INTRODUCTION

Nursing theories are organized bodies of knowledge to define what nursing is, what
nurses do, and why do they do it. Nursing theories provide a way to define nursing as a unique
discipline that is separate from other disciplines (e.g., medicine). It is a framework of concepts
and purposes intended to guide the practice of nursing at a more concrete and specific level.

Nursing, as a profession, is committed to recognizing its own unparalleled body of

knowledge vital to nursing practice—nursing science. To distinguish this foundation of
knowledge, nurses need to identify, develop, and understand concepts and theories in line with
nursing. As a science, nursing is based on the theory of what nursing is, what nurses do, and
why. Nursing is a unique discipline and is separate from medicine. It has its own body of
knowledge on which delivery of care is based.

NURSING PROCESS

DEFINITION OF NURSING PROCESS

Nursing process is a systematic, rational method of planning and providing
individualized nursing care.

THE PURPOSE OF NURSING PROCESS:

• To identify client’s health status, actual or potential healthcare problems or need.
• To establish plans to meet the identified needs and to deliver specific interventions
to meet those needs.
• It provides a framework in which to practice nursing.

CHARACTERISTICS OF A NURSING PROCESS:

1. Dynamic and cyclic
2. Patient centered
3. Goal directed
4. Open and Flexible
5. Problem Oriented
6. Planned
7. Universally accepted
8. Interpersonal and collaborative
 9. Holistic
10. Systematic

BENEFITS OF NURSING PROCESS

• Improves the quality of care that the client receives
• Ensures a high level of client participation together with continuous evaluation
designed to meet the client’s unique needs
• Enables nurses to use time and resources efficiently to both their own and their
client’s benefit

IMPORTANCE OF THE NURSING PROCESS

• The process helps to provide standardization in the care offered by nurses. Since a nurse
knows what to do and the steps that they should follow to care for clients they can give the
same high-quality services consistently.

• It speeds up the care process meaning that the intervention can be provided within a
reasonable amount of time once the patient comes to the hospital. The nurse might be a
trained medical personnel but no matter how skilled he or she may be it is impossible to
determine the problem or needs of a patient without the first step that is the assessment. It
makes it easy to identify the problem, come up with a care plan, and hence intervene without
wasting any time.

• Without this process, there would be many mistakes in the caregiving process. As rare as
they may be medical mistakes can be fatal and they are not always major things because
something simple like failing to check on the patient routinely might cost their life.

• It is used to teach new nurses of what is expected of them once they get to the hospitals.
Nursing as a profession is very complicated, and it involves many things, but this process
summarizes everything into five simple steps.

PHASES OF NURSING PROCESS

Phases of nursing process are commonly abbreviated as the ADPIE. Each of them contributes
something specific in ensuring that the client gets the best care.

1. Assessment: It usually starts when the patient first arrives at the facility or when he makes
contact with the nurse. It involves the collection of as much information about the patient’s
medical history as possible. The caregiver uses a dynamic and systematic approach to
 collect and analyze data on the information. It can involve simple things such as asking the
patients some questions, making observations and reviewing their medical history. This
assessment will include not only data on their physical health but also social, psychological,
economic, spiritual and lifestyle factors.
2. Diagnosis: Diagnosis, as the name suggests, involves the clinical judgment of a nurse on
the response of a patient to the actual or potential health condition. The diagnosis is done
by a skilled nurse, and so it should be very detailed. For example, it should not just indicate
that the patient is in pain but should also state that the pain has caused other problems like
poor nutrition, anxiety and even a social effect like causing conflict in the family if that is
the case. A detailed diagnosis should provide as much information as possible as it is critical
for any interventions.
3. Planning: After the diagnosis or once the patient and the nurse agree on it, a plan of action
should be created. The purpose of the plan is to make the intervention that will follow a
success. A care plan helps the nurse determine what needs to be done, how it should be done
and when it is to be done so as to make sure that the care offered meets the medical
requirements and expectations of the patient. Here the diagnosis should be addressed, and
the head nurse will look at the symptoms and classify them according to their severity. Each
of the problems is also assigned a measurable goal for the expected outcome. The
assessment data is then written on the patient’s care plan so that nurses and everybody else
caring for the patient has access to it.
4. Implementation: This stage is where the nurse follows through with the care plan that was
developed in the previous phase of the process. The care plan developed is specific for the
patient, and it should focus on achieving attainable outcomes so that the implementation
process may be successful. Actions involved in this stage include monitoring the client for
signs of improvement or any new changes in the symptoms or condition, offering direct care
and performing medical tasks. Other activities that may be done in the implementation stage
may include instructing or educating patients on health management, referring and
contacting the patient for follow-ups if need be. The implementation phase can take a couple
of hours, weeks or even many months.
5. Evaluation: This is the last step in the process, and it is done once all the interventions have
taken place. The primary aim of evaluation is to determine whether the goals set in the care
plan have been met. It can also be used to identify areas where the outcome is not desirable
and to determine the reason behind this. Evaluation is not only beneficial to that specific
patient but is also important in the development of care plans for future patients. In this
 stage, the patient’s condition can be described in any of the following three ways: condition
of the patient has improved, the state of the patient has stabilized, and condition of the
patient has deteriorated, discharged or died. If the patient has not shown any improvement
or the set wellness goals have not been fulfilled the process has to begin again from step
one.

