Abdellah’s Patient-Centered Approaches to Nursing is all encompassing, and the metaparadigms addressed in the theory are related to person, environment, health, and nursing.

 

 

Person

Person is defined as the patient needing care. McEwen & Wills (2014) explain that Abdellah’s theory views the patient as the “individual who needs nursing care and who is dependent on the health care provider” (p. 141). When using Patient-Centered Approaches to Nursing, it is important to know that Abdellah emphasized the significance of individualized care and knowing the person’s needs.

Environment

When using Abdellah’s theory, it is important to know that the environment from the patient’s standpoint is interconnected to include not only the physical environment, but also external factors that impact the patient such as social problems, poverty, racism, etc. These are all factors within the environment that affect the health of patients and how they approach health care delivery (McEwen & Wills, 2014).

Health

Health can be viewed as a better state of being. The purpose of Abdellah’s theory is to identify problems that are negatively impacting patients and eliminating these problems. Later we will discuss Abdellah’s 21 Nursing Problems and nursing’s responsibility to identify these problems.

Nursing

Nursing is considered “a service to individuals and families to society, which helps people cope with their health needs” (McEwen & Wills, 2014, p. 141). Nursing is expected to identify nursing problems and work collaboratively with the healthcare team to ensure that patients get desired outcomes.

 

 

Major Concepts of the Theory

The major concepts related to Abdellah’s theory involve using ten steps to identify and develop treatment to nursing problems related to patients. Abdellah explains that there are 21 basic nursing problems related to patients, and it is important for nurses to know these identified nursing problems so they can use them while trying to identify what needs to be the plan of care. Below is an abbreviated version of Abdellah’s 21 Nursing Problems.

Abdellah’s 21 Nursing Problems

Maintenance of Hygiene and Comfort Recognition of physiological responses to conditions Maintenance of Nutrition for Body Cells
Promotion of activity, exercise, rest, etc. Maintenance of normal body functions Achievement of spiritual goals
Promotion of Safety Appropriate sensory function Maintenance of Therapeutic Environment
 

 

Maintenance of Proper Body Mechanics

 

Identification and acceptance of positive and negative expressed and reacting appropriately

 

Awareness of physical, emotional, and developmental needs

 

Appropriate Oxygenation

 

Understand relationship between emotions and illness

 

Acceptance of optimal goals despite physical & emotional limitations

 

Appropriate Elimination

 

Maintenance of appropriate verbal and nonverbal communication

 

Willing to use community resources

Maintenance of Fluid & Electrolyte Balance Development of positive interpersonal relationships Recognition that social problems impact illness

(McEwen & Wills, 2014)

Clearly, it is very important to know the 21 Nursing Problems because these are the problems nurses must link to their findings while using the ten steps for identification and development of a nursing care plan. The ten steps build upon each other from learning about the basics of a patient, then getting more specific to identify the exact nursing problem(s) that need to be addressed. Below are the ten steps that nurses must follow to successfully develop a plan of care and reach expected patient outcomes.

Ten Nursing Skills to Identifying Problems & Developing a Treatment Plan

1.      Get to know the patient 6. Validate conclusions with patient
2.      Define relevant and irrelevant information 7. Observe and Evaluate Patient
3.      Develop generalizations 8. Evaluate patient & family reaction to plan— incorporate family in care if possible
4.      Identify a therapeutic nursing plan 9. Nursing’s perception of patient’s problems
5.      Test generalizations and modify plan if needed 10. Discuss & develop a nursing care plan

(McEwen & Wills, 2014)

Understanding how to use the 21 Nursing Problems along with the Ten Nursing Skills is important for nurses to grasp in order to see the full potential of this nursing theory for patients. Each of the Ten Nursing Skills needs to be followed so nurses can individualize care plans and work collaboratively with the patient and family to improve the patient’s state of health.

Major Propositions

The major proposition of Abdellah’s theory focuses on looking at the patient as a human being, not an illness.  While her theory touches on many factors, it primarily focuses on patient centered care (McEwen & Willis, 2014).  Due to its broad nature, it is testable in principle such as patient satisfaction and nursing care.

How has it been used?

In the past, Abdellah’s theory has been used in nursing education and nursing research.  In nursing education, her theory has been used to organize lectures and curricula by categorizing nursing problems based on the patient’s needs and developing a classification of nursing skills and treatment (McEwen & Willis, 2014).  Abdellah’s nursing theory has also been used in research such as patient-centered approach to nursing, evolution of nursing, perspectives on nursing theory, public policy impacting on nursing care of older adults, and preparing nursing research for the 21st century to name a few (McEwen & Willis, 2014).

Action Plan

It would behoove this institution to adopt Abdellah’s theory as a foundation of practice.  The following action plan could be used as daily practice for all nurses to not only hone their critical thinking skills, but to also give more person centered care (PCC).  PCC is important and has been a focus for many healthcare institutions for years.  In 1969, Edith Balint described person centered care as “understanding the patient as a unique human being” (Santana et al., 2017, p. 430).  Many healthcare systems are adopting a PCC to help gauge high quality care.

This action plan would focus around the Person-Centered Nursing (PCN) Framework developed by McCormack and McCance.  The PCN Framework comes from research focusing on PCC with older people and the experience of caring in nursing (McCance, McCormack, & Dewing, 2011).  The PCN Framework is comprised of four steps.

The first is prerequisites, which focuses on the professional competence of the nurse and his or her commitment to their job.  The nurse needs to be able to demonstrate their beliefs and values and know himself or herself before they can move on.  The second step is the care environment.  This includes if the nurse and the service line are an appropriate fit, making sure the nurse is equipped with the skills and the knowledge to take care of patients.  It is important that the heath care system is organized and can offer a supportive system for its employees so that they can safely deliver patient care and have effective relationships with one another.  Third is person-centered process, which can be thought of as one of the most important steps.  This step includes care that is focused on cultural competence, employee and patient engagement, staff being present, and providing holistic care.  The fourth and final step is outcomes.  This is known as the central component of the PCN Framework and where we can tie it all together.  This includes patient and nurse satisfaction, feeling of well being, and obtaining a therapeutic work environment (McCance et al., 2011).

Integration

A PCC Team would need to come together to develop current data within their hospital.  Data would include patient satisfaction scores, nurse satisfaction scores, readmission rates, and a basis of patient-centered care knowledge among nurses by developing a questionnaire for them to fill out.  The PCC Team would them form a class for all currently employed nurses with an in depth explanation of the PCN Framework and what each step includes.  Role-playing and case studies could be used in order to help staff put PCC into play in a practice setting.  This portion would be integral to the roll out of PCC because it helps nurses to see the importance of person-centered care within their own healthcare setting and would help them to deliver higher quality care (McCance et al., 2011).  Once staff is completely trained, leaders will be able to put the PCN Framework into action.  According to McCance et al.,  “using the Framework ‘in action’ within the workplace as a tool to evaluate care during handovers or during analysis of critical events, both positive or negative; and using the Framework to assess the experience of patients being cared for in each site” (para. 17) we can evaluate the outcomes listed previously: patient satisfaction scores, nurse satisfaction scores, and readmission rates.  It would be important to reevaluate the nurses after one year with the same questionnaire that was handed out at the beginning of the PCN Framework roll out.  The PCC Team would be able to assess their effectiveness in delivering the information and the data from the satisfaction scores and readmission rates would give them the ability to verify how well the PCN Framework works.

After data is collected, the PCC Team would move forward in presenting the information to all new hire nurses and developing a curriculum for preceptors to be able to teach the PCN Framework and to help to develop new nurses within it.  It would be important to continue with the PCC knowledge questionnaire so the PCC Team can continue to evaluate the efficiency of their team.  After one year of new hire education, the team will then collect satisfaction scores and readmission rates to submit to the Board of Directors for the healthcare institution so that the PCN Framework can be presented as a standard of practice in all hospitals within the healthcare institution.

In conclusion, health care costs are rising at an exponential level and due to this rise; patients and their insurance companies are expecting higher-grade care.  Nursing as profession needs to move towards a more patient centered approach.  Without this approach, nursing is just assumed to be medicine and patients will continue to feel that they have no place in their care team.  Currently, patients are being told what medications they should take, when they should take it, and who will be overseeing their care.  In order to reduce readmission rates and subsequently cut costs, patients need to have ample say in their treatment plan and should be able to have open conversations with their caregivers about how they feel about their illness and their plan of care.  If they feel their nurses are competent in their skills and that they truly care about their wellbeing, patients will feel safer and more willing to speak up when they do not understand something and will trust in their care plan to continue it after discharge, thus reducing their risk of readmission.

 

References

Dewey, J. P. (2016). Faye Abdellah. Salem Press Biographical Encyclopedia. Retrieved from

http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=4&sid=b8238afd-f12d-4800-89ca-ff4e2c58d36d%40sessionmgr101&bdata=JnNpdGU9ZWRzL

WxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=113931050&db=ers

McCance, T., McCormack, B., & Dewing, J. (2011, May 2). An exploration of person-centeredness in practice. The Online Journal of Issues in Nursing, 16. http://dx.doi.org/10.3912/OJIN.Vol16No02Man01

McEwen, M., & Willis, E. M. (2014). Theoretical Basis for Nursing (4 ed.). Philadelphia: Lippincott Williams & Wilkins.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2017, September 30). How to practice person-centred care: A conceptual framework. Health Expectations, 429-440. http://dx.doi.org/http://dx.doi.org.lopes.idm.oclc.org/10.1111/hex.12640

 

1. Grand nursing theories that are based on human needs include all but one of the following. Which is not considered to be a part of needs-based theories?
A) Focus is on the client.
B) Client is considered biopsychosocially.
C) Individual parts of the client are considered.
D) Interventions are prescribed to meet client needs.

