Term paper on “Nursing care theories and models and their application to: 1. Adult health nursing” 2. Community Health nursing” 3. Reproductive Health nursing” A theory is a set of propositions used to describe , explain predict and control. Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of each profession of nursing. Levels of nursing theories. * Grand nursing theories. This type of theory has the broadest scope and present general concept and propositions.
Theories at this level may both reflect and provide insight useful for practice but are not designed for empirical testing. This limits the use of grand nursing theories for directing, explaining and predicting nursing in particular situations . * Mid range nursing theories. Are narrower in scope than grand nursing theories and offer an effective bridge between grand nursing theories and nursing practice. They present concept and positions at a lower level of abstraction and hold great promise for increasing theory-based research and nursing practice strategies. * Nursing practice theories.
Nursing practice theories have the most limited scope and level of abstraction and are developed for use within a specific range of nursing situations. Nursing practice theories provide frameworks for nursing interventions and predict outcomes and the impact of nursing practice. Types of theories. i. Descriptive theory : it defines properties and components of a discipline, it sorts out meaning and observations and sets forth what elements exists in the discipline it identifies and describes specific characteristics of particular people, groups, situation or event. ii.
Explanatory theory: identifies how the properties and components relate to each other and accounts for how the properties and components related to each other and accounts for how the discipline functions. It describes relationships among various phenomena. iii. Predictive theory: predicts the relationship between the components of a phenomenon and predicts what conditions it will occur but does not provide control. iv. Prescriptive Theory: addresses nursing therapeutics and consequences of interventions. Such theories designate under what conditions something should occur.
Characteristics of nursing theory * They are interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. * Logical in nature. * Generalizable. * Bases for hypotheses that can be tested. * Increasing the general body of knowledge within the discipline through the research implemented to validate them. * Used by the practitioners to guide and improve their practice. * Consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated. 1. ENVIRONMENTAL THEORY FLORENCE NIGHTNGALE
The environmental theory is attributed to Florence Nightingale. The main focus of her theory is the control of the environment of individuals and families both healthy and ill. She discusses the need for ventilation and light in sickroom, proper disposal of sewage and appropriate nutrition. Her ideas about nursing have guided both theoretical thought and actual nursing practice throughout the history of modern nursing. Nightingale considered nursing similar to a religious calling to be answered only by women with an all consuming and passionate response.
She considered nursing to be both an art and science and believed that nurses should be formally educated. . Application of environmental theory in: Adult health nursing Unnecessary noise is not healthy for recuperating patients. Nightingale advocated for a quite environment in the hospitals. Petty management proposed the avoidance of psychological harm no upsetting news strictly war issues and concerns should not be discussed inside the hospital. She includes the use of small pets of psychological therapy while nursing adult patients.
Dietary intake- patients to be fed with clean food and water Light has quite as real and tangible effects to the body. Her nursing intervention includes direct exposure t sunlight. Control of room temperature- patients should be nursed at appropriate temperature With the use of Nightingales ideas hospitals became a place for people to recover rather Than a place to die. Community Health Nursing Warmth quiet and diet environment she introduced the manipulation of the environment for patient’s adaptation such as fire operating the windows and repositioning the room seasonally.
Cleanliness and sanitation- she assumes that dirty environment was the source of infection and rejected the germ theory. Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage frequent bathing for patients and nurses, clean clothing and hand washing. The environmental theory is utilized by modern architecture in the prevention of “sick building syndrome” applying the principles of ventilation and good lighting. Noise management- noise pollutes the environment making it unhealthy for people and can cause serious conditions e. . ear problems When for a reason hospitals did not hire their own nursing graduates nurses applied nightingales principles in the community in the development of public health nursing. Reproductive Health Nursing Good balanced diet is important to pregnant women in order to bring forth healthy children. Clean environment is an important aspect in child delivery to prevent postnatal complications; this is a clear application of the environmental theory. 2. DEVELOPMENTAL THEORIES. Developmental theories are called sometimes theories of growth and development.
Development models emphasize processes of growth development and maturation. Focus is also on identification of actual and potential developmental problems and delineation of intervention strategies that foster maximum growth and development of people and their environment. The theorists classified under the developmental model branch include: 1. Sigmund Freud Freud proposed one of the best known grand theories of child development. According to Freud’s theory child development occurs in a series of stages focused on different pleasure areas of the body.
