OUTLINE OF NURSING THEORIES AND FRAMEWORKS OF CARE

Chapter 2 OUTLINE OF NURSING THEORIES AND FRAMEWORKS OF CARE

KEY TERMS/CONCEPTS

caring behaviours in nursing

nursing paradigm

nursing process

theoretical views on caring

A study of nursing theory can help the student develop an understanding of the purpose of nursing practice. Nursing theory assists nurses to develop meaning in their approach to clients and can facilitate continuity of care. Over the last 50 years the growth of nursing as a scientific health care profession has led to the development of various philosophies and theoretical models of nursing on which nursing practice can be based. A nursing model provides the basis for the framework of nursing practice, and the direction for nursing research. Nursing theory is about what nursing means and is different from the theory taken from other disciplines that is usually the focus of the nursing classroom and specific procedures performed during clinical practicum. This chapter introduces the student to a variety of nursing theories that inform nursing practice.

LIVED EXPERIENCE

Initially, I didn’t understand why we were having lectures on nursing theories. This was until our lecturer explained to us that, although most nurses have a clear idea of what nursing is, other health care professionals and the community may not understand the role of nursing. Our lecturer also explained that nursing theories provide nurses with direction and guidance for structuring professional nursing practice, education and research.

Siobhan, Enrolled Nurse student

THEORIES AND MODELS OF NURSING

Nursing, as a profession, is in the midst of change. Society is changing and nursing is affected by social forces that require a community receives a system of health care delivery that will make quality care available for all people. The demand for quality care is reflected in the philosophical belief in the dignity and value of the individual. To provide quality care, nursing must focus on the needs of both the individual and the community.

In earlier times the responsibilities of nurses were centred around sanitation measures, nutrition, hygiene and comfort, prevention of cross-infection and relief of the prime symptoms of infection. Nurses functioned not only as nurses but as housekeepers, dietitians and cleaners. Nursing has shifted from being primarily illness oriented to being a profession that is health oriented. Nurses practise in a growing variety of settings, and nursing roles continue to expand as the focus of nursing care expands. Current nursing philosophies and theoretical models reflect the trend to address the total person, in all dimensions, as an individual in interaction with the family and the community.

Nursing theories can help make sense of processes and practices. Nursing theories explain why and when nursing takes place, provide an understanding of how the practice of nursing proceeds and also assist with practice change through critique. In this way nursing theories help create an understanding of the practice of nursing, how nurses interact with clients and how nursing actions and provision of nursing care is structured (Daly et al 2006).

DEFINING THEORY AND MODEL

A theory is an abstract statement formulated to explain or describe the relationships among concepts or events. A nursing theory is a conceptualisation of some aspect of nursing communicated for the purpose of describing, explaining, predicting and/or prescribing nursing care. A model is a conceptual framework developed from a set of concepts and assumptions; it is a conceptual representation of reality. A model provides the outline for which theory provides the functions. Thus, a model represents structure while a theory suggests function. Numerous conceptual models of nursing practice have been devised, most of which:

• Are based on sound theory

• Contain implied or explicit assumptions, values and goals

• Are implemented by the nursing process.

Nursing theories serve several essential purposes, as is illustrated in Clinical Interest Box 2.1.

CLINICAL INTEREST BOX 2.1 Purposes of nursing theories and conceptual frameworks

In clinical practice:

• Assist nurses to describe, explain and predict everyday experiences

• Serve to guide assessment, intervention and evaluation of nursing care

• Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation

• Help to establish criteria to measure the quality of nursing care

• Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined

• Enhance autonomy of nursing by defining its own independent functions

• Provide a general focus for curriculum design

• Guide curricular decision making

• Offer a framework for generating knowledge and new ideas

• Assist in discovering knowledge gaps in the specific field of study

• Offer a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions

(Kozier et al 2004)

COMPONENTS OF NURSING THEORETICAL MODELS

Within any scientific discipline there are specific domains. A domain is the perspective and territory of the discipline and contains the subject, central concepts, values and beliefs, phenomena of interest and the central problems of the discipline. Components of a discipline’s domain are described in a paradigm. A paradigm is a term used to denote the links to science, philosophy and theory accepted by the discipline. Nursing’s paradigm directs the activity of the nursing profession and includes four links of interest — the person, health, environment/situation and nursing.

The person

Person refers to the recipient of care, including individual clients, families and the community. The person is central to the care being provided. Because the person’s needs are multidimensional, it is important that nursing provide care individualised to the person’s needs.

Health

Health is defined in different ways by the client, clinical setting and by the health care profession and is the goal of nursing care. The nurse is challenged to provide care based on the client’s individualised level of health and health care needs at the time of health care delivery.

Environment/situation

Environment/situation includes all possible conditions affecting the client and the place in which health care needs occur. There is continuous interaction between the client and the environment. This interaction can have positive and negative effects on the person’s level of health and health care needs.

