Application of nursing theory samples

Application of nursing theory samples

Application of nursing theory samples

A comprehensive look at the Application of nursing theory featuring the major nursing theorists; Florence Nightingale – Environment theory, Hildegard Peplau – Interpersonal theory, Virginia Henderson – Need Theory, Fay Abdella – Twenty One Nursing Problems, Ida Jean Orlando – Nursing Process theory, Dorothy Johnson – System model, Martha Rogers -Unitary Human beings, Dorothea Orem – Self-care theory, Imogene King – Goal Attainment theory, Betty Neuman – System model, Sister Calista Roy – Adaptation theory, Jean Watson – Philosophy and Caring Model, Madeleine Leininger -Transcultural nursing, Patricia Benner – From Novice to Expert, Lydia E. Hall – The Core, Care, and Cure, Joyce Travelbee – Human-To-Human Relationship Model, Margaret Newman – Health As Expanding Consciousness,
Katharine Kolcaba – Comfort Theory, Rosemarie Rizzo Parse – Human Becoming Theory, Ernestine Wiedenbach – The Helping Art of Clinical Nursing, Nola Pender’s Health Promotion Model(HPM).

Nursing Theories for Nurse Educators; Types of Nursing Theories: Concepts, Levels and Uses. Major/top nursing theorist

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Florence Nightingale – Environment theory

Florence Nightingale (1820-1910) was born in Italy and unlike other women in that era, was educated in many fields including science, philosophy, and nursing. She was heavily committed to serving people and as a result, gained better skills in healthcare and began serving as a nurse. Her heroic acts in the healthcare world were witnessed in the Crimean War when she fought for better treatment of wounded British soldiers by requesting better provisions and sanitary conditions in Scutari hospital wards. She focused on comforting the soldiers especially those who were seriously injured and dying and provided a place where their families could stay. After the Crimean War, Nightingale helped to establish nursing schools and engaged in advocacy through lobbying for better healthcare policies. Generally, Nightingale is regarded as the pioneer of modern nursing and her main focus was the healthcare environment which in her opinion, was crucial to better patient outcomes. The environmental theory posits that one of the most important components of nursing care is the physical environment. This includes factors such as warming, ventilation, nutrition, hygiene, noise, light, and warmth. Lack of balance within the environmental aspects is likely to stress patients by forcing them to use more energy to counter the imbalance. Additional stress makes it harder for the patient to heal. Nightingale also focused on the idea that the psychological and social environments impact the physical environment (Gilbert, 2020).

Major concepts of the Florence Nightingale – Environment Theory

1. Health of Houses

This concept focuses on the importance of proper hospital construction. Nightingale stressed that the health of houses is characterized by access to efficient drainage, pure water and air, location within a clean environment, and access to proper lighting (Gilbert, 2020).

2. Ventilation and Warming

Nightingale emphasized the need to ensure that patients breathe clean air without feeling chilly and urged healthcare professionals to always find a way of aerating their patients’ rooms. Nightingale held the belief that patients who had no access to ventilation would become sicker. Another concern was that many hospitals at the time would be located close to raw sewage that emitted foul odors and Nightingale stressed that this should be avoided. Furthermore, maintaining a moderate room temperature is necessary for healing (Gilbert, 2020).

3. Noise

Noise can accidentally or unintentionally wake patients and this is undesirable since they need adequate sleep to heal. Nightingale felt that unnecessary noise should be avoided at all costs and this includes noise from clothing, jewelry, and unnecessary talk from healthcare professionals (Gilbert, 2020).

4. Light

Nightingale noted that patients needed direct sunlight noting that sick people mostly slept facing the window where they could access sunlight. Light can make a difference between sickness and health although Nightingale lacked scientific information to prove this fact (Gilbert, 2020).

5. Variety

Variety within the healthcare environment includes changes in form and color that increase interaction between the body and mind. Nightingale advocated for access to items such as colored paintings, flowers, and plants that would be helpful to the recovery of the patient. She also encouraged activities such as needlework, reading, and writing to prevent boredom among patients (Gilbert, 2020).

6. Bed and bedding

Nightingale believed that adults exhale copious amounts of moisture through the skin and lungs in a day and for sick patients lying in bed all day, this moisture remains in the beddings until it is aired or changed. She urged all caregivers to frequently change their patients’ beddings and to place the bed near windows. Moreover, she urged caregivers to avoid sitting or leaning against the patients’ beds (Gilbert, 2020).

7. Cleanliness of patients’ rooms

To Nightingale, maintaining cleanliness is among the most important parts of nursing care. Ventilated rooms need to be cleaned to be kept fresh. When cleaning patients’ rooms, Nightingale urged the use of damp clothing to remove dust and regular cleaning of the floor instead of covering them with carpets. All walls and furniture should be constantly cleaned (Gilbert, 2020).

8. Personal Hygiene

Components of personal hygiene described by Nightingale included cleaning the skin constantly and keeping it dry and the use of handwashing practices when working with patients. Unwashed skin can be poisonous to the patient and constant bathing helps patients feel better (Gilbert, 2020).

9. Food and nutrition

Nightingale urged nurses to present a variety of food to patients noting that people desire different types of food daily. Furthermore, patients should be provided with small portions served more frequently in comparison to large portions served less frequently. She also explained that incapacitated patients should always be fed noting that they can starve to death if no attention is paid to their feeding capability. During meal times, patients should not be distracted and food should be brought and taken away at the right times (Gilbert, 2020).

10. Social environment

Nightingale urged nurses to constantly observe the sick for any improvements or deterioration in physical condition. She also emphasized the significance of accurate and comprehensive patient assessment. Additionally, she focused on addressing the social environment including factors such as poverty that impacted the living environments of patients (Gilbert, 2020).

Nursing Metaparadigm

Although Nightingale did not directly define the nursing metaparadigm, the definitions were developed after a critical analysis of her writings. The four metaparadigm include nursing, person, environment, and health. Nightingale asserted that healthcare, including surgery, medicine, and nursing, are processes that bring people back to good health. She viewed nursing as a process that entails making the physical environment conducive to patient healing. The physical environment in nursing includes aspects such as ventilation, noise, light, warmth, and cleanliness that influence physical health and these aspects must be in balance or else they will stress the patient. Nightingale successfully synthesized the link between sanitary conditions and disease. Nightingale did not describe the person component specifically although she focused on the relationship between the person and the healthcare environment. Although she did not provide a specific definition of healthy, Nightingale observed that nature has healing capabilities and that nursing is an art that uses nature to bring people back to good health. She also advocated for nursing assessments especially using observation and asking the patients about their specific needs. Diagnoses made by nurses should be based on what they learn from assessing the patient. After diagnosis, nurses should identify the best actions that will enhance the patient’s comfort and implement these actions through environmental modification. Evaluation processes should include assessing the impact of the environment on patient health (AliSher et al., 2019).

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Application of Florence Nightingale’s Environmental Theory to the Nursing Profession

The environmental theory is still applicable to the nursing profession and is one of the reasons why Nightingale is regarded as a timeless theorist. The theory is applied when conducting nursing assessments through observation and interviews to determine patient needs. The theory also informs nursing diagnosis and interventions based on the findings obtained through assessments. Nursing actions, especially those implemented as part of interventions, are also based on the environmental theory. For instance, actions such as maintaining personal and environmental hygiene help prevent hospital-acquired infections such as pressure ulcers. Nurses apply the theory by modifying the patient environment to promote positive outcomes (Zborowsky, 2016).

Nightingale also provided a framework that influenced the concept of holistic care in nursing. She encouraged caregivers to assess both the physical and social environment as they influence health. Furthermore, she introduced the concept of family involvement in care when she communicated with the families of injured soldiers and provided them with a place to stay when they visited the patients. Nightingale, being a strong believer of God, encouraged the incorporation of spirituality in care (AliSher et al., 2019).

Nightingale’s works also encourage critical thinking as an important skill for nurses that promotes positive outcomes. Although research in the healthcare environment was still scarce, Nightingale pioneered the use of evidence-based practice since she integrated medical knowledge when engaging with patients and even acknowledged that some of her writings did not have evidence to support it (Riegel et al., 2021).

Conclusion

The environmental theory posits that the physical environment influences patient outcomes. Nightingale described various aspects of the environment including warmth, light, ventilation, and cleanliness as factors that nurses must consider when providing care. Her theory heavily influenced modern nursing practices including assessment, diagnosis, and care plans. Nightingale also encouraged critical thinking and the provision of holistic care.

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References

AliSher, A., Atta, S., Yasin, I., & Sohail, M. (2019). Clinical application of nightingale’s theory. International Journal of Nursing Care, 7(1), 13. https://doi.org/10.5958/2320-8651.2019.00002.4

Gilbert, H. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27(6), 626-633. https://doi.org/10.1016/j.colegn.2020.09.006

Riegel, F., Crossetti, M., Martini, J., & Nes, A. (2021). Florence Nightingale’s theory and her contributions to holistic critical thinking in nursing. Revista Brasileira De Enfermagem, 74(2), 1-5. https://doi.org/10.1590/0034-7167-2020-0139

Zborowsky, T. (2016). The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. https://doi.org/10.1177/193758671400700404

Hildegard Peplau – Interpersonal theory 

Hildegard Peplau was born in 1909 in Pennsylvania and worked as a nurse from 1931. Her book on interpersonal theory was completed in 1947 although it was viewed as too radical since it was the first book written by a nurse without the help of a physician. As a result, the book was published in 1952 and from there, Peplau published other articles that focused on nursing and the interpersonal theory. In her book, Peplau discussed interpersonal relations in healthcare practice including the role of nurses in developing a professional relationship with patients. Peplau viewed the nursing process as therapeutic since it constitutes the art of helping sick patients during their healing process. She also viewed the nursing process as sequential in that it follows various steps that lead to the achievement of a specific goal. Patients and nurses work together to solve a specific problem. Notably, both patients and nurses come from different backgrounds and hold different perspectives regarding the interpersonal process. However, in the care process, nurses are expected to observe and make accurate interpretations regarding patients before coming up with care plans. As the professional relationship develops, both parties demonstrate better maturity and increased knowledge. As a result, the therapeutic encounters result in both professional and personal development. The interpersonal theory is a middle-range theory since it is not abstract and is relevant to clinical nursing practice (McEwen & Wills, 2018).

Role of the Nurse in the Hildegard Peplau Interpersonal Relationship Theory

Peplau generally identified that nurses serve as teachers, counselors, resources, leaders, surrogates, and technical experts. In their teaching role, nurses impart knowledge about specific needs. Nurses act as resources since they provide specific information based on the unique situation of different patients. As counselors, nurses use their professional skills to identify the interaction between physical and mental health issues and find effective strategies for enhancing the patient’s wellbeing. The surrogacy role entails taking the place of others as the main caregiver of the patient while the technical expert role entails demonstrating clinical skills including the operation and handling of healthcare equipment (McEwen & Wills, 2018).

Phases in Nursing

The defined nursing roles are embedded in four phases of the interpersonal relationship: orientation, identification, exploitation, and resolution.

1. Orientation

At the beginning of the interpersonal relationship, patients and nurses are strangers who sought professional healthcare because of specific needs. The main components of the orientation phase include finding a mutual definition of the patient’s problem, making decisions regarding the type of services required, and patients posing questions regarding the care process while nurses provide appropriate responses. Alternatively, the nurse may choose to refer patients to other professionals such as psychiatrists, social workers, and psychologists to help define the issue and find effective solutions (McEwen & Wills, 2018).

The main factors that impact the success of the orientation process include the attitudes that both nurses and patients have about giving or receiving help. Nurses must be aware of how they interact with patients including their reactions. Factors such as religion, race, age, educational background, experiences, preconceived expectations, and culture also impact the attitudes that nurses and patients have towards each other. stereotypes and biases act as barriers to effective interpersonal relationships (McEwen & Wills, 2018).

2. The Working Phase

This stage is where the nurse and client begin to work interdependently. Patients in this phase can either actively reach out to nurses or wait for the nurse to approach them. As a result, the main patient responses include full participation in the care process, exhibiting independence from the nurse, or passive involvement in the care process by fully depending on the nurse’s abilities. The working phase also entails clarifying the expectations from both parties although these expectations are more complicated than in the orientation phase. If they develop a good interpersonal relationship, patients become more confident about their ability to deal with the problem. A positive attitude is important because it helps channel the patient’s inner strength (McEwen & Wills, 2018).

3. Exploitation

As the patient becomes more aware of their capacity to deal with the healthcare issues, they start exploiting the services they require and as a result, are gain better control of the situation. Some patients may be more demanding which may pose a challenge for the healthcare professional who may opt to use tools such as interviews to explore the underlying issue. Nurses are expected to convey a trusting and accepting attitude to maintain interpersonal relationships. Additionally, the nurse must encourage patients to share and explore any emotions, thoughts, behaviors, and feelings by being non-judgmental. Some patients may be more self-sufficient than others and may seek interventions they feel will be more helpful to them. nurses should encourage self-determination as patients become more independent. Nurse-patient collaboration is critical to the success of this phase and as the patient moves towards better health, he or she makes progress towards the termination of the interpersonal relationship (McEwen & Wills, 2018).

4. Resolution and Termination

Termination occurs if the collaborative process fulfills the needs of the patient and entails dissolving the interpersonal relationship. In some cases, patients may be dependent on the nurse hence this stage may be difficult to accomplish since it is likely to lead to tension and anxiety. Nurses can engage in actions that prepare patients for the termination process including providing patient education and developing a follow-up action plan to ensure that the patient is progressing well. The termination process is essential since it helps the patient become more independent and takes more responsibility in health maintenance (McEwen & Wills, 2018).

Nursing Metaparadigm

Peplau defined the person as an organism that focuses on reducing any tension created by specific needs. Health refers to a situation characterized by productive, creative, community, and personal living. Peplau did not provide a direct definition of the environment although she emphasized the importance of assessing the patient’s environment including the home environment, work environment, and culture instead of only focusing on the patient’s welfare in the hospital. Peplau viewed nursing as a therapeutic and interpersonal process where the nurse is an educated professional whose role is to respond to the patients’ needs (McEwen & Wills, 2018).

Application of Hildegard Peplau interpersonal theory in Nursing Practice Theory

Being a middle-range theory, the interpersonal theory is applicable in practice. The theory offers a concrete base for handling care situations. The theory teaches nurses the significance of developing a therapeutic relationship with patients including the benefits of this relationship in patient recovery. The most important aspect of practice described by the theory is a collaboration between patients and nurses. Effective collaboration encourages patients to take part in their care and also makes it easier for them to be independent after the relationship is terminated. Peplau also focused on patient experience which is heavily influenced by the therapeutic relationship. Nurses can use the four phases described by Peplau as a framework for initiating and developing positive therapeutic relationships (Hagerty et al., 2017).

Empirical evidence illustrates the benefits of the interpersonal relationship to patients. For instance, Arabaci (2019) demonstrated the application of the interpersonal theory when working with juvenile delinquents and determined that the theory encourages patients to commit to taking charge of their health and life.  Wasaya et al. (2021) applied the interpersonal relationship to a case study and determined that the theory provides an adequate structure that supports the patient-nurse relationship which makes it easier to deal with barriers to effective care such as language barriers.

Conclusion

The interpersonal theory emphasizes the relations between patients and nurses. The theory focuses on collaboration as an important part of the care process and factors such as cultural and religious factors that impacts nurse and patient attitude towards the care process. Positive interpersonal relations lead to positive outcomes and encourage patients to take charge of their health after they are discharged.

References

Arabaci, L. (2019). Effect Of Using A Peplau’s Interpersonal Relation Nursing Model In The Care Of A Juvenile Delinquent. Journal Of Psychiatric Nursing, 10( 3), 218-226. https://doi.org/10.14744/phd.2019.54366

Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data?. Nursing science quarterly, 30(2), 160–167. https://doi.org/10.1177/0894318417693286

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Wasaya, F., Shah, Q., Shaheen, A., & Carroll, K. (2021). Peplau’s Theory of Interpersonal Relations: A Case Study. Nursing Science Quarterly, 34(4), 368-371. https://doi.org/10.1177/08943184211031573

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Virginia Henderson – Need Theory

Virginia Henderson was a nursing theorist who made significant contributions to the nursing profession that earned her the title of modern Florence Nightingale. Henderson was born in 1897 in Missouri and entered the Army School of Nursing during World War I when there was a shortage of nurses. In nursing school, she developed more interest in the nursing concept as a practice that supports medicine. During the war, Henderson had the opportunity to provide care to wounded and sick military personnel and the experience had a great influence on her understanding of the ethics behind nursing. The experience also opened her eyes to the significance of the nurse-patient relationship. After the war, she earned her undergraduate and master’s degrees and went on to serve as a nursing professor for many years. Henderson described nursing based on her experiences and focused on the unique responsibility of nurses (McEwen & Wills, 2018).

She developed the need theory to describe the main focus of nursing practice and the importance of enhancing the independence of the patients. The need theory is a grand nursing theory since it focuses on abstract concepts and provides nurses with a general framework for ideas associated with metaparadigm components such as health and person. The need theory also qualifies as a grand theory since it stems from Henderson’s personal experiences (McEwen & Wills, 2018).

Role of nurses

Henderson believed that the role of nurses entails acting on patients’ behalf when they lack the physical strength and knowledge to take care of them. The role provides nurses with the opportunity to apply biological, physical, and social sciences. Henderson also expected nurses to implement therapeutic plans developed by physicians when working as members of multidisciplinary healthcare teams. Additionally, they act as prime helpers whose role entails administering prescribed medication correctly and facilitating the client-nurse relationship. Nurses also work with other professionals to provide support to terminally-ill patients. To Henderson, the most ideal position is where a nurse is regarded as an important member of the healthcare team and is allowed to implement nursing functions without interference. Henderson also cautioned nurses from engaging in tasks that would distract them from their roles except in cases where there is the need to assume the role of another professional and the nurse has the required expertise to do so (McEwen & Wills, 2018).

Theory Assumptions

The main assumptions of the theory are that nurses provide care for patients until they are capable of caring for themselves. Nurses are willing and devoted to their role at all hours and patients possess the desire to improve their health. The theory also assumes that nurses are educated in sciences and arts at and beyond the undergraduate level. Henderson also emphasized that one cannot separate the body and mind because they are interrelated (McEwen & Wills, 2018).

Theory components

Henderson defined 14 components of the need theory. These components illustrate a holistic approach to nursing since they covered social, psychological, physiological, and spiritual needs. The physiological components include the ability to ingest food and drink, sleep and rest, clothing, good body hygiene, effective elimination of body waste, optimum movement and good posture, and avoiding any dangers that may exist within the environment. the ability to breathe properly and maintain normal body temperature are also important physiological components.

The spiritual aspect entails worshiping according to what one believes in while the psychological aspects include proper communication with other people and engaging in learning and discovery as part of personal development. The socially-oriented components include engaging in work activities that result in a sense of accomplishment and participating in various forms of recreation (Wallace & Jones, 2020).