THE STEPS OF THE NURSING PROCESS

1. Assessment
2. Nursing Diagnosis
3. Goals
4. Planning
5. Rationale
6. Implementation
7. Evaluation

1- Nursing Assessment
• The process of collecting, validating and recording data about a client’s health
status.
• Phase which identifies patient’s strengths and limitations and is done continuously
throughout the nursing process.

2- Nursing Diagnosis

• In this phase the nurse sort, clusters and analyzes data.

• These questions could serve as guidelines:
 o What are the actual and potential health problems for which the client
needs nursing assistance?
o What factors contributed to this problem?
• Nursing diagnoses are identified through actual and potential health problems or
responses to life processes.

Types of nursing diagnosis:

It can be ACTUAL, POTENTIAL or WELLNESS DIAGNOSIS :

• ACTUAL – identifies an occurring health problem
• POTENTIAL – identifies a high risk health problem
• WELLNESS‐ focused on promoting or enhancing a patient’s level of wellness.

3-Goal
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and
long-range goals for this patient

4- Planning and 5-Rationale

• Planning expected outcomes to resolve or minimize the identified problems of the

client.
• In collaboration with the client, the nurse develops specific nursing intervention for
each nursing diagnosis.

6- Implementation
• Also called intervention; putting the nursing care plan into action to achieve goals
and outcomes
• As you implement your plan, you continue to assess your patient’s responses and
modify plan as needed.
• Care done should always be documented.

7- Evaluation
 • Assessing the client’s response to nursing interventions and then comparing the
response to the goals or outcome criteria written in the planning phase.

Assessment Nursing Objectives Planning Rationale Implementation Evaluation

diagnosis

DEFINING TERMS
Development of nursing theory demands an understanding of selected terminologies,
definitions, and assumptions.

• Philosophy. Beliefs and values that define a way of thinking and are generally
known and understood by a group or discipline.
• Theory. A belief, policy, or procedure proposed or followed as the basis of action.
It refers to a logical group of general propositions used as principles of explanation.
Theories are also used to describe, predict, or control phenomena.
• Concept. Concepts are often called the building blocks for a conceptual framework
or a theory. They are primarily the vehicles of thought that involve images. It is a
word picture or mental idea of phenomenon. It is an image or symbolic
representation of an abstract idea.

Chinn and Kramer (1999) defined concept as a “complex mental formulation of

experience”. For eg : stress, anxiety , love. Webster (1999) defined concept as
something conceived in the mind- a thought or a notion.

• Models. Models are representations of the interaction among and between the
concepts showing patterns. They present an overview of the thinking behind the
theory and may demonstrate how theory can be introduced into practice.
• Conceptual framework. A conceptual framework is a group of related ideas,
statements, or concepts. It is often used interchangeably with the conceptual model
and with grand theories.

Conceptual Framework=Concept +Framework

 It can be defined as “ knitting concepts in a frame to have meaningful information”.

A written or visual presentation that:

“explains either graphically or in narrative form, the main things to be studied-the

key factors, concepts or variables and the presumed relationship among them”
The conceptual framework indicates how the research views the concept involved
in a study, especially the relationships among concepts.

• Proposition. Propositions are statements that describe the relationship between the
concepts.

Concept Concept

Proposition

• Domain. Domain is the perspective or territory of a profession or discipline.

• Process. Processes are a series of organized steps, changes or functions intended to
bring about the desired result. During a process , one takes place systemic and
continuous steps to meet a goal and uses both assessments and feedback to direct
action to the goal.
• Paradigm. A paradigm refers to a pattern of shared understanding and assumptions
about reality and the world; worldview or widely accepted value system.
• Metaparadigm. A metaparadigm is the most general statement of discipline and
functions as a framework in which the more restricted structures of conceptual
models develop. Much of the theoretical work in nursing focused on articulating
relationships among four major concepts: person, environment, health, and nursing.
THE NURSING METAPARADIGM
There are four major concepts that are frequently interrelated and fundamental to nursing
theory: person, environment, health, and nursing. These four are collectively referred to as
metaparadigm for nursing. Four main concepts that make up the nursing metaparadigm, it
includes :
→ Person
→ Nursing
→ Environment
 → Health