 

 

2. Florence Nightingale developed a model for nursing practice that was inductively derived based on her experiences during a time of war. What is the model considered by most nursing scholars?
A) Philosophy
B) Practice theory
C) Schema
D) Research theory

 

 

3. One of the concepts of Nightingale’s model included the following five points: pure air, pure water, efficient drainage, cleanliness, and light. In which concept are these five points included?
A) Social considerations
B) Personal cleanliness
C) Ventilation and warming
D) Health of house

 

 

4. The nurse theorist Virginia Henderson developed which theory?
A) The Principles and Practice of Nursing
B) Patient-Centered Approaches to Nursing
C) The Self-Care Deficit Nursing Theory
D) The Behavioral System Model

 

 

5. In the theory by Virginia Henderson, The Principles and Practice of Nursing, she defines nursing and considers her definition of nursing which of the following?
A) A concept
B) A model
C) An assumption
D) An axiom

 

 

6. One nurse theorist and her colleague listed 10 steps in identifying the client’s problems and 10 nursing skills to be used in developing a treatment typology. Who is this nurse theorist?
A) Betty Neuman
B) Dorothy Johnson
C) Faye Abdellah
D) Florence Nightingale

 

 

7. The nurse theorist Dorothea E. Orem developed which nursing theory?
A) Patient-Centered Approaches to Nursing
B) The Self-Care Deficit Nursing Theory
C) The Principles and Practice of Nursing
D) The Behavioral System Model

 

 

8. Included in The Self-Care Deficit and Nursing Theory by Orem, there are three nested theories. Which is not one of the nested theories?
A) Self-care
B) Nursing system
C) Family system
D) Self-care deficit

 

 

9. The nurse theorist Dorothy Johnson developed which nursing theory?
A) The Behavioral System Model
B) The Principles and Practice of Nursing
C) The Self-Care Deficit Nursing Theory
D) Patient-Centered Approaches to Nursing

 

 

10. In the theory developed by Dorothy Johnson, The Behavioral System Model, she incorporated all but one of the following into her theory. Which one is not included?
A) Systems theory
B) Human behavior
C) Stress
D) Family

 

 

11. Which of the following theories was founded on general systems theory, stress theory, and stress and coping theory?
A) The Neuman Systems Model
B) The Self-Care Deficit Model
C) Patient-Centered Approaches to Nursing
D) The Principles and Practice of Nursing

 

 

12. In the model by Betty Neuman, she focused on system theory, human needs of protection, or relief from stress. Which of the following was emphasized by her theory?
A) Humans have a need for dynamic balance that the nurse can provide.
B) The healthful house is a vital concept.
C) Nurses should care for the patient until the patient can care for self.
D) Behaviors should be organized around specific goals.

 

Abraham Maslow

Question

Maslow focused his theory of motivation on the hierarchy of human needs (Hergenhahn & Olson, 2011). The hierarchy of human needs is divided into two different categories: deficiency needs and growth needs. Deficiency needs or basic needs, are the needs at the bottom of the pyramid, these needs must be met before it becomes possible for a person to move into the growth area (Buskirk-Cohen, April 24, 2012). Growth needs or Meta needs, are the higher needs, these needs may emerge once the basic needs are met (Buskirk-Cohen, April 24, 2012).   The hierarchy of needs is then broken down into five subcategories: physiological needs, safety needs, belongingness and love needs, esteem needs, and self-actualization needs (Hergenhahn & Olson, 2011).

Physiological needs are the most basic cluster of needs in the hierarchy of needs; this includes the needs for water, food, oxygen, sleep, elimination, and sex (Hergenhahn & Olson, 2011). Safety needs are the second cluster of needs in the hierarchy of needs; these needs include the need for order, security, and predictability (Hergenhahn & Olson, 2011). Belongingness and love needs are the third cluster of needs in the hierarchy of needs; these needs include the needs for affiliation with others and for the feeling of being loved (Hergenhahn & Olson, 2011). Esteem needs are the fourth cluster of needs in the hierarchy of needs; these needs include the need for status, prestige, competence, and confidence (Hergenhahn & Olson, 2011). The last cluster in the hierarchy of needs is the self- actualization, this is the highest level which can only be reached if the preceding need levels have been met; the self-actualizing individual operates at full capacity and is B-motivated rather than D-motivated (Hergenhahn & Olson, 2011). A D-motivated, or deficiency motivation, person is a person that is influenced by the absence of the things such as food, love, or esteem; these people are characterized as people who are not self-actualizing (Hergenhahn & Olson, 2011).  B-motivated people are people who have met the level of self-actualization; these people include values such as truth, goodness, beauty, justice, and perfection (Hergenhahn & Olson, 2011).

According to the personality theories workbook, Cindy was malnourished baby, she did not receive much love when she was a baby, and her living conditions were not the safest in the world. Cindy’s pediatrician noticed that Cindy was not the correct weight during her first checkup, babies are usually supposed to lose some weight when they stay in the hospital and then they are supposed to regain that weight and sometimes more by the time they are two weeks old (Ashcraft, 2009). But the pediatrician noticed that four week old Cindy did not gain additional weight after leaving the hospital (Ashcraft, 2009). Noticing these things about Cindy, she obviously was not meeting the first need of physiological need of being fed and being taken care of.

Children and Youth Services were then called and Cindy was put into a foster home. The foster home she was placed into did not really care for Cindy either; they were in it for the compensation checks (Ashcraft, 2009). The foster parent’s showed her little affection, never holding her and never talking to her (Ashcraft, 2009). At age twelve months, Cindy would cringe as someone’s touch, having gotten very little during her first year of life; she barely got any interaction with people and she had a lack of love from her biological family and her foster parents (Ashcraft, 2009).

When Cindy lived with her mom, she had a very unstable life. Cindy was around drugs because her mom was a drug addict; her mom did not have a home for the two of them to live in so they went from house to house (Ashcraft, 2009). Cindy would be taken to the pediatrician by her grandmother, who was sickly and elderly, one time Cindy was so dehydrated to the point that she was in medical danger (Ashcraft, 2009). This is an example of Cindy not meeting the safety needs in the hierarchy of needs.

After the year of going through all of that, the caseworker put Cindy into a foster family that was loving, caring, lived in a nice neighborhood, and loved Cindy. Cindy was at first hesitant about them because she was never given that much attention, but the foster family understood what she went through and took everything slow until Cindy was ready for the affection that they were willing to give her. She then met the three basic needs of physiological needs, safety needs, and belongingness and love needs. Cindy is now a happy and confident four year old that lives with this family.

 

 

Work Cited

Ashcraft, D. (2009). Personality theories workbook. (5th ed.). Belmont, CA: Wadsworth

Pub Co.

Biskirk-Cohen, Allison. April 17, 2012.

Hergenhahn, B.R., & Olson, M.H. (2011). An introduction to theories of personality. (8

ed.).

 

 

 

Nursing Theories and Theorists

What are Nursing Theories?

Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why do they do it. Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). It is a framework of concepts and purposes intended to guide the practice of nursing at a more concrete and specific level.

Nursing, as a profession, is committed to recognizing its own unparalleled body of knowledge vital to nursing practice—nursing science. To distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing. As a science, nursing is based on the theory of what nursing is, what nurses do, and why. Nursing is a unique discipline and is separate from medicine. It has its own body of knowledge on which delivery of care is based.

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Defining Terms

Development of nursing theory demands an understanding of selected terminologies, definitions, and assumptions.

  • Philosophy. Beliefs and values that define a way of thinking and are generally known and understood by a group or discipline.
  • Theory. A belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical group of general propositions used as principles of explanation. Theories are also used to describe, predict, or control phenomena.
  • Concept. Concepts are often called the building blocks of theories. They are primarily the vehicles of thought that involve images.
  • Models. Models are representations of the interaction among and between the concepts showing patterns. They present an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice.
  • Conceptual framework. A conceptual framework is a group of related ideas, statements, or concepts. It is often used interchangeably with the conceptual model and with grand theories.
  • Proposition. Propositions are statements that describe the relationship between the concepts.
  • Domain. Domain is the perspective or territory of a profession or discipline.
  • Process. Processes are a series of organized steps, changes or functions intended to bring about the desired result.
  • Paradigm. A paradigm refers to a pattern of shared understanding and assumptions about reality and the world; worldview or widely accepted value system.
  • Metaparadigm. A metaparadigm is the most general statement of discipline and functions as a framework in which the more restricted structures of conceptual models develop. Much of the theoretical work in nursing focused on articulating relationships among four major concepts: person, environment, health, and nursing.

History of Nursing Theories

The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education.