Nursing Process

Henderson held the perspective that nurses utilize a logical approach when dealing with patient problems. She described the main elements of the nursing process as similar to the approach taken in traditional medicine. This process includes patient assessment, nursing diagnosis, planning, implementation, and evaluation of outcomes. In assessments, nurses use systematic strategies to access patient information. Assessments are also comprehensive in that they include spiritual, psychological, physiological, lifestyle, and economic factors. Henderson stressed problem-solving in the nursing process including the use of experience, intuition, expert opinion, and authority when making decisions. She also placed more emphasis on collaboration between nurses, other healthcare professionals, patients, and their families. She claimed that nursing focuses on independent functions rather than incorporating interdependent roles that involve other professionals (Wallace & Jones, 2020).

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An example of a practice-level nursing theory is the theory of human caring.
Application of nursing theory? Featuring theorists Hildegard, Virginia Henderson, Jean Orlando, Dorothy, Martha Rogers, Dorothea Orem, Imogene King, Betty Neuman, Sister Calista Roy, Jean Watson, Madeleine Leininger, Patricia Benner, Lydia E. Hall, Joyce Travelbee, Margaret Newman, Katharine Kolcaba, Rosemarie Rizzo Parse, Ernestine Wiedenbach and more.

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Metaparadigm of nursing

1. Person

Henderson explained that all people have health needs and that they often need help to achieve independence and health. She also explained that wholeness can only be achieved if people maintain emotional and psychological balance. Henderson described patients as people with biopsychosocial needs who need the help of a nurse. Additionally, the bodies and minds of patients are interconnected and interrelated (Wallace & Jones, 2020).

2. Health

Henderson did not provide an explicit definition of health although her concepts implied that to achieve good health, people must balance all the aspects of their lives and that health is directly associated with human functioning. She described health as being independent or having the ability to perform the fourteen components of the need theory without assistance. Henderson also mentioned the need for engaging in health promotion to prevent disease. She also explained how factors such as emotional balance, intellectual abilities, cultural background, and health impact the health of an individual. Moreover, she believed that nurses should be part of social justice groups that fight for equal access to basic needs, employment, and education since these needs affect individual health (Wallace & Jones, 2020).

3. Environment

Henderson did not define the environment although she mentioned that a supportive environment is crucial to good health when describing the 14 activities. All the external conditions surrounding a human being are critical to their development. Additionally, Henderson viewed people as their communities and families. She supported the role that both public and private institutions play in advancing the wellbeing of the population. Just as society relies on nurses to provide services for people who cannot function independently, society should be involved in nursing education at the university or college level. Nursing education should also include experiences in all healthcare aspects including preventive care. Comprehensive education ensures that nurses have a better understanding of healthcare consumers and environmental factors that impact individual and community health (Wallace & Jones, 2020).

4. Nursing

Henderson described the nursing process as a unique function that entails engaging in activities that promote recovery that entails both artistic and scientific components. The main aim of the nursing process is to help patients regain their ability to perform activities of daily living without any help. Therefore, nurses should focus on promoting their patients’ independence by improving their will, strength, and knowledge that will make it easy for them to satisfy the fourteen basic needs. Furthermore, Henderson explained that actions that nurses engage in during practice are similar to what they would do for themselves. She also encouraged independent judgment among nurses (Wallace & Jones, 2020).

Applications to Virginia Henderson -Need theory to Nursing Practice

The need theory can be applied when conducting patient assessments to determine specific patient needs. For instance, when nurses assess critically ill patients, they consider some of the components identified by the need theory including breathing patterns, body temperature, movement and posture, and the ability to eliminate body waste effectively. Some of these components entail vital signs which nurses are expected to monitor as part of patient care (Fernandes et al., 2019).

Nurses can also apply the theory in practice by setting patient goals based on the 14 components defined within the theory. Achieving some or all of these components would imply that a patient has become more independent and no longer needs nursing care. The components can also be used as the basis for discharge planning and follow-up because they help determine if the patient requires any support after discharge. The need theory also informs teamwork for nurses since it encourages them to perform their functions as team members including adhering to care and medication instructions provided by physicians (Gligor & Domnariu, 2020).

Conclusion

Virginia Henderson’s theory provided a comprehensive approach to nursing care since it described the role of nurses to patients and within multidisciplinary teams. The theory also defined the components of nursing care that are associated with patient independence. Using this theory, nurses can engage in care processes that improve their patients’ independence which in turn promotes a better quality of life.

References

Fernandes, B., Clares, J., Borges, C., Nóbrega, M., & Freitas, M. (2019). Nursing diagnoses for institutionalized elderly people based on Henderson’s theory. Revista Da Escola De Enfermagem Da USP, 53. https://doi.org/10.1590/s1980-220×2018004103472

Gligor, L., & Domnariu, C. (2020). Patient Care Approach Using Nursing Theories – Comparative Analysis of Orem’s Self-Care Deficit Theory and Henderson’s Model. Acta Medica Transilvanica, 25(2), 11-14. https://doi.org/10.2478/amtsb-2020-0019

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Wallace, A., & Jones, M. (2020). An evaluation of Henderson’s nursing needs model and how it can be adapted for use in veterinary nursing. The Veterinary Nurse, 11(8), 340-347. https://doi.org/10.12968/vetn.2020.11.8.340

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Fay Abdella – Twenty-One Nursing Problems Theory

Faye Abdella was born in 1919 in New York and is regarded as a pioneer in nursing research due to the significant contributions she made in the area. Faye witnessed the explosion of the Hindenburg and the destruction it caused. She realized that she wanted to be a nurse because she did not want to be powerless to help people in case of similar incidents in the future. Faye graduated from nursing school in 1942. She went on to receive her master’s degree and worked as a teacher at Yale. The teaching experience was frustrating and this prompted Abdella to pursue the scientific basis of nursing (McEwen & Wills, 2018).

In 1955, Abdella chaired a subcommittee in charge of creating meaningful medical records for nursing students. The committee identified the main barriers to successful completion of its task and they included lack of a clear nursing definition and lack of patient-centered approach in the nursing curriculum. The old nursing approach had become inadequate since it no longer met the needs of the patients. The subcommittee used a typology of nursing issues that were established in 1953 and refined them to come up with 21 problems. This led to the publication of patient-centered approaches nurses could use to enhance their practice in 1960. The publication described nursing as a profession that serves people and their families and consequently, the entire society. Additionally, the publication defined nursing as both a science and art. Faye’s contributions were rather progressive mainly because she used the term nursing diagnosis at a time where the role of nurses in clinical care did not include making diagnoses (George, 2014).

Components of the Abdella  Twenty One Nursing Problems Nursing Theory

In the 1960 publication, Abdella described the nursing process as a service that includes recognition of patient’s problems, selecting appropriate interventions based on nursing principles, and ensuring that the care plan aligns with the individual needs of a patient. Additionally, nursing entails continuous care to relieve discomfort and pain while attending to the total healthcare needs of the patient. Nurses are also tasked with helping people take more responsibility for their health and involving the family in the treatment process to promote better outcomes. Furthermore, nursing entails working with allied healthcare providers to develop plans that promote individual and population health at national, state, local, and international levels. Nurses were also encouraged to engage in continuous evaluation and conduct research studies that help to identify better practice techniques. Abdella’s theory is a grand nursing theory that focuses on human needs and provides nurses with a framework to utilize when engaging with patients. The ideas presented have a broad scope hence they are applicable in any healthcare setting (George, 2014).

The 21 Nursing Problems.

The nursing problems described by Abdella can be categorized into basic, substernal, remedial, and restorative needs. Basic needs apply to all patients and include maintaining physical comfort and hygiene, promoting optimal activity including exercise, sufficient sleep, and rest, promoting patient safety through trauma, injury, or accident prevention, and maintaining optimal body mechanisms. Sustenal care needs include facilitating the maintenance of physiological aspects of the body including maintenance of sufficient oxygen supply to body cells, elimination, nutrition of body cells, fluid and electrolyte balance, and recognizing how the body responds to disease mechanisms including physiological, pathological, and compensatory mechanisms. Remedial needs include maintaining the sensory functions, maintaining regulatory functions, identifying feelings and expressions, identifying the link between emotions and physical illness, maintaining effective communication, and facilitating the creation of positive interpersonal relationships. Other remedial needs include promoting progress towards spiritual goals, creating a therapeutic healthcare environment, and facilitating self-awareness. Restorative care needs include setting and accepting optimum goals based on emotional and physical limitations, effective use of community resources to solve healthcare issues, and understanding how social problems impact illness (George, 2014).

These problems generally focus on the psychological, sociological, and biological needs of the patient and were aimed at providing a meaningful basis that nurses could use when providing care. The most difficult problems according to Abdella included identifying and accepting negative and positive feelings, expressions, and reactions, maintenance of communication, development of positive interpersonal relationships, creating a therapeutic care environment, and setting goals based on emotional and physical limitations. The healthcare needs of a patient can either be covert or overt. Since covert issues can be sociological, emotional, or interpersonal, it is easy to misconstrue or miss them. However, solving covert problems often results in solving overt problems. Notably, it is possible to interpret the term ‘nursing problems’ used by Abdella to mean nursing goals or functions although this may shift focus to the nurse rather than the patient. Abdella labeled them nursing problems because they are experienced by patients and the role of the nurse is to provide solutions to them (George, 2014).

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Abdella emphasized problem-solving as a critical skill for all nurses. The ability to correctly identify nursing problems by engaging with the patient, observing them, using available patient data, and seeking the opinions of other professionals is very important. Abdella also suggested a criterion that nurses could use to determine if patient-centered care is effective. This criterion includes assessing the patient’s ability to satisfy their own needs, examining if the nursing care plan meets all patient needs (substernal, restorative, preventive, and remedial care needs), continuity of the care plan beyond the healthcare setting, the care plan focuses on helping the patient, involvement of family members, and using varying nursing skills when meeting the care requirements of individual patients (George, 2014).

Nursing Metaparadigm

Abdella did not directly define or address the four metaparadigm although her works can be connected to each one of them. For the person component, the characteristics of humans were not identified. However, the 21 nursing problems included specific psychological, biological, and social factors which are directly linked to the wellbeing of human beings. She also focused on improving patient-centered care in the nursing process and believed that it was essential for better patient outcomes (George, 2014).

Abdella did not provide a specific definition of the health component although she did identify the specific health needs that nurses should meet when caring for patients. Furthermore, she included both physical and mental health components when she identified physiological factors influencing health and how emotional and behavioral factors contribute to physical health.

For the environment component, Abdella focused on how society affects the health of individuals. Abdella’s nursing problems included an assessment of factors such as interpersonal relationships, effective communication, and the development of therapeutic care environment which are all part of the patient environment. She also explained that when promoting the health of the society, it is important to focus on all levels including state, local, national, ad international levels (George, 2014).

Abdella described nursing as a profession that draws on both science and art and that these two perspectives are essential when dealing with patient needs. She described various nursing skills including communication, problem solving, knowledge application, effective use of healthcare resources, care planning and organization, and providing health education to patients and families. She also described that nursing as a service profession that offers comprehensive services such as assessment, developing care plans based on nursing principles, and the provision of continuous services based on patient-specific needs. She also described the role of nurses in promoting patient responsibility towards personal health and the involvement of family members in care provision (George, 2014).

Application of Abdella Twenty One Nursing Problems Nursing Theory to Nursing Practice

The 21 nursing problems are not popular in the current nursing environment like other theories. However, they have heavily influenced the development of curricula for education programs and facilitated the shift from illness-centered care to patient-centered care. In an increasingly complex healthcare environment, patient-centered care is highly valued. The scientific approach used by Abdella can be applied by nurses to inform patient assessment, make accurate diagnoses, and develop care plans (George, 2014). Abdella’s work has also been used to develop the evaluation criteria for student nurses working within the clinical environment. Additionally, nursing problems have influenced the grouping of patients in healthcare settings based on their specific needs (Mitchell, 2018).

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Mitchell, A. (2018). Nurses Implementing a Newly Designed Fall Risk Tool for Inpatients on Medical/Surgical Units: A Quality Improvement Project. Biomedical Journal Of Scientific & Technical Research, 2(1), 2319-2321. https://doi.org/10.26717/bjstr.2018.02.000686

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Ida Jean Orlando – Nursing Process theory

Ida Jean Orlando had a varied nursing career since she worked as a practitioner, nursing consultant, researcher, and educator. Orlando also worked as a supervisor and nursing director and had a bachelor’s degree in public health nursing as well as a master’s degree in a mental health consultation. Orlando published her first book in 1961 when working as a Research Associate at Yale University. The book was titled The Dynamic Nurse-Patient Relationship. She later moved to Massachusetts and worked at the McLean hospital where she conducted research and released a second publication titled The Discipline and Teaching of Nursing Process in 1972 (George, 2014). Orlando’s description of the nursing process is based on patient-nurse interactions. Her educational background in addition to her experience in psychiatric nursing heavily influenced her work although her ideas can be applied to other areas of practice. The nursing theory is less abstract and more specific to the nursing care process hence it falls under middle-range theories (Smith & Parker, 2015).

The Main Concepts in Orlando’s Theory

The main concepts discussed by Orlando include uniqueness, independence, immediacy, the interactive nature of nurse-patient relationships, and discipline. Orlando believed that the nursing process is both independent and unique since it focuses on the need for help among patients in immediate situations. Nurses help interactively solve their patient’s issues and can work in any setting where people need help to resolve healthcare issues. The nursing process is disciplined and requires adequate training. Orlando believed that nurses must select their actions by considering the rationale behind them instead of simply following set protocols. Additionally, she recommended that nurses work independently due to their unique function ad that any orders recommended by the physician are directed to the patients. Orlando also outlined the role of nurses in resolving conflicts that may occur when institutional policies do not align with the patient’s needs (Smith & Parker, 2015).

Orlando focused on healthcare consumers as unique individuals with different healthcare needs and encouraged nurses to individualize the healthcare plans for patients regardless of their similarities in symptoms. Orlando defined the concept of immediacy since nursing action plans must address the immediate needs of the patients. Notably, a patient’s needs change from time to time hence focusing on immediacy ensures that each need is adequately met (Smith & Parker, 2015).

Orlando also described the nursing process as interactive since nurses work with patients to identify their needs and to come up with an action plan. The actual interaction process is similar to normal interpersonal interactions because the main focus is constant communication. In effective nursing care, however, the main difference between nurse-patient and normal interactions is nurses focus on providing disciplined professional responses (George, 2014).

Nursing Process Discipline

Orlando defined the nursing process discipline as to how nurses act when they engage with patients. The main aim of the process discipline is to meet the needs of the patient with the desired result being resolving these needs. Additionally, in the healthcare environment, professional responsibilities for different workers influence each other (George, 2014).

Patient behavior

Patient behavior precipitates the nursing process discipline. All behaviors demonstrated by patients should be regarded as calls for help until the nurse understands their immediate situations. Patients can either demonstrate non-verbal or verbal behavior. Verbal behavior constitutes all manners of language use including requests, complaints, statements, questions, and demands. Nonverbal behaviors may include motor activity such as eye contact or smiling and physiological symptoms such as changes in blood pressure and heart rate. Patients experience helplessness when they are unable to resolve their needs, and this is reflected in their behavior (McEwen & Wills, 2018). Orlando categorized patient distress as either physical limitation, failure to communicate personal needs, or demonstrating adverse reactions to the healthcare setting. Physical limitations may arise from environmental restrictions, permanent or temporary disability, or incomplete development. Factors such as nurse mistrust, inability to correctly define their needs, and feeling embarrassed about the need also result in distress. It is important to note that even though patients may indicate that they need help, their behavior may not illustrate that need, and this may result in issues within the nurse-patient relationship. The ineffective behavior prevents nurses from responding to patient needs or maintaining a proper professional relationship (George, 2014).

Nurse reaction

The behavior demonstrated by the patient stimulates specific reactions from nurses. The nurse’s reaction takes place in three parts. The first part is where the nurse perceives the patient’s behavior using any of the five senses. The second part is where the perception results in automatic thought, while the third part is where the thought results in an automatic feeling. Nurses must learn to recognize every component of their reactions which makes it easier to analyze any actions taken after the reaction. Notably, it is possible to share feelings without using words. Just like patients share their feelings using non-verbal cues, nurses’ behavior also illustrates what they feel about the care process. However, it is important for nurses to always verbalize their feelings to patients because it may invite the patient to explain specific verbal and nonverbal cues they may have demonstrated. Therefore, when nurses share their reactions, they create an environment that encourages patients to also share their reactions (George, 2014).

Nurse Action: Automatic and Deliberative Actions

These actions include what nurses do to benefit the patient. Actions must be aligned with the patient’s needs. Nurse action can either be deliberative or automatic. Automatic actions include those which are selected for reasons other than the immediate need of the patient while deliberative actions are selected after accurate recognition of patient needs. Nurses must explore the meaning of deliberative actions to assess their relevance to patient needs and must also assess their effectiveness once they are complete (George, 2014).

Professional Function

Nurses should only accept roles that they can fulfill about meeting their patients’ needs. They must know that any actions taken can only be referred to as professional if they deliberately target patient issues (George, 2014).

Nursing Metaparadigm

Orlando describes the person concept by emphasizing individuality and interpersonal relationships between patients and nurses. She also considers patients as humans in need of help from nurses. There is no specific description of the health concept although Orlando implied that poor health is feeling helpless and that helplessness is what initiates contact between nurses and patients. Orlando did not define the environment component and largely ignored it except when she mentioned the nurse-patient interaction. She also mentioned institutional policies and how they may conflict with patient needs but failed to discuss how the social impacts health.

Orlando’s theory focuses on nursing and describes it as a unique and independent profession whose main concern is to meet the needs of the patient population. Any actions taken to fulfill people’s needs are implemented in interactive situations. Nurses require discipline to interact with patients and they acquire it through proper training (Smith & Parker, 2015).

Application of  Ida Jean Orlando – Nursing Process Theory to Nursing Practice

Orlando’s theory is very useful to nursing practice. the theory guides nurse-patient interactions and ensures that patients are allowed to make constant input in their care process. The theory emphasizes the nurse’s role towards the patient instead of the care settings and encourages them to advocate on their patients’ behalf in case of any conflicts. Nurses should always keep the theory in mind especially when exploring the reactions they have towards patient behavior to maintain professionalism and to effectively develop and implement action plans. Furthermore, Orlando’s theory helps nurses pay attention to any verbal and non-verbal cues that may indicate the problems experienced by patients (George, 2014).

Several studies have demonstrated the effectiveness of Orlando’s theory in improving the quality of care. Osman et al. (2021) applied the theory in a Ghanaian hospital and determined that the theory improves nursing outcomes since it serves as a framework for nurse action. Yekefallah et al. (2021) demonstrated that the nursing theory can be used to relieve anxiety among patients undergoing medical procedures such as endoscopies.