Person
Person (also referred to as Client or Human Beings) is the recipient of nursing care and may
include individuals, patients, groups, families, and communities.
Environment
Environment (or situation) is defined as the internal and external surrounds that affect the
client. It includes all positive or negative conditions that affect the patient, the physical
environment, such as families, friends, and significant others, and the setting for where they go
for their healthcare.
Health
Health is defined as the degree of wellness or well-being that the client experiences. It may
have different meanings for each patient, the clinical setting, and the health care provider.
Nursing
The attributes, characteristics, and actions of the nurse providing care on behalf of or in
conjunction with, the client. There are numerous definitions of nursing, though nursing scholars
may have difficulty agreeing on its exact definition, the ultimate goal of nursing theories is to
improve patient care.
COMPONENTS OF NURSING THEORIES
For a theory to be a theory it has to contain a set of concepts, definitions, relational statements,
and assumptions that explain a phenomenon. It should also explain how these components
relate to each other.
Phenomenon
A term given to describe an idea or responses about an event, a situation, a process, a group of
events, or a group of situations. Phenomena may be temporary or permanent. Nursing theories
focus on the phenomena of nursing.
Concepts
Interrelated concepts define a theory. Concepts are used to help describe or label a
phenomenon. They are words or phrases that identify, define, and establish structure and
boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or
concrete.
 Abstract Concepts. Defined as mentally constructed independent of a specific time or
place.
 Concrete Concepts. Are directly experienced and related to a particular time or place.
Definitions
Definitions are used to convey the general meaning of the concepts of the theory. Definitions
can be theoretical or operational.
 Theoretical Definitions. Define a particular concept based on the theorist’s perspective.
 Operational Definitions. States how concepts are measured.
Relational Statements
Relational statements define the relationships between two or more concepts. They are the
chains that link concepts to one another.
Assumptions
Assumptions are accepted as truths and are based on values and beliefs. These are statements
that explain the nature of concepts, definitions, purpose, relationships, and structure of a theory.
IMPORTANCE OF NURSING THEORIES
Importance of nursing theory and its significance to nursing practice:
✓ Nursing theories help recognize what should set the foundation of practice by explicitly
describing nursing.
✓ By providing a definition of nursing, nursing theory also helps nurses to understand
their purpose and role in the healthcare setting.
✓ Theories serve as a rationale or scientific reasons for nursing interventions and give
nurses the knowledge base necessary for acting and responding appropriately in nursing
care situations.
✓ Nursing theories provide the foundations of nursing practice, helps generate further
knowledge, and indicate in which direction nursing should develop in the future
(Brown, 1964).
✓ By providing nurses a sense of identity, nursing theory can help patients, managers, and
other healthcare professionals to acknowledge and understand the unique contribution
that nurses make to the healthcare service (Draper, 1990).
✓ Nursing theories prepare the nurses to reflect on the assumptions and question the
values in nursing, thus further defining nursing and increasing knowledge base.
✓ Nursing theories aim to define, predict, and demonstrate the phenomenon of nursing
(Chinn and Jacobs, 1978).
✓ It can be regarded as an attempt by the nursing profession to maintain and preserve its
professional limits and boundaries.
✓ In many cases, nursing theories guide knowledge development and directs education,
research, and practice although each influence the others. (Fitzpatrick and Whall, 2005).
PURPOSES OF NURSING THEORIES
In Academic Discipline
Much of the earlier nursing programs identified the major concepts in one or two nursing
models, organized the concepts and build an entire nursing curriculum around the created
framework. The unique language in these models was typically introduced into program
objectives, course objectives, course descriptions, and clinical performance criteria. The
purpose was to explain the fundamental implications of the profession and to enhance the status
of the profession.
In Research
Development of theory is fundamental to the research process where it is necessary to use
theory as a framework to provide perspective and guidance to the research study. Theory can
also be used to guide the research process by creating and testing phenomena of interest. To
improve the nursing profession’s ability to meet the societal duties and responsibilities, there
need to be a continuous reciprocal and cyclical connection with theory, practice, and research.
This will help connect the perceived “gap” between theory and practice and promote the
theory-guided practice.
In Profession
Clinical practice generates research questions and knowledge for theory. In a clinical setting,
its primary contribution has been the facilitation of reflecting, questioning, and thinking about
what nurses do. Because nurses and nursing practice are often subordinate to powerful
institutional forces and traditions, the introduction of any framework that encourages nurses to
reflect on, question, and think about what they do provide an invaluable service.
CLASSIFICATION OF NURSING THEORIES
There are different ways to categorize nursing theories. They are classified depending on their
function, levels of abstraction, or goal orientation.
By Abstraction
There are three major categories when classifying nursing theories based on their level of
abstraction: grand theory, middle-range theory, and practice-level theory.
 LEVELS OF NURSING THEORIES ACCORDING
LEVELS OF ABSTRACTION