  • In 1860, Florence Nightingale defined nursing in her “Environmental Theory” as “the act of utilizing the environment of the patient to assist him in his recovery.”
  • In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself through the production of its own scientifically tested body of knowledge.
  • In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that puts emphasis on the nurse-client relationship as the foundation of nursing practice.
  • In 1955, Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs, thus her Nursing Need Theory was developed.
  • In 1960, Faye Abdellahpublished her work “Typology of 21 Nursing Problems” that shifted the focus of nursing from a disease-centered approach to a patient-centered approach.
  • In 1962, Ida Jean Orlandoemphasized the reciprocal relationship between patient and nurse and viewed the professional function of nursing as finding out and meeting the patient’s immediate need for help.
  • In 1968, Dorothy Johnsonpioneered the Behavioral System Model and upheld the fostering of efficient and effective behavioral functioning in the patient to prevent illness.
  • In 1970, Martha Rogersviewed nursing as both a science and an art as it provides a way to view the unitary human being, who is integral with the universe.
  • In 1971, Dorothea Orem states in her theory that nursing care is required if the client is unable to fulfill biological, psychological, developmental, or social needs.
  • In 1971, Imogene King‘s Theory of Goal attainment states that the nurse is considered part of the patient’s environment and the nurse-patient relationship is for meeting goals towards good health.
  • In 1972, Betty Neuman in her theory states that many needs exist, and each may disrupt client balance or stability. Stress reduction is the goal of the system model of nursing practice.
  • In 1979, Sr. Callista Royviewed the individual as a set of interrelated systems who strives to maintain the balance between these various stimuli.
  • In 1979, Jean Watsondeveloped the philosophy of caring highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.

The Nursing Metaparadigm

There are four major concepts that are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing.


Person, Nursing, Environment, and Health – the four main concepts that make up the nursing metaparadigm.

Person

Person (also referred to as Client or Human Beings) is the recipient of nursing care and may include individuals, patients, groups, families, and communities.

Environment

Environment (or situation) is defined as the internal and external surrounds that affect the client. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.

Health

Health is defined as the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider.

Nursing

The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client. There are numerous definitions of nursing, though nursing scholars may have difficulty agreeing on its exact definition, the ultimate goal of nursing theories is to improve patient care.

You’ll find that these four concepts are used frequently and defined differently throughout different nursing theories. Each nurse theorist’s definition varies in accordance with their orientation, nursing experience, and different factors that affect the theorist’s view of nursing. The person is the main focus but how each theorist defines the nursing metaparadigm gives a unique take specific to a particular theory. To give you an example, below are the different definitions of various theorists on the nursing metaparadigm:

An overview of the nursing metaparadigm of different nursing theories. (Click to enlarge)

Components of Nursing Theories

For a theory to be a theory it has to contain a set of concepts, definitions, relational statements, and assumptions that explain a phenomenon. It should also explain how these components relate to each other.

Phenomenon

A term given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent. Nursing theories focus on the phenomena of nursing.

Concepts

Interrelated concepts define a theory. Concepts are used to help describe or label a phenomenon. They are words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or concrete.

  • Abstract Concepts. Defined as mentally constructed independent of a specific time or place.
  • Concrete Concepts. Are directly experienced and related to a particular time or place.

Definitions

Definitions are used to convey the general meaning of the concepts of the theory. Definitions can be theoretical or operational.

  • Theoretical Definitions. Define a particular concept based on the theorist’s perspective.
  • Operational Definitions. States how concepts are measured.

Relational Statements

Relational statements define the relationships between two or more concepts. They are the chains that link concepts to one another.

Assumptions

Assumptions are accepted as truths and are based on values and beliefs. These are statements that explain the nature of concepts, definitions, purpose, relationships, and structure of a theory.

Why are Nursing Theories Important?

Nursing theories are the basis of nursing practice today. In many cases, nursing theory guides knowledge development and directs education, research, and practice. Historically, nursing was not recognized as an academic discipline or as a profession we view it today. Before nursing theories were developed, nursing was considered to be a task-oriented occupation. The training and function of nurses were under the direction and control of the medical profession. Let’s take a look at the importance of nursing theory and its significance to nursing practice:

  • Nursing theories help recognize what should set the foundation of practice by explicitly describing nursing.
  • By providing a definition of nursing, nursing theory also helps nurses to understand their purpose and role in the healthcare setting.
  • Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations.
  • Nursing theories provide the foundations of nursing practice, helps generate further knowledge, and indicate in which direction nursing should develop in the future (Brown, 1964).
  • By providing nurses a sense of identity, nursing theory can help patients, managers, and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990).
  • Nursing theories prepare the nurses to reflect on the assumptions and question the values in nursing, thus further defining nursing and increasing knowledge base.
  • Nursing theories aim to define, predict, and demonstrate the phenomenon of nursing (Chinn and Jacobs, 1978).
  • It can be regarded as an attempt by the nursing profession to maintain and preserve its professional limits and boundaries.
  • In many cases, nursing theories guide knowledge development and directs education, research, and practice although each influence the others. (Fitzpatrick and Whall, 2005).

Purposes of Nursing Theories

The primary purpose of theory in the profession of nursing is to improve practice by positively influence the health and quality of life of patients. Nursing theories are also developed to define and describe nursing care, guide nursing practice, and provide a basis for clinical decision making. The accomplishments of nursing in the past led to the recognition of nursing in academic discipline, research, and profession.

In Academic Discipline

Much of the earlier nursing programs identified the major concepts in one or two nursing models, organized the concepts and build an entire nursing curriculum around the created framework. The unique language in these models was typically introduced into program objectives, course objectives, course descriptions, and clinical performance criteria. The purpose was to explain the fundamental implications of the profession and to enhance the status of the profession.

In Research

Development of theory is fundamental to the research process where it is necessary to use theory as a framework to provide perspective and guidance to the research study. Theory can also be used to guide the research process by creating and testing phenomena of interest. To improve the nursing profession’s ability to meet the societal duties and responsibilities, there need to be a continuous reciprocal and cyclical connection with theory, practice, and research. This will help connect the perceived “gap” between theory and practice and promote the theory-guided practice.

In Profession

Clinical practice generates research questions and knowledge for theory. In a clinical setting, its primary contribution has been the facilitation of reflecting, questioning, and thinking about what nurses do. Because nurses and nursing practice are often subordinate to powerful institutional forces and traditions, the introduction of any framework that encourages nurses to reflect on, question, and think about what they do provide an invaluable service.

Classification of Nursing Theories

There are different ways to categorize nursing theories. They are classified depending on their function, levels of abstraction, or goal orientation.

By Abstraction

There are three major categories when classifying nursing theories based on their level of abstraction: grand theory, middle-range theory, and practice-level theory.

Levels of Nursing Theory According to Abstraction nursing theories essay examples

Grand Nursing Theories

  • Grand theories are abstract, broad in scope, and complex, therefore requiring further research for clarification.
  • Grand nursing theories do not provide guidance for specific nursing interventions but rather provide a general framework and ideas about nursing.
  • Grand nursing theorists develop their works based on their own experiences and the time they were living explaining why there is so much variation among theories.
  • Address the nursing metaparadigm components of person, nursing, health, and environment.

Middle-Range Nursing Theories

  • More limited in scope (as compared to grand theories) and present concepts and propositions at a lower level of abstraction. They address a specific phenomenon in nursing nursing theories essay examples.
  • Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory.
  • Most middle-range theories are based on the works of a grand theorist but they can be conceived from research, nursing practice, or the theories of other disciplines.

Practice-Level Nursing Theories

  • Practice nursing theories are situation specific theories that are narrow in scope and focuses on a specific patient population at a specific time.
  • Practice-level nursing theories provide frameworks for nursing interventions and suggest outcomes or the effect of nursing practice.
  • Theories developed at this level have a more direct effect on nursing practice as compared to more abstract theories.
  • These theories are interrelated with concepts from middle-range theories or grand theories. nursing theories essay examples.

By Goal Orientation

Theories can also be classified based on their goals, they can be descriptive or prescriptive.

Descriptive Theories

  • Descriptive theories are the first level of theory development. They describe the phenomena and identify its properties and components in which it occurs.
  • Descriptive theories are not action oriented or attempt to produce or change a situation. nursing theories essay examples.
  • There are two types of descriptive theories: factor-isolating theory and explanatory theory.
Factor-Isolating Theory
  • Also known as category-formulating or labeling theory.
  • Theories under this category describe the properties and dimensions of phenomena.
Explanatory Theory
  • Explanatory theories describe and explain the nature of relationships of certain phenomena to other phenomena.

Prescriptive Theories

  • Address the nursing interventions for a phenomenon, guide practice change, and predict consequences.
  • Includes propositions that call for change.
  • In nursing, prescriptive theories are used to anticipate the outcomes of nursing interventions.

Other Ways of Classifying Nursing Theories

Classification According to Meleis

Afaf Ibrahim Meleis (2011), in her book Theoretical Nursing: Development and Progress, organizes the major nurse theories and models using the following headings: needs theories, interaction theories, and outcome theories. These categories indicate the basic philosophical underpinnings of the theories.