Conclusion

Ida Orlando’s theory describes nurse-patient interactions and emphasizes the importance of assessing patient behaviors to determine their needs and developing nursing actions that cater to immediate needs. The theory is rather informative and applicable in all nurse interactions to improve the care process and patient outcomes.

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Osman, W., Ninnoni, J., & Anim, M. (2021). Use of the nursing process for patient care in a Ghanaian Teaching Hospital: A cross-sectional study. International Journal Of Africa Nursing Sciences, 14, 100281. https://doi.org/10.1016/j.ijans.2021.100281

Smith, M., & Parker, M. (2015). Nursing Theories & Nursing Practice (4th ed.). F.A. Davis.

Yekefallah, L., Ashktorab, T., Ghorbani, A., Pazokian, M., & Azimian, J. (2021). Orlando’s nursing process application on anxiety levels of patients undergoing endoscopy examination. International Journal Of Epidemiologic Research.

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Dorothy Johnson – Behavioral System Model Theory

Dorothy Johnson was born in 1919 in Georgia and served as an educator in pediatric nursing until 1978 when she retired as a professor emeritus. Most of her publications focused on expanding the knowledge base for nurses. Johnson’s contribution to nursing theory is very important since she was among the first grand nursing theorists who described and presented their perspectives on nursing practice in form of a conceptual model. Johnson addressed issues associated with nursing practice and science during her career as an educator. She wrote numerous journal articles and worked with several nursing associations including the American Nurses Association and the National League for Nursing. Johnson proposed that the main purpose of nursing care is to ensure that patients maintain a state of equilibrium. Patients are stressed by either external or internal stimuli that create disequilibrium and healthcare helps restore the state of equilibrium. Johnson identified two areas of nursing care including a focus on reducing stressors and supporting the natural defenses of the patient to help restore equilibrium. In 1992, Johnson stated that most of her works could be attributed to Florence Nightingale’s work. She noted that Nightingale focused on the association between the physical environment and the patient and as a result, she shifted her focus to how environmental systems impact patients. Johnson’s experience in pediatric nursing also influenced her work. Johnson’s theory is a grand nursing theory that focuses on the healthcare needs of humans (Smith & Parker, 2015).

Assumptions of Dorothy Johnson – Behavioral System Model Theory

Johnson described several assumptions required to understand how people operate within the behavioral system. Behavioral systems are characterized by organization, integration, interdependency, and interactions between elements. The interrelated components of a system are what make up the entire system. The second assumption is that within systems, there are various forces that work to create balance. Human beings are always striving to maintain balance within the behavioral system by constantly adapting to any forces affecting them. people encounter numerous situations in daily life that require them to adjust or adapt. The adaptation process is a natural part of human nature. The third assumption of the theory is that human beings must be part of systems that require some extent of constancy and regularity for them to thrive. Such systems are useful in both personal and social life. The final assumption is that the balance in behavior systems is a reflection of how people successfully adjust to different situations (George, 2014).

Johnson also described the assumptions behind the functioning and structure of the behavior system. Firstly, the drive or goal behind specific behavior can be deduced from the form or consequences of the behavior. Secondly, everyone is predisposed to engage in specific actions when pursuing certain goals. Thirdly, every subsystem contains many alternative actions that people can choose from. More adaptable people have a wider range of alternatives in comparison to those who are less adaptable. Life experiences also increase the number of alternatives and with time, the ability to acquire new behavior alternatives diminishes when people become more comfortable with the choices they can access. Fourthly, the main outcome of the subsystems is observable behavior. Every subsystem has three requirements: protecting the system from influences that it cannot cope with, nurturing the system using appropriate environmental supplies, and stimulating the system to prevent stagnation (George, 2014).

The Seven Subsystems

The seven subsystems include attachment, dependency, ingestive, eliminative, sexual, achievement, and aggressive subsystems. People develop the attachment subsystem first as infants since it is critical to their survival. With time, people develop an attachment with other people beyond their caregivers. The attachment subsystem is related to the dependency subsystem although the result of dependency is attention or approval from others. The ingestive subsystem focuses on behaviors linked to food intake which are heavily influenced by culture and social surroundings. The eliminative subsystem focuses on waste excretion including behaviors such as physical control over the elimination process and acceptable behavior for excretion. The sexual subsystem is associated with procreation behaviors, while the aggressive subsystem focuses on self-preservation behaviors. The achievement subsystem focuses on how people try to control their environment to feel accomplished. Johnson recognized several areas including creative, physical, social, mechanical, and intellectual skills (George, 2014).

Nursing Metaparadigm

1. Person

Johnson viewed the person concept as comprising of behavioral and biological systems. The main role of nursing practice is to deal with disequilibrium in the behavioral system, while the main role of medicine is to counter disequilibrium in the biological system. Johnson also recognized how biological and behavioral systems influence each other. Individual behavior is a reflection of how one responds to various stimuli within the environment (Smith & Parker, 2015).

2. Environment

Johnson defined the environment as the set of things or objects which influence the functioning of the system when their attributes change. According to Johnson, the environment comprises both external and internal components, and people adjust to changes in environmental forces. People must respond to any changes in the external environment including changes in physical settings, cultural, and psychosocial components. Internal factors include attitudes, development capacity, physiology, ego, and temperament. The main focus of nursing assessment is to determine which changes in the internal environment result in poor health (Smith & Parker, 2015).

3. Health

Johnson’s description of health is centered on the effectiveness and efficiency of the system including the stability and balance of the system. The balance in behavioral systems is demonstrated by orderly, purposeful, and predictable behavior. People exhibit behavior changes when the functioning of the system is disrupted. Poor health is associated with system instability and imbalance (Smith & Parker, 2015).

4. Nursing

The main goal of the nursing process is to foster balance and stability within patients. nursing interventions may focus on altering behaviors that result in equilibrium disruption. To restore equilibrium, nurses may provide the conditions and resources required for survival and growth, provide stimuli that result in better adjustment and new behaviors, and protect patients from negative stimuli including unnecessary stress. Johnson also explained that nursing is a service that complements other healthcare professionals. Johnson did not describe the nursing process although she emphasized the role of nurses in regulating the external environment of the patient. She expected nurses to make decisions and judgments after fully understanding the systems and subsystems impacting the health of an individual (Smith & Parker, 2015).

Application of Dorothy Johnson – Behavioral System Model Theory to Nursing Practice 

Johnson’s theory influenced nursing practice by providing nurses with a framework for assessing the system and subsystems affecting clients. Nurses can use the seven subsystems to assess patients and determine the main cause of disequilibrium. The theory also advises nurses to consider both internal and external factors that affect the well-being of an individual when conducting assessments. The behavioral systems model can also be applied when making nursing diagnoses since it helps determine any form of insufficiencies, discrepancies, dominance, or incompatibility within different subsystems. Nurses use the assessment information to determine effective interventions that will help modify the patient’s behavior and help restore equilibrium in the patient’s subsystem (Smith & Parker, 2015).

Nurse researchers have also demonstrated the significance of Johnson’s model in practice. Cheng and Luo (2020), for instance, described how Johnson’s theory can be used in the development of nursing care plans for patients with mental disorders and other areas of nursing including tumor nursing and treatment of patients with nervous system diseases. The basis of application is the ability of patients to adapt to various changes in their physical and mental state. Karkhah et al. (2020) demonstrated how Johnson’s theory can be used to develop care plans for patients including a focus on subsystems such as ingestive ad elimination subsystems. Karkhah et al. (2020) also explained how Johnson’s theory can be used to promote self-care and independence among patients by helping patients improve self-esteem, range of motion, desire for food, excretion, and adjusted libido.

Johnson’s model was used to inform the development of the nursing undergraduate curriculum in UCLA nursing school. The theory also influenced nursing education in other universities including Colorado, Alaska, and Hawaii universities (Smith & Parker, 2015).

Conclusion

Johnson’s theory describes the systems and subsystems that affect human functioning. Human behavior is directly linked to changes within the subsystem and the role of nurses is to restore equilibrium within the subsystem. The behavioral systems theory is informative and can be applied in various areas of nursing practice including assessment, diagnosis, and nursing intervention.

References

Cheng, Y., & Luo, Y. (2020). The Application Progress of Johnson’s Behavior System Model. Journal Of Engineering Research And Application, 1(3), 39-42. https://doi.org/10.9790/9622-1003053942

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Karkhah, S., Ghazanfari, M., Norouzi, M., Khaleghdoust, T., Dahka, S., Taheri, Z., & ghanbari, a. (2020). Designing a nursing care plan based on Johnson’s behavioral model in patients with wrist joint hematoma: A case study. Research Square. https://doi.org/10.21203/rs.3.rs-34306/v1

Smith, M., & Parker, M. (2015). Nursing Theories & Nursing Practice (4th ed.). F.A. Davis.

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Martha Rogers -Unitary Human beings Theory

Martha Rogers was a nurse theorist who demonstrated several skills including innovative thinking and was also advocated for changes within nursing education. She was born in 1914 in Dallas, Texas, and received a nursing diploma in Knoxville General Hospital in 1937. She advanced her education by getting a bachelor’s degree and two master’s degrees in public health nursing and public health supervision. Rogers worked as a supervisor, mentor, and teacher and had a great influence on other nurse theorists including Newman and Parse. Her conceptual system had a significant impact on clinical practice, nurse research, and theory development. Before Rogers developed her theory, human beings were generally viewed as recipients of healthcare by physicians and nurses. Additionally, the healthcare system was categorized based on specific specializations such as medication administration and health education instead of viewing the patient as a whole person. Many professionals at that time worked in isolation and had no information about the whole person. Rogers emphasized that people were unitary beings who engage in mutual interaction with their environment. The theory had a significant influence on nursing practice since it encouraged nurses to pay attention to the entire person when developing care plans and implementing them. Rogers’s theory is a grand nursing theory because it has a broad scope with general propositions and can be applied in a wide range of healthcare settings, practice areas, and populations (McEwen & Wills, 2018).

Theoretical Underpinnings

The theory of unitary human beings was initially abstract. Rogers deductively derived the theory from the works of various scientists including Heisenberg and Einstein to demonstrate that the universe was unpredictable. She also incorporated Bertalanffy’s general systems theory that posits that one of the characteristics of open systems is that they engage in constant interaction with their environments. She also used the works of Herrick and Rapoport to further understand open systems and human nature. After synthesizing the works of these scientists, Rogers developed a basis of her idea that human systems are examples of open systems which exist within other open systems within the environment. She included other significant concepts including the unidirectional nature of time, organization and patterns present in living systems, and the idea that human beings can make choices and have feelings and awareness. Rogers’s theory was continuously refined until a short time before she died (McEwen & Wills, 2018).

Theory Assumptions

In 1970, Rogers described several assumptions that explained the nature of man. She viewed man as a unified whole being with characteristics that are more complex than the sum of his parts. Man is in constant interaction with the environment and they continuously engage in energy exchange. Life is a process that undergoes unidirectional and irreversible evolution within the space-time continuum. Man generally exhibits organization and patterns which identify them and are a reflection of their wholeness. Other characteristics of man include thought, sensation, emotion, language, and the capacity for imagery and abstraction. In 1990, Rogers revised the term man to a human being as a way of incorporating gender-neutral language within the theory (McEwen & Wills, 2018).

Theory Concepts

Rogers considered the environment and the unitary human being as the main focus of clinical practice for nurses. She refined her assumptions and came up with five main concepts including pattern, pandimensionality, energy fields, the environment, and unitary persons.

1. Energy field

Rogers described the energy field as the basic unit for both nonliving and living things. she viewed the environment and humans as energy fields due to characteristics such as infinite nature and boundaries that extend beyond what can be seen physically. Since the energy concept may be hard to comprehend, some nurses view Rogers as an abstract theorist (Smith & Parker, 2015).

2. Pattern

A pattern is a characteristic of an energy field that is regarded as one wave. It is impossible to understand human beings by just examining their parts because each one of them has unique patterns. One of the issues associated with the operationalization of Rogers’s theory is that it is difficult to examine patterns that exist within the human energy field (Smith & Parker, 2015).

3. Pandimensionality

The term refers to an infinite domain with no limits. All reality, including environmental and human fields, are pandimensional. the concept of pandimensionality, in reality, can be explained by phenomena such as clairvoyance and precognition (Smith & Parker, 2015).

4. Unitary human beings

Humans are pandimensional, indivisible, and irreducible energy fields characterized by specific patterns and presenting characteristics that are unique to the whole and cannot be predicted just from knowing the parts (Smith & Parker, 2015).

5. The environment

Rogers described the environment as an energy field that just like the unitary human being, is pandimensional, irreducible, and can be identified by unique patterns. The environment is also an integral component of the human field (Smith & Parker, 2015).

Principles of Martha Rogers -Unitary Human beings Theory

Apart from the described concepts, Rogers also described three principles including the principles of integrality, helicy, and resonancy. The helicy principle refers to the characteristics of both environmental and human field patterns including increasing diversity, unpredictability, innovativeness, and continuous. The helicy principle explains that humans become more complex and diverse instead of regressing. The resonancy principle refers to the changes in wave frequency patterns in both environmental and human fields. The Rogers perceived humans as wave patterns and most of the life rhythms such as changes in emotional states and fluctuations in hormones can be compared to waves. The integrality principle refers to the mutual process that exists between environmental and human fields (McEwen & Wills, 2018).

Nursing Metaparadigm

Rogers described the four metaparadigm concepts although she did not perceive them as the building blocks of the science of unitary human beings. She defined humans as unitary beings with energy fields whose patterns can be identified. Humans are also integral to the environment they exist in. Rogers defined the environment as an energy field that demonstrates similar characteristics as the human field. She described nursing as a concept that is concerned with helping humans achieve their full potential within their environment. The complex nature of the human field necessitates the individualization of nursing interventions which is the best way for promoting good health and wellbeing. Rogers also described nursing as a noun based on its unique body of knowledge. The nursing process focuses on strengthening the integrity of the human field. Roger defined health as a value in that human health is signified as an irreducible manifestation of the human field and that disease occurs as a result of undesirable characteristics in the human field. Rogers also emphasized the infinite and relative nature of health and fluctuations in illness and health are part of the life process (Smith & Parker, 2015).

Application of Martha Rogers -Unitary Human beings Theory in Nursing Practice

The theory is abstract and contains a derived framework. In addition, it does not define specific hypotheses but provides a general worldview that nurses can use to derive hypotheses and theories. Generally, the theory provides a wide range of options that can be used to study human beings and to assess various health situations by focusing on the manifestation of patterns (McEwen & Wills, 2018). In addition, Rogers’s theory helps nurses recognize the complexity and diversity of human nature and to appreciate that human complexity increases with time. Such knowledge is essential for understanding patients as whole human beings including their values and beliefs and helps nurses to define health from the perspective of the patient. Essentially, the theory informs patient-centered practice (Wierenga & Moore, 2020).

Rogers’s theory can also be applied in nurse leadership by informing leaders that people can choose to create change and that people are unique. This information can help nurse leaders develop healthcare environments that encourage diversity, creativity, and openness which in turn encourages professional growth through constant improvement (McEwen & Wills, 2018).

Conclusion

Roger’s theory provides a synthesis of concepts that are very important in nursing practice. the theory helps nurses view patients as whole beings and strive to understand any patterns manifested in their health. The use of the theory in practice requires nurses to engage in critical thinking in order to effectively integrate the systems theory in practice. Nurses who apply the theory can conduct accurate assessments of patients by considering their perspectives and make better healthcare decisions.

References

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Smith, M., & Parker, M. (2015). Nursing Theories & Nursing Practice (4th ed.). F.A. Davis.

Wierenga, K. L., & Moore, S. E. (2020). Adapting to Uncertainty: Nursing Responsiveness to COVID-19. The Journal of cardiovascular nursing, 35(4), 322–323. https://doi.org/10.1097/JCN.0000000000000712

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Dorothea Orem – Self-care Theory

Dorothea Orem was born in Maryland in 1914. She pursued her nursing diploma in a nursing school in Washington DC and earned her degree in 1939. She also pursued a master’s degree in nursing education at Catholic University and held numerous job positions as a staff nurse, private duty nurse, and educator. She served as the director of a nursing school and later as a member of the Board of Health of Indiana until 1957. In 1959, she became a faculty member of the Catholic University and was later promoted to become the Dean. Her interest in nursing theory began when she was selected alongside other colleagues to come up with a practical nursing curriculum for the education department in Washington DC. She began working on the concept of self-care in nursing and her work has received numerous accolades due to the value of the self-care theory. Even after she died in 2007, Orem is still revered as a pioneer in nursing theory. Orem’s theory was not influenced by other nursing theorists although she references the systems theory by von Bertalanffy and the structure of social action by Parson in her description of the self-care theory (McEwen & Wills, 2018).

Orem’s theory contains a well-developed nursing theoretical system. Orem believed that people engage in constant interchange and communication with their environment and other people to function effectively. People exercise their power to act to identify their needs. Additionally, adult humans engage in self-care as a way of maintaining their functioning (McEwen & Wills, 2018). The self-care theory is a middle-range theory that provides a framework that guides nurses in daily practice. The theory can be tested through research and can be applied in numerous health settings. Orem’s theory is mainly comprised of three interrelated theories which include the self-care theory, the self-care deficit theory, and the nursing systems theory (Younas, 2017).

The Dorothea Orem – Self-care Theory concepts

Self-care theory

The self-care theory focuses on the activities that people perform to maintain their personal health and wellbeing. The concept of self-care requisites refers to the actions taken by people to control environmental or human factors which affect their development or functioning. The main types of self-care requisites include developmental, universal, and health deviation. Developmental requisites include self-care actions required for growth and development. Universal requisites include self-care actions applicable to all humans (McEwen & Wills, 2018). Examples of universal requisites include maintaining sufficient air, food, and water intake, maintaining a balance between rest and activity, balancing social interaction and solitude, maintaining efficient elimination processes, and preventing hazards that negatively impact functioning and wellbeing. Promoting growth and development is also an important universal requisite. Health deviation requisites include actions linked to health deficits that are needed when one experiences injury or illnesses. These requisites include seeking healthcare services, awareness of pathological states and conditions, adhering to rehabilitative and therapeutic measures, accepting one’s particular health state, and learning how to effectively manage pathologic conditions through lifestyle changes (Younas, 2017).

Self-care agency refers to the power or ability that humans have to engage in self-care. This ability is affected by several conditioning factors including gender age, health state, developmental state, environmental factors, living patterns, and availability and adequacy of self-care resources. Therapeutic self-demand refers to all actions that people take for a specific time to meet self-care requisites (McEwen & Wills, 2018).

Self-care deficit

This concept delineates when patients require nursing help which in most cases, is when people are incapable of engaging in self-care. Orem viewed nursing as a helping professional which focuses on actions such as acting and doing on behalf of the patient, providing guidance, supporting patients, teaching them, and providing a healthcare environment that supports personal development (McEwen & Wills, 2018).

