chapter 07

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 7Grand Nursing Theories Based on Human

Needs


Florence Nightingale

“For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every

week, take my word for it, we are going back.”


Florence Nightingale—(cont.)

• Born: Florence, Italy, 1820

• Wealthy English parents

– Well educated

– Parents desired her to pursue social graces.

• Attended nursing school in Kaiserswerth, Germany in 1851 (program was 3 months)

– Believed that nursing was her “calling”


Florence Nightingale—(cont.)

• Spent most of her later life (54 years) confined to her home

• Died in 1910—age 90 years


Florence Nightingale—Work

• Crimean War (1854–1855)

– Served at Scutari Army Hospital in Turkey

– Conditions deplorable

• Advocated cleanliness, pure water, good food

• Cut casualties from 48% to 2%

• Kept excellent statistics demonstrating changes


Florence Nightingale—Work—(cont.)

• Nightingale School for Nurses

– St. Thomas’ Hospital, London

– In 1872, the New York Training School (Bellevue Hospital) was the first nursing school in the United States using Nightingale’s model.


Florence Nightingale—Work—(cont.)

• Writings

– Notes on Nursing

– Notes on Hospitals

– Many essays and letters


Question

Which of the following is NOT among the many accomplishments credited to Florence Nightingale?

A. She wrote extensively on nursing and nursing care.

B. She served during World War I, actively improving the care of British soldiers.

C. She instituted a program of record keeping for government health statistics.

D. She started a program for formal education for nurses in England.


Answer

B. She served during World War I, actively improving the care of British soldiers.

Rationale: Nightingale’s work predated WWI by about 60 years. She was active during the Crimean War in the 1850s.


Florence Nightingale—Theory

• Notes on Nursing: What It Is and What It Is Not

• Based on providing a healthful environment

– Improve cleanliness, ventilation, warming, light, noise, bedding, etc.

• Believed that nursing is an art, medicine is a science

• Nurses were to do what they could to provide “the best possible conditions for nature to restore or preserve health.”


Florence Nightingale—Theory—(cont.)

• A nurse may be any woman who had “charge of the personal health of somebody.”

• Believed that nursing is a calling or “God’s work”

• Nursing is based on compassion, observation, experience, statistical data, sanitation, nutrition, and administrative skills.


Florence Nightingale—Theory—(cont.) • Basic tenets/issues of Nightingale’s work

– Ventilation and warming

– Avoidance of “petty management”

– Avoidance of noise

– Variety of sights, activities, foods

– Taking food/selection of food

– Clean and dry bedding

– Light

– Cleanliness of rooms and walls

– Personal cleanliness

– Observation of the sick

– Avoidance of “chattering homes and advices”


Florence Nightingale—Theory—(cont.)

• Nurses performed tasks to and for the patient.

• Interestingly, she rejected the “germ theory” but was a very strong advocate of cleanliness.


Florence Nightingale—Metaparadigm Concepts

• Nursing—Nursing is an art that serves to “put the constitution in such a state that it will have no disease, or that it can recover from disease.”

• Health—“to be well and to be able to use well every power we have”

• Environment—central concept

• Person—not explicitly addressed


Florence Nightingale—Resources

• http://www.florence-nightingale.co.uk/

• http://clendening.kumc.edu/dc/fn/

http://www.florence-nightingale.co.uk/

http://www.florence-nightingale.co.uk/

http://clendening.kumc.edu/dc/fn/


Virginia Henderson

• Well-known nursing educator

• Prolific author

• Created basic nursing curriculum for the NLN

– Nursing is “patient centered and organized around nursing problems rather than medical diagnoses.”


Virginia Henderson—(cont.)

• Born 1897 in Kansas City

– Large family

• Education

– Graduated from the Army School of Nursing in Washington, DC in 1921

– Received her BS in Nursing Education (1932) and MA in nursing education (1934) from Columbia University



• Career

– Taught nursing at Columbia between 1934 and 1948

– With Bertha Harmer, revised the fifth edition of The Principles and Practice of Nursing (1953); sixth edition (1966); Nature of Nursing (1966)

– Yale University School of Nursing faculty 1953–1959



• Remained very active in nursing well into her 90s

• Died in 1996—99 years old


Virginia Henderson—Theory

• “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 . . . that he would perform unaided if he had the necessary strength, will or knowledge.”


Question

Which theorist related her theory to the metaparadigm of nursing with a belief that the function of the nurse is to assist the individual client?

A. Betty Neuman

B. Virginia Henderson

C. Dorothea E. Orem

D. Dorothy Johnson


Answer

B. Virginia Henderson

Rationale: Henderson believed that nurses should care for patients until they can care for themselves. The nurse was the focus and the theory related to the nursing metaparadigm.


