A brief discussion of selected nursing theories follows.
The date identified indicates the year in which the theory was first presented. However, most theories have contin- ued to be refined and modified. A summary of the major nursing theorists with a brief description of their theory or conceptual model is presented in Table 5-2, which provides the reader with information to guide further exploration of nursing theory. Box 5-5 provides online resources for further investigation of nursing theories.
Hildegard E. Peplau (1952)—Interpersonal Relations as a Nursing Process: Man as an Organism That Exists in an Unstable Equilibrium
When the client incurs an insult that renders her or him incapable of moving forward because of stressful envi- ronmental conditions, anxiety increases. This condition creates a situation wherein the option is to either move in a backward direction or remain on a plateau. Nurs- ing intervention in Peplau’s model focuses on reducing the related incapacitating stressors through therapeu- tic interpersonal interaction. Intervention involves the nurse assisting the client with mutual goal setting. These goals may address exploration of the identified problem, identification of viable options, and implementation of available resources for resolution. Nursing interpersonal process is present and interactive, using associated and appropriate nursing intervention skills, which incorpo- rate the roles of the nurse as resource person, educator, mentor, transfer agent, and counselor. Peplau’s model requires that the nurse have a self-awareness and insight regarding her or his own behaviors. This awareness may be applied in identifying and working through those behaviors unique to the client’s schema. Figure 5-2 presents Peplau’s psychodynamic nursing model.
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TABLE 5-2 SUMMARY OF MAJOR NURSING THEORISTS AND THEORY DESCRIPTION
DATE AND
THEORIST THEORY DESCRIPTION Florence Nightingale
1860
Investigates the effect of the environment on healing.
Hildegard E. Peplau 1952
Interpersonal relations model explores the interpersonal relationship of the nurse and the client and identifies the client’s feelings as a predictor of positive outcomes related to health and wellness.
Faye Abdellah 1960
Twenty-one nursing problems. Client-centered interventions.
Ida Jean Orlando 1961
Theory of the nursing process. Deliberate nursing approach using nursing process, which stresses the action of the individual client in determining the action of the nurse; focus is on the present or short-term outcome.
Virginia Henderson 1966
Definition of nursing. Nursing assists patients with 14 essential functions toward independence.
Myra Estrin Levine 1967
Conservation model. Four conservation principles of inpatient client resources (energy, struc- tural integrity, personal integrity, and social integrity).
Martha E. Rogers 1970
Science of unitary human beings: energy fields, openness, pattern, and organization; nurse promotes synchronicity between human beings and their universe or environment.
Betty Neuman 1970
Systems model: wellness-illness continuum; promotes the nurse as the agent in assisting the client in adapting to and therefore reducing stressors; supports the notion of prevention through appropriate intervention.
Dorothea Orem 1971
Self-care model. Nursing facilitates client self-care by measuring the client’s deficit relative to self-care needs; the nurse implements appropriate measures to assist the client in meeting these needs by matching them with an appropriate supportive intervention.
Imogene King 1971
Goal attainment theory. Goal attainment using nurse-client transactions; addresses client sys- tems and includes society, groups, and the individual.
Sister Callista Roy 1974
Roy’s adaptation model. Client’s adaptation to condition using environmental stimuli to adjust perception.
Madeline Leininger 1977
Theory of cultural care diversity and universality. Transcultural nursing and caring nursing;
concepts are aimed toward caring and the components of a culture care theory; diversity, universality, worldview, and ethnohistory are essential to the four concepts (care, caring, health, and nursing).
Jean Watson 1978
Philosophy and science of caring and humanistic nursing; there are 10 “carative” factors that are core to nursing; this holistic outlook addresses the impact and importance of altruism, sensitivity, trust, and interpersonal skills.
Margaret Newman 1979
Central components of this model are health and consciousness followed by concepts of movement, time, and space; all components are summative units, described in relationship to health and to each other.
Dorothy E. Johnson 1980
Behavioral system model for nursing; separates the psychologic and the physiologic aspects of ill- ness; role of the nurse is to provide support and comfort to attain regulation of the client’s behavior.
Rosemarie Rizzo Parse
1981
Theory of human becoming (1992) proposes that quality of life from each person’s individual perspec- tive should be the goal of nursing practice. Parse first published the theory in 1981 as the “man- living-health” theory. The name was officially changed to “the human becoming theory” in 1992 to remove the term man after the change in the dictionary definition of the word from its former meaning of “humankind”; individual, by existing, actively participates in creating health according to environmental influences; individual is regarded as an open system wherein health is a process.
Patricia Benner 1982
Primacy of caring; the practice of nurses depends on the experience absorbed by engaging in five practice areas (novice, advanced beginner, competent, proficient, and expert) in the seven domains of nursing practice (helping, teaching-coaching, diagnostic and patient moni- toring, effective management of rapid change, administration and monitoring of therapeutic interventions and regimens, monitoring and ensuring the quality of health care practices, and organizational work-role competencies).
83 CHAPTER 5 Theories of Nursing Practice
Martha E. Rogers (1970)—Science of Unitary Human Beings: Humans as Energy Fields That Interact Constantly with the Environment
When the client-human unit incurs an insult that renders him or her out of balance with the universe, nursing interventions must be geared toward helping the client-human unit attain an increasing complex
balance and synchronicity with the universe. Essential to Rogers’s theory is the belief that each being is unique and consists of more than the collective sum of parts and that each being is constantly evolving in a forward momentum as he or she interacts continually with the surrounding environmental field. Rogers’s theory states that a brain integration is necessary to support the notion of human-environmental synergy, using the right side of the brain to recognize every human unit’s capacity for imagery, sensation, and emotion and the left side of the brain for language, abstraction, and thought.
Dorothea Orem (1971)—Self-Care Deficit Model: Self-Care, Self-Care Deficits, and Nursing Systems
When a client incurs an insult that renders him or her incapable of fully functioning, deficient self-care occurs, which makes nursing intervention necessary. The object of Orem’s theory is to restore the client’s self-care capa- bility to enable him or her to sustain structural reli- ability, performance, and growth through purposeful nursing intervention. The aim of such intervention is to help the client cope with unmet care needs by acquiring the maximal level of function. This would be to either regain previous function or maximize available func- tion present after the insult, hence restoring a sense of well-being.
BOX 5-5 HELPFUL ONLINE RESOURCES
The following sites are excellent resources for nursing theory and information about nursing theorists, includ- ing King, Leininger, Levine, Neuman, Newman, Orem, Parse, Peplau, Rogers, Roy, Watson, and others:
www.sandiego.edu/academics/nursing/theory www.nursingtheory.net
This site links to Leininger’s theory of cultural care diversity and universality.
www.tcns.org
This site brings together current knowledge and expe- riences with teaching, practicing, and researching comfort.
www.thecomfortline.com
This site describes early nurse theorists and classifies nursing theories.
www.enursecribe.com/nurse_theorists,.php# Early Nurse Theorists
Margaret Newman:
www.healthasexpandingconsiousness.org
Phases in nursing relationship
Stranger
Stranger
Unconditional surrogate:
Mother Sibling
Counselor Resource person Leadership surrogate:
Mother Nurse
Middle-Range Nursing Theory
Patient
Adult person
Orientation
Infant Child Adolescent Adult person
Identification Exploitation Resolution
FIGURE 5-2 Peplau’s Psychodynamic Nursing Model. Phases and changing roles in nurse-patient relationships. (From Peplau HE: Interpersonal relations in nursing, New York, 1952, GP Putnam, p. 54.)
84 UNIT 1 The Development of Nursing