The Nursing System

The nursing system is described as a product of the interactions between nurses and patients. the system is activated when self-care demands for the patient exceed their available agency hence they need help from nurses to meet these demands. The nursing system concept can either be wholly compensatory or partial compensatory. Wholly compensatory systems are represented by instances when the patient is unable to engage in self-care due to limitations associated with ambulation and refraining from the activity for medical reasons. People with such limitations fully depend on others for their well-being. Partial compensatory systems are situations where the patient and the nurse both engage in self-care activities. For instance, a nurse can help a patient to move around after a surgical procedure or can bring food to patients who can feed themselves. the supportive-educative system is also a sub-concept of the nursing system that focuses on teaching patients how to engage in self-care activities. An example is teaching a new mother how to breastfeed her baby (McEwen & Wills, 2018).

Nursing Metaparadigm

Orem defined the person component as comprising of women, men, and children cared for either as social units or singly. Human beings are also referred to as material objects of healthcare providers including nurses. According to Orem, the environment includes chemical, biological, and physical components. People are surrounded by their families and communities. Culture also has a significant influence on the health of an individual. The biological component includes mechanisms such as elimination processes that impact the wellbeing of an individual. Orem defined the health component as the state of being functionally and structurally sound or whole. Additionally, health encompasses group and individual health and it includes the ability to engage in self-reflection and effectively communicate with others. Self-care is a critical determinant of human health and poor health is described as the inability to engage in self-care.

Orem viewed the nursing component as an art where the nurse provides specialized assistance to patients who are unable to meet their self-care needs and those with disabilities through the nursing system. The role of nurses also includes providing education to patients who can meet their needs but need help doing so. Nurses can either be partially or wholly involved in helping patients meet their needs based on the extent of disability (McEwen & Wills, 2018).

Applications of Dorothea Orem – Self-care Theory to Nursing Practice

Many nursing schools and colleges have used the self-care theory as a basis for their curriculum. Orem’s theory has also been applied in the nursing process to determine self-care deficits for patients and to define the role of nurses and patients in meeting self-care demands. In nurse assessments, the theory helps to determine the health status of a patient by evaluating the ability to perform self-care activities and eliciting the patient’s perspective of health (McEwen & Wills, 2018). Additionally, Orem’s theory is used to assess health by considering factors such as living patterns and environmental factors. Assessments help nurses determine whether patients require partly compensatory, wholly compensatory, or supportive-educative systems. The choice of nursing system should be efficient and effective in helping patients overcome any self-care deficits. The theory can also be applied when evaluating the effectiveness of nursing interventions by determining if these interventions have improved self-care abilities for patients or if they fulfill all deficits (Younas, 2017).

Orem’s theory has been applied in numerous healthcare settings including critical care, community nursing, ambulatory, pediatric nursing, maternal-child nursing, renal dialysis, and medical-surgical nursing to develop a care structure for patients. the theory has specifically been proven to be useful in the management of chronic illnesses such as diabetes, hypertension, gastrointestinal, arthritis, and renal diseases (McEwen & Wills, 2018). Numerous research studies have published the application of Orem’s theory in nursing practice. for instance, Khademian et al. (2020) applied the self-care theory to improve self-efficacy and quality of life among patients diagnosed with chronic hypertension. The study illustrated that training patients on how to engage in self-care following Orem’s framework improve self-management and consequently the quality of life of hypertensive patients. Borji et al. (2017) obtained similar results when they used Orem’s model to improve functioning and quality of life among diabetic patients.

Conclusion

Orem’s self-care theory describes activities that people engage in for optimal functioning. Poor health status results in the inability to engage in self-care and the role of nurses is to help patients meet their care needs. Orem’s theory is applicable in numerous areas of the nursing profession including clinical practice, research, and nurse education.

References

Borji, M., Sharifi, A., Otaghi, M., & Kazembeigi, S. (2017). The Impact of Orem’s Self-Care Model on the Quality of Life in Patients with Type II Diabetes in Ilam. Biomedical And Pharmacology Journal, 10(1), 213-220. https://doi.org/10.13005/bpj/1100

Khademian, Z., Kazemi Ara, F., & Gholamzadeh, S. (2020). The Effect of Self Care Education Based on Orem’s Nursing Theory on Quality of Life and Self-Efficacy in Patients with Hypertension: A Quasi-Experimental Study. International Journal of Community Based Nursing And Midwifery, 8(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Younas, A. (2017). A Foundational Analysis of Dorothea Orem’s Self-Care Theory and Evaluation of Its Significance for Nursing Practice and Research. Creative Nursing, 23(1), 13-23. https://doi.org/10.1891/1078-4535.23.1.13

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Imogene King – Goal Attainment theory

Imogene King is a nursing theorist who was born in 1923 in Missouri. She studied ad St. John’s hospital School of Nursing and obtained her Bachelor’s degree in nursing in 1948. She obtained her master’s degree in 1957 and a doctorate of education in 1961 from Columbia University. Additionally, she did a postdoctoral study in computers, statistics, and research design. King worked as a nurse practitioner, an educator, and an administrator. In clinical practice, she worked as a medical-surgical nurse. The beginning of the 20^th century was marked by the rapid development of knowledge in many professions including the nursing profession. By the 1960s, many nurses were developing knowledge bases for their profession to expand the nursing role and improve practice (McEwen & Wills, 2018).

King’s first publication was in 1964 when she wrote a paper discussing issues encountered when developing nursing knowledge and prospects for the profession. In 1968, King defined concepts that would later be used in the goal attainment theory. She focused on answering questions regarding factors influencing changes in nursing, elements that remain constant through the changes in the profession, the scope of practice, changes in nursing goals as compared to 50 years ago, and the dimensions of nursing practice. King’s work was based on von Bertalanffy General Systems Model. When assessing the model, King focused on questions regarding decision-making for nurses including information required for effective decision making, availability of alternatives, and skills necessary in decision making. The goal attainment theory was developed from the conceptual system and is a middle-range nursing theory. The main focus of the theory is on interpersonal systems where two strangers come together in healthcare settings to maintain positive health states required for optimum functioning (George, 2014).

Imogene King – Goal Attainment Theory Assumptions

The assumptions in King’s model are associated with the nursing process, the individual, and the nurse-patient relationship. The model identifies individuals as sentient, social, and rational beings whose behavior is action oriented, purposeful, and time oriented. For nurse-patient interactions, the main assumptions include that both nurse and patient perceptions impact the interaction process, the values, goals, and needs of the patient and nurse also affect the interaction, people have the right to know about themselves and to participate in decisions with impact their health. King also stated that people have the right to decline healthcare services and in some cases, the goals of the patient may contradict the goals of the healthcare professional. King described nursing as a care process that involves thinking, perceiving, acting, and relating about the behavior demonstrated by patients. a nursing situation occurs when two people establish a professional relationship to cope with negative health events. The main purpose of nursing is to help people restore, maintain, or attain health and in cases where restoration is impossible, nurses support patients to ensure that they die with dignity (McEwen & Wills, 2018).

Imogene King – Goal Attainment Theory Concepts

King discussed several concepts including interaction, perception, stress, transaction, role, decision making, and communication. Interaction refers to both nonverbal and verbal behavior that people demonstrate in their mutual presence. Communication and perception are integral components of interactions. The people in the interaction bring different beliefs, attitudes, perceptions, and ideas, and each one of them either take mental action or makes a decision to act and react to the situation and each other. King defined perception as the reality as seen by each person in an interaction. Perception is derived from the energy in the surroundings and is organized by energy transformation, information processing, storage, and exportation through observable behavior. King defined communication as information exchange through written, verbal, or electronic means. During interactions, people engage in a series of exchanges called transactions which include observable behavior. Each individual in the transaction has a specific role to play. King defined roles as expected behaviors associated with the individual’s position and the relationship between the people in an interaction. Notably, people must identify roles and expected behaviors to avoid confusion and conflict. The decision making process entails making choices after considering several alternatives. It is important to rely on values and facts when making choices (George, 2014).

King also described predictive propositions. The first proposition is that role congruence, perceptual accuracy, and communication result in transactions between nurses and patients. the second proposition is that these transactions result in goal attainment and consequently, growth and development. The third proposition is that goal attainment is an indicator of effective nursing care and results in satisfaction. King described reciprocity in the nurse-patient relationship such that nurses possess skills and knowledge and can provide patients with helpful healthcare information. Patients also possess knowledge and information about themselves hence they can communicate any concerns to nurses. Patient information is crucial to the goal setting process. These interactions also occur in a natural environment between nurses and patients who require nursing care. Nurses and patients work together to identify issues, establish goals, and develop interventions that will ensure the goals are achieved (George, 2014).

Nursing Metaparadigm

1. Person

King described humans as social, rational, perceiving, reacting, controlling, time-oriented, and action oriented beings. She later added that humans are spiritual and that they have the right to acquire knowledge about their health and to participate in making decisions that impact their health, lives, and community services. People seek healthcare services when they need them and their basic health needs include access to usable health information, access to preventive healthcare services, and access to care when unable to engage in self-care (George, 2014).

2. Health

King described health as a life experience and implied that people have to make adjustments to their external and internal environment by efficient use of personal resources to live full lives. She also viewed health as a dynamic state where change is ongoing and constant. Additionally, health is an individual’s ability to perform their designated roles (George, 2014).

3. Environment

King described the environment as the balance created between external and internal interactions. The external environment exists outside the person while the internal environment exists within the person. King also mentioned society as part of the social system within which people exist (George, 2014).

4. Nursing

King defined the nursing process as the interaction between patients and nurses that involves sharing of information through communication that facilitates goal-setting. Nurses work with patients to recognize the presenting health issues and engage in physical action alongside the patient to deal with these issues. The nursing process also includes mental action which entails exerting control over the health issue on the patient’s part. King also discussed the goal of nursing which is to help people regain or maintain good health. Other nursing functions include planning, implementing, and evaluating care plans (George, 2014).

Application of Imogene King – Goal Attainment theory To Nursing Practice

King’s theory has been applied in nursing education. For instance, it served as the framework for the development of the curriculum as the nursing school at Ohio State University. The model has also been applied internationally in Sweden, Japan, Canada, and Portugal to develop nurse education curriculum (McEwen & Wills, 2018).

The theory also provides a guide for organizing nursing practice. the theory can be applied to facilitate the development of a therapeutic relationship between patients and nurses through mutual interactions with patients. In addition, the theory illustrates that patient assessment occurs during interactions and nurses should apply their skills and knowledge to fully understand patient’s problems (Adib-Hajbaghery & Tahmouresi, 2018). The theory also promotes collaboration in practice since it focuses on patient involvement in information sharing and decision making during nurse-patient interactions (da Silva & Ferreira, 2016). As per Park (2021), the goal attainment theory can be used to develop nurse-led healthcare programs focusing on patient education, counseling, health promotion, and disease prevention.

Conclusion

The goal attainment theory focuses on nurse-patient interactions during the care process. The theory emphasizes information sharing between nurses and patients since both of them have the knowledge to offer. Nurses engage in patient assessment during the interaction process. Patients have the right to acquire information and participate in decision-making.

References

Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse–patient relationship based on the Imogene king’s theory of goal attainment. Nursing And Midwifery Studies, 7(3), 141-144. https://doi.org/10.4103/nms.nms_10_17

da Silva, R., & Ferreira, M. (2016). Users’ participation in nursing care: an element of the Theory of Goal Attainment. Contemporary Nurse, 52(1), 74-84. https://doi.org/10.1080/10376178.2016.1172493

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Park, B. (2021). Effects of Nurse-Led Intervention Programs Based on Goal Attainment Theory: A Systematic Review and Meta-Analysis. Healthcare, 9(6), 699. https://doi.org/10.3390/healthcare9060699

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Betty Neuman – System model Theory

Betty was born in Ohio in 1924. When she was 11 years, her father passed on after suffering from kidney disease. Before his death, he was hospitalized many times and Neuman had the opportunity to interact with nurses. Her father praised them and this influenced her perspective of nursing and made her committed to being a good bedside nurse. Her mother was also a midwife and this further exposed her to the nursing world at a young age. I 1947, she earned her diploma in nursing and later received a bachelor’s degree in public health nursing and a master’s degree in a public health consultation. Neuman practiced as a bedside nurse in numerous healthcare settings including industrial and school settings. She also worked as a counselor in community mental health settings and later as a mental health consultant in Ohio State. Her theory was originally developed in 1970 after Neuman was requested by University of California students to create an introductory course that focused on sociocultural, psychological, developmental, and physiological concepts of human beings. Therefore, the systems model was developed to serve as a teaching aid and was published in 1972. Neuman continued to publish other editions of the model in subsequent years (George, 2014).

Neuman attributed the development of the theory to her philosophy of how people should help each other live quality lives. Her experience working in both community and private health settings also contributed significantly to her model. Generally, the systems model considers the nursing profession as a system since it comprises of different elements that influence each other and the fact that nurses have diverse functions and roles. Neuman identified that the profession was becoming increasingly complex and that it was important to utilize a systems perspective that values the parts while recognizing the complexity of the entire system. She regarded wholism as a biological and philosophical concept that encompasses both external and internal environments. Neuman’s theory qualifies as a grand theory due to its broad perspectives for clinical practice. Its conceptual framework is global (McEwen & Wills, 2018).

Betty Neuman – System model Concepts

1. Basic Structure

The basic structure refers to the survival factors used by different organisms such as genetic features and system variables which include spiritual, developmental, psychological, sociocultural, and physiological variables. For human beings, the structure comprises the internal environment including genetic characteristics, body system functioning, stimuli responses, and maintenance of normal body temperature. Baseline characteristics such as cultural perspectives, cognitive abilities, developmental stage, physical strength, and value systems also impact the features of the human basic structure (George, 2014).

2. Client variables

The nursing care recipient is a patient. Neuman had a holistic view of the patient and considered all the system variables and their impacts. She defined the physiological variable as the body structure including its external and internal functions; the development variable as growth that occurs throughout the lifespan, the psychological variable as interpersonal relationships and mental states; spirituality as different beliefs and their influence on the person (George, 2014).

3. Lines of resistance

Lines of resistance are activated when environmental stressors invade the line of defense. Their purpose is to ensure that the basic structure is not damaged by stressors (George, 2014).

4. A normal line of defense

This concept embodies stability over time. Systems have a normal stability level that is considered to be the baseline level when assessing wellness deviation in the patient’s system. Notably, the normal stability level varies with time as people find ways of coping with stressors (George, 2014).

5. Flexible line of defense

This line serves as the initial factor that protects the system from being invaded by stressors. The line moves closer or away from the normal line accordingly such that when the flexible line is far away from the normal line, the system has access to a larger degree of protection. The flexible line can be altered within short periods by danger, lack of sleep, or poor nutrition (George, 2014).

6. Stressors

Stressors refer to stimuli that result in tension and instability within the system. Stressors are usually neutral although their impacts on the system are influenced by the individual’s perceptions. More than one stressor may affect the system and their nature, type, and intensity impact the individual’s perception and the type of reaction elicited by the system. Stressors exist in both the external and internal environment (George, 2014).

7. Prevention as intervention

The different forms of prevention; primary, tertiary, and secondary prevention are used to attain, retain, or maintain the balance of the system. Primary prevention strategies reinforce the flexible line of defense by reducing risk factors and preventing stressors. In healthcare, prevention strategies include health education, immunization, lifestyle changes, and physical activity. Secondary prevention strategies are implemented after a stressor has already affected the system. The main focus of this form of prevention is protecting the basic structure by reinforcing the line of resistance through treatment of disease symptoms. Unsuccessful implementation of secondary prevention strategies destroys the basic structure and leads to death. Tertiary prevention strategies are implemented to promote system reconstitution through energy conservation after treatment using secondary prevention (George, 2014).

8. Reconstitution

Treatment of any stressors invading the system begins the reconstitution process. Reconstitution helps to attain and retain the stability of the system by repairing and reinforcing the normal line of defense. The success of reconstitution is based on the successful use of resources to reverse negative reactions to the stressor (George, 2014).

Nursing Metaparadigm

1. Person

Neuman described the person component as an open system that constitutes the external and internal environment that can be invaded by stressors. The human system constantly changes by moving through the illness or system stability. The open system is made up of the lines of defense, the central core, and the five variables (spiritual, developmental, psychological, sociocultural, and physiological variables) (George, 2014).

2. Environment

Neuman viewed the environment as both external and internal factors which impact the patient’s system. The environment can either have a negative or positive impact on the patient and both environmental and system variations influence the reaction direction. The internal environment is intrapersonal while the external environment is outside the patient’s system. Neuman later described the created environment which is both internal and external and is developed unconsciously when the patient system is whole (George, 2014).

3. Health

Health refers to optimal stability in the system and entails optimal wellness as well as harmony in the external and internal environments. Neuman viewed health as a continuum that changes with time. Health levels vary as people respond to environmental stressors and adapt to them. People achieve wellness by considering the impacts of stressors on the energy levels of the system (George, 2014).

4. Nursing

Neuman described the nursing process as a critical part of the model. Nursing involves implementing interventions that help the patient’s system retain, maintain, or attain stability. The goal of nursing is to promote wellness by preventing stressors or treating stressors that have already affected the system. Nurses conduct accurate assessments of the impacts of stressors invading the system and develop effective interventions based on the nature of the stressor (George, 2014).

Application of Betty Neuman – System model Theory to Nursing Practice

Neuman’s theory has heavily influenced numerous areas of nursing practice including mental health, pediatric nursing, women’s health, surgery, and gerontology. The theory provides nursing professionals with practice guidelines. Nursing interventions should focus on attaining, maintaining, or retaining stability in the patients’ system. Clinical problems are a result of reactions to both internal and external stressors. The nursing process includes assessment of the stressors affecting the patient, diagnosis, setting goals, implementing interventions, and assessing outcomes. Neuman emphasized the use of primary, secondary and tertiary responses when attempting to restore stability in the patient’s system (McEwen & Wills, 2018).

The theory has also been applied in nursing education and is particularly useful to nursing students and graduates. Although the theory cannot be fully tested, it helps in the formulation of research hypotheses and is also commonly used as the theoretical framework for research studies. Bademli and Duman (2017) used Neuman’s theory as a conceptual framework for providing care to patients with schizophrenia. Ahmadi and Sadeghi (2017) applied the theory to support the nursing process for patients with multiple sclerosis and illustrated that Neuman’s theory promotes better outcomes and satisfaction with care.

Conclusion

Neuman’s theory posits that humans are open systems that constitute both external and internal environments and encounter stressors that can cause instability in the system. Poor health is a manifestation of system instability and the role of nurses is to restore stability by applying primary, secondary, and tertiary methods.