  • Needs-Based Theories. The needs theorists were the first group of nurses who thought of giving nursing care a conceptual order. Theories under this group are based on helping individuals to fulfill their physical and mental needs. Theories of Orem, Henderson, and Abdella are categorized under this group. Need theories are criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position  nursing theories essay examples.
  • Interaction Theories. These theories placed the emphasis of nursing on the establishment and maintenance of relationships and highlight the impact of nursing on patients and how they interact with the environment, people, and situations. Theories of King, Orlando, and Travelbee are grouped under this category.
  • Outcome Theories. These theories describe the nurse as controlling and directing patient care by using their knowledge of the human physiological and behavioral systems. Nursing theories of Johnson, Levine, Rogers, and Roy belong to this group.

Classification According to Alligood

In her book, Nursing Theorists and Their Work, Raile Alligood (2017) categorized nursing theories into four headings: nursing philosophy, nursing conceptual models, nursing theories and grand theories, and middle-range nursing theories.

  • Nursing Philosophy. Is the most abstract type and sets forth the meaning of nursing phenomena through analysis, reasoning, and logical presentation. Works of Nightingale, Watson, Ray, and Benner are categorized under this group.
  • Nursing Conceptual Models. Are comprehensive nursing theories that are regarded by some as pioneers in nursing. These theories address the nursing metaparadigm and explain the relationship between them. Conceptual models of Levine, Rogers, Roy, King, and Orem are under this group.
  • Grand Nursing Theories. Are works derived from nursing philosophies, conceptual models, and other grand theories that are generally not as specific as middle-range theories. Works of Levine, Rogers, Orem, and King are some of the theories under this category nursing theories essay examples.
  • Middle-Range Theories. Are precise and answer specific nursing practice questions. They address the specifics of nursing situations within the perspective of the model or theory from which they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel, and Barker.

List of Nursing Theories and Theorists

You’ve learned from the previous sections the definition of nursing theory, its significance in nursing, and purpose in generating a knowledge base for nursing. In this section, we’ll give you an overview and summary of the various published works in nursing theory (in chronological order). Deep dive into learning about the theory by clicking on the links provided for their biography and comprehensive review of their work.

Florence Nightingale

See Also: Florence Nightingale: Environmental Theory and Biography

  • Founder of Modern Nursing and Pioneer of the Environmental Theory. 
  • Defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery.”
  • Stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selectiozn and administration of diet – all at the least expense of vital power to the patient.”
  • Identified five (5) environmental factors: fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight nursing theories essay examples.

Hildegard E. Peplau

See Also: Hildegard Peplau: Interpersonal Relations Theory

  • Pioneered the Theory of Interpersonal Relations
  • Peplau’s theory defined Nursing as “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.”
  • Her work is influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.
  • Helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting.

Virginia Henderson

See Also: Virginia Henderson: Nursing Need Theory 

  • Developed the Nursing Need Theory
  • Focuses on the importance of increasing the patient’s independence to hasten their progress in the hospital.
  • Emphasizes the basic human needs and how nurses can assist in meeting those needs.
  • “The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is result of the nurse’s creativity in planning for care.” nursing theories essay examples.

Faye Glenn Abdellah

See Also: Faye Glenn Abdellah: 21 Nursing Problems Theory

  • Developed the 21 Nursing Problems Theory
  • “Nursing is based on an art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs.”
  • Changed the focus of nursing from disease-centered to patient-centered, and began to include the care of families and the elderly in nursing care.
  • The nursing model is intended to guide care in hospital institutions, but can also be applied to community health nursing, as well.

Ernestine Wiedenbach

  • Developed The Helping Art of Clinical Nursing conceptual model.
  • Definition of nursing reflects on nurse-midwife experience as “People may differ in their concept of nursing, but few would disagree that nursing is nurturing or caring for someone in a motherly fashion.”
  • Guides the nurse action in the art of nursing and specified four elements of clinical nursing: philosophy, purpose, practice, and art.
  • Clinical nursing is focused on meeting the patient’s perceived need for help in a vision of nursing that indicates considerable importance on the art of nursing nursing theories essay examples.

Lydia E. Hall

See Also: Lydia Hall: Care, Cure, Core Theory

  • Developed the Care, Cure, Core Theory also known as the “Three Cs of Lydia Hall.
  • Hall defined Nursing as the “participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.”
  • The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core.
  • The “care” circle defines the primary role of a professional nurse such as providing bodily care for the patient. The “core” is the patient receiving nursing care. The “cure” is the aspect of nursing which involves the administration of medications and treatments.

Joyce Travelbee

  • States in her Human-to-Human Relationship Model that the purpose of nursing was to help and support an individual, family, or community to prevent or cope with the struggles of illness and suffering and, if necessary, to find significance in these occurrences, with the ultimate goal being the presence of hope.
  • Nursing was accomplished through human-to-human relationships.
  • Extended the interpersonal relationship theories of Peplau and Orlando.

Kathryn E. Barnard

  • Developed the Child Health Assessment Model.
  • Concerns improving the health of infants and their families.
  • Her findings on parent-child interaction as an important predictor of cognitive development helped shape public policy nursing theories essay examples.
  • She is the founder of the Nursing Child Assessment Satellite Training Project (NCAST) which produces and develops research-based products, assessment and training programs to teach professionals, parents and other caregivers the skills to provide nurturing environments for young children.
  • Borrows from psychology and human development and focuses on mother-infant interaction with the environment.
  • Contributed a close link to practice that has modified the way health care providers assess children in light of the parent-child relationship.

Evelyn Adam

  • Focuses on the development of models and theories on the concept of nursing.
  • Includes the goal of the profession, the beneficiary of the professional service, the role of the professional, the source of the beneficiary’s difficulty, the intervention of the professional, and the consequences.
  • A good example of using a unique basis of nursing for further expansion.

Nancy Roper, Winifred Logan, and Alison J. Tierney

  • A Model for Nursing Based on a Model of Living
  • Logan produced a simple theory, “which actually helped bedside nurses.”
  • The trio collaborated in the fourth edition of The Elements of Nursing: A Model for Nursing Based on a Model of Living and prepared a monograph entitled The Roper-Logan-Tierney Model of Nursing: Based on Activities of Daily Living.
  • Includes 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.

Ida Jean Orlando

See Also: Ida Jean Orlando: Nursing Process Theory

  • She developed the Nursing Process Theory.
  • “Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.”
  • Allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient.
  • According to her, persons become patients requiring nursing care when they have needs for help that cannot be met independently because of their physical limitations, negative reactions to an environment, or have an experience that prevents them from communicating their needs.
  • The role of the nurse is to find out and meet the patient’s immediate needs for help.

Jean Watson

See Also: Jean Watson: Theory of Human Caring

  • She pioneered the Philosophy and Theory of Transpersonal Caring.
  • “Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health.”
  • Mainly concerns on how nurses care for their patients, and how that caring progresses into better plans to promote health and wellness, prevent illness and restore health.
  • Focuses on health promotion, as well as the treatment of diseases.
  • Caring is central to nursing practice and promotes health better than a simple medical cure.

Marilyn Anne Ray 

  • Developed the Theory of Bureaucratic Caring
  • “Improved patient safety, infection control, reduction in medication errors, and overall quality of care in complex bureaucratic health care systems cannot occur without knowledge and understanding of complex organizations, such as the political and economic systems, and spiritual-ethical caring, compassion and right action for all patients and professionals.”
  • Challenges participants in nursing to think beyond their usual frame of reference and envision the world holistically while considering the universe as a hologram nursing theories essay examples.
  • Presents a different view of how health care organizations and nursing phenomena interrelate as wholes and parts in the system.

Patricia Benner

  • Caring, Clinical Wisdom, and Ethics in Nursing Practice
  • “The nurse-patient relationship is not a uniform, professionalized blueprint but rather a kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life.”
  • Attempts to assert and reestablish nurses’ caring practices during a time when nurses are rewarded more for efficiency, technical skills, and measurable outcome.
  • States that caring practices are instilled with knowledge and skill regarding everyday human needs.

Kari Martinsen

  • Philosophy of Caring
  • “Nursing is founded on caring for life, on neighborly love, […]At the same time, it is necessary that the nurse is professionally educated.”
  • Human beings are created and are beings for whom we may have administrative responsibility.
  • Caring, solidarity, and moral practice are unavoidable realities.

Katie Eriksson

  • Theory of Carative Caring
  • “Caritative nursing means that we take ‘caritas’ into use when caring for the human being in health and suffering […] Caritative caring is a manifestation of the love that ‘just exists’ […] Caring communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering of the patient.”
  • The ultimate goal of caring is to lighten suffering and serve life and health.
  • Inspired many in the Nordic countries, and used as the basis of research, education, and clinical practice. nursing theories essay examples.

Myra Estrin Levine

See Also: Myra Estrin Levine: Conservation Model for Nursing

  • According to the Conservation Model, “Nursing is human interaction.”
  • Provides a framework within which to teach beginning nursing students.
  • Logically congruent, is externally and internally consistent, has breadth as well as depth, and is understood, with few exceptions, by professionals and consumers of health care.

Martha E. Rogers

See Also: Martha Rogers: Theory of Unitary Human Beings

  • In Roger’s Theory of Human Beings, she defined Nursing as “an art and science that is humanistic and humanitarian.
  • The Science of Unitary Human Beings contains two dimensions: the science of nursing, which is the knowledge specific to the field of nursing that comes from scientific research; and the art of nursing, which involves using the science of nursing creatively to help better the life of the patient.
  • A patient can’t be separated from his or her environment when addressing health and treatment.