1.Grand Nursing Theories

Grand theories are abstract, broad in scope, and complex, therefore requiring further research
for clarification.
Grand nursing theories do not provide guidance for specific nursing interventions but rather
provide a general framework and ideas about nursing.
Grand nursing theorists develop their works based on their own experiences and the time they
were living explaining why there is so much variation among theories.
Address the nursing metaparadigm components of person, nursing, health, and environment.
2.Middle-Range Nursing Theories
More limited in scope (as compared to grand theories) and present concepts and propositions
at a lower level of abstraction. They address a specific phenomenon in nursing.
3.Practice-Level Nursing Theories
Practice nursing theories are situation specific theories that are narrow in scope and focuses on
a specific patient population at a specific time.
Practice-level nursing theories provide frameworks for nursing interventions and suggest
outcomes or the effect of nursing practice.
By Goal Orientation
Theories can also be classified based on their goals, they can be descriptive or prescriptive.
1.Descriptive Theories
Descriptive theories are the first level of theory development. They describe the phenomena
and identify its properties and components in which it occurs. Descriptive theories are not
action oriented or attempt to produce or change a situation. There are two types of descriptive
theories: factor-isolating theory and explanatory theory.
(a)Factor-Isolating Theory
Also known as category-formulating or labeling theory.Theories under this category describe
the properties and dimensions of phenomena.
(b)Explanatory Theory
Explanatory theories describe and explain the nature of relationships of certain phenomena to
other phenomena.
2.Prescriptive Theories
Address the nursing interventions for a phenomenon, guide practice change, and predict
consequences. Includes propositions that call for change.In nursing, prescriptive theories are
used to anticipate the outcomes of nursing interventions.
Other Ways of Classifying Nursing Theories
Classification According to Meleis
1.Needs-Based Theories.
The needs theorists were the first group of nurses who thought of giving nursing care a
conceptual order. Theories under this group are based on helping individuals to fulfill their
physical and mental needs. Theories of Orem, Henderson, and Abdella are categorized under
this group. Need theories are criticized for relying too much on the medical model of health
and placing the patient in an overtly dependent position.
2.Interaction Theories.
These theories placed the emphasis of nursing on the establishment and maintenance of
relationships and highlight the impact of nursing on patients and how they interact with the
environment, people, and situations. Theories of King, Orlando, and Travelbee are grouped
under this category.
3.Outcome Theories.
These theories describe the nurse as controlling and directing patient care by using their
knowledge of the human physiological and behavioral systems. Nursing theories of Johnson,
Levine, Rogers, and Roy belong to this group.
Classification According to Alligood
1.Nursing Philosophy. Is the most abstract type and sets forth the meaning of nursing
phenomena through analysis, reasoning, and logical presentation. Works of Nightingale,
Watson, Ray, and Benner are categorized under this group.
2.Nursing Conceptual Models. Are comprehensive nursing theories that are regarded by some
as pioneers in nursing. These theories address the nursing metaparadigm and explain the
relationship between them. Conceptual models of Levine, Rogers, Roy, King, and Orem are
under this group.
3.Grand Nursing Theories. Are works derived from nursing philosophies, conceptual models,
and other grand theories that are generally not as specific as middle-range theories. Works of
Levine, Rogers, Orem, and King are some of the theories under this category.
4.Middle-Range Theories. Are precise and answer specific nursing practice questions. They
address the specifics of nursing situations within the perspective of the model or theory from
which they are derived. Examples of Middle-Range theories are that of Mercer, Reed, Mishel,
and Barker.
NURSING THEORIES AND THEORISTS
 Florence Nightingale : Environmental Theory
Florence Nightingale is the founder of Modern Nursing and Pioneer of the Environmental
Theory.
Definition of Nursing : “the act of utilizing the environment of the patient to assist him in his
recovery.”
Evolution of nightingale theory:
Early at her work in army hospital Scutari. Nigtingale noted that the majority of the soldier
death was caused by transport to the hospital and condition in the hospital itself.Nightingale
found that open sewers and lack of cleanliness, pure air, fresh water, wholesome food were
most often the cause of soldier death than their wounds, she implemented changes to address
these problems.
Goals of nursing:The goal of nursing is to put the patient in the best condition for nature to
act upon him.
Nigtingale’s 13 canons:
1- Ventilation and warmth:
• Keeping patient and patient room warmth.
• Keeping patient room well ventilated and free of odors
• Keep the air within as pure as the air external without noxious smells.
2- Health of houses
• This canon includes five essentials of pure air, pure water, efficient
drainage, cleanliness, light
 • Eg: removing garbage or standing water
3- Petty management
• Continuity of care when nurse is absent
• Documentation of plan of care.
4- Noise
• Avoidance of sudden /startling noises
• Keeping noise in general to a minimum
• Refrain from whispering outside the door.
5- Variety
• Provide variety in the patients room to help him to avoid boredom and
depression.
• This is accomplished by cards, flowers, pictures, books or puzzles.
• Encourage significant othersto engage with the client.
6- Food intake
• Assess the diet of the client
• Documentation of amount of foods and liquids ingested at every meal.
7- Food
• Trying to include patients food preference.
• Attempts to ensure that the client always has some food or drink
available that she/he enjoys.
8- Bed and Bedding
• Comfort measures related to keeping the bed dry , wrinkle free and at
the lowest height to ensure clients comfort.
9- Light
• There should be adequate light.
• Sunlight works best.
• Develop and implement adequate light without placing the client in
direct light.
10- Cleanliness of rooms /walls
• Assess the room for dampness,darkness and dust or mildew.
• Keep the environment clean.
11- Chattering hopes and advices
 • Avoidance of talking without reason or giving advice that is without
fact.
• Continue to talk to the client as a person and stimulate the client’s mind.
• Avoid personal talks
12- Personal cleanliness
• Keeping the patient clean and dry all the time
• Frequent assessment of clients skin is needed to maintain adequate
moisture.
13- Observation of the sick
• Making and documenting observations
• Continue to observe the clients surroundings and environment.
Metaparadigms of nursing according to nightingale:
There are 4 metapardigms:
→ Person:
Recipient of nursing care. People are multidimensional , composed of biological,
psychological, social and spirutal components.
→ Environment
It can be internal as well as external environment, Poor or difficult environment lead
to poor health and disease. Environment could be altered to improve conditions so
natural laws would allow for healing to take place.
→ Health
“Health is not only to be well, but to be able to use well every power we have”.
Disease is considered as absence of comfort.6 D’s of Dys-ease are Drink, Dirt, Diet,
Damp, Draught and Drains(need proper drainage and sewer system.
→ Nursing
“Service to God in the relief of man”
Nursing is the activities that promote health which occur in any caregiving situations.
  Hildegard E. Peplau: Interpersonal Relations Theory
-Pioneered the Theory of Interpersonal Relations
Definition of nursing:
-Peplau’s theory defined Nursing as “An interpersonal process of therapeutic interactions
between an individual who is sick or in need of health services and a nurse especially educated
to recognize, respond to the need for help.”
Purpose of Theory
Focus on nurse-patient relationship
Identify different roles nurses take on when working with patients
Metaparadigm of Interpersonal Relationship theory
Client / Person
A developing organism that tries to reduce anxiety caused by needs
Nursing
A significant therapeutic interpersonal process
Functions cooperatively with other.
Health
Forward movement of personality and other ongoing human processes
In direction of creative, constructive, productive, personal and community living.
Environment
 Existing forces outside the organism and in the context of culture process that make health
possible for individuals in communities