During each stage the child encounters conflicts that play a major role in the course of development. 2. Erick Erickson Rather than focusing on sexual interest as a driving force in development, Erickson believed that social interaction and experience played a decisive role. His eight stage theory of human development described this process from infancy through death. During each stage people are faced with a developmental conflict that impacts later functioning and further growth 3. Jean Watson Caring is the most important aspect of nursing.
According to Watson caring is when the nurse enters in to the experience of another person and another can enter into the nurses experiences (Watson 1989 pg 234) Her main concern in the development of this theory is to balance the impersonal aspects of nursing care that are found in the technological and scientific aspects of practice with the personal and interpersonal elements of care that grow from a humanistic belief in life. She openly recognized the clients and family’s spirituality and spiritual beliefs as an essential element of health 4. Madeleine Leininger’s Cultural care Diversity
Leininger states that care is the essence of nursing a man caring and dominant distinctive and unifying feature of nursing. This model model emphasizes that health and care are influenced by elements of social structure such as technology, religious and philosophical factors, kinship and social systems, cultural values political and legal factors economic and educational factors. Along with the universal nature of human beings as caring beings, the cultural care values, beliefs and practices that are specific to a given culture provide a basis for the patterns, conditions and actions associated with human care.
Application of Developmental theories: Adult health Nursing. According to Watson’s caring way, the theory helps in establishing a relationship of help and trust between the nurse and the client. Watson’s theory aids in the adult patients/clients nursing as they are able to express both positive and negative feelings with acceptance. It assists in whatever way deemed appropriate to meet the basic human needs of the client. Community health nursing Watson’s model aids in manipulating the environment to make it more supportive, protective or connective for the client with any type of disease process.
Watson’s theory recognizes the client’s and family’s spirituality and spititual beliefs as an essential element of health. Reproductive Health nursing Developmental theories are useful in assessing whether a child’s growth and developmental stage is keeping pace with his chronological age. Children falling outside the normal ranges need medical and nursing interventions. Growth and developmental theories are also useful to nurses teaching parents about what to expect from their children at certain ages and stages.
Through the study of developmental theories, nurses understand and should remember that although knowing characteristic traits, developmental tasks and stages is useful, each individual is unique in style and behavior. 3. INTERACTIVE MODEL. This model emphasizes the importance of interpersonal relationships between the nurse and the person. It focuses on identifying any interpersonal problems and providing intervention techniques to promote optimal socialization. The leading theorists of interactive model include: Hildegard Peplau’s interpersonal theory.
Her theory of interpersonal relations provides a useful framework for investigating clinical phenomena and guiding nurses’ actions. Her theory focuses primary on the nurse-client relationship in which problem solving are developed. Four phases occur during this interactive process: orientation, identification, exploitation and resolution phase. Throughout these phases, the conselling, leadership, surrogate, resource person and teaching role. Virginia Henderson’s Model. The foundation of Henderson’s theory is that nurses should focus on the patients rather than the task.
The core component to Henderson’s theory is for nurses to help patients become self sufficient. She emphasized the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed. APPLICATION OF INTERPERSONAL THEORIES; Adult Health Nursing Peplau’s theory is significant for practice in that it propelled psychiatric nursing from custodial based care to interpersonal relationship theory based care Peplau’s theory has provided an enduring educational for teaching the nurse patient relationships as a pivotal nursing process in all contexts of practice.
The therapeutic nurse patient relationship promotes active participation of patients in their health care. Peplau’s theoretical work has also promoted a paradigm of professionalization and empowerment for educating nurses for the 21st century. Nursing education has been deeply affected by Henderson’s clear vision of the function of nurses. The nursing theories of Peplau and Henderson are commonly used by psychologists and psychiatrists as well as nurses in mental health clinic settings. They provide a framework for understanding patients’ reactions to illness, birth, deaths and traumatic life events.
Henderson conceptualizes the nurses role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs. Community Health nursing. Interactive models are applied in the community as there is enhancement of social acts and relationships, through interaction of the community members and the nurse. People are able to clearly identify any problems they may have and look for intervention techniques to promote optimal socialization amongst themselves. Henderson’s theory expects society to contribute to nursing education.