References

Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical, 3(3). https://doi.org/10.1177/2055217317726798

Bademli, K., & Duman, Z. (2017). Conceptual Framework for Nurses in the Use of the Neuman Systems Model on Caregivers of People Suffering by Schizophrenia. International Archives of Nursing and Health Care, 3(3). https://doi.org/10.23937/2469-5823/1510079

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

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Sister Callista Roy – Adaptation theory

Sister Callista Roy, born in 1939, is a nursing theorist who is best known for the development of the adaptation model. She worked as an educator and researcher and made significant contributions to nursing knowledge and practice. Roy has a bachelor’s and master’s degrees in nursing in addition to a sociology doctorate. Sister Roy developed the theory as part of her graduate work at the University of California in 1964 and since then, the theory has evoked a lot of respect and interest due to its applicability in nursing education and practice.

Roy’s work was drawn from the works of other nursing theorists including the adaptation theory by Helson and the general system theory by von Bertalanffy. These theories were used to develop the basis for the assumptions of the adaptation theory. Roy’s theory is a grand theory since it has a broad scope and is highly abstract (George, 2014).

Sister Callista Roy – Adaptation Theory Assumptions

The assumptions behind the adaptation theory are based on both scientific and philosophic perspectives. The philosophical assumptions were derived from the perspectives of humanism including purposefulness, creativity, interpersonal process, and holism. They include the idea that people are in a mutual relationship with a spiritual being and the world. The meaning of human life exists within the universe’s omega point convergence and that God revealed Himself in creation diversity. People make use of human creative abilities including faith, enlightenment, and awareness, and are accountable for taking part in the transformation and sustenance of the universe (George, 2014).

The scientific assumptions were derived from the perspectives of the systems theory including interdependence, holism, information feedback, control processes, and complex living systems. The assumptions include the idea that energy and matter systems are always improving to higher self-organization levels. The environment and person have meaning and consciousness, feeling and thinking are the main factors in self-awareness, and the decisions that people make are responsible for creative process integration. Roy also viewed feeling and thinking as normal human actions and described characteristics of system relationships including protection, acceptance, and interdependence. People and the earth have several similarities including integral relations and common patterns. Human consciousness results in transformations within the environment and the person and when the environment and human meanings integrate, they result in adaptation (George, 2014).

Sister Callista Roy – Adaptation Theory Concepts

The main concepts of the adaptation model include humans as adaptive systems, health, the environment, and the goal of nursing practice.

1. Humans as adaptive systems

Roy viewed the human system using a holistic perspective which is the idea that the system as a whole is greater than all its parts. The human system is affected by stimuli inputs which include residual, contextual, and focal stimuli. The adaptation level refers to a combination of stimuli that are representatives of the life process conditions in the system. The main adaptation levels include compensatory, compromised, and integrated live processes. Integrated processes occur when the level of adaptation meets the system’s needs while compensatory processes are a result of activation of the response system. Compromised processes happen when both integrated and compensatory processes fail to facilitate adaptation. Adaptive responses maintain the system’s integrity while ineffective responses are threatening to the growth, survival, transformation, and reproduction of the system. Coping mechanisms refer to processes used by people to control the system and can either be genetic or learned. These mechanisms include cognator and regulator mechanisms. The cognator mechanism refers to the mental coping mechanism that involves brain functions of learning, perception, emotion, and judgment. The regulator mechanism comprises physiological coping strategies where the body’s regulatory system facilitates adaptation to system changes through endocrine, neural, or chemical processes (George, 2014).

The Adaptive Modes

Roy defined four adaptive models including physiological-physical, role function, self-concept group identity, and interdependence modes. The physiological-physical mode refers to the physical responses in the human system and environmental interactions. The underlying need of the physiological-physical mode for individuals is to maintain physiologic integrity through nutrition, oxygenation, protection, activity and rest, and elimination. This mode is the main focus of assessment in the nursing process. The self-concept group identity mode relates to spiritual and psychic integrity as basic needs. Self-concept is associated with both the personal and physical self. The physical self includes body image and body sensation while the personal self comprises self-esteem and personal ethics and morals. The role function mode represents behavior among people and groups. Roles are behavioral expectations based on the position one holds in society that fulfills the need for social integrity. In groups, roles facilitate the achievement of functions and goals that fulfill the need for role clarity. The interdependence mode is related to relational integrity or the ability to nurture relationships. This mode entails mutual respect, love, and value with other people and the development of support systems (George, 2014).

2. The Environment

Roy viewed the environment as the stimuli from both within and around the human adaptive system. This includes all influences, circumstances, and conditions which affect the behavior and development of the systems. Roy’s definition of the environment also considered the earth and personal resources.

3. Health

Roy viewed health as a process and state where one becomes a whole and integrated being. People’s integrity is expressed in form of the ability to meet growth, survival, mastery, and reproduction goals. Roy also expressed that health goes beyond the physical absence of disease and includes mental and spiritual wellness (George, 2014).

4. The Goal of Nursing and the Nursing Process

The main goal of nursing practice is to promote positive adaptation of the four adaptive modes. Adaptive responses have a positive impact on health and maintain the integrity of the human system. Nursing interventions also focus on reducing ineffective responses. The nursing process involves behavior assessment to help gather information on responses within the human system. Nurses are expected to utilize interview techniques to assess the four adaptive modes to clarify the main focus of patient care. The adaptation model also expects nurses to assess emerging patterns in patient responses to both external and internal stimuli to identify poor coping mechanisms. After assessing stimuli, nurses can make a diagnosis. Roy defined nursing diagnoses as interpretative statements based on a nurse’s judgment about the patient’s adaptation status. After diagnosis, nurses develop interventions to enhance and maintain adaptation. Nurses involve patients when planning interventions which focus on either changing stimuli or improving adaptive processes. Nurses also conduct an evaluation to assess the effectiveness of the interventions. Evaluations mostly focus on the achievement of behavioral goals. If the patient has not achieved the goals, the nurse poses additional questions to determine whether the assessment data was complete and accurate (George, 2014).

Application of Sister Callista Roy – Adaptation theory to Nursing Practice

The adaptation model can be applied to numerous health settings. Nurses can use the model to inform their assessment, diagnosis, intervention, and evaluation processes. The model has also been used in nursing education in numerous countries in Europe, Asia, Central America, and South America. The model provides students with a solid framework for holistic thinking because of its usefulness in organizing, focusing, and directing the nurse’s thoughts. Research evidence illustrates that the adaptation model results in a better quality of nursing care and positive patient outcomes. Roy’s theory has also influenced the development of other nursing theories. Additionally, the theory has been used in research studies as the main conceptual framework (McEwen & Wills, 2018). Callis (2020) used the adaptation theory as a framework for developing a care program to be applied in nursing practice. The program improved the wellbeing and morale of nurses which in turn led to better nurse retention. Jennings (2018) used the adaptation model as a framework for informing nursing care for anorexic patients. The theory facilitated the understanding of patients with anorexia nervosa and also promoted weight restoration during the treatment process.

Conclusion

The adaptation theory focuses on how human systems adapt to changes within their internal and external environments including stimuli. The theory posits that nurses should focus on promoting positive coping and adaptive processes when treating patients. The theory provides a wide reflection of human experiences and is critical to understanding the association between coping, adaptation, and behavior.

References

Callis A. M. (2020). Application of the Roy Adaptation Theory to a care program for nurses. Applied Nursing Research: ANR, 56, 151340. https://doi.org/10.1016/j.apnr.2020.151340

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Jennings K. M. (2017). The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa. ANS. Advances in nursing science, 40(4), 370–383. https://doi.org/10.1097/ANS.0000000000000175

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

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Jean Watson – Philosophy and Transpersonal Caring Model Theory

Jean Watson was born in West Virginia in 1940. She holds a diploma and bachelor’s degree in nursing as well as a master’s degree in psychiatric nursing. She worked as a nurse and also held administrative and faculty positions in Colorado. Her work is largely published and she has received many honors and awards. The main purpose of Watson’s caring model is to promote healing while at the same time preserving the dignity of the patient and valuing the interconnectedness and wholeness of human beings. Her theory describes the nursing profession as a science and healing art and challenges nurses to expand their mission to care for people beyond their immediate environment. Watson’s work is a reflection of Florence Nightingale’s perspective that the nursing profession is a calling (George, 2014). The theory is a grand theory since it provides a general framework that can be used by nurses in the care environment although it also meets the empirical adequacy criteria required among middle range theories (Alharbi & Baker, 2020).

Philosophical Background

Watson stated that the original purpose of her work was to provide a worldview that nurses could use to understand the purpose and traditions of the profession. Watson emphasized the spiritual and metadimensions of nursing practice and her ideas were based on the postmodern paradigm. She described the principles of postmodernism including the idea that there are multiple truths, the physical world cannot define any universal reality, there are multiple realities with multiple meanings, and that it is important to appreciate both non-physical and physical phenomena. She also described the non-linearity of acting and thinking. Watson described the nursing profession using the postmodern worldview by identifying the universe’s interconnected and holistic nature. Her work is essentially an amalgamation of both Western and Eastern philosophies and was heavily influenced by transcendental phenomenology. She drew from the works of several philosophers including deChardin, Kierkegaard, and Whitehead when describing the concepts of ontological caring. She also used Carl Rogers’s work to describe the interpersonal nature of caring. Additionally, she incorporated the works of other nursing theorists including Martha Rogers, Leininger, Henderson, and Gadow. Furthermore, Watson acknowledged the influence of philosophers Emmanuel Levinas and Knud Logstrup on her descriptions regarding morality in humanity and the sanctity of life (George, 2014).

Jean Watson – Philosophy and Transpersonal Caring Model Theory Assumptions

Watson’s theory made several assumptions about the caring process and the healthcare environment. She assumed that caring is demonstrated and practiced effectively if it happens interpersonally, carative factors are part of the caring process and they help satisfy human needs, the caring process involves accepting previous, current, and future states of the patient, the caring environment promotes growth and decision making for patients, and that caring and curing are complementary. Caring is also the basis of nursing practice (George, 2014).

Jean Watson – Philosophy and Transpersonal Caring Model Theory Concepts

The main concepts in Watson’s theory include the transpersonal caring relationship, the ten carative factors, and the caring occasion (George, 2014).

1. Transpersonal caring relationship

This relationship is the main element of the transpersonal model. Watson described factors that influence the transpersonal caring relationship and stated that the relationship depends on the moral commitment of the nurse and the need to enhance, protect, and promote human dignity. The relationship also relies on the ability of the nurse to accurately detect and develop a connection with the patient’s inner condition. Additionally, the nurse’s ability to accurately assess and understand the patient’s health condition and develop caring-healing methods that promote wholeness, comfort and harmony impact the transpersonal relationship. Nurses also have previous experience and a life history that impacts their approach to the caring relationship. Nurses gain more sensitivity and knowledge when they work with patients from diverse cultures and when they explore personal beliefs and values.

Watson also explained that one can only care for others if one care for themselves. In 2005, she expanded the concept of self-care to include an appreciation of life, the ability to forgive oneself and others, and to be accepting of personal experiences without feeling the need to control them or resisting them (George, 2014).

2. The ten carative factors

Watson identified the ten carative factors which define the caring relationship according to the moral commitment of the nurse towards patients. The carative factors have guided research and practice models. Watson later provided a translation of the factors into clinical caritas processes. The carative factors and their caritas processes as described by George (2014) are presented below:

Carative Factor	Clinical Caristas Process
Development of a humanistic-altruistic value system:	Practicing love, equanimity, and kindness within the caring process.
Promoting faith and hope	Being genuine and authentic when caring for patients and enabling belief systems for both the nurse and the patient.
Sensitivity to others and to oneself	developing a personal spiritual practice, forgiving oneself.
Developing a caring relationship characterized by trust	Working truthfully with patients.
Encouraging patients to express both negative and positive emotions and feelings	Being present and supportive of any feelings expressed is a way of connecting with the spirit of the patient.
Engaging in an individualized care process that is creative and encourages problem-solving	Engaging in artistry during care, incorporating the use of self in the care process
Promoting teaching and learning in the care relationship	Focusing on teaching and learning experiences
Assessing protective, supportive, and corrective physical, mental, spiritual, and societal environments.	Developing a healing environment at both internal and external levels.
Helping with the satisfaction of basic needs in a manner that maintains wholeness and dignity.	Helping patients with basic needs and administering any care essentials that promote wholeness.
Incorporating spiritual aspects in the care process	Being open to both existential and spiritual dimensions regarding health, life and death, and soul care for both the patient and the nurse.

3. The Caring Occasion

Watson described the caring occasion as nurses coming together with other people who have unique experiences and histories to provide care. the occasion is important since it becomes a component of the life history of each person involved. Watson also defined the caring moment as the connection that occurs between two human spirits that manifest in a loving and caring interaction (George, 2014).

Nursing Metaparadigm

1. The person

Watson viewed the person as a transcendent being and based on the words of de Chardin, a philosopher, she explained that we are spiritual beings who are undergoing a human experience. Watson described five basic premises associated with the person component: the emotions and mind of a person are a reflection of their soul, the person’s body and space are confined within the physical universe but the soul and mind are not, the soul or spirit of a person exists for itself, and people depend on each other for love and care (George, 2014).

2. Health

Watson described poor health as a perceived state because it can result from a troubled inner soul which manifests as disease. She defined health as the harmony and unity that exists within an individual’s soul, body, and mind (George, 2014).

3. Environment

Watson viewed the environment as comprising of the nurse and the healing environment. She also emphasized the idea of healing at both societal and planetary levels (George, 2014).

4. Nursing

Watson described the nursing process as a human science characterized by thought, knowledge, philosophy, action, commitment, and beliefs. The role of nurses is to engage in care processes that enhance, preserve, and protect humanity. Nursing interventions focus on compassion, empathy, and comfort (George, 2014).

Application of Jean Watson – Philosophy and Transpersonal Caring Model Theory to Nursing Practice

The transpersonal caring model informs nursing practice since it emphasizes the importance of human dignity. Additionally, the theory teaches nurses to honor the caring moment and approach it with intentionality. Watson also described a nursing process that includes assessment, planning, patient intervention, and evaluation of patient outcomes. These steps are followed by nurses in all care environments. (Murali, 2019) explained that Watson’s model can be used when making decisions regarding end-of-life. The theory not only mentions the importance of preserving human dignity but also advocates for individualized care as well as patient education. Pajnkihar et al. (2017) add that Watson’s theory improves patient satisfaction with care when used as a practice framework.

References

Alharbi, M., & Baker, D. (2020). Jean Watson’s Middle Range Theory of Human Caring: A Critique. International Journal Of Advanced Multidisciplinary Scientific Research, 3(1), 1-14. https://doi.org/10.31426/ijamsr.2020.3.1.3011

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Murali, K. (2019). End of Life Decision-Making: Watson’s Theory of Human Caring. Nursing Science Quarterly, 33(1), 73-78. https://doi.org/10.1177/0894318419881807

Pajnkihar, M., Stiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis)harmony with patient satisfaction. Peerj, 5, e2940. https://doi.org/10.7717/peerj.2940

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Is your assignment about the Application of nursing theory? Featuring theorists Hildegard, Virginia Henderson, Jean Orlando, Dorothy, Martha Rogers, Dorothea Orem, Imogene King, Betty Neuman, Sister Calista Roy, Jean Watson, Madeleine Leininger, Patricia Benner, Lydia E. Hall, Joyce Travelbee, Margaret Newman, Katharine Kolcaba, Rosemarie Rizzo Parse, Ernestine Wiedenbach and more?

Madeleine Leininger -Transcultural nursing Theory

Leininger was born in Nebraska in 1925 and died in 2012. She had a bachelor’s degree in biological science and a master’s degree in psychiatric mental health nursing. Leininger worked in administrative positions in several universities and published extensively about transcultural nursing theory. She has also held many visiting lectureships and professorships in Germany, Australia, Sweden, Taiwan, Russia, and Switzerland. Her publications are stored at the Madonna University in Michigan while her earlier works are housed in Boston University. Leininger recognized the significance of caring to the nursing profession. Her patients often made statements that showed appreciation for nursing care and this enhanced the attention she paid to care values. In the 1950s, Leininger worked in a child guidance home located in the Midwestern part of the country and observed differences in behavior among the children. Upon further examination, she realized that the behavior could be attributed to cultural differences and identified that she lacked sufficient knowledge to fully understand the children’s behavior since she did not understand their culture. The experience propelled her to earn an anthropology doctorate and played a significant role in the development of transcultural nursing as a field (George, 2014).

In the 1960s, Leininger first described the terms ethnonursing, cross-cultural nursing, and transcultural nursing. She then offered a nursing course focusing on the terms in the University of Colorado. She defined transcultural nursing as a discipline that centers on recognizing cultural similarities and differences in the care process to help patients access culturally-based therapeutic and meaningful healthcare services. She defined ethnonursing as a discipline that entails systematic, rigorous, and in-depth examination of various cultures that informs the provision of culturally sensitive healthcare. Her theory was based on the premise that an individual’s culture impacts their health beliefs and practices and influences their perception and experience in nursing care. the premise encourages the incorporation of the cultural context within nursing care (George, 2014). Leininger’s theory is a middle-range theory since it provides a framework for caring for patients from diverse cultures (Im & Lee, 2018).

Madeleine Leininger -Transcultural nursing Theory Concepts

Care

Madeleine defined care as a phenomenon associated with supportive, assistive, and enabling ideas that are directed towards others to improve health and wellbeing. Care also includes preventive services and is assumed to be the central and unifying factor in nursing practice. Leininger assumed that care is necessary for human survival, wellbeing, growth, and healing (George, 2014).

Culture

Leininger defined culture as shared, learned, and transmitted sets of beliefs, values, and norms that exist among specific groups of people. Culture acts as a guide to decisions, thinking, and actions and is usually passed down from one generation to the next. Subcultures are groups that exist within a culture that contain different beliefs, values, and moral codes (George, 2014).

Culture care

This term refers to the synthesis of care and culture such that the care process is embedded in an individual’s culture. Culture care assists in the understanding of human conditions.

Emic and etic care

Emic care is culturally learned skills and knowledge that apply to cultures during care. this type of care has a humanistic orientation, uses familiar and practical methods, focuses on caring, and is an integrated and holistic approach that emphasizes the importance of social relationships, lifestyle, and language. Etic care refers to professional care such as nursing care. Etic care is scientifically oriented and patients are treated using unfamiliar methods by strangers. The services offered under etic care are not integrated and mainly focus on diagnosis, treatment, and curing. Additionally, etic care uses technological and diagnostic tests to determine which scientific treatments should be provided to patients. While emic care includes communication modes and focuses on disease prevention, etic care does not involve communication and focuses on the treatment of diseases (George, 2014).

Social and cultural structure factors

These factors include spirituality, kinship ties, education, legal issues, politics, cultural beliefs, and the philosophy of life. They also include values associated with social class differences and gender (George, 2014).

Environmental Context

The environment refers to the sum of situations, events, and experiences that give meaning to social interactions, interpretations, and expressions among people within ecological, geophysical, technological, and sociopolitical factors in specific cultures (George, 2014).

Worldview

The perspectives that people hold about the world and their lives. The worldview is essential since it influences understanding and perspectives during the care process (George, 2014).