Roles of the Nurse:

Stranger
Resource person
Teacher
Leader
Surrogate
Counselor
Phases in nurse-patient relationships
Orientation
Identification
Exploitation
Resolution
Limitations
Can not use with non-participative patient
Unable to participate (Unconscious, Catatonic)
Unwilling to participate ( No perceived need, Defiant)
Ways to enhance nursing care
Interactive care
Relationships enhance healing
Personal fulfillment

 VIRGINIA HENDERSON: NURSING NEED THEORY

-Focuses on the importance of increasing the patient’s independence to hasten their progress in
the hospital.
-Emphasizes the basic human needs and how nurses can assist in meeting those needs.
“The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is
result of the nurse’s creativity in planning for care.”

Assumptions

The major assumptions of the theory are:

• "Nurses care for patients until patient can care for themselves once again. Patients
desire to return to health, but this assumption is not explicitly stated.
• Nurses are willing to serve and that “nurses will devote themselves to the patient day
and night” A final assumption is that nurses should be educated at the university level
in both arts and sciences.

Henderson’s theory and the four major concepts

1. Individual

• Have basic needs that are component of health.

• Requiring assistance to achieve health and independence or a peaceful death.
• Mind and body are inseparable and interrelated.
• Considers the biological, psychological, sociological, and spiritual components.
 • The theory presents the patient as a sum of parts with biopsychosocial needs.

2. E n v i r o n m e n t

• Settings in which an individual learns unique pattern for living.

• All external conditions and influences that affect life and development.
• Individuals in relation to families
• Minimally discusses the impact of the community on the individual and family.
• Basic nursing care involves providing conditions under which the patient can perform
the 14 activities unaided

3. H e a l t h

• Definition based on individual’s ability to function independently as outlined in the 14

components.
• Nurses need to stress promotion of health and prevention and cure of disease.
• Good health is a challenge -affected by age, cultural background, physical, and
intellectual capacities, and emotional balance Is the individual’s ability to meet these
needs independently.

4. Nursing

• Temporarily assisting an individual who lacks the necessary strength, will and
knowledge to satisfy 1 or more of 14 basic needs.
• Assists and supports the individual in life activities and the attainment of independence.
• Nurse serves to make patient “complete” “whole", or "independent."
• The nurse is expected to carry out physician’s therapeutic plan Individualized care is
the result of the nurse’s creativity in planning for care.
• “Nurse should have knowledge to practice individualized and human care and should
be a scientific problem solver.”
• In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and supplement
his strength will or knowledge according to his needs.”

Henderson’s and Nursing Process

Nursing Process Henderson’s 14 components and definition of nursing

Nursing Henderson’s 14 components

Assessment

Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease.

Nursing plan Identify individual’s ability to meet own needs with or without
assistance, taking into consideration strength, will or knowledge.

Nursing Document how the nurse can assist the individual, sick or well.
implementation

Nursing Assist the sick or well individual in to performance of activities in

implementation meeting human needs to maintain health, recover from illness, or to aid
in peaceful death.

