By its very nature, the development of nursing’s theoretical base has progressed in a methodical and systematic, albeit slow, fashion. Knowledge development is an ongoing process that is often influenced by driving forces outside the discipline of nursing. The early nurse theorists were not attempting to
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ABLE2-2 Summary of Selected Nursing Theorists’ Major Concepts
THEORIST AND
MODEL PERSON ENVIRONMENT HEALTH NURSING
Nightingale (1859) Environmental Theory
Physical, intellectual, and spiritual being unable to manipulate the environment to promote health
Physical elements that affect the healing process: cleanliness, light, pure air and water, comfort
State of well-being using one’s powers to the fullest extent
To facilitate healing and restore health by manipulating the person’s environment
Peplau (1952) Interpersonal Process
Developing organism living in an unstable equilibrium and striving to reduce anxiety
External factors and significant others
Interpersonal processes that facilitate forward movement of the personality
To develop interaction between the nurse and the person
Henderson (1955) Basic Needs
Biological being, oneness of mind and body, who has 14 fundamental needs
The aggregate of all external conditions affecting life and development
Wholeness, the ability to function
independently in relation to 14 needs
To assist the person (well and sick) to perform the 14 essential functions Levine (1969)
Conservation Theory
Who the person knows himself or herself to be
Context in which the person lives his or her life
Response of the person to the environment
To use conversation activities aimed at optimizing the person’s resources Rogers (1970)
Science of Unitary Beings
A unified irreducible whole; more than the sum of the parts
Pandimensional energy field integral with the human energy field
Patterns of living in harmony with the environment; defined by the culture or individual
Science and art; the art of nursing is the creative use of science for human betterment King (1971) Goal
Attainment Theory
Open system who exhibits
characteristics common to others
Internal and external elements involving temporal and spatial reality
Ability to adjust to stressors to achieve maximum potential for daily living
A process of action, reaction, and interaction
Orem (1971) Self- Care Deficit Theory
A unity who functions biologically,
symbolically, and socially and whose functioning is linked with the environment
Linked to the individual, forming an integrated system
State in which the individual is structurally and functionally whole
A triad of interrelated action systems
Roy (1976) Adaptation Model
Biopsychosocial being interacting with a dynamic environment
Internal and external conditions that surround and affect individuals
State or process of being or becoming an integrated and whole person through adaptation
To support the individual’s adaptation to stimuli
Paterson &
Zderad (1976) Humanistic Nursing
Process of becoming in an environment of time and space
Awareness of the individual’s uniqueness and commonality with others
State of becoming, well-being, rather than freedom from disease
To respond to human needs and build humanistic nursing science
(continues)
address the metaparadigm concepts because initial consensus on these had not yet been achieved. Rather, these theories were attempting to answer the question ‘‘What is nursing?’’
Hildegard Peplau
Hildegard Peplau, a psychiatric nurse, combined her research and experience in the development of a theory of psychodynamic nursing, published in Interpersonal Relations in Nursing (1952). Drawing from her own knowledge and that from other disciplines, Peplau defined the concepts and stages involved in the development of the nurse-client rela- tionship. From that relationship, she identified the roles of the nurse as stranger, resource person, teacher, leader, surro- gate, and counselor. Peplau developed a middle-range theory with a focus on both nursing and the person and did not
incorporate all aspects of the metaparadigm into her theory.
Although other theories may view the nurse-client relation- ship differently, the primacy of this relationship in nursing has remained.
Virginia Henderson
Virginia Henderson’s definition of nursing, considered to be a classic, first appeared in 1955.
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 a peaceful death) that he would per- form unaided if he had the necessary strength, will, or knowledge.
And to do this in such a way as to help him gain independence as rapidly as possible. (Henderson, 1966, p. 15)
THEORIST AND
MODEL PERSON ENVIRONMENT HEALTH NURSING
Leininger (1978) Transcultural Caring Theory
Caring, cultural beings Interrelated, interdependent systems of a society
State of well-being that is culturally defined
To provide care;
caring is the central, unifying domain for nursing knowledge and practice Neuman (1972/
1995) Systems Model
Wholistic client, dynamic composite of interrelationships among physiological, psychological, sociocultural, developmental, and spiritual variables
Internal and external factors affecting and affected by the system
Health and wellness is a condition or degree of system stability
To assist client adjustments required for an optimal wellness level through accuracy in the assessment of effects and possible effects of environmental
stressors Watson (1979/
1989) Human Caring Theory
Person possesses three spheres: mind, body, and soul; strives to actualize the higher self
Internal and external variables
Unity and harmony within the mind, body, and soul
To assist persons attain a higher degree of harmony by offering caring relationships that clients can use for personal growth and development Parse (1981/1995)
Human Becoming Theory
An open being, coexisting with the environment
Inseparable from the individual; humans and the environment interchange energy, and influence one another’s rhythmical patterns of relating
An open process of becoming that emcompasses a lived experience, synthesis of values, and rhythmic process of being or becoming
A discipline, the practice of which is a performing art
Delmar/Cengage Learning
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ABLE2-2 (Continued)
Together with Bertha Harmer, Henderson attempted to identify those basic human needs viewed as the basis of nursing care. These needs include the need to maintain physiologic balance, to adjust to the environment, to com- municate and participate in social interaction, and to worship according to one’s faith. Henderson’s 14 basic needs were published in the Textbook of the Principles and Practice of Nursing, one of the first nursing textbooks. Henderson viewed the nursing role as helping the client from depend- ence to independence. As an early nursing theorist, she did not intend to develop a theory of nursing but rather attempted to define the unique focus of nursing. Hender- son’s emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs.
Faye Abdellah
Faye Abdellah, acknowledging the influence of Henderson, expanded Henderson’s 14 needs into 21 problems that she believed would serve as a knowledge base for nursing.
Throughout her career, she strongly supported the idea that nursing research would be the key factor in helping nursing to emerge as a true profession. The research that was done regarding these common needs or problems has served as a foundation for the development of what we now know as nursing diagnoses.
Joyce Travelbee
Joyce Travelbee, an educator and psychiatric nurse, was influ- enced by the philosophy ofexistentialism, a movement that is centered on individual existence in an incomprehensible world, the role that free will plays in it, and the search to find meaning in life’s experiences. She extensively developed the ideas of sympathy, empathy, and rapport in which the nurse could begin to comprehend and relate to the uniqueness of others. Her work focused on the human-to-human relation- ship and on finding meaning in experiences such as pain, ill- ness, and distress. Travelbee based most of her theory on her own experiences and readings and first published her work in Interpersonal Aspects of Nursingin 1966.
Josephine Paterson and Loretta Zderad
The work of Josephine Paterson and Loretta Zderad was similar to that of Travelbee in that it emphasized the human- istic and existential basis of nursing practice. According to Paterson and Zderad, theory developed from the practice of nursing. Although the models proposed by Travelbee and Paterson and Zderad had some impact at the time of their initial introduction, they did not gain wide popularity and application in nursing. The work of Travelbee and Paterson and Zderad most appropriately fits the simultaneity para- digm. Current theorists—such as Watson, Rogers, Parse, Fitzpatrick, and Newman—who have an existential orienta- tion, are rediscovering the merits of Travelbee and Paterson and Zderad.