Action-decision care modes

These include cultural care preservation, accommodation, and re-patterning. Cultural care preservation entails decisions and actions that help cultures maintain or preserve any beneficial beliefs regarding healthcare. Cultural care accommodation includes actions or decisions made by healthcare providers that facilitate the incorporation of culture as part of the care process. Cultural re-patterning entails actions or decisions that help people restructure their lifestyles to improve their health (George, 2014).

Culturally congruent care

This concept refers to nursing care that fits the cultural beliefs, lifestyles, and values held by patients to enhance their wellbeing. Nurses serve people from diverse backgrounds hence it is important to meaningfully incorporate culture in healthcare (George, 2014).

Nursing Metaparadigm

1. Person

Human beings are viewed as caring individuals who are concerned about the well-being and needs of other people. Human care is a universal concept since it is witnessed in all cultures. people have survived through time and place because they care for each other. Culture is an important aspect of human existence since it influences values, norms, beliefs, and behavior (George, 2014).

2. Health

The health component refers to the well-being of human beings. Health is universal although each culture defines it based on its values, practices, and beliefs hence it is diverse. Leininger described health systems, health promotion, healthcare practices, and health maintenance as significant aspects in transcultural nursing (George, 2014).

3. Environment

Leininger focused on the worldview and social structure and defined the environment as a collection of ecological and geographic settings within which cultures exist (George, 2014).

4. Nursing

Leininger described nursing as a profession responsible for serving people by focusing on human care. she was concerned that most nurses do not have adequate preparation to engage in transcultural care and explained that nursing care should entail cultural care accommodation, preservation, and re-patterning (George, 2014).

Application of Madeleine Leininger -Transcultural nursing theory to Nursing Practice

Leininger’s cultural care worldview focuses on factors such as language, context, and ethnohistory which influence the care patterns and practices provided to patients. The theory explained that nurses should possess adequate knowledge regarding families, individuals, groups, and communities to provide transcultural care since each culture is unique. The transcultural theory heavily informed the concept of cultural competence and culturally sensitive practice in nursing care (George, 2014). The theory is still applicable to the current care environment since the U.S. is becoming increasingly diverse. Although the theory does not specify nursing actions, it directs nurses to learn about their patients’ culture and consider how cultural practices impact health and how they can be used to maintain or enhance wellbeing.

Research evidence illustrates that culturally sensitive care promotes better patient outcomes, especially among minority communities with different beliefs and values about health and healthy lifestyles (Im & Lee, 2018). The theory has also influenced nursing education since nursing curricular in different institutions incorporate it as an important component of the education process (Jongen et al., 2018).

In nursing research, the theory is used to develop hypotheses for studies and as frameworks for assessing transcultural practices among nurses from different care environments (Im & Lee, 2018). (Caglar & Bilgili, 2020) used the transcultural model to assess cultural competence among nurses in Turkey and determined that transcultural nursing has become more common in the country as reflected in nursing education and practice. As per (Jongen et al., 2018), transcultural nursing is an effective intervention for reducing healthcare disparities since it improves health outcomes for minorities.

Conclusion

The transcultural theory focuses on the importance of incorporating culture as part of patient care. cultural norms, values, and beliefs impact an individual’s worldview including their perspectives about health and healthcare services. The theory is applicable in clinical practice and nursing research since it is used to improve the quality of care and to develop theoretical frameworks.

References

Caglar, S., & Bilgili, N. (2020). Transcultural Nursing Care in Turkey. Florence Nightingale Journal Of Nursing, 28(1), 110-123. https://doi.org/10.5152/fnjn.2020.18008

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Im, E., & Lee, Y. (2018). Transcultural Nursing: Current Trends in Theoretical Works. Asian Nursing Research, 12(3), 157-165. https://doi.org/10.1016/j.anr.2018.08.006

Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3001-5

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Patricia Benner – From Novice to Expert Theory

Benner was born in Virginia although she grew up in California where she obtained her early education as well as her bachelor’s degree in nursing. She also has a master’s degree in medical-surgical nursing and a Ph.D. She worked as a staff nurse and nurse manager in several care environments including emergency room, medical-surgical, intensive care, coronary care, ad home care. Benner has written many books and research articles on nursing practice and her publications have received many awards in several countries. Benner’s career was significantly influenced by the works of Virginia Henderson. She initially focused on the series of steps taken to acquire nursing skills by applying Hubert Dreyfus’s skill acquisition theory. Benner focused on validating Dreyfus’s theory and extending it into the nursing process (George, 2014). Benner’s theory is a high middle-range nursing theory since it is socially significant in practice settings and theoretically significant (Thomas & Kellgren, 2017).

The 5 levels of proficiency

1. Novice

Benner described a novice as a beginner with minimal experience in an area of practice. Novices focus on the theoretical knowledge obtained from formal learning during practice. Additionally, they depend on the rules set for making decisions and conclusions based on objectives and recognizable characteristics of a care situation. Novices also exhibit inflexible and limited behavior since they mostly focus on learned rules (George, 2014).

2. Advanced Beginner

Advanced beginners can either be nurses who have just graduated or those transferred from one unit or specialty to another. Their performance can be rated as marginally acceptable since they have some experience in dealing with real healthcare situations. Advanced beginners can notice and differentiate objective and situational elements and can acknowledge the structure in clinical settings. They can identify complex care situations although they may be overwhelmed trying to determine all relevant aspects of care. Generally, advanced beginners tend to remain task-oriented, goal-oriented, and rely on standards of care. They also believe in other nurses’ expertise and always look to them for decision-making. Moreover, they focus on the present since they have limited ability to apply the patient’s past health history and to perceive present needs in terms of future expectations (George, 2014).

3. Competent

Nurses who demonstrate competence are those who have at least two years of experience working in specific clinical units. They have better clinical understanding, organizational ability, and technical skills than advanced beginners and are the epitome of adhering to standards in nursing care. Competent nurses can recognize different elements in practice and sort them according to their importance. Their sense of responsibility may be exaggerated since a variety of potential action plans presents them with many possibilities. Competent nurses are more emotionally involved in their patient’s care and can distinguish differences in skill levels among other nurses. Additionally, they can integrate clinical and theoretical knowledge and recognize variations between signs and symptoms for different patients. They slowly begin to deviate from a focus on standard care to patient-centered care (George, 2014).

4. Proficient

Proficient nurses can discriminate different care situations and can respond intuitively to specific care situations. They exhibit better practical reasoning and their actions are more situationally appropriate. They focus on the patient’s past and their outcomes and effectively utilize communication skills to meet the patient’s needs. Furthermore, they have less stress in clinical situations since they know what is required of them (George, 2014).

5. Expert

Expert nurses do not depend on rules to guide their interactions with patients. They demonstrate deep knowledge and experience and can distinguish between relevant and irrelevant issues. They are skilled enough to determine care situations that require immediate action and communicate effectively with patients and other professionals about care processes. They possess sophisticated practice maxims which they may not be able to explain verbally to other people. Their organizational expertise enables them to direct and facilitate care on several levels at the same time (George, 2014).

The 7 domains of nursing practice – Patricia Benner – From Novice to Expert Theory

The helping role

Nurses facilitate the development of a healing relationship which includes establishing a climate that promotes commitment to healing. They provide comfort measures and are present with the patient. They also focus on enhancing patient participation in the care process and provide informational and emotional support to both patients and families. Nurses possess the ability to assess and interpret pain and can develop effective pain management interventions. They also guide patients as they undergo development and emotional change by providing new options through teaching and mediation (George, 2014).

The teaching-coaching role

Nurses assess the patient’s readiness to enhance knowledge about personal care and educate them on self-management. They also interpret health conditions and inform patients about specific procedures and their rationales (George, 2014).

The diagnostic and patient-monitoring role

Nurses constantly assess patients to determine any changes in their conditions and use this information to determine warning signals that would indicate deterioration in a patient’s condition. They assess the patients’ health state and determine if they are likely to respond positively to specific interventions (George, 2014).

Managing rapidly-changing situations

Nurses can demonstrate skilled performance when faced with life-threatening emergencies and can rapidly determine resources required in patient treatment during emergencies. They can manage patient crises until they obtain the assistance of a physician (George, 2014).

Administering treatment interventions

Nurses possess the skills to require to start and maintain different forms of therapy including intravenous therapy with minimal complications to the patient. They administer medications at correct times, correct dosage, and monitor any negative reactions that may be linked to incompatibility. They also prevent complications that may arise with immobility and engage in effective wound management (George, 2014).

Monitoring quality of care practices

Nurses ensure that patients access safe nursing care including timely responses from other healthcare professionals such as physicians (George, 2014).

Work-role and organizational competencies

Nurses can set care priorities and coordinate, multiple care needs. They can build an efficient care team to provide optimum care and effectively cope with issues such as high turnover and staff shortages (George, 2014).

Nursing Metaparadigm

Person

Benner defined humans as holistic beings whose wholeness goes beyond the mind-body dualism. She also described people as self-interpreting beings whose lives are defined within the course of living (George, 2014).

Health

Benner described health as wellbeing that is associated with effective self-care. Promoting health and wellbeing entails incorporating patient beliefs in practice, planning, making deliberate health choices, and understanding emotional responses (George, 2014).

Environment/situation

Benner explained that people are situated in environments that provide meaning to their existence. People develop an understanding of themselves and their world by relating their past and present with future possibilities (George, 2014).

Nursing

Benner described nursing as a caring practice that focuses on the ethics of responsibility and care. The nursing process involves the treatment of diseases and health promotion. Benner also emphasized nursing knowledge and experience when she described the levels of proficiency. Additionally, she described the importance of several nursing skills including technical, communication, relational, and cognitive skills (George, 2014).

Application of Patricia Benner – From Novice to Expert Theory to Nursing Practice

Benner’s theory has been applied in many settings including nursing education and practice. The theory has informed the development of nursing curricula and career guides for advanced practice nurses (Ozdemir, 2019). It has also been used to describe the challenges associated with IT integration into clinical practice. In practice, the theory has influenced faculty mentorship, nurse evaluation, and clinical decision-making. The theory also provides a foundation for improving clinical skills as nurses acquire experience in the course of their careers (Thomas & Kellgren, 2017).

Benner’s theory has also been applied in various research studies as a framework for assessing nurse competence. (Tang et al., 2021) applied the theory to understand nurses’ perceptions on deployment to intensive care units to help with the treatment of COVID-19 patients. The study determined that despite lack of experience in ICU units, general ward nurses were positive that they would provide effective care and identified the need for ongoing support to make their transition easier. Nyikuri et al. (2020) also determined that Benner’s theory can be effectively applied in nurse training and mentorship to enhance nurse skills.

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Nyikuri, M., Kumar, P., English, M., & Jones, C. (2020). “I train and mentor, they take them”: A qualitative study of nurses’ perspectives of neonatal nursing expertise and its development in Kenyan hospitals. Nursing Open, 7(3), 711-719. https://doi.org/10.1002/nop2.442

Ozdemir, N. (2019). The Development of Nurses’ Individualized Care Perceptions and Practices: Benner’s Novice to Expert Model Perspective. International Journal Of Caring Sciences, 12(2), 1279-1285.

Tang, C., Lin, Y., & Chan, E. (2021). ‘From Expert to Novice’, Perceptions of General Ward Nurses on Deployment to Outbreak Intensive Care Units during the COVID‐19 Pandemic: A Qualitative Descriptive Study. Journal Of Clinical Nursing. https://doi.org/10.1111/jocn.16029

Thomas, C., & Kellgren, M. (2017). Benner’s Novice to Expert Model: An Application for Simulation Facilitators. Nursing Science Quarterly, 30(3), 227-234. https://doi.org/10.1177/0894318417708410

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Lydia E. Hall – The Core, Care and Cure Theory

Lydia Hall was born in 1906 in New York City. She had a bachelor’s degree in public health nursing and a master’s degree in education. She served as the first director for the Loeb center until 1969 when she died. She had experience in various nursing sectors including educational, clinical, research, and supervisory nursing, and authored many articles on nursing care as a theory. Hall was a unique theorist because she mainly used her nursing philosophy in practice and barely documented her philosophy. Her philosophy of care was originated at the Loeb center where she provided care to chronically-ill patients. She physically designed the facility such that the rooms were organized based on patient maneuverability and comfort. The primary caregivers in the facility included registered nurses and Hall focused on demonstrating that nurses could provide quality services in non-directive settings by offering support to people who are past the acute phase of chronic conditions. The center had few routines, no specific meal times, no schedules, or specific visiting hours. Patients were referred to the facility by their physicians and the services provided promoted faster recovery and faster return to society. Hall’s theory is a middle-range theory since it can be used as a framework to guide daily nursing practice (George, 2014).

Lydia E. Hall – The Core, Care, and Cure Theory Concepts

Hall’s theory was presented in form of three interlocking circles, and each of them represented core, care, and cure, the three aspects of nursing practice.

1. The care circle

The care circle comprises the nurturing component, a phenomenon that exclusively applies to nursing practice. The nurturing role entails mothering and the provision of teaching-learning services. The role of the professional nurse is to provide physical care for the patient and ensure that patients can engage in daily living activities such as bathing and dressing. nurses also ensure that the biological functions for patients are working effectively especially the elimination process. The main goal of nursing care is to provide comfort. As nurses work with patients, they get closer, and patients can explore and share emotions and feelings with their nurses who in turn use this opportunity to implement the teaching-learning aspect. Nurses utilize the knowledge obtained from biological and natural sciences as the theoretical base for practice. It is also important to define the role of the nurse during practice and to focus on professionalism (George, 2014).

2. The Core Circle

This circle represents the therapeutic use of self, a concept that is shared by nurses and other healthcare professionals. As nurses develop therapeutic relationships and help patients express emotions and feelings about illness and health, they promote self-identity. Nurses use a reflective technique that allows patients to honestly explore what they feel about the current health status and how they can implement changes that will improve their wellbeing. Increased awareness on the patient’s part informs decision making and motivates them to engage in activities that promote healing such as lifestyle changes (George, 2014).

3. The Cure Circle

This circle focuses on interventions that are meant to heal the patient. The role of the nurse is to help patients in the implementation of surgical, rehabilitative, and medical prescriptions as described by the physicians. Nurses act as their patients’ advocates by representing their interests with other healthcare professionals. The role of the nurse in the cure aspect deviates from that of the care circle in that some interventions, such as injections, may cause pain and patients may view nurses as the cause of this pain (George, 2014).

Interaction of the Concepts

The three concepts do not function independently. Instead, they are interrelated since they interact frequently. the patient’s progress results in size changes for the three circles. When Hall observed the events that occur during hospitalization, she realized that the need for nursing care increases as individual moves beyond the acute illness stage. Such patients no longer require intensive medical care hence Hall believed that they should access care in a setting that focuses on their specific needs while at the same time encouraging their participation in the healing process. at this stage, core and care are the most important aspects. Hall also encouraged evaluation of the patient’s progress by assessing several goals including the patient’s understanding of self, ability to explore feelings and emotions associated with behavior, motivation, congruency of patient goals with the medical regime, and the level of comfort (George, 2014).

Nursing Metaparadigm

Person

Hall did not directly define the person concept although she mentioned that the Loeb facility provides care to patients above age 16 who are beyond the acute illness stage. She also emphasized the uniqueness of patient needs and the importance of growth and learning. Additionally, Hall mentioned that patients are the source of motivation in the healing process (George, 2014).

Health

Hall defined health as the state of awareness associated with selecting behaviors that promote optimal wellbeing. Nurses help patients realize good health through the teaching-learning process (George, 2014).

Environment

The environment refers to the setting that promotes good health among patients. Nurses, as well as family members, are part of the patient’s environment (George, 2014).

Nursing

Nurses are skilled individuals whose role entails full participation in the cure, core, and care concepts. The main aim of nursing care is to facilitate the development of an interpersonal relationship that allows patients to explore and express any emotions and feelings about their health and provides an opportunity for nurses to apply the use of self and to encourage teaching-learning (George, 2014).

Applications of Lydia E. Hall – The Core, Care and Cure Theory to Nursing Practice

Hall’s theory informs rehabilitative nursing since it describes patient care after the acute illness stage. The theory stresses the importance of nursing practice after patients no longer require acute medical interventions. Nurses can apply the theory in patient assessment, planning, and development of nursing care plans. The theory also mentions the use of self, a concept which applies to nursing practice and other healthcare professionals such as physicians. The use of self is also an important aspect of mental healthcare and social work practice (Mudd et al., 2020). Additionally, the theory encourages nurses to involve patients in the care process and to help them find the motivation to engage in practices that promote good health. The theory also contributes to the body of knowledge regarding the therapeutic nurse-patient relationship and its benefits to patients (Umara, 2019).

Hall’s theory has been applied in many research papers. Sumarno (2019) examined the use of the theory in the prevention and management of pressure ulcers within the healthcare setting. Sumarno (2019) explained that the cure component in Hall’s theory can be used to inform the development of organizational strategies for pressure ulcers prevention and management. Hall’s theory also encourages nurses to incorporate effective care standards, especially when treating immobile patients who are at high risk of pressure ulcers. Mudd et al. (2020) also demonstrated the use of Hall’s theory in various practice areas including the development of nurse-patient relationships and integrating psychosocial, physical, and relational needs during care.

Theory Limitations

Unlike other theories which consider the role of nursing practice at the beginning of hospitalization, Hall’s theory only focuses on care after the acute illness stage. Regardless, it is possible to apply Hall’s three concepts when working with acutely ill patients. Hall’s theory also failed to include pediatric patients since she mentioned an age limit of 16 although the theory can still be applied when caring for children. Hall also excluded critical components of nurse-patient communication including active listening and observation of nonverbal cues which may be just as effective in promoting self-awareness among patients. The theory only mentioned family involvement in the cure circle although they should be part of the entire care process (George, 2014).

Conclusion

Hall’s theory focuses on three concepts; core, cure, and care and their interrelations during nursing practice. The theory stressed the importance of nursing care after the acute illness stage. The main components of nursing care mentioned in the theory include the therapeutic nurse-patient relationships, promoting self-awareness and enhancing motivation among patients, and patient participation in the care process.