Nursing process Implementation based on the physiological principles, age, cultural

background, emotional balance, and physical and intellectual capacities.

Carry out treatment prescribed by the physician.

Nursing evaluation Henderson’s 14 components and definition of nursing

Use the acceptable definition of ;nursing and appropriate laws related to

the practice of nursing.

The quality of care is drastically affected by the preparation and native

ability of the nursing personnel rather that the amount of hours of care.

Successful outcomes of nursing care are based on the speed with which
or degree to which the patient performs independently the activities of
daily living

Characteristic of Henderson’s theory

• There is interrelation of concepts.

• Concepts of fundamental human needs, biophysiology, culture, and interaction,
communication are borrowed from other discipline.Eg.. Maslow’s theory.
• Her definition and components are logical and the 14 components are a guide for the
individual and nurse in reaching the chosen goal.
 • Relatively simple yet generalizable.
• Applicable to the health of individuals of all ages.
• can be the bases for hypotheses that can be tested.
• assist in increasing the general body of knowledge within the discipline.
• Her ideas of nursing practice are well accepted.
• can be utilized by practitioners to guide and improve their practice.

Limitations

• Lack of conceptual linkage between physiological and other human characteristics.

• No concept of the holistic nature of human being.
• If the assumption is made that the 14 components prioritized, the relationship among
the components is unclear.
• Lacks inter-relate of factors and the influence of nursing care.
• Assisting the individual in the dying process she contends that the nurse helps, but there
is little explanation of what the nurse does.
• “Peaceful death” is curious and significant nursing role.

 FAYE GLENN ABDELLAH: 21 NURSING PROBLEMS THEORY

-Developed the 21 Nursing Problems Theory
Definition of nursing
-“Nursing is based on an art and science that molds the attitudes, intellectual competencies,
and technical skills of the individual nurse into the desire and ability to help people, sick or
well, cope with their health needs.”-Abdella

Abdellah explained nursing as a comprehensive service, which includes:

1. Recognizing the nursing problems of the patient

2. Deciding the appropriate course of action to take in terms of relevant nursing principles
3. Providing continuous care of the individuals total needs
4. Providing continuous care to relieve pain and discomfort and provide immediate
security for the individual
5. Adjusting the total nursing care plan to meet the patient’s individual needs
 6. Helping the individual to become more self directing in attaining or maintaining a
healthy state of mind & body
7. Instructing nursing personnel and family to help the individual do for himself that which
he can within his limitations
8. Helping the individual to adjust to his limitations and emotional problems
9. Working with allied health professions in planning for optimum health on local, state,
national and international levels
10. Carrying out continuous evaluation and research to improve nursing techniques and to
develop new techniques to meet the health needs of people

MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS

• She uses the term ‘she’ for nurses, ‘he’ for doctors and patients, and refers to the object
of nursing as ‘patient’ rather than client or consumer.
• She referred to Nursing diagnosis during a time when nurses were taught that diagnosis
was not a nurses’ prerogative.

Assumptions were related to

• change and anticipated changes that affect nursing;

• the need to appreciate the interconnectedness of social enterprises and social problems;
• the impact of problems such as poverty, racism, pollution, education, and so forth on
health care delivery;
• changing nursing education
• continuing education for professional nurses
• development of nursing leaders from under reserved groups

Abdellah 10 steps to identify the client’s problems

• Learn to know the patient

• Sort out relevant and significant data
• Make generalizations about available data in relation to similar nursing problems
presented by other patients
• Identify the therapeutic plan
• Test generalizations with the patient and make additional generalizations
 • Validate the patient’s conclusions about his nursing problems
• Continue to observe and evaluate the patient over a period of time to identify any
attitudes and clues affecting his behavior
• Explore the patient’s and family’s reaction to the therapeutic plan and involve them in
the plan
• Identify how the nurses feels about the patient’s nursing problems
• Discuss and develop a comprehensive nursing care plan

11 nursing skills

• Observation of health status

• Skills of communication
• Application of knowledge
• Teaching of patients and families
• Planning and organization of work
• Use of resource materials
• Use of personnel resources
• Problem-solving
• Direction of work of others
• Therapeutic use of the self
• Nursing procedure

21 NURSING PROBLEMS

Three major categories

• Physical, sociological, and emotional needs of clients

• Types of interpersonal relationships between the nurse and patient
• Common elements of client care

BASIC TO ALL PATIENTS

• To maintain good hygiene and physical comfort

• To promote optimal activity: exercise, rest and sleep
• To promote safety through the prevention of accidents, injury, or other trauma and
through the prevention of the spread of infection
 • To maintain good body mechanics and prevent and correct deformity

SUSTENAL CARE NEEDS

• To facilitate the maintenance of a supply of oxygen to all body cells

• To facilitate the maintenance of nutrition of all body cells
• To facilitate the maintenance of elimination
• To facilitate the maintenance of fluid and electrolyte balance
• To recognize the physiological responses of the body to disease conditions
• To facilitate the maintenance of regulatory mechanisms and functions
• To facilitate the maintenance of sensory function.