Dorothea E. Orem

See Also: Dorothea E. Orem: Self-Care Theory

  • In her Self-Care Theory, she defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness.”
  • Focuses on each individual’s ability to perform self-care.
  • Composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive-educative.

Imogene M. King

See Also: Imogene M. King: Theory of Goal Attainment

  • Conceptual System and Middle-Range Theory of Goal Attainment
  • “Nursing is a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation” and “a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals.”
  • Focuses on this process to guide and direct nurses in the nurse-patient relationship, going hand-in-hand with their patients to meet the goals towards good health.
  • Explains that the nurse and patient go hand-in-hand in communicating information, set goals together, and then take actions to achieve those goals. nursing theories essay examples.

Betty Neuman

See Also: Betty Neuman: Neuman’s Systems Model

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  • In Neuman’s System Model, she  defined nursing as a “unique profession in that is concerned with all of the variables affecting an individual’s response to stress.”
  • The focus is on the client as a system (which may be an individual, family, group, or community) and on the client’s responses to stressors.
  • The client system includes five variables (physiological, psychological, sociocultural, developmental, and spiritual) and is conceptualized as an inner core (basic energy resources) surrounded by concentric circles that include lines of resistance, a normal line of defense, and a flexible line of defense.

Sister Callista Roy

See Also: Sister Callista Roy: Adaptation Model of Nursing

  • In Adaptation Model, Roy defined nursing as a “health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole.”
  • Views the individual as a set of interrelated systems who strives to maintain balance between various stimuli.
  • Inspired the development of many middle-range nursing theories and of adaptation instruments.

Dorothy E. Johnson

See Also: Dorothy E. Johnson:Behavioral Systems Model

  • The Behavioral System Model defined Nursing as “an external regulatory force which acts to preserve the organization and integration of the patients’ behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found.”
  • Advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness and stresses the importance of research-based knowledge about the effect of nursing care on patients.
  • Describes the person as a behavioral system with seven subsystems: the achievement, attachment-affiliative, aggressive-protective, dependency, ingestive, eliminative, and sexual subsystems.

Anne Boykin and Savina O. Schoenhofer

  • The Theory of Nursing as Caring: A Model for Transforming Practice
  • Nursing is an “exquisitely interwoven” unity of aspects of the discipline and profession of nursing.
  • The focus and aim of nursing as a discipline of knowledge and a professional service is “nurturing persons living caring and growing in caring.”
  • Caring in nursing is “an altruistic, active expression of love, and is the intentional and embodied recognition of value and connectedness.”

Afaf Ibrahim Meleis

  • Transitions Theory
  • Began with observations of experiences faced as people deal with changes related to health, well-being, and ability to care for themselves.
  • Types of transitions include developmental, health and illness, situational, and organizational.
  • Acknowledges the role of nurses as they help people go through health/illness and life transitions.
  • Focuses on assisting nurses in facilitating patients’, families’ and communities’ healthy transitions nursing theories essay examples.

Nola J. Pender

See Also: Nola Pender: Health Promotion Model

  • Health Promotion Model
  • Describes the interaction between the nurse and the consumer while considering the role of the environment in health promotion.
  • Focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes.
  • Describes the multidimensional nature of persons as they interact within their environment to pursue health.

Madeleine M. Leininger

See Also: Madeleine M. Leininger: Transcultural Nursing Theory

  • Culture Care Theory of Diversity and Universality
  • Defined transcultural nursing as “a substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.”
  • Involves learning and understanding various cultures with regard to nursing and health-illness caring practices, beliefs, and values with the intention to implement significant and efficient nursing care services to people according to their cultural values and health-illness context nursing theories essay examples.
  • Focuses on the fact that various cultures have different and unique caring behaviors and different health and illness values, beliefs, and patterns of behaviors.

Margaret A. Newman

  • Health as Expanding Consciousness
  • “Nursing is the process of recognizing the patient in relation to the environment, and it is the process of the understanding of consciousness.”
  • “The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible . . . “
  • Nursing is regarded as a connection between the nurse and patient, and both grow in the sense of higher levels of consciousness.

Rosemarie Rizzo Parse

  • Human Becoming Theory
  • “Nursing is a science and the performing art of nursing is practiced in relationships with persons (individuals, groups, and communities) in their processes of becoming.”
  • Explains that a person is more than the sum of the parts, the environment and the person are inseparable, and that nursing is a human science and art that uses an abstract body of knowledge to help people.
  • Centered around three themes: meaning, rhythmicity, and transcendence.

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain

  • Modeling and Role-Modeling
  • “Nursing is the holistic helping of persons with their self-care activities in relation to their health . . . The goal is to achieve a state of perceived optimum health and contentment.”
  • Modeling is a process that allows nurses to understand the unique perspective of a client and learn to appreciate its importance.
  • Role-modeling occurs when the nurse plans and implements interventions that are unique for the client.

Gladys L. Husted and James H. Husted

  • Created the Symphonological Bioethical Theory
  • “Symphonology (from ‘symphonia,’ a Greek word meaning agreement) is a system of ethics based on the terms and preconditions of an agreement.”
  • Nursing cannot occur without both nurse and patient. “A nurse takes no actions that are not interactions.”
  • Founded on the singular concept of human rights, the essential agreement of nonaggression among rational people that forms the foundation of all human interaction.

Ramona T. Mercer

  • Maternal Role Attainment—Becoming a Mother
  • “Nursing is a dynamic profession with three major foci: health promotion and prevention of illness, providing care for those who need professional assistance to achieve their optimal level of health and functioning, and research to enhance the knowledge base for providing excellent nursing care.”
  • “Nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle.”
  • Maternal role attainment is an interactional and developmental process occurring over time in which the mother becomes attached to her infant, acquires competence in the caretaking tasks involved in the role, and expresses pleasure and gratification in the role. (Mercer, 1986) nursing theories essay examples.
  • Provides proper health care interventions for nontraditional mothers in order for them to favorably adopt a strong maternal identity.

Merle H. Mishel

  • Uncertainty in Illness Theory
  • Presents a comprehensive structure within which to view the experience of acute and chronic illness and to organize nursing interventions to promote optimal adjustment.
  • Describes how individuals form meaning from illness-related situations.
  • The original theory’s concepts were organized in a linear model around the following three major themes: Antecedents of uncertainty, Process of uncertainty appraisal, and Coping with uncertainty.

Pamela G. Reed

  • Self-Transcendence Theory
  • Self-transcendence refers to the fluctuation of perceived boundaries that extend the person (or self) beyond the immediate and constricted views of self and the world (Reed, 1997).
  • Has three basic concepts: vulnerability, self-transcendence, and well-being.
  • Gives insight into the developmental nature of humans associated with health circumstances connected to nursing care.

Carolyn L. Wiener and Marylin J. Dodd

  • Theory of Illness Trajectory
  • “The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large. By listening to those who are tolerating this exaggerated uncertainty, we can learn much about the trajectory of living.”
  • Provides a framework for nurses to understand how cancer patients stand uncertainty manifested as a loss of control.
  • Provides a new knowledge on how patients and families endure uncertainty and work strategically to reduce uncertainty through a dynamic flow of illness events, treatment situations, and varied players involved in the organization of care nursing theories essay examples.

Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth

  • Theory of Chronic Sorrow
  • “Chronic sorrow is the presence of pervasive grief-related feelings that have been found to occur periodically throughout the lives of individuals with chronic health conditions, their family caregivers and the bereaved.”
  • This middle-range theory defines the aspect of chronic sorrow as a normal response to the ongoing disparity created by the loss.

Phil Barker

  • Barker’s Tidal Model of Mental Health Recovery is widely used in mental health nursing.
  • Focuses on the fundamental care processes of nursing, is universally applicable, and is a practical guide for psychiatry and mental health nursing.
  • Draws on values about relating to people and help others in their moment of distress. The values of the Tidal Model are revealed in the Ten Commitments: Value the voice, Respect the language, Develop genuine curiosity, Become the apprentice, Use the available toolkit, Craft the step beyond, Give the gift of time, Reveal personal wisdom, Know that change is constant, and Be transparent.

Katharine Kolcaba

  • Theory of Comfort
  • “Comfort is an antidote to the stressors inherent in health care situations today, and when comfort is enhanced, patients and families are strengthened for the tasks ahead. In addition, nurses feel more satisfied with the care they are giving.”
  • Patient comfort exists in three forms: relief, ease, and transcendence. These comforts can occur in four contexts: physical, psychospiritual, environmental, and sociocultural.
  • As a patient’s comfort needs change, the nurse’s interventions change, as well.

Cheryl Tatano Beck

  • Postpartum Depression Theory
  • “The birth of a baby is an occasion for joy—or so the saying goes […] But for some women, joy is not an option.”
  • Described nursing as a caring profession with caring obligations to persons we care for, students, and each other.
  • Provides evidence to understand and prevent postpartum depression.

Kristen M. Swanson

  • Theory of Caring
  • “Caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.”
  • Defines nursing as informed caring for the well-being of others.
  • Offers a structure for improving up-to-date nursing practice, education, and research while bringing the discipline to its traditional values and caring-healing roots.