Reproductive health Nursing. Marriage and family-This theory can involve marriage and family planning methods for adults. This process teaches abstinence and practicing safe sex until marriage. Nurses open lines of good communication to address the concerns the client has about preventing unwanted pregnancy. Family planning programs are available to young adults interested in practicing birth control techniques and abstinence until marriage. Nurses counsel on the choice of birth control, its use or change of use.
As per Peplau’s theory, the nurse assumes the teaching role and assists couples in knowledge concerning the fertility cycles. 4. SYSTEMS THEORIES. The systems model of nursing views the person as a multidimensional being who reacts continually to a world of stressors. Systems may be closed or open depending on the amount of information coming in or out of the systems. Opens systems allow for exchange of information through their bounderies. closed systems refer to rigid structures in which minimal exchange of ideas are limited. Some theorists include King Imogene, Neuman and Orem.
Imogene King. His theory describes a dynamic interpersonal relationship in which a person grows and develops to attain certain life goals. Betty Neuman Her theory is a nursing theory based on the individual’s relationship to stress, the relationship to it and reconstitution factors that are dynamic in nature. The purpose of the nurse is to retain this system’s stability through the primary, secondary and tertiary prevention. Roy’s adaptation model. Roy’s model sees individuals a set of interrelated systems (biological, psychological and social).
The individual strives to live within a unique band in which he or she can cope adequately. Nursing attempts to alter the environment when the person is not adapting well or has in effecting coping responses. According to The Roy adaptation model, the person has coping mechanisms that are broadly categorized in either regulator or cognator systems. Orem’s General theory of nursing. Orem’s theory revolves around a person centered model, in which the nurse identifies self care needs of the patient and then works as collaboratively as possible with the patient to meet those needs.
The theory includes self care, self care deficit and nursing system concepts. APPLICATION OF SYSTEMS THEORY Adult Health nursing. King’s theory highlights the importance of a client’s participation in decision making that influence care and focuses on both the process of nurse-client interaction and the outcomes of care. Newnan’s system model is applied in attempting to restore the stability of the system using the primary, secondary and tertiary interventions. Neumann’s theory is also used in practice and in research.
Its concentric layers allow for a simple classification of how severe a problem is the level of insult can be quantified allowing for graduated intervention. Today’s nurses use nursing diagnoses to describe patient’s problems. Orem’s self care deficits are well represented here. Roy’s adaptation theory is applied in nursing as it allows to assess patient’s stressors and abilities to cope. Nurses familiar with adaptation theories can help patients realistically appraise their stressors, examine their usual coping responses and if necessary learn new ones.
By use of these theories in adult nursing, nurses can interact with the patients to facilitate achievement of health-related goals. Community Health nursing As people interact with others in the community, they must continually adjust to stressors’ in the internal and external environment Nurses can effectively provide care at the interactional systems level at which they deal with small to moderate-sized groups in activities such as group therapy and in health promotion classes. King’s theory offers insight into nurse’s interaction with individuals and groups within the environment.
The role of nursing at the social systems level can be expanded to include involvement in Policy decisions that have an effect on the health care system as a whole. Orem’s self care deficit theory has been widely adopted in a variety of clinical settings like rehabilitation nursing, with its focus on addressing self care deficits in patients with physical disability or chronic illness and home health nursing which is aimed at making patients as safe and independent as possible in their own homes. Reproductive Health nursing
Parenthood and stress management-Nurses taking part in family planning are available with advice after delivery of the child. This postnatal care consists of feeding techniques, health concerns for the baby as well as for the mother. Nursing give needed counseling and support to mothers who might experience postpartum depression. These theories provide the necessary guidance to couples to handle the entire process from conception to birth so that the couple can make the most of becoming a happy and healthy family. Orem’s self care theory is applies in diagnosing various reproduction disorders.
Reference: * Yema M. Luhahi, Nursing Theories and professionalism, NRSG 121:RN, BSN, MPH, Senior lecturer. * Linderg and al (1998) introduction to Nursing: concepts. issues and opportunities. * Barium Barbara (1998). Nursing theory: Analysis, Evaluation, Lippincott Williams and Wikins ISBN 978. * Allender J N:(2001)Community Health concepts and practice,8th edition. * Tomey A M Alligood. MR. (2002)Nursing theorist and their work(5th edition),Mosby, Philadelphia. * Memmott,Rae Jeane,use of the Neumann systems model in interdisciplinary team.
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