HISTORICAL DEVELOPMENT OF THEORIESPRIOR TO 1960s

Florence NightingaleNotes on Nursing (mid 19th century) – reflected her beliefs, observations and practice of nursingHer work paved way for modern nursing1st one to insist that formal education is needed in the preparation of a nurse

PRIOR TO 1960sShe stressed the importance of observations and recordingShe recorded her observations and used statistics to support her request for reforms

Nightingale’s theory focused on the control of the environment of individuals requiring nursing care

PRIOR TO 1960sShe believed that disease was a reparative process, that it was nature’s effort to remedy a

process of poisoning or decay, or a reaction against the conditions in which a person was placedIn order to prevent the disease or hasten the healing process, the nurse must provide a clean and quiet environment with proper ventilation and lighting, clean air free from foul odor and

unnecessary noise.

PRIOR TO 1960sShe also stressed the importance of room temperature

She emphasized the need for appropriate nutrition in promoting a person’s well-being. Her major concepts of ventilation, light, warmth, noise, cleanliness, and diet in relation to nursing

are still valid today.

PRIOR TO 1960sPublication of the journal of Nursing Research (1952)

Encouraged nurses to pursue research, thus developing questioning attitudes and inquiries that set the stage for conceptualization of nursing practice

1960s-1970sEmergence of Scientific era (1960s)

The nature of practice was debated as nursing leaders recognized the need to define nursing practice, develop nursing theory, and create a substantive body of knowledgeLiterature on Philosophy of nursing, as well as conceptual models and frameworks proliferatedThe role of the nurse came under scrutiny during this period, what they do, for whom, where and when were determined

1960s-1970sEmergence of Scientific era (1960s)

The process of theory development was also discussed and was the subject of writings of a number of nurse scholarsSymposia were also held dealing with subjects such as Theory Development in Nursing, Nature of Science and Nursing

1960s-1970s1969 – first conference on nursing theory was first held

Conferences brought leading scholars and theorists together to discuss and debate on issues regarding nursing science and theory development in nursing

1960s-1970sWritings of Dickoff, James and Wiedebach on “Theory in a Practice Discipline” (1968)

influenced the development of theoretical thinking in nursingthey presented a definition of nursing theory and goals for theory development in nursingtheir approaches discussed iin many writings and conferences reflecting gorwing and evolving interest in developing nursing theory

1980scharacterized by acceptance of the significance of the theory in nursing

there were less debates on whether or not to use theory, whether it is practice or basic theory, borrowed or nursing theory

1980s to the PRESENTcharacterized by publication of nurmerous books and articles on analysis, application,

evaluation and further development of nursing theoriesgraduate schools of nursing developed courses on how to analyze and apply theories

Types of theoriesAccording to orientation or focus of the theory

1. Client-centered – are those focused on the needs and problems of clients which are met, resolved or alleviated by nursing interventions.

Examples:NightingaleAbdellahHendersonOremPenderRoyLevineHall

According to orientation or focus of the theory 2. Nurse-client dynamics – focus on interaction between the nurse and client.

Examples:PeplauWatsonKingOrlando

According to orientation or focus of the theory 3. Nurse-client-environment –focus on the interaction between nurse and client in an

environment that includes broader dimensions of time and space, as well as culture, cultural diversity, and universality

Examples:NeumanLeininger

FRAMEWORK TO ANALYZE A NURSING THOERY1. CONCEPTS, KEY CONCEPTS AND SUB-CONCEPTS

PersonNursingHealthEnvironment

FRAMEWORK TO ANALYZE A NURSING THOERY2. STRUCTURE

3. FOCUSClient-centeredNurse-client dynamicsNurse-client-environment dynamics

4. APPLICATION5. LIMITATIONS

FRAMEWORK TO ANALYZE A NURSING THOERYHENDERSON’S THEORY – DEFINITION OF NURSING

MAJOR CONCEPTSA. PERSON/ PATIENT/ CLIENT

An individual person or client is a whole, complete and independent being with biological, sociological, and spiritual components which are operationalized in the 14

fundamental or basic human needs

14 fundamental or basic human needs1. Breathe normally

2. Eat and drink adequately3. Eliminate body wastes4. Move and maintain desirable position/posture5. Sleep and rest6. Select suitable clothes – dress and undress7. Maintain body temperature within normal range by adjusting clothing and

modifying the environment8. Keep the body clean & well groomed & protect the skin 9. Avoid dangers in the environment and avoid injuring others10.Communicate with others, expressing emotions, needs, fears, or opinions11.Worship according to one’s faith

12.Work in such a way that there is a sense of accomplishment13.Play or participate in various forms of recreation14.Learn, discover or satisfy the curiosity that leads to normal development

and health, and use available health facilities

B. HEALTH- Health is equated with independence

Individuals will achieve or maintain health if they have the necessary strength, will or knowledgeHealth is viewed in terms of the patient’s ability to independently perform the 14 basic needs

B. HEALTHIt is the “quality of health rather than the life itself, that margin of metal physical vigor that allows the person to work most effectively and to reach his highest potential level of satisfaction in life.”She described health as basic to human functioning and that promotion of health is more important than care of the sick

C. NURSINGNursing is assisting the individual, sick or well, in the performance of those activities contributing to the health or its recovery (or to peaceful death) so 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

D. ENVIRONMENT

Is the “aggregate (combination) of all the external conditions and influences affecting life and the development of an organism”

UNDERLYING ASSUMPTIONSIndependence is valued by the nurse and the patient , more than dependence

Health has a meaning shared by the society at largeIndividuals desire health or peaceful death and will act in such a way to achieve this

Individuals will perform activities leading to health if they have the knowledge, capacity or willThe individual’s goal and the nurse’s goal are congruent (similar)

UNDERLYING ASSUMPTIONSThe 14 basic needs represent the nursing’s basic functions

Nursing’s goal may be subsumed into the medical treatment planThe major explicit assumption of Henderson’s contention that the nurse is an independent practitioner. However, she also contends that the nurse is a primary helper in carrying out

physician’s prescriptions

RELATIONSHIP OF CONCEPTS Role of nurse

- Has a complementary-supplementary role to maintain or restore independence in the satisfaction of the client’s 14 fundamental or basic needs

Source of difficultyIn a client-centered model, the source of difficulty resides with the client and not with the nurse.Clients in health care agencies have health problems that may be subcategorized as medical, nursing, dietary, etc.To Henderson, the source of difficulty is the lack of strength, will or knowledge of the client

RELATIONSHIP OF CONCEPTS Intervention focus

- To Henderson, this is the deficit that is the source of the client difficulty Modes of intervention

- These are actions to replace, complete, substitute, add, reinforce, or increase strength, will or knowledge

Consequences of nursing activityThese include

1. Increased independence in satisfaction of the client’s 14 fundamental or basic needs2. Peaceful death

INTERRELATIONSHIP BETWEEN CONCEPTS