Cornelia M. Ruland and Shirley M. Moore

  • Peaceful End-of-Life Theory
  • The focus was not on death itself, but on providing a peaceful and meaningful living in the time that remained for patients and their significant others.
  • The purpose was to reflect the complexity involved in caring for terminally ill patients.

Leading Educational Theories in Nursing

Nursing theories can be applied to many different circumstances. However, the leading nursing programs, including the program at Duquesne University, incorporate the grand theories into the master’s in nursing curriculum. Grand theories are considered the theoretical framework that supports the principles and key concepts of nursing.

Self-Care Nursing Theory

Introduced by Dorothea Orem, the Self-Care Nursing Theory (also known as the Self-Care Deficit Nursing Theory) focuses on the nurses’ role in supporting the patients’ ability to be self-sufficient and responsible for their own care. The theory is based on the idea that people must be knowledgeable about their health problems to provide adequate self care. The theory is made up of three interconnected theories: the theory of self-care, the theory of self-care deficit and the theory of nursing systems.

Orem said she based her theory on her practice as a nurse and contemporary nursing literature and thought. During her career, she published several books that explored and expanded her theory, including Guides for Developing Curricula for the Education of Practical Nurses and Nursing: Concepts of Practice.

Culture Care Theory

As a nurse, Madeleine Leininger recognized a lack of cultural and care knowledge as a missing component in nursing and patient care. From her experiences, she developed transcultural nursing and the Cultural Care Theory to study and explain the outcomes of transcultural nursing.

Leininger’s theory is focused on providing care that is in harmony with a patient’s cultural beliefs, practices and values. In the 1960s, she coined the phrase “culturally congruent care,” which is the primary goal of transcultural nursing. Some of the basic tenets of transcultural nursing include an understanding of the following:

  • Cultural care diversity and universality, which refers to the differences and commonalities between different cultures.
  • Cultural and social structure dimensions, which includes factors that include religion, social structures and economics that set cultures apart. nursing theories essay examples.
  • Cultural care preservation or maintenance, which relates to nursing care activities that help specific cultures to retain the core cultural values related to healthcare.

Humanistic Nursing Theory

Also called the holistic approach, the Humanistic Theory looks to meld mental and emotional health with physical health. The theory is based on the idea that patients grow in healthy and creative ways. This approach to nursing, created by APRNs Josephine Paterson and Loretta Zderad, looks at each patient as an individual who needs personalized care.

Paterson and Zderad developed five phases of nursing, called phenomenological nursing, to accompany the Humanistic Theory:

  • Nurses prepare for “coming to know” or start investigating a case.
  • Nurses create an “I-You” relationship so they can understand their patients and use their intuitive knowledge.
  • Nurses apply scientific knowledge and begin a subject-object or “I-It” relationship, which allows nurses to reflect on their own experiences and put them into context for the current situation.
  • Nurses synthesize their knowledge to become a source of continually evolving information.
  • Nurses transform from the “many to the paradoxical one” to apply knowledge to a practical clinical setting.

Theory of Interpersonal Relations

The Interpersonal Relations Theory, developed in 1952 by Hildegard Peplau, focuses on the importance of the nurse-patient relationship. Nurses are able to prove better care to their patients if they build a strong relationship based on mutual respect. Peplau’s theory evolves in three phases:

  1. Orientation: The nurse-patient relationship is initiated by a patient’s needs. The nurse helps the patient get acquainted with the treatment process and answers questions.
  2. Working: As the nurse-patient relationship develops, the patient concentrates on expressing reactions to the illness and becomes an active participant in care.
  3. Termination: The nurse helps the patient follow through on care that has been provided and return to a normal productive life.

During the different phases, the nurses take on many roles, including resource person, teacher, surrogate and counselor.

Need Theory

Developed by Virginia Henderson, an RN who was inducted into the American Nurses Association’s Hall of Fame, the nursing Need Theory focuses on a nurse’s role in assisting patients to maintain health, recover from injuries or achieve a peaceful death. In her work, she continually stressed nursing’s duty to focus on helping the patient rather than the doctor.

Henderson, considered the mother of modern nursing care, outlined four basic needs—psychological, physiological, social and spiritual — that are required for patients to live independently:

  • Psychological needs including communicating and handling fears.
  • Physiological needs    including eating and sleeping.
  • Spiritual needs including worship and faith.
  • Social needs including recreational activities.

Among Henderson’s noted works was Nursing Research: Survey and Assessment and Nursing Studies Index, published in 1964 and 1972 respectively.

 

Application of Nursing Theory

Nursing theory helps makes sense of our complex healthcare system and has provided the foundation that defines the nursing profession by organizing thoughts and ideas identified by nursing theories (Karnick, 2016). Concepts offer an understanding of theories and combine evidence based practice towards clinical practice to improve patient health outcomes. Theory can further provide a framework to create a positive work environment by implementing strategies defined in a theory set out to improve work environments. Nurse retention directly reflects a cohesive positive work environment revolving around a supportive health care team and management system outlined in Jean Watson’s Theory of Human Caring (Twigg and McCullough, 2014).

Jean Watson’s Theory of Human Caring was published in 1979. This theory is designed to care for another person utilizing the 10 Caritas meaning to “cherish” or give special loving attention to someone. This theory can assist nurse leaders with a framework to create a positive work environment for health care team members aiding in nurse retention rates. The basis of this theory is recognizing a “caring moment” to establish an authentic caring relationship with another person. The formation of an authentic relationship is a sacred encounter connecting both parties on a spiritual and emotional level enabling a positive impact for one another. When allowing oneself to be authentically present in a “caring moment,” Watson believed this sets the tone for daily connections made with each other through communication, therapeutic touch, and any type of interaction where a person feels cared for. Leaders are empathetic and compassionate towards their health care team members by practicing the Carita of love, kindness, and equanimity to facilitate staff retention (Norman, Rossillo, and Skelton, 2016).

As more patients require health care services, the nursing shortage and the inability to retain staff threatens our health care system since hospitals are unable to provide staff to meet these needs. The purpose of this paper is utilizing Jean Watson’s Theory of Human Caring to encourage and effect staff retention. The layout of the paper includes a description of the issue or concern, the application of selected nursing theory to issue or concern, and finally, the conclusion.

Description of Issue or Concern

The United States continues to face a nursing shortage crisis and is unable to meet the demands projected for years to come. The World Health Organization estimates an average nurse shortage by 2020 of 285,000 and 500,000 by 2025 (Twigg and McCullough, 2014). The statistics presented are alarming and concerning. Whenever an insufficient number of nurses are available to produce high quality of care in a hospital setting, the effects of a nursing shortage are noticed. The nursing shortage is a result of an imbalance in supply and demand credited by demographics, qualifications, and availability of nurses willing to perform work (Hellerava, and Adambarage, 2015). The nursing shortage combined with the inability to retain staff poses economic factors and poor-quality healthcare care being delivered. Not only does this influence individual health organizations and the health care industry, but this crisis affects the patients who are at the receiving end of patient care nursing theories essay examples.

According to the Bureau of Labor Statistics, nursing is the leading profession for employment growth between 2010 and 2020. Due to the retirement of the baby boomer generation, the healthcare reform, and the ever-changing economy will cause healthcare to continually assess various methods to retain nursing staff. By 2020, half a million nurses will retire. Nurses who are unable to retire will face an overwhelming prediction of being unsatisfied in the workplace. Retention rates for these nurses are very poor (Dotson, Dave, Cazier, and Spaulding, 2014).

The individual hospital and corporation are affected by decreased retention rates due to financial burdens. Hiring a new nurse can cost a hospital an estimated 62,000 to 67,000 dollars in 2002. Inflation caused an average of 82,000-88,000 dollars spent on hiring a nurse in 2007. The costs were considerably higher if a new graduate nurse was hired since they are required to take additional classes and training to provide safe practice. Of the nurses hired, 10% of the new hire population will quit. An average of 17% to 85% of the new graduate nurses hired will quit. A 1% change in turnover or retention has the ability to save or cost a hospital an average of 373,200 dollars, according to Woten (2017).

The effects of nurse turnover and the inability to retain staff is noticed during patient care. Decreased nurse retention rates cause the rest of the nursing staff to be short-staffed each day. This requires one nurse to endure the responsibility desired for two nurses correlating with a decrease in quality of care. One study compared years with sufficient staff versus insufficient staff that yielded results linking a decrease in medication errors, falling incidents, and adverse event incidents when enough staff was present during a shift. Nurse turnover damages patient satisfaction and organizations due to lack of continuity of care, additional time required to manage fellow employees, and a loss in staff productivity. As more experienced nurses are reaching retirement and inexperienced nurses continue to have high turnover, the medical floors are experiencing inadequate skills, limited knowledge, and unfavorable patient care causing an issue and concern relating to poor health care (Hayes et al., 2012) nursing theories essay examples. Nurse turnover triggers unsafe patient care.

The most common reason related to nurse turnover is organizational factors. Nurses were more likely to stay if they had a positive relationship with a nurse leader in their organizational structure. Positive nurse leaders empower fellow health care team members by providing access to resources and information, providing support when needed, and offering learning opportunities to develop confidence that guides nursing practice. If inconsistencies arise in the workplace, the health care team members believe their goals will be unfulfilled causing them to quit (Goodare, 2017). Twigg and McCullough (2014) state nursing leaders provide a positive work environment by encouraging and supporting team members to perform to the best of their ability. An example might include when nurse leaders recognize team members when the nurse exceeds the expectations of the hospital. Positive work environments also consist of nursing autonomy, flexibility of scheduling, shared governance of the workplace, and continuous mentoring and support of health care teams.  A leader that is present and willing to be a part of authentic relationship with his or her health care team begins the process of nurse retention and satisfactory working conditions.