Nursing

Nursing is the diagnosis and treatment of human responses to actual or potential health problems. For example, a nurse does not make a medical diagnosis of a client’s heart condition but instead develops nursing diagnoses of fatigue, change in body image and altered coping mechanisms. From these nursing diagnoses, the nurse creates an individualised plan of care.

OVERVIEW OF SELECTED NURSING THEORIES

Many nursing theories have been developed in the past and many are still being developed today. The following selection of nursing theories is an historical overview that discusses nursing’s four fields of interest: the person, health, environment/situation and nursing.

PEPLAU’S THEORY

In 1952 Hildegard Peplau made an attempt to analyse nursing action using an interpersonal theoretical framework. Her theory focuses on the relationships formed by people as they progress through each developmental stage. She viewed the goal of nursing as developing a relationship between the nurse and client whereby the nurse acts as resource person, counsellor, teacher and surrogate.

ABDELLAH’S THEORY

In 1960 Fay Abdellah, with her colleagues, devised a theory that emphasised the delivery of nursing care to the whole person. Using a problem-solving approach the nurse formulates a plan to help clients meet their physical, emotional, intellectual, social and spiritual needs. Abdellah identified 21 basic nursing procedures. These are to:

1. Maintain good hygiene and physical comfort

2. Achieve optimal activity, exercise, rest and sleep

3. Prevent accident, injury or other trauma and prevent the spread of infection

4. Maintain good body mechanics and prevent and correct deformities

5. Facilitate the supply of oxygen to all body cells

6. Facilitate the maintenance of nutrition to all body cells

7. Facilitate the maintenance of elimination

8. Facilitate the maintenance of fluid and electrolyte balance

9. Recognise the physiological responses of the body to disease conditions, pathological, physiological and compensatory

10. Facilitate the maintenance of regulatory mechanisms and functions

11. Facilitate the maintenance of sensory functions

12. Identify and accept positive and negative expressions, feelings and reactions

13. Identify and accept the interrelatedness of emotions and organic illness

14. Facilitate the maintenance of effective verbal and non-verbal communication

15. Facilitate the development of productive interpersonal relationships

16. Facilitate progress towards achievement of personal spiritual goals

17. Create and/or maintain a therapeutic environment

18. Facilitate awareness of self as an individual with varying physical, emotional and developmental needs

19. Accept the optimal possible goals in light of limitations — physical and emotional

20. Use community resources as an aid in resolving problems arising from illness

21. Understand the role of social problems as influencing factors in the cause of illness.

HENDERSON’S THEORY

In 1964 Virginia Henderson described the goal of nursing as helping the client to gain independence as rapidly as possible, and defined nursing as:

assisting the individual, sick or well, in the performance of those activities contributing to health, its recovery, promoting quality of life or to a peaceful death that the client would perform unaided if he or she had the necessary strength, will or knowledge.

(Crisp & Taylor 2005: 2)

Henderson identified 14 basic needs that provide a framework for nursing care. These are to:

1. Breathe normally

2. Eat and drink adequately

3. Eliminate by all avenues of elimination

4. Move and maintain a desirable position

5. Sleep and rest

6. Select suitable clothing; dress and undress

7. Maintain body temperature within normal range

8. Keep the body clean and well groomed

9. Avoid dangers in the environment

10. Communicate with others

11. Worship according to faith

12. Work at something that provides a sense of accomplishment

13. Play or participate in various forms of recreation

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

(Crisp & Taylor 2005)

JOHNSON’S THEORY

In 1968 Dorothy Johnson portrayed the goal of nursing as reducing stress so that the client can recover as quickly as possible. Johnson viewed people as a collection of behavioural subsystems that interrelate to form a whole person, and her theory focuses on a person’s needs in terms of the following behaviours:

• Security-seeking behaviour

• Nurturing-seeking behaviour

• Mastery of oneself and one’s environment according to internalised standards of excellence

• Taking in nourishment in socially and culturally acceptable ways

• Ridding the body of waste in socially and culturally acceptable ways

• Sexual and role identity behaviour

• Self-protective behaviour.

Johnson saw the nurse’s role as identifying the client’s inability to adapt to stress, and as providing the nursing care necessary to assist them in resolving problems to meet their needs.

KING’S THEORY

Imogene King (1971, cited in Crisp & Taylor 2005) viewed the goal of nursing as helping individuals and groups to attain, maintain and restore health, or to die with dignity. King saw nursing as a process of interaction between nurse and client whereby, through communication, goals are set and agreement reached on ways to achieve goals.

OREM’S THEORY

In 1973 Dorothea Orem depicted the goal of nursing as helping the client to achieve health through self-care (cited in Crisp & Taylor 2005). Orem saw nursing as a service required when individuals are unable to care for themselves, or unable to be cared for by others of significance to them; that is, when demands exceed their self-care abilities. The nurse identifies why an individual is unable to care for themself, and implements measures that assist them to meet their needs. The overall goal of nursing care is to assist the client to achieve self-care whenever possible.

Tags: Tabbners Nursing Care Theory and Practice

Feb 12, 2017 | Posted by admin in NURSING | Comments Off

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