REMEDIAL CARE NEEDS

• To identify and accept positive and negative expressions, feelings, and reactions
• To identify and accept the interrelatedness of emotions and organic illness
• To facilitate the maintenance of effective verbal and non verbal communication
• To promote the development of productive interpersonal relationships
• To facilitate progress toward achievement of personal spiritual goals
• To create and / or maintain a therapeutic environment
• To facilitate awareness of self as an individual with varying physical , emotional, and
developmental needs

RESTORATIVE CARE NEEDS

• To accept the optimum possible goals in the light of limitations, physical and emotional
• To use community resources as an aid in resolving problems arising from illness
• To understand the role of social problems as influencing factors in the case of illness

ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS

NURSING

• Nursing is a helping profession.

 • Nursing care is doing something to or for the person or providing information to the
person with the goals of meeting needs, increasing or restoring self-help ability, or
alleviating impairment.
• Nursing is broadly grouped into the 21 problem areas to guide care and promote use of
nursing judgment.
• Nursing to be comprehensive service.

PERSON

• Abdellah describes people as having physical, emotional, and sociological needs.

• Patient is described as the only justification for the existence of nursing.
• Individuals (and families) are the recipients of nursing
• Health, or achieving of it, is the purpose of nursing services.

HEALTH

• In Patient–Centered Approaches to Nursing, Abdellah describes health as a state

mutually exclusive of illness.
• Although Abdellah does not give a definition of health, she speaks to “total health
needs” and “a healthy state of mind and body” in her description of nursing as a
comprehensive service.

SOCIETY AND ENVIRONMENT

• Society is included in “planning for optimum health on local, state, national, and
international levels”. However, as she further delineated her ideas, the focus of nursing
service is clearly the individual.
• The environment is the home or community from which patient comes.

CHARACTERISTICS OF THE THEORY

• Abdellah’s theory has interrelated the concepts of health, nursing problems, and
problem solving.

• Problem solving is an activity that is inherently logical in nature.

• Framework focus on nursing practice and individuals.

 • The results of testing such hypothesis would contribute to the general body of nursing
knowledge

• Easy to apply in practice.

USE OF 21 PROBLEMS IN THE NURSING PROCESS

ASSESSMENT PHASE

• Nursing problems provide guidelines for the collection of data.

• A principle underlying the problem solving approach is that for each identified problem,
pertinent data are collected.
• The overt or covert nature of the problems necessitates a direct or indirect approach,
respectively.

NURSING DIAGNOSIS

• The results of data collection would determine the client’s specific overt or covert
problems.
• These specific problems would be grouped under one or more of the broader nursing
problems.
• This step is consistent with that involved in nursing diagnosis

PLANNING PHASE

• The statements of nursing problems most closely resemble goal statements. Once the
problem has been diagnosed, the nursing goals have been established.

IMPLEMENTATION

• Using the goals as the framework, a plan is developed and appropriate nursing
interventions are determined.

EVALUATION

• The most appropriate evaluation would be the nurse progress or lack of progress toward
the achievement of the stated goals.
  LYDIA E. HALL : CARE, CURE, CORE THEORY
-Developed the Care, Cure, Core Theory also known as the “Three Cs of Lydia Hall.“
Definition of nursing
-Hall defined Nursing as the “participation in care, core and cure aspects of patient care, where
CARE is the sole function of nurses, whereas the CORE and CURE are shared with other
members of the health team.”
Purpose
-The major purpose of care is to achieve an interpersonal relationship with the individual that
will facilitate the development of the core.
-The “care” circle defines the primary role of a professional nurse such as providing bodily
care for the patient. The “core” is the patient receiving nursing care. The “cure” is the aspect
of nursing which involves the administration of medications and treatments.
Metaparadigm

Person
- She viewed a patient as composed of three aspects: body, pathology and person. She
emphasized the importance of the individual as unique, capable of growth and learning and
requiring a total person approach. Patients achieve their maximal potential through learning
process, therefore, the chief therapy they need is teaching. (Sidon, 2014)
Environment
- The concept of environment is dealt with in relation to the individual. She was credited with
developing the concept of Loeb Center for Nursing because she assumed that the hospital
environment during the treatment of acute illness creates a difficult psychological experience
for the ill individual. Loeb Center focuses on providing an environment conducive to self
development in which the action of nurses is for assisting the individual in attaining a personal
goal.
Health
- Hall viewed becoming ill is behaviour. Illness is directed by feelings-out-of-awareness,
which are the root of adjustment difficulties. Healing may be hastened by helping people move
in the direction of self-awareness. Once people are brought to terms with their true feelings and
motivations, they become free to release their own powers of healing. Through the process of
reflection, the patient has the chance to move from the unlabeled threat of phobia or disease to
a properly labelled threat (fear) with which he can deal constructively.
Nursing
- Nursing is identified as consisting of participation in the care core and cure aspects of
nursing care. Nursing can and should be professional. Hall stipulated that patients should be
cared for only by professional nurses who can take total responsibility for the care and teaching
of their patients. Care is the sole function of the nurse, where as core and cure are shared with
other member of the health team. However the major purpose of care is to achieve an
interpersonal relationship with the individual that will facilitate the development of care.