Virginia Henderson—Theory—(cont.)14 Basic Needs of Patients

1. Breathe normally.

2. Eat and drink adequately.

3. Eliminate body wastes.

4. Move and maintain desirable postures.

5. Sleep and rest.

6. Select suitable clothes—dress and undress.

7. Maintain body temperature within normal range.


Virginia Henderson—Theory—(cont.)

14 Basic Needs of Patients—(cont.)

8. Keep the body clean and well groomed.

9. Avoid dangers in the environment.

10. Communicate with others in expressing emotions, needs, fears, or opinions.

11. Worship according to one’s faith.

12. Work to provide a sense of accomplishment.

13. Play or participate in recreation.

14. Learn, discover, or satisfy the curiosity that leads to normal development and uses health facilities.


Virginia Henderson—Theory—(cont.)

• The person must maintain physiological and emotional balance.

• The mind and body of the person are inseparable.

• Patients require help toward independence.


Virginia Henderson—Metaparadigm Concepts

• Nursing—“to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery . . . that he would perform unaided if he had the necessary strength, will or knowledge . . .”

• Person—“patient” as someone who needs nursing care (not limited to illness care)


Virginia Henderson—Metaparadigm Concepts—(cont.) • Environment—not explicitly defined; maintaining a

supportive environment is implicit in her 14 activities

• Health—not explicitly defined; inferred to be a balance in all realms of human life


Virginia Henderson—on Education

• Strong advocate for university-based education for nurses

• Also strong advocate for liberal education courses for nurses

• Pushed library research and increasing knowledge for all nurses

• Promoted research and research-based practice


Virginia Henderson—Resources

• http://www.unc.edu/~ehallora/henderson.htm

• http://www.nursinglibrary.org/vhl/

• http://www.angelfire.com/ut/virginiahenderson/index.html

http://www.unc.edu/~ehallora/henderson.htm

http://www.unc.edu/~ehallora/henderson.htm

http://www.nursinglibrary.org/vhl/

http://www.stti.org/VirginiaHendersonLibrary/

http://www.angelfire.com/ut/virginiahenderson/index.html


Dorothea Orem

Self-Care Deficit Theory

“Nursing is an art . . .”


Dorothea Orem—(cont.)

• Born in Baltimore—1914

• Diploma in nursing—1930s from Providence Hospital School of Nursing, Washington, DC

• BSN in 1939 and master’s degree in 1945 from Catholic University


Dorothea Orem—(cont.)

• Director of the School of Nursing at Detroit’s Providence Hospital in the late 1940s

• Indiana Board of Health 1949–1957

• Joined Catholic University Faculty in 1959


Orem: Self-Care Deficit Nursing Theory

• First book on Self-Care Deficit Nursing Theory (SCDNT) in 1971; latest edition in 2001

• Three nested theories

– Theory of self-care

– Theory of self-care deficit

– Theory of nursing system


Question

Which of the following is NOT one of the three nested theories that comprise the SCDNT?

A. Theory of self-care

B. Theory of self-care deficit

C. Theory of self-care interventions

D. Theory of nursing system


Answer

C. Theory of self-care interventions

Rationale: Orem’s SCDNT is composed of the theory of nursing system as the outer/encompassing component with the theory of self-care deficit and theory of self-care being subsumed within it.


Self-care deficit nursing theory. (Source: Orem, D. [2001]. Nursing: Concepts of practice [6th ed.]. St. Louis: Mosby.)


Theory of Self- Care

Theory of Self- Care Deficit

Theory of Nursing Systems

Self-care When therapeutic self-care demand exceeds self-care agency, a self-care deficit exists and nursing is needed.

Nursing agency

Self-care agency Nursing systems Wholly compensatory

Partially compensatory Supportive/educative

Self-care requisites

Therapeutic self-care demand

Orem: Self-Care Deficit Nursing Theory—(cont.)



“Condition that validates the existence of a requirement for nursing is an adult . . . . The absence of the ability to maintain continuously the amount and quality of self-care that is therapeutic in sustaining life and health, removing from disease or injury in on coping with their effects”



• Nursing—”an art through which the practitioner . . . gives specialized assistance to persons with disabilities . . . to meet needs for self-care. . . . also intelligently participates in the medical care the individual receives from the physician”



• Metaparadigm concepts

– Nursing—an art through which the practitioner . . . gives specialized assistance to persons with disabilities . . . to meet needs for self-care. . . . also intelligently participates in the medical care the individual receives from the physician”

– Humans—“men, women, and children cared for either singly or as social units” objects of nursing care



• Metaparadigm concepts—(cont.)