The nursing shortage and inability to retain staff is causing many healthcare systems to have unsafe patient ratios. They are unable to supply the demand needed to provide safe patient care. The concern of the nursing profession is safe working environment which the patient safety and positive patient outcomes being the center of focus in nursing practice. The hospitals and organizations are affected by the financial burden, patients are affected by poor quality healthcare, and nurses are all effected by unsafe nurse-patient ratios caused by nurse turnover; which is detrimental to health care. The statistics are alarming and a strategy needs to be implemented to retain staff. Nursing literature states an influential nurse leader who values support, encourages, empowers, and believes in authentic relationships is paramount to nurse retention.

Application of Selected Nursing Theory to Issue or Concern

Jean Watson’s Theory of Human Caring is based on concepts such as caring, “caring moments,” and a transpersonal authentic relationship. A “caring moment” transpires into an authentic transpersonal relationship where the 10 Caritas are applied to care for another person. The 10-Caritas used to explain and define caring include practicing equanimity, being physically and emotionally present, intentional assisting with basic needs, establishing a trusting authentic relationship, being culturally sensitive, engaging in a learning experience to create a “wholeness,” by creating an environment revolving around holism and humanism (Norman, Rossillo, and Skelton, 2016).

Research proposes a positive nurse leadership and environment is more effective towards nurse retention than increasing salaries (Twigg and McCullough, 2014). Implementing Watson’s Theory of Human Caring from a nurse leader standpoint is a possible strategy to decrease nurse turnover rate. Caring occurs when the nurse leader encompasses the 10-Caritias previously defined to empower his or her health care team.

Norman, Rossillo, and Skelton (2016) state practicing love, kindness, and equanimity that is empathetic and compassionate towards a team member’s needs is providing a safe work environment. Team members are always aware of a nurse leader’s actions, and when both party’s views and values and beliefs are aligned, an authentic relationship to ensue. For example, a nurse leader enforcing a zero-tolerance relating to workplace bullying is practicing this Carita by protecting his or her health care team from verbal or physical abuse.  Tending to health team members basic needs may mean being a team player when help is needed or providing learning opportunities and resources to allow a nurse to become confident in his or her knowledge and skills nursing theories essay examples. A positive leader will even go above and beyond and model an exemplary attitude and caring approach portrayed by Watson’s theory to motivate other team members to display a caring demeanor. Nurse leaders who recognize fellow nurses that display kindness, love, and equanimity in nursing practice are more satisfied with his or her work environment. Any kind act or encouraging words will never go unnoticed.

At a hospital, a nurse leader is utilizing Jean Watson’s theory if he or she is interacting with healthcare team members and developing a sacred encounter. A sacred encounter can transpire by communication, therapeutic touch, or any action where a team member feels cared for by the offering person. Each team member is positively affected creating a deeper human connection. A team member feels cared for when the nurse leader is authentically present and actively listening to his or her concerns and issues during these encounters. Trust and rapport are built between the two parties. Being able to create authentic caring relationship with healthcare team members allows them to feel supported which increases nurse retention and quality of care delivered in nursing practice (Norman, Rossillo, and Skelton, 2016).

Future research conducted would be to include if a caring nurse leadership approach that increased nurse retention caused a hospital to reach magnet level status. Tai, Wai, and Bame (2017) state magnet hospitals are the result of qualified nurse retention, better quality of patient care, acceptable patient satisfaction, and decreased mortality rate. Magnet level hospitals have acceptable nurse-patient ratios that decrease adverse events and patient mortality providing a safer environment for patient care. Are hospitals reaching a magnet level status due to sufficient staffing caused by a positive nurse leader being able to retain his or her staff?

Conclusion

            As the nursing shortage and staff retention continues to become more visible in the workplace, it is imperative that the nursing profession utilizes theory as a framework to follow. Jean Watson’s Theory of Human Caring can be incorporated and guide clinical practice by including the 10 Caritas empowering other healthcare team members. The purpose of applying the Human Caring theory is to improve patient healthcare and outcomes, decrease the financial burden the hospital faces, and create a positive working environment with sufficient safe staffing ratios. The theory is built on the concepts of caring, caring moments, and transpersonal caring relationships that a nurse leader must feel comfortable being a part of. To care for someone, is the ability to be aware of a “caring moment” and seizing the opportunity to build an authentic relationship with fellow healthcare team members. This essentially builds trust and rapport and increases job satisfaction that leads to increased nurse retention rates.

As I reflect over the new knowledge gained from my research efforts, I have learned that theory will always provide the foundation for which the nursing profession has been established. Nurses will continue to be satisfied as management remains present and acknowledges the hard work that is put out to create and provide safe patient care. Empowering others utilizing Jean Watson’s Theory of Human Caring is incredibly important to fulfill the goals of health care team members to motivate them to stay within the hospital nursing theories essay examples. Being able to positively manage health care team members is necessary to ensure job satisfaction and reduce turnover and nursing shortages.

   

References

Dotson, M., Dave, D., Cazier, J., &Spaulding, T. (2014). An empirical analysis of nurse retention: What keeps rns in nursing. The Journal of Nursing Administration, 44(2), 111-116. doi: 10.1097/NNA.0000000000000000034

Goodare, P. (2017). Literature review: Why do we continue to lose our nurses. Australian Journal of Advanced Nursing, 34(4), 50-56. Retrieved from eds.b.ebscohost.com.proxy.chamberlain.edu:8080/eds/detail/detail?vid=2&sid=8d62a810-605f-4be1-a743-c7fccea99

Hayes, L., Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Laschinger, S., & North, N. (2012) Nurse turnover: A literature review- an update. International Journal of Nursing Studies, 49(7), 887-905. doi: 10.1016/j.ijnurstu.2011.10.001

Hellerava, K., & Adambarage, A. (2015). The nursing shortage impact on job outcome. Journal of Competitiveness, 7(3), 75-94. doi: 10.7441/joc.2014.03.06

Karnick, P. M. (2016). Evidence-based practice and nursing theory. Nursing Science Quarterly, 29(4), 283-284. doi:10.1177/0894318416661107 nursing theories essay examples

Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. AORN Journal, 104(5), 401-409. doi: 10.1016/j.aron.2016.09.006

Tai, T., Wai, C., & Bame, S. (2017). Organizational and community factors associated with magnet status of u.s. hospitals. Journal of Healthcare Management, 62(1), 62-76. Retrieved from http://proxy.chamberlain.edu/8443/login?url=https://search-proquest-com

Twig, D., & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92. doi: 10.1016/j.ijnurstu.2013.05.015

Woten, M. (2016). Recruitment and retention of healthcare personnel: Nursing Residency. CINAHL Nursing Guide. Retrieved from eds.a.ebscohost.comproxy.chamberlain.edu: 8080/eds/detail/detail?vid=0&sid=5db30734

 

Nursing Theories and Their Works

 

  • Florence Nightingale (“Environmental Theory”)
  • Nursing as “act of utilizing the environment of the patient to assist him in his recovery”
  • Nightingale’s Concepts:
  1. Person: Patient who is acted on by nurse; Affected by environment; has reparative powers nursing theories essay examples.
  2. Environment: Foundation of theory; Included everything, physical, psychological, and social
  3. Health: Maintaining well-being by using a person’s powers; Maintained by control of environment
  4. Nursing: Provided fresh air, warmth, cleanliness, and good diet, quiet to facilitate person’s reparative process

 

  • Virginia Henderson (“The Nature of Nursing”)
  • “The unique function of the nurse is to assist the individual, 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. She must in a sense, get inside the skin of each of her patients in order to know what he needs”.

 

  • Dorothea Orem (“Self-Care Model”)
  • Nursing is “ an art, a helping service and a technology”
  • The theory includes:
  • Self care – practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being
  • Self care agency – is a human ability which is “the ability for engaging in self care” -conditioned by age developmental state, life experience sociocultural orientation health and available resources nursing theories essay examples.
  • Therapeutic self care demand – “totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions”
  • Self care requisites-action directed towards provision of self care.

 

  • Sister Calista Roy (“Adaptation Model”)
  • Nursing is “a theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill or potentially ill person”
  • Five Interrelated Essential Elements:
    • Patiency- The person receiving care
    • Goal of nursing- Adapting to change
    • Health-Being and becoming a whole person
    • Environment
    • Direction of nursing activities- Facilitating adaptation

 

  • Betty Neuman (“Health Care Systems Model”)

–     Nursing is “a unique profession in that is concerned with all the variables affecting an individual’s response to stressors, which are intra, inter, extra personal in nature” nursing theories essay examples.

–     The model represents the client within the system perspective, holistically and multi-dimensionally. It illustrates the components of five interacting client variables; physiological, psychological, developmental, sociocultural and spiritual in relation to environmental influences upon the client as a system consisting of basic structure, lines of resistance and lines of defense.