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Mudd, A., Feo, R., Conroy, T., & Kitson, A. (2020). Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts. Journal Of Clinical Nursing, 29(19), 3652–3666. https://doi.org/10.1111/jocn.15420

Sumarno, A. (2019). Pressure ulcers: the core, care and cure approach. British Journal Of Community Nursing, 24(Sup12), S38-S42. https://doi.org/10.12968/bjcn.2019.24.sup12.s38

Umara, A. (2019). The Model Theory Approach “Care, Core, Cure” for Patients with Cardiovascular Disease. International Journal Of Nursing And Health Services (IJNHS), 1(2), 120-128. https://doi.org/10.35654/ijnhs.v1i2.53

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Joyce Travelbee – Human-To-Human Relationship Model Theory

Travelbee was a psychiatric nurse born in 1926. She began her career as a psychiatric nurse when she was working on her baccalaureate degree. She also worked as a psychiatric nursing educator and an associate professor. Travelbee was generally described as a progressive thinker based on her propositions about nursing care. She held the perspective that obstetrical care should comprise prenatal care, natural childbirth, and the father should be involved in the birthing process. she also identified the importance of focusing on healthcare prevention and predicted that it would become the main focus of care in the future. Furthermore, she mentioned the significance of minimizing hospital admission rates and improving patient education to control illnesses. The human-to-human relationship model was first published in the early 1960s. she first described several concepts including empathy, sympathy, and rapport, and further improved the theory in the years 1966 and 1971. Her main focus was on the nursing process, patient perceptions, and nurse-patient relationships. Travelbee acknowledged using other theorists’ work to inform her model including Lydia Hall, Virginia Henderson, Dorothy Johnson, Hildegard Peplau, Florence Nightingale, Faye Abdella, and Martha Rogers. Her theory was also influenced by Catherine Norris, Eunice Lyle, and Viktor Frankl (George, 2014).

Concepts

The Purpose of Nursing

Travelbee described nursing as an interpersonal process where nurses work with individual patients, their families, and communities to engage in disease prevention and to help sick people cope with their illnesses. This purpose can only be achieved with the development of a human-to-human relationship (George, 2014).

Disciplined Intellectual Approach

Travelbee explained that the disciplined intellectual approach is essential if one wants to fulfill the purpose of nursing. Nurses must be able to engage in critical thinking, reasoning, reflection, deliberation, analysis, and synthesis. Nursing is also comprised of affective and cognitive components hence nurses must possess knowledge in various areas including technical knowledge, biological, behavioral, physical, medical, and nursing. They should also be able to apply this knowledge logically during care processes to help other people maintain optimal health. Travelbee emphasized the importance of nursing education in building scientific knowledge (George, 2014).

Therapeutic use of self

This concept refers to the ability of a nurse to consciously use themselves to relate to patients during care. nurses must possess self-insight, understanding, awareness, and the ability to interpret their patients’ behavior as well as their own to effectively incorporate the use of self in care. Travelbee further explained that the concept is a science and an art and nurses must be disciplined, logical, and empathetic to use it successfully (George, 2014).

Human-to-human relationships

The nursing process can only be effective it involves the development of a professional nurse-patient relationship. The relationship refers to experiences that involve both the nurse and patient and every interaction provides a basis for a positive relationship. As the relationship develops, patients and nurses engage in dynamic information exchange through both nonverbal and verbal cues. The Travelbee also described the nursing process as unique and dynamic since it is characterized by continuous activity, movement, and change. She also described nursing as continually evolving within time and space. The professional relationship encourages influence and counter-influence among both parties and results in progression, change, and growth. The relationship between nurses and patients also increases the patient’s confidence since it helps patients realize that they have someone to rely on. Travelbee also emphasized the importance of communication and involvement of family members during care. Assisting the family members translates to assisting patients (George, 2014).

The nurse-patient relationship does not occur by chance. Instead, it is planned consciously and deliberately by the nurse. The main phases of the relationship include the original encounter, emerging identities, empathy, and sympathy phases (George, 2014).

1. The original encounter

This phase occurs when the patient and nurse meet each other. The two parties do not recognize their uniqueness since they barely know each other. Each one of them observes the other and makes judgments based on their observation. These judgments are triggered by communication and interpersonal cues. This phase is heavily influenced by the background experiences of both the patient and nurse hence they can develop distorted perspectives about each other especially if they have a personal bias (George, 2014).

2. Emerging identities.

At this phase, the patient and nurse have interacted with each other and they start to develop a bond. They begin to identify each other’s uniqueness. The main requirement at this phase is self-transcendence on the nurse’s part. Patients and nurses who are unable to progress from this phase create superficial interactions that may not be helpful to the patient’s health situation (George, 2014).

3. Empathy

This phase entails a clear perception of each other’s uniqueness and the similarities and differences between nurses and patients become clearer. The main characteristic of this phase is empathy which refers to the ability to understand and share in the psychological state experienced by another person. Empathy helps to see beyond the outward behavior of a person by understanding their inner experience and the relevance and meaning of certain feelings and thoughts (George, 2014).

4. Sympathy

Sympathy refers to the urge or compulsion to help another person out of a distressing situation. Nurses demonstrate sympathy through compassion, warmth, and kindness and give part of themselves to their patients in an attempt to relieve their suffering. Sympathy impacts both the psychological and physiological well-being of the patient (George, 2014).

5. Rapport

Progression through the previous phases leads to the development of a nurse-patient relationship. Rapport is a process that is always changing and grows from the relationship between the nurse and patient. Travelbee defined rapport as the ability to honestly care for other people and nurses possess the ability to establish rapport because they have the skills and knowledge needed to help others improve their health status as well as the ability to perceive and respond to the needs of the patient. The main outcome of rapport is growth for both the nurse and patient (George, 2014).

Communication Process

Communication enables the establishment of the therapeutic relationship hence nurses must be skillful when exchanging verbal information and nonverbal cues. Communication entails the ability to read, understand and interpret information, the ability to express oneself verbally and in written form, listening, and making observations, and interpreting them (George, 2014).

Nursing Metaparadigm

Travelbee described humans as living and thinking organisms who are always evolving and becoming. She also identified the uniqueness in humans. In her definition of health, Travelbee acknowledged the definition provided by the World Health Organization and described it as a value judgment. She provided a brief discussion of the environment including the impact of culture on patient values. For the nursing component, Travelbee described the nursing process as an interpersonal process that entails interactions with patients, their families, and the entire community. The main nursing actions described in the theory include prevention and treatment of diseases (Noviana et al., 2016).

Application of Joyce Travelbee – Human-To-Human Relationship Model Theory to Nursing Practice

Travelbee’s theory is useful in practice since it informs bedside nurses about the process of developing relationships with the patient as a way of providing better care and improving patient outcomes. She also identified the importance of compassion and empathy in the care process as well as the effective use of nursing knowledge gained through education and experience. The theory also informs nurses about the importance of effective communication within the care environment and appreciation or the uniqueness of patients. Travelbee’s theory has been applied in research studies (Shelton, 2016). Parola et al. (2020) examined how the theory can be applied in palliative care and mentioned that the emphasis on nurse0patient relationships promotes its use among patients in providing care for terminally-ill patients.

Conclusion

The human-to-human model focuses on the therapeutic relationship developed by nurses and patients during the care process. The theory stresses the importance of communication and genuine compassion and empathy from the nurse. The main outcome of the therapeutic relationship is growth for the nurse and patient.

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Noviana, U., Miyazaki, M., & Ishimaru, M. (2016). Meaning in Life: A conceptual model for disaster nursing practice. International Journal Of Nursing Practice, 22, 65-75. https://doi.org/10.1111/ijn.12441

Parola, V., Coelho, A., Fernandes, O., & Apostolo, J. (2020). Travelbee’s Theory: Human-to-Human Relationship Model – its suitability for palliative nursing care. Revista De Enfermagem Referência, V Série(Nº 2). https://doi.org/10.12707/rv20010

Shelton G. (2016). Appraising Travelbee’s Human-to-Human Relationship Model. Journal of the advanced practitioner in oncology, 7(6), 657–661.

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Margaret Newman – Health As Expanding Consciousness Theory

Margaret Newman’s theory is based on the transformative and unitary perspectives of the nursing profession. Newman was born in 1933. Her first Bachelor’s degree was in home economics and English and at this time she had the feeling that nursing was her calling but she waited for eight years before getting a nursing degree. She was her mother’s caregiver when she battled amyotrophic lateral sclerosis and when her mother died, she enrolled in the University of Tennessee for a nursing major. The latter received a master’s and Ph.D. in nursing. She worked as part of the faculty at the University of Tennessee and retired in 1996 as a professor. When pursuing her doctoral study, she became interested in nursing theory, and based on her experience as her mother’s caregiver, she viewed disease as a meaningful health aspect and recognized the need for a better definition of the term ‘health’ (George, 2014).  Newman’s theory is a grand nursing theory because it has complex concepts, is broad, and is abstract. The theory provides a general framework for nursing theory and is based on Newman’s experience with the healthcare process (Moyle et al., 2016).

Influence from other theorists

Newman’s theory was influenced by other nursing theorists including Martha Rogers. She drew from the idea of unitary human nature and the interactions between people and the environment. She also drew from the works of other scientists including Bentov, Moss, and Bohm to gain a better understanding of health and its relation to space, time, and movement (George, 2014).

Theory Assumptions

The main assumptions for the theory include that the wholeness of a person can be identified via patterns that reflect their dynamic interactions with the environment. Health includes conditions that are described as pathology or illness. These conditions are regarded as total pattern manifestations of an individual. The pattern primarily manifests as pathology and exists before any functional or structural changes. Focusing on eliminating the pathology does not result in pattern changes. If illness facilitates the manifestation of individual patterns, then that is what health refers to for the person. Newman also recognized that health entails consciousness expansion (George, 2014).

Theory Concepts

The main concepts described by Newman’s theory include expanding consciousness, consciousness, the interaction between the person and environment, recognizing patterns, disorganization, and transformation.

Consciousness

This concept refers to the system’s capacity to interact with the environment. Human consciousness includes the informational capacity about things we interact with frequently and the information embedded in various body systems including endocrine, genetic, immune, and the central nervous system. Consciousness expands with human development and this enhances its coexistence within the universe. Consciousness is part of human nature and is the essence of matter (George, 2014).

Pattern

This concept depicts wholeness and includes diversity, rhythm, and movement. relatedness is a characteristic that defines patterns. For instance, movement is rhythmic and constant and both of these parts are diverse. Patterning occurs via the penetration of human energy and this leads to transformation. Organization within patterns increases with an increase in information (George, 2014).

Pattern recognition

This concept happens within the observer. For instance, it is possible to predict sequential events given that we access some information although we cannot be certain about the predictions we make. It is impossible to see the entire pattern at once although more parts of it are revealed with expanded time frames. Patterns are embedded in each other such that an individual’s pattern is embedded in their family’s pattern and the family is embedded within the community pattern. Recognizing patterns facilitates better understanding and promotes faster evolution of an individual’s consciousness (George, 2014).

Disorganization

This concept refers to pattern changes that occur from new information. Illness is an example of new information that may not fit into an individual’s existing pattern and this leads to disorganization and in some cases, chaos. Disorganization illustrates the need for change and if a change is implemented, transformation occurs (George, 2014).

Health As a Whole

Newman provided a new perspective of health. Initially, health was defined as the absence of illness and this led to the perspective that ill people are inferior. Newman proposed a perspective of health that involved fusion of both absence and presence of disease. She explained that health and disease cannot be separated because they reflect each other. Additionally, she recognized that ill health results in pattern disturbances which are resolved by reorganizing pattern relationships. People evolve and grow when they experience pattern disturbances because they learn how to achieve equilibrium by changing the way they interact with their environment. Therefore, disease should be viewed as an emergent pattern that results in expanded consciousness (George, 2014).

Newman’s understanding of health led to a paradigm shift in how healthcare professionals view health. This shift entailed moving from an instrumental perspective to a more relational view and represents assessing for patterns rather than only focusing on treating symptoms. additionally, Newman described the need to perceive pain and disease as information instead of only focusing on their negative aspects and the body as an energy field that exists within a larger field instead of a machine that requires repair. Diseases should also be viewed as processes instead of single entities. Viewing disease as a pattern manifestation helps to increase awareness of the significance of person-environment interactions and the information obtained from this perspective is essential for transformation within the individual and family. The new paradigm is important to nursing practice since it enhances focus on the wholeness of health (George, 2014).

Metaparadigm Concepts

Newman explained that human beings and the environment are unitary in that they have no boundaries. People are identified by their patterns which are embedded with the family, community, and societal patterns. people are constantly evolving to higher organization levels and can make effective decisions. Disorganization periods facilitate movement to higher organization levels and this process is a choice made within evolving consciousness. Humans also demonstrate abstract thinking, intuitiveness, and wholeness.

Health according to Newman’s theory refers to an expanding consciousness that includes both the presence and absence of disease. the theory also described nursing as a profession whose growth occurs in three stages: formative, normative, and integrated stages. The formative stage is when the nurse is establishing individual identity, is in the process of becoming, and is responsible for personal practice. The normative stage is when nursing becomes more persuasive and competitive about the environment. Nurses at this stage begin serving in hospital settings as employees. The integrated stage is when nurses take up other roles such as a clinician, staff nurse, and nurse team leader. Newman also described nursing as providing care within the human health experience. Nursing care is a reflection of the wholeness of the professional and requires openness, vulnerability, and suffering which lead to higher consciousness levels (George, 2014).

Application of Margaret Newman – Health As Expanding Consciousness Theory to Nursing Practice

Newman’s theory can be used to inform nursing processes in clinical practice. Nurses may use the theory to establish an inquiry process that involves both the patient and the family. Nurses could initiate conversations regarding meaningful relationships and events and use the information gained to identify patterns that influence patient health. Newman’s theory also encourages authentic nurse-patient interaction which promotes high consciousness levels for both parties. Newman’s theory has been applied when intervening with chronically ill patients such as cancer patients. The theory has been applied all over the world although it has been heavily adopted by nurses from Eastern cultures (Endo, 2017).

Newman’s theory has been applied in nursing research as a theoretical framework for care improvement. Endo and Fujiwara (2017) applied the theory to a case study involving the treatment of a cancer patient. The study illustrated the significance of the theory in enhancing the development of a caring partnership between patients, families, and healthcare professionals. The findings of the study illustrated family growth resulting from the cancer experience even though the patient was terminally ill. Younas and Parveen (2017) illustrated the use of the theory in various aspects of nursing care including psychological, spiritual, and social aspects, and described its importance in acute care settings.

Conclusion

Newman’s theory presents a paradigm shift in the definition of health since it focuses on both the presence and absence of disease. the theory encourages nurses to determine individual, family, and societal patterns that influence health. Newman considered ill health as a process that disorganizes the pattern and gives room for growth and expanded consciousness levels.

References

Endo, E. (2017). Margaret Newman’s theory of health as expanding consciousness and a nursing intervention from a unitary perspective. Asia-Pacific Journal Of Oncology Nursing, 4(1), 50. https://doi.org/10.4103/2347-5625.199076

Endo, E., & Fujiwara, Y. (2017). A patient with cancer and her family in caring partnership based on Margaret Newman’s theory of health as expanding consciousness. Asia-Pacific Journal Of Oncology Nursing, 4(3), 265. https://doi.org/10.4103/apjon.apjon_20_17

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Moyle, W., Rickard, C., Chambers, S., & Chaboyer, W. (2016). The Partnering with Patients Model of Nursing Interventions: The First Step to a Practice Theory. Healthcare, 3(2), 252-262. https://doi.org/10.3390/healthcare3020252

Younas, A., & Parveen, S. (2017). Finding Patterns of Meaning: Margaret Newman’s Theory of Health as Expanding Consciousness. Creative Nursing, 23(4), 207-214. https://doi.org/10.1891/1078-4535.23.4.207

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Katharine Kolcaba – Comfort Theory

Kolcaba is a nursing theorist who was born in Cleveland, Ohio in 1944. She earned her nursing diploma from St. Luke’s Hospital School of Nursing in 1965. She later earned her master’s in 1987 and Ph.D. in 1997. She is a certified gerontologist and her work in nursing theory has earned her many honors and awards. Kolcaba’s theory of comfort was based on Nightingale’s perspective regarding the importance of a comfortable healthcare environment in the healing of patients. Nightingale illustrated the association between comfort and health. Nightingale also cited the works of other theorists including Bertha Harmer, Linda Aiken, and Minnie Goodnow who had included patient comfort in their publications regarding nursing practice (George, 2014).

Theory assumptions

Human beings react to complex stimuli using holistic responses. Comfort is a significant part of nursing practice since it is the most desirable holistic patient outcome. Human beings naturally strive to engage in actions that promote their comfort. Comfort includes absence of various forms of discomfort including anxiety and pain (George, 2014).

Theory type

Kolcaba categorized her theory as a middle-range nursing theory since it is meant to be easily understood and applied in nursing practice. She also described the comfort theory as normative meaning that it provides a framework that directs action among healthcare professionals’ actions including what they should do when engaging in the practice. Kolcaba’s theory posits that when patients achieve comfort, they are more likely to engage in actions that promote their health (health-seeking behavior) which further influences their wellness levels (George, 2014).

Theory Concepts

The main concepts in Kolcaba’s theory include comfort, comfort care, measures, and needs, health-seeking behavior, intervening variables, and institutional integrity (George, 2014).

Comfort

Kolcaba described three types of comfort: ease, relief, and transcendence. If a nurse meets the comfort needs of patients, they experience relief. For instance, administration of pain medication to patients suffering from chronic pain results in relief which is a type of comfort. Ease refers to a sense of contentment that arises when various healthcare issues such as anxiety are addressed. Transcendence refers to improved ability to rise above any challenges including pain (George, 2014).

Kolcaba also described different contexts of comfort including physical, psychospiritual, environmental, and sociocultural comfort. Physical comfort is related to bodily sensations that may or may not be associated with a patient’s illness. This type of comfort includes activities that promote relief and ease and efficient homeostatic mechanisms within the body. Psychospiritual comfort is about concepts, ideologies, or things that give meaning to the life of the patient and may include religious beliefs, relations with a higher being or order, self-esteem, and sexuality. Environmental comfort refers to any external influences, surroundings, and conditions. These surroundings include noise, color, ambiance, access to nature, temperature, light, and views from the window. Sociocultural comfort is associated with family, interpersonal, and societal relationships that impact health. Access to support, education levels, and finances are examples of factors that influence physical and mental health. Culture includes language, traditions, family history, customs, and clothing (George, 2014).

Comfort care

This concept is a healthcare philosophy that addresses the different comfort contexts including the physical, psychospiritual, environmental, and sociocultural contexts. the three components of comfort include the provision of timely and appropriate interventions, delivering comfort in a manner that projects empathy and caring, and having the intent to provide adequate comfort measures (George, 2014).

Comfort measures

The main interventions developed by nurses enhance the comfort of patients and their family members. Examples of comfort measures described by Kolcaba include technical, coaching measures, and comfort food. Technical measures include interventions that facilitate pain management such as administering pharmacological interventions and those that maintain homeostasis such as monitoring the patient’s physiological functioning. Coaching interventions help to instill hope, provide information, reassurance, relieve anxiety, and help the patient develop achievable and realistic plans for the future (George, 2014).

Comfort needs

The deficit or desire for transcendence, ease, or relief within the psychospiritual, physical, environmental, and sociocultural contexts (George, 2014).

Health-seeking behavior

These are behaviors that people engage in either subconsciously or consciously to promote their wellbeing. They can either be external or internal or peaceful death (George, 2014).