– Environment—has physical, chemical, and biological features (includes the family, culture, and community)

– Health—“being structurally and functionally whole or sound”; also a state that encompasses both the health of individuals and groups



• Self-care—“human regulatory function that is a deliberate action to supply or ensure the supply of necessary materials needed for continued life, growth, and development and maintenance of human integrity”

http://www.google.com/url?sa=i&rct=j&q=orem+self+care+theory&source=images&cd=&cad=rja&docid=A1RP74-aHgXcJM&tbnid=AWybMxu4HA-c6M:&ved=0CAUQjRw&url=http://www.nursingconsult.com/nursing/journals/0882-5963/figure?issn=0882-5963&article_id=626027&PAGE=If07002904001.fig&spid=20360273&article_author=BakerLK&start_pg=37&end_pg=48&ei=fJLpUaTiOIzI9QS74IGwAg&bvm=bv.49478099,d.aWc&psig=AFQjCNGrAkhQkKaS7VIX-bxpj1StpNk_oA&ust=1374348263987229




Orem: Self-Care Deficit Nursing Theory—(cont.)• Self-care requirements

– Maintenance of sufficient intake of air, water, and food

– Provision of care associated with elimination and excrement

– Maintenance of balance between activity and rest

– Maintenance of balance between solitude and social interaction

– Prevention of hazards to human life, functioning, and well-being

– Promotion of human functioning and development


Orem: Self-Care Deficit Nursing Theory—(cont.)• Ms. Orem died in 2007.

• Her work is readily applied in nursing practice, education, and research.

• Many research articles testing relationships within the theory

• One of the most frequently used theories for nursing education curricular frameworks


Dorothea Orem—Resources

• http://www.nurses.info/nursing_theory_person_orem_dorothea.htm

• http://www.orem-society.com/

http://www.nurses.info/nursing_theory_person_orem_dorothea.htm

http://www.nurses.info/nursing_theory_person_orem_dorothea.htm

http://www.orem-society.com/


Betty Neuman

• Born in 1924 in Ohio

• Mother was a midwife.

• Graduated from Peoples’ Hospital (Akron, OH) diploma program in 1947

• BS in Public Health Nursing (1957) and an MS in Public/Mental Health Nursing (1966) from UCLA

• PhD in Clinical Psychology—Pacific Western University (1985)


Neuman Systems Model

• Developed the model in 1970—UCLA graduate students introductory course that considers holistic view of humans

• Model initially published in Nursing Research in 1972


The Neuman systems model. (Source: Neuman, B., & Fawcett, J. [2002]. The Neuman systems model [4th ed.]. Upper Saddle River, NJ: Pearson Education, Inc. Used with permission of Betty Neuman, RN, PhD, FAAN.)


Neuman Systems Model—(cont.)

• Two major components

– Stress

– Reaction to stress

• Client is an open system (may be individual, family, group or community).

• Exchanges between the client/system and environment are reciprocal.



• Nursing is provided to achieve optimal stability.

• Concept of “prevention as intervention”

– Combines elements of primary, secondary, and tertiary prevention

• Multiple lines of resistance

• Lines of defense

• Client variables (physiological, psychological, sociocultural, developmental, and spiritual) are considered in care.


Neuman Systems Model—(cont.)• Stressors are stimuli that produce tensions and might

cause system instability.

– Intrapersonal

– Interpersonal

– Extrapersonal

• Goal of nursing is to help the client attain, maintain, or retain system stability.

– Assessment of actual and potential effect of stressors

– Assisting the client make adjustments needed for wellness


Neuman Systems Model—(cont.)• Metaparadigm concepts

– Person—“human beings” as “client/client system as a composite of variables (physiological, psychological, sociocultural, developmental and spiritual), each of which is a subpart of all parts . . .”

– Nursing—Major concern is to maintain client system stability through assessing environmental and other stressors and assisting the client to adjust to maintain wellness.



• Metaparadigm concepts—(cont.)

– Environment—“both internal and external forces surrounding the client, influencing and being influenced by the client at any point in time”

– Health—“a continuum; wellness and illness are at opposite ends”



• One of most widely used of the grand nursing theories in nursing research

– Many studies test relationships between variables.

– Most commonly used as a framework for a study

• Widely used as a curriculum framework in nursing programs throughout the world

• Continual development—latest edition (5th) (with J. Fawcett) published in 2010


Betty Neuman—Resources

• http://currentnursing.com/nursing_theory/Neuman.html/

• http://www.neumansystemsmodel.org/

http://currentnursing.com/nursing_theory/Neuman.html

http://www.neumansystemsmodel.org/

chapter 07

Health & Medicine

nursing school

nursing education

personal health

nursing notes

nursing care

nln nursing

nursing problems

army school of nursing