 

  • Martha Rogers (“Unitary Human Beings”)
  • Nursing is “a humanistic science dedicated to the compassionate concern with and maintaining and promoting health, preventing illness, and caring for and rehabilitating the sick and disabled”

 

  • Imogene King (“Goal Attainment Theory”)
  • Nursing is “a helping profession that assists individuals and groups in society to attain maintains and restores health. If this is not possible, nurses help individual die with dignity”
  • Open systems framework nursing theories essay examples.
  • Human beings are open systems in constant interaction with the environment
  • Personal System
    • individual; perception, self, growth, development, time space, body image
    • Interpersonal
    • Society
  • Personal System: Individual; perception, self, growth, development, time space, body image
  • Interpersonal: Socialization; interaction, communication and transaction
  • Society: Family, religious groups, schools, work, peers
  • The nurse and patient mutually communicate, establish goals and take action to attain goals
  • Each individual brings a different set of values, ideas, attitudes, perceptions to exchange

 

  • Hildegard Peplau (“Interpersonal Relations Model”)
  • Based on psychodynamic nursing
  • using an understanding of one’s own behavior to help others identify their difficulties
  • Applies principles of human relations
  • Patient has a felt need
  • Peplau’s Concepts
  1. Person: An individual; a developing organism who tries to reduce anxiety caused by needs; Lives in instable equilibrium
  2. Environment
  3. Health: Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
  4. Nursing: A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible

 

  • Jean Watson (“Philosophy and Science of Caring”)
  • Caring can be demonstrated and practiced
  • Caring consists of carative factors nursing theories essay examples
  • Caring promotes growth
  • A caring environment accepts a person as he is and looks to what the person may become
  • A caring environment offers development of potential
  • Caring promotes health better than curing
  • Caring is central to nursing

 

  • Lydia Hall (“Care Core and Cure Theory”)
  • The “Core, Care, and Cure” Theory was developed in the late 1960’s.  She postulated that individuals could be conceptualized in three separate domains: the body (care), the illness, (cure), and the person (core).
  • Hall believed patients should receive care ONLY from professional nurses. Nursing involves interacting with a patient in a complex process of teaching and learning. Hall was not pleased with the concept of team nursing–she said that “any career that is defined around the work that has to be done, and how it is divided to get it done, is a “trade” (rather than a profession).

 

  • Ida Jean Orlando (“Deliberative Nursing Process”)
  • The deliberative nursing process is set in motion by the patient’s behavior
  • All behavior may represent a cry for help. Patient’s behavior can be verbal or non-verbal.
  • The nurse reacts to patient’s behavior and forms basis for determining nurse’s acts.
  • Perception, thought, feeling
  • Nurses’ actions should be deliberative, rather than automatic nursing theories essay examples.
  • Deliberative actions explore the meaning and relevance of an action.

 

  • Katherine Kolcaba (“Comfort Theory”)
  • Holistic comfort is defined as the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental)

 

The Importance of Nursing Theory

Nursing theory can be defined as a rigorous yet creative structure of ideas that emanate a purposeful, tentative, and systematic view of healthcare phenomena. Nursing theories incorporates many theories; with this culmination an introduction of action is placed into model practice. These theories are used to define, revolutionize, and disseminate current nursing knowledge and advance healthcare into the next era. Utilizing these theories provide for a plan for reflection and gives certainty for which the plan should be headed. With each new situation encountered, the framework of nursing theory provides an order for management, research, and decision making. These theories also provide a structure of communication for nurses amongst one another and with other healthcare professionals within the team. Nursing theories assist the nurse in developing goals, beliefs, and values. nursing theories essay examples.

Foundations of theory are and will remain an important aspect of nursing and advanced practice nursing education. Today, theory play an even larger role in nursing with increased emphasis on nursing research and evidence-based practices for advanced practice nurses. With this being said, it is expected of nurse practitioner graduates to demonstrate competencies in skills and knowledge in order to provide safe and quality care to a diverse population of patients in a very complicated health care system.

With increase in acuity of patients, hospitalization length decreasing, and the boom of healthcare technology and specialization, the need for highly experienced nurses have increased. With this increase in need, the responsibility and complexity of current nursing practice requires constant, long term career development. According to the AACN, many Master’s level nursing programs were reported to have wide varying clinical practicum requirements, didactic course work experiences, and titling. Unfortunately, in certain instances, new graduates from these nursing programs reportedly had no direct care experiences in their chosen master’s programs such as adult health, community health, and child health (AACN, 2011). nursing theories essay examples.

From Novice to Expert, a theory formulated by Patricia Benner, is probably one of the simplest nursing theories to understand. Benner’s theory proposes that in gaining and developing skills, a nurse must pass through five proficiency levels: as a novice, an advanced beginner, competent, proficient, and lastly, an expert. Advancing through each level reflects a movement from dependence on abstract principles to the application of past concrete experiences. As a nurse advances through each step, she builds upon the previous step and gains clinical expertise with each advancement (Benner, 1982).

In Benner’s first stage of clinical competence, the novice or beginner has little to no experience in circumstances in which they are expected to perform in. There is lack of confidence in demonstrating safe practice and the requirement of continuous verbal and physical cues are present. Practice is within an extended period of time and the individual is unable to make and use discretionary, independent judgement. An example of this would be a nursing student in the first year of clinical education; upon observation, the observer will witness limited and inflexible behavior in the clinical setting. Novices lack the ability to predict and ascertain what may occur in certain patient situations, i.e., mental status change, this knowledge may be obtained once a novice nurse has gained experience working with patients who have had similar symptoms (1982 nursing theories essay examples.

The next stage of clinical competence, advanced beginner, the nurse demonstrates slightly acceptable performance due to prior experiences in actual situations. The nurse is competent and skillful in certain areas of practice, requiring minimal verbal and physical cues with continued knowledge development. These are nurses who have obtained a first job, acquired experiences which allow them to recognize situations in which they have been previously exposed and have the knowledge combined with the know-how to respond but still lack in depth experience.

Benner’s third stage, Competence, is demonstrated by the nurse who has been practicing in the same job/situation for at least two to three years. The nurse holds the ability to demonstrate efficiency, possesses coordination and confidence in her actions. A plan effectively establishes a perspective and is based on substantial abstract, conscious, logical contemplation of the situation. The deliberate, conscious planning associated with this skill level assists the nurse in achieving efficiency and organization with care completion in an appropriate timeframe with no supporting cues.

For Benner’s next stage, Proficient, the nurse’s perception of a situation is whole rather than in bits and pieces. The proficient nurse understands and views the situation a whole due to the ability to perceive the meaning in terms of long term goals. The Proficient nurse obtains knowledge from experience from typical situations, how to respond to these situations and how to modify plans in response to these situations. The Proficient nurse holds the ability to recognize what is an atypical event/situation. The Proficient nurse perceives decision making as holistic and decision making becomes less arduous due to gained experience nursing theories essay examples.

For Benner’s last stage, Expert, the nurse has the ability to intuitively grasp each situation and event which allows for accurate assessment and addressing of certain problems without unnecessary wasting of consideration, time, and solutions. The Expert nurse functions from a deep understanding of the situation as a whole. Performance becomes flexible and fluid with high proficiency. For situations in which the nurse has had no exposure or experience, a high skilled analytic ability is necessary.

When applying the metaparadigm in Benner’s perspective, the perception is that the person does not enter this world pre-defined but is defined through the course of living life; a self – interpreting being, the view is of the person being a participant in common meanings (Tomey & Allgood, 2002). According to Benner, the person must understand and handle the role of the situation, the body, the personal concern, and temporality. Benner’s focus on health was through the lived experience of being healthy and sick. Benner defined health as objective assessment, with well-being as experienced by health and wholeness. For Benner, environment, or situation, is used to suggest a social atmosphere. This is defined by Benner as the person’s involved interaction, perception, interpretation, and understanding of the situation.

According to Huffstutler, newly graduated nurse practitioners often express feelings of being a “fake” or “imposter, as they make the transition from nurse to nurse practitioner (2006). After exceeding the stages of novice to expert, the newly graduated nurse practitioner must once again gain experience and get established in a “new” situation and role. Huffstutler suggests strategies for new nurse practitioners to develop during this transitional phase is to be aware of the transition. Self-reflection and calm inward looking may assist with this transitional process. The novice nurse practitioner should acknowledge initial lack of command as a nurse practitioner.

As I review this theory and its stages, I have the ability to ascertain where my methods and practice arise from. Applying Benner’s stages, I had no knowledge, I gained knowledge, I developed confidence, and I became an expert. As a nurse, it is crucial that we recognize and are able to differentiate between cultures and the many different views of healthcare, amongst life and death and are able to work within these frameworks to provide the best and most effective quality of care for our patients nursing theories essay examples.

References

American Associations of Colleges of Nursing (2011). The Essentials of Master’s Education in Nursing. Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf. 

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.

Huffstutler, S. Y. (2006). The Impostor Phenomenon in New Nurse Practitioner Graduates. Topics in Advanced Practice Nursing EJournal, 6(2).

Tomey, A. M., & Allgood, M. R. (2002). Nursing Theorists and Their Work. International Journal of Nursing Studies, 42(1), 114. http://dx.doi.org/10.1016/j.ijnurstu.2004.05.009 nursing theories essay examples

 

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