Institutional integrity

The state of clinical institutions includes wholeness, soundness, professionalism, completeness, and ethical practice that affect comfort contexts and measures (George, 2014).

Intervening variables

These are negative or positive factors that cannot be controlled by healthcare institutions or nurses and provide minimal comfort but impact the success of any care plans developed to enhance patient comfort (George, 2014).

Theory propositions

The role of nurses is to identify the comfort needs of patients that may be lacking due to insufficient support systems. Nurses develop interventions based on patient-specific comfort needs. The intervening variables must be considered when developing patient interventions since they influence their success. Additionally, appropriate implementation of interventions results in enhanced comfort levels as the immediate outcome. The interventions should also be implemented in a caring manner. Nurses and patients come together to agree on realistic, achievable, and desirable health-seeking behaviors and if patients are comfortable, they will have the strength to implement these behaviors (George, 2014).

Nursing Metaparadigm

Kolcaba provided clear definitions of the four nursing metaparadigm. She defined the person component as the individual, family, or members of the society or community who need healthcare services. These include preventive, primary, and tertiary healthcare. The health component refers to the optimum functioning of the individual, family, or community. Comfort measures enhance functioning by promoting the implementation of health-seeking behaviors. The description of health should be based on the perspective of the patient, family, or the community. The environment refers to components of individual, family, or community surroundings that impact comfort either positively or negatively. Physical, psychospiritual, and sociocultural contexts are also part of the patient environment. Environmental components can be manipulated to increase comfort. The nursing component refers to a process that entails intentional assessment of the individual’s, communities’, or family’s comfort needs. The assessment process can either be subjective by questioning the patients about their needs or objective by using observation or clinical tools. Nurses then develop appropriate interventions to address these needs. Additionally, nursing involves re-evaluating comfort levels to determine the effectiveness of the interventions in promoting comfort (George, 2014).

Application of Katharine Kolcaba – Comfort Theory to Nursing Practice

The comfort theory has been applied in various areas of the nursing profession including research and clinical care. the theory informs nurses on ways of handling the care process including patient assessment, development of care plans, implementation, and assessing the effectiveness of these plans in meeting comfort needs. The theory also informs nurses on the importance of examining both internal and external environments that impact comfort including psychospiritual and sociocultural environments. The theory also informs nurses of the importance of culturally competent practice since various aspects of culture including language, beliefs, and traditions influence the wellbeing of a patient, perspectives regarding health, and the ability to engage in health-seeking behaviors (George, 2014).

Kolcaba’s theory has been applied in many clinical research studies to illustrate the usefulness of comfort measures and as a theoretical framework for research. Lima et al. (2016) examined the usefulness of the theory in nursing care for new mothers. The study incorporated the theory by assessing comfort needs such as pain levels, availability of rest periods, environmental irritants, and anxiety. Measures such as providing analgesics for pain management and providing clean beddings, comfortable temperature, and lighting as preferred by patients were implemented. the study determined that the theory promotes physical comfort by facilitating better pain control and relaxation among new mothers and also enhanced the desire to engage in health-seeking behavior.

Faria et al. (2018) illustrated how the comfort theory can be applied to intensive care units in psychospiritual and physical contexts as a way of relieving pain and suffering and creating a peaceful environment for patients. Vo (2020) used the theory to develop a practical guideline that could be implemented by frontline healthcare workers who provide care to COVID-19 patients. The framework was based on implementing comfort measures in environmental, physical, and psychospiritual contexts to improve wellbeing or facilitate a peaceful transition to death.

Conclusion

The comfort theory focuses on creating conducive internal and external contexts that promote ease, relief, and transcendence among patients. The theory provides a framework for the nursing process including assessment of patient needs, developing care plans, implementation, and evaluation of the effectiveness of comfort measures. The theory has heavily informed nursing practice and research.

References

Faria, J., Pontífice-Sousa, P., & Pinto Gomes, M. (2018). Comfort care of the patient in intensive care – an integrative review. Enfermería Global, 17(2), 477-514. https://doi.org/10.6018/eglobal.17.2.266321

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Lima, J., Guedes, M., Silva, L., Freitas, M., & Fialho, A. (2016). Usefulness of the comfort theory in the clinical nursing care of new mothers: critical analysis. Revista Gaúcha De Enfermagem, 37(4), e65022. https://doi.org/10.1590/1983-1447.2016.04.65022

Vo, T. (2020). A Practical Guide for Frontline Workers During COVID-19: Kolcaba’s Comfort Theory. Journal Of Patient Experience, 7(5), 635-639. https://doi.org/10.1177/2374373520968392

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Rosemarie Rizzo Parse – Human Becoming Theory

Most nursing theories emphasize the bio-psycho-spiritual approach in nursing care and pay little to no attention to the patient’s quality of life. Rosemarie Parse addresses the issue by considering healthcare from the patient’s perspective. Parse was born in 1938 and attended Duquesne University for her Bachelor’s degree in nursing. She also holds a master’s degree and Ph.D. in nursing. Parse’s theory was based on the works of Martha Rogers, another nursing theorist, and several European philosophers including Sartre, Heidegger, and Merleau-Ponty. The theory is based on three themes: meaning, rhythmicity, and transcendence. Parse’s theory is a grand nursing theory that focuses on the unitary process between human beings and the universe. The theory has abstract concepts and comprises broad ideas and principles (George, 2014).

Theory Assumptions

Human beings are connected to their environments in that they both coexist while at the same time mutually constituting rhythmical patterns with the universe that surrounds them such that human beings engage in mutual evolution with the universe. Humans are open beings who can define the meaning of specific situations and bear the responsibility or consequences arising from these situations. In addition, human beings are a living unity that continuously co-constitute relating patterns and transcend mutidimensionally beyond the actual since they have numerous possibilities. Parse described health as an open becoming process and as a human experience that also mutually constitutes the interrelationship between human beings and the environment. Health is also a human pattern and an inter-subjective process. Becoming is related to human living and health and mutually constitutes the human-universe process. Becoming is also a process where human patterns relate with the environment and universe and an inter-subjective process that entails the possibility of transcendence. Becoming is linked to the emergence of human beings (George, 2014).

Parse also believed that human beings are more than the sum of their parts and that they evolve mutually with their environments. Moreover, they choose meanings in specific situations and use them to co-create personal health. They also convey meanings based on their values and these meanings reflect their hopes and dreams (George, 2014).

Themes in the Rosemarie Rizzo Parse – Human Becoming Theory

Meaning

Meaning is defined as the imagined and realistic content of an event or experience or the interpretations that people give to something. Meaning comes from the human-universe process and can be used to describe the purpose or meaning of a person’s life or the meaning of various moments that occur in daily life. People co-participate in the development of personal reality and express them in the manner in which they choose to live their lives (Parse, 1992).

Rhythmicity

This theme refers to the paradoxical and paced patterns within the human-universe process and can be visually compared to the flow of waves as they come towards the shore. The patterns move in a single direction and can also de illustrated as a flowing process that follows changes brought about by new experiences (Parse, 1992).

Transcendence

This theme is about reaching beyond what is considered to be humanly possible. Humans are surrounded by many possibilities which they can choose from on their path to becoming. Transcendence entails moving away from the current moment and developing a unique personal bath while existing in a universe that is ambiguous and characterized by constant change (Parse, 1992).

The Principles of the Rosemarie Rizzo Parse – Human Becoming Theory

The principles of human becoming are based on the main themes of the theory include meaning, rhythmicity, and transcendence. The first principle is interrelated with the concepts of valuing, imaging, and languaging and states that structuring or developing meaning is a multidimensional process that entails co-creation of reality via languaging of imaging and valuing. This principle means that human beings use their experiences to develop the meaning of reality. The meaning is susceptible to change based on numerous possibilities in lived experiences. Co-creation refers to the process where human beings and the universe engage to create patterns. languaging is the reflection of values and images through movement and speech or stillness and silence. Valuing is defined as the process of incorporating valued beliefs in an individual’s worldview. Imaging refers to both tacit and explicit knowledge (Parse, 1992).

The second principle states that engaging in the co-creation of rhythmical patterns of relating entails existing within the paradoxical unity of three concepts: enabling-limiting and revealing-concealing while at the same time, connecting-separating. The concepts are not opposites but rather, they exist simultaneously since they are aspects that exist within the same rhythm such that one aspect exists in the background and the other in the foreground. An example of the revealing-concealing concept occurs when people relate to one another and reveal certain aspects of themselves and simultaneously conceal other aspects. An example of enabling-limiting is based on the choice that one makes to engage in one activity which limits their ability to engage in another activity (Parse, 1992).

The third principle states that when co-transcending with possibilities, people engage in transformation processes that power or lead to the development of unique ways of originating. The main concepts in this principle include transforming, originating, and powering. Transformation entails change and is mainly identified by increased diversity. Originating refers to coming up with new ways of living that do not conform to certainty. Powering is a force that is generated in encounters between human beings (Parse, 1992).

Theoretical Structure

The human becoming theory can be summarized into three structures. The first one is powering is a concept that arises with the revealing-concealing of both tacit and explicit knowledge (imaging). The second theoretical structure is that originating arises when people enable-limit the integration of valued limits with the personal worldview (valuing). The last structure is that transforming arises when the languaging process falls within the concept of connecting-separating. This structure implies that people develop changing views as they move with and speak to others (Parse, 1992).

Nursing Metaparadigm

Human and Environment (human-universe)

Parse (1992) described that human beings are in a constant mutual process with the universe that surrounds them. together, they co-create patterns that influence relations with others. Additionally, humans exist in the universe’s multidimensional realms and can choose the meanings they give to specific situations. Therefore, human beings were central to Parse’s theory based on their interconnectedness with the universe.

Health

Parse (1992) defined health as a way of living that comprises human values. Furthermore, she considered health as a changing process based on human interactions with the universe that is revealed as patterns of value priorities. Health is also a personal commitment since humans can define and change their health.

Nursing

Nursing, under Parse’s theory, refers to a basic science whose practice process is a performing art. Parse compared the nursing process to dance and drama where every performer is unique in their creation. The main responsibility of nurses is to guide people and families towards different possibilities that influence their health process through creativity and innovation. Nurses must also focus on the patient’s perspectives of quality of life when describing health possibilities (Parse, 1992).

Application of Rosemarie Rizzo Parse – Human Becoming Theory  to Nursing Practice

The theory applies to numerous living situations within and beyond nursing practice. Some research studies have examined how the theory can be used in clinical care. Wilson (2016), for instance, examined the use of the human becoming theory in the treatment of families experiencing stillbirths or pregnancy losses. The theory was applied by helping patients and families give meaning to their loss and helping them express them while at the same time, considering future possibilities. Patients who lived the loss experience found it easier to define hope. Notably, hope co-existed with no hope among such patients and Wilson (2016) explained that the ability to move through the paradox of treasuring moments and anticipating future possibilities is what leads to transcendence. Tapp et al. (2016) applied the human becoming theory in the palliative setting and determined that the theory can be successfully integrated into care settings although people make different interpretations of the theory due to the abstractness of its concepts.

Conclusion

Parse’s theory mainly views health from the patient’s perspective. The theory stresses the human ability to give meaning to experiences. Additionally, the becoming process for human beings involves transcendence which is initiated by transformations resulting from changes that occur as a result of human interactions with each other and with the universe.

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Parse, R. (1992). Human Becoming: Parse’s Theory of Nursing. Nursing Science Quarterly, 5(1), 35-42. https://doi.org/10.1177/089431849200500109

Tapp, D., Lavoie, M., & Vonarx, N. (2016). Theory-based practice as plural interpretations: A case of the integration of the Human becoming theory in a palliative care setting. Quality Advancement In Nursing Education, 2(2). https://doi.org/10.17483/2368-6669.1078

Wilson, D. (2016). Parse’s Nursing Theory and its Application to Families Experiencing Empty Arms. International Journal Of Childbirth Education, 31(2), 29-33.

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Ernestine Wiedenbach – The Helping Art of Clinical Nursing Theory

Ernestine Wiedenbach was a nursing theorist born in 1900 in Germany. Her family moved back to the U.S. when she was 8 years old and she attended Wellesley College where she received a degree in liberal arts. Ernestine became interested in nursing as she cared for her sick grandmother and the stories she heard from her sister’s friend who was a medical student. Her family was affluent and was disappointed when she decided to enroll in a nursing school in New York. However, she was suspended from the school after she became a student spokesman. She continued her nursing education at John Hopkins located in Baltimore, Maryland, and received her diploma in 1925. After getting her master’s degree, she worked in supervisory positions at John Hopkins and later obtained a master’s degree in 1934. Wiedenbach helped prepare nurses who would provide care to soldiers in World War II although she did not leave the country due to cardiac problems. She studied for a midwifery certificate and practiced as a midwife. She also held public health nursing positions and taught in several nursing schools. After her retirement, she served as a visiting professor at Yale University. Her theory was described in a publication released in 1964. She credited other nursing theorists including Ida Orlando and Patricia James as the main influences in her theory development (George, 2014).

Nurse Characteristics and Components of Nursing Practice

Wiedenbach’s theory is based on the idea that the nursing process is caring and nurturing a patient in a motherly way. She also explained that healthcare should be provided in the immediate context and any caring person can do it. Nurses acquire wisdom as they gain meaningful experiences in their work. The main characteristics of a nursing professional include clarity of purpose, ability to develop positive working relationships with other people including nonprofessional and professional individuals, mastery of knowledge and skills required to provide care, interest in knowledge creation and advancement, and dedication to improving mankind instead of enhancing one’s wealth or power (George, 2014).

The main components of nursing practice include identifying the patient’s need for care, ministering the required care, and validating the effectiveness of the care provided. Wiedenbach also described the main helping principles including inconsistency/consistency, self-extension, and purposeful perseverance. The inconsistency/consistency principle is defined as the patient assessment process that helps to determine any appearances, actions, or words that deviate from the norm. assessments are mainly conducted through careful observation. Purposeful perseverance refers to the desire that the nurse has to help a patient despite any challenges or difficulties that may be encountered in the care process. self-extension is a principle that identifies the situational and personal limitations encountered by nurses. Nurses need to recognize such limitations and solve them by seeing help from God through prayer and from other people. Based on the theory’s application to nursing practice, it falls under the middle-range category of nursing theories (George, 2014).

The Prescriptive Theory

This theory is comprised of three factors: central purpose, prescription, and the characteristics of the immediate situation that impact the nurse’s ability to fulfill the central purpose. In nursing, the central purpose refers to the health quality that nurses desire to sustain or impart to the patient through caring. Nurses are expected to adhere to the nursing philosophy with stresses on revering the gift of life, respecting the autonomy, worth, individuality, and dignity of every patient, and accepting that personal belief may not be applicable in the nursing process since they may differ from patients’ beliefs.

After addressing the philosophies of nursing, nurses should work with patients to come up with a care plan that describes the nature of action and the rationale behind it. The process of developing a care plan is referred to as a prescription and may include both involuntary and voluntary actions. The voluntary actions should include those which are mutually agreed upon by the nurse and patient, those which are directed by the patient, and those that are provider-directed (George, 2014).

After developing the prescription, the nurse must assess the realities of the care situation which includes all the emotional, psychological, physiological, spiritual, and physical factors that impact the care situation. The five realities include the agent (healthcare provider), patient, the goals of care, the means used to achieve the goal and the framework followed during practice (George, 2014).

Conceptualization of Nursing Practice

Wiedenbach viewed nursing as an art where action follows helping principles. The main types of nursing action include reflex, impulsive, deliberate, and conditioned action. She also explained that nursing is an internalized mechanism influenced by sensitivity, knowledge, concern, wisdom, the nurse’s culture, and purpose. The nursing process is initiated by an activating situation that acts as a stimulus that arouses the consciousness of the nurse. The intuitive awareness initiates voluntary responses from the nurse although as one progresses to cognition, the actions change to voluntary (George, 2014).

Nursing Metaparadigm

Wiedenbach’s theory describes the person component as an individual with limitless and unique potential who focuses on achieving self-direction and requires the nurse’s stimulation to do so. People also engage in actions which they perceive as the best judgment at the current moment. In addition, people need to be self-accepting and self-aware. Wiedenbach did not describe the health component and stated that she accepts the definition provided by the World Health Organization (George, 2014).

She viewed the environment as the realities of the care situation which include factors such as emotional, psychological, physiological, spiritual, and physical factors. These factors impact the care recipient and the means used to achieve the healthcare goals described after patient assessment (George, 2014).

The nursing component was described as a clinical discipline that entails a helping process developed to restore the ability of the patient to cope with specific experiences. The role of the nurse is to identify the purpose of care, develop a care plan that will help fulfill the purpose, and consider how external and internal environmental factors affect the care situation. Nurses must also master the knowledge and skills required to fulfill the purpose of care. the theory also mentioned the significance of meaningful working relationships during the care process and the nurse’s dedication to advancing healthcare knowledge (George, 2014).

Application of Ernestine Wiedenbach – The Helping Art of Clinical Nursing Theory to Nursing practice

Wiedenbach’s theory provides a framework for nursing care through the definition of the nursing process which includes patient assessment, nursing diagnosis, and the development of care plans. The theory also emphasizes the importance of nursing skills and knowledge in successful care and identifies environmental factors that impact healthcare. Nursing knowledge is important since it helps nurses make a sound judgment after conducting comprehensive patient assessments. The theory has also been applied to inform interdisciplinary practice since it describes the significance of nurses developing meaningful work relationships with other professionals. Furthermore, the theory informs collaborative practices since it stresses patient participation in assessment and when developing care goals and action plans (McEwen & Wills, 2018).

Wiedenbach’s theory has also been used to inform nursing practice. Jayamalli and Priya (2021) used the theory to develop a theoretical framework for improving the quality of life and coping abilities of perimenopausal women. Nagarajan (2018) also applied the theory to improve the quality of life among psoriasis patients and determined that the theory informs nursing practice and can help improve the quality of care which translates to better patient outcomes.

Conclusion

The theory of the helping art of clinical nursing describes nursing as an art and includes nursing philosophy and the purpose of care. the theory stresses conducting comprehensive assessments to determine the concerns and the needs of the patient and working with them to develop goals ad action plans that will improve the patient’s coping abilities. The theory also describes the prescriptive theory that includes the central purpose, prescribing actions that help fulfill this purpose, and considering how realities affect the care situation and the central purpose.

References

George, J. (2014). Nursing Theories: The Base for Professional Nursing Practice (6th ed.). Pearson.

Jayamalli, M., & Priya, M. (2021). Conceptual Framework for the study based on Ernestine Wiedenbach helping art of clinical nursing theory – for coping and quality of life among perimenopausal women. Annals Of Tropical Medicine & Public Health, 23(23). https://doi.org/10.36295/asro.2020.232381

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.

Nagarajan, P. (2018). Helping art of clinical nursing: Application of theory in enhancing the quality of life of patients with psoriasis. International Journal Of Psychiatric Nursing, 4(2), 36. https://doi.org/10.5958/2395-180x.2018.00013.0

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