Care
It alludes the “hands on”, intimate bodily care aspect of nursing of the patient and
implies a comforting, nurturing relationship. While intimate physical care is given, the patient
and the nurse develop a close relationship representing the teaching and learning aspect of
nursing. The natural and biological sciences (the Body). (Sidon, 2014)

• Nurturing component of care

• It is exclusive to nursing
• “Mothering”
• Provides teaching and learning activities
• Nurses goal is to “comfort” the patient
• Patient may explore and share feeling with nurse
• Nurse is concerned with intimate bodily care
 • Nurse applies knowledge of natural and biological sciences
• Nurse act as potential comforter

Core
It involves the therapeutic use of self in communicating with the patient. The nurse
through the use of reflective technique helps the patient clarify motives and goals, facilitating
the process of increasing the patients self awareness.

• Patient care is based on social sciences

• Therapeutic use of self
• Helps patient learn their role is in the healing process
• Patient is able to maintain who they are
• Patient able to develop a maturity level when nurse listens to them and acts as
sounding board
• Patient able to make informed decisions
• Emphasis on social, emotional, spiritual and intellectual needs
• Patient makes more rapid progress towards recovery and rehabilitation

Cure
It is the aspect of nursing involved with the administration of medications and
treatments. The nurse functions in his/her role as an investigator and potential cause of pain
related to skills such as injections and dressing changes. Seeing the patient, and family through
the medical care aspect of nursing.

• Care based on pathological and therapeutic sciences

• Application of medical knowledge by nurses
• Nurse assisting the doctor in performing tasks
• Nurse is patient advocate in this area
• Nurses role changes from positive quality to negative quality
• Medical surgical and rehabilitative care
• Cooperate with the families or care givers

General assumptions
 1. The motivation and energy necessary for healing exist within the patient, rather than
in the health care team.

2. The three aspects of nursing should not be viewed as functioning independently but
as interrelated.

3. The three aspects interact, and the circles representing them change size, depending
on the patient’s total course of progress.

 KATHRYN E. BARNARD :CHILD HEALTH ASSESSMENT MODEL

-Concerns improving the health of infants and their families.

-Her findings on parent-child interaction as an important predictor of cognitive development
helped shape public policy.
-Borrows from psychology and human development and focuses on mother-infant interaction
with the environment.
-Contributed a close link to practice that has modified the way health care providers assess
children in light of the parent-child relationship.

Major Concepts

Caregiver
• Physical Health
 • Mental Health
• Coping
• Educational Level
Environment
• Cultural Factors/Expectations
• Support Available
• Financial Resources
• Community Resources/Involvement
Child
• Sleep/Feeding Patterns
• Temperament
• Physical Appearance
• Physical/Mental Abilities

NURSING PARADIGM

• Person: to comprehend auditory, visual, and tactile stimuli; and then put this information
to good use.
• Health: family provides the basic preventative health care.
• Environment: places, people, objects, sounds, and sights.
• Nursing: education facilitates changes.

Strength of the model

 • To promote the health of this relationship, the main necessity is the family and the way
it interacts. Through a successful parent-child relationship, it is a way of preventative
health care, which will avoid behavioral issues as the child grows.

• Barnard also depicts anything that can come into play within the environment of the
parent and child. Animate and inanimate objects within the environment can affect the
relationship. Lastly, nurses promote healthy environments and educate.

• Encourage bonding among newborns and their parents and ensure that the changing
environment is adaptable.

Weaknesses: Some criticisms include how Dr. Barnard’s theory is population-specific but not
according to disciplines, which can also impact early interactions if someone is not trained with
infants. There’s also little information about the maintenance of a stable environment.

 NANCY ROPER, WINIFRED LOGAN, AND ALISON J. TIERNEY:A MODEL

FOR NURSING BASED ON A MODEL OF LIVING
Logan produced a simple theory, “which actually helped bedside nurses.”
The activities of living listed in the Roper-Logan-Tierney Model of Nursing are:

• maintaining a safe environment

• communication

• breathing

• eating and drinking

• elimination

• washing and dressing

• controlling temperature

• mobilization

• working and playing

• sleeping
Five factors influencing activities of living

According to the model, there are five factors that influence the activities of living. The
incorporation of these factors into the theory of nursing makes it a holistic model. If they aren’t
considered, the resulting assessment is incomplete and flawed. The factors are used to
determine the individual patient’s relative independence in regards to the activities of daily
living.
They are:

→ biological
→ psychological
→ sociocultural
→ Environmental
→ politicoeconomic.

The biological factor addresses the impact of the overall health, of current injury and illness,
and the scope of the patient’s anatomy and physiology. The psychological factor addresses the
impact of emotion, cognition, spiritual beliefs, and the ability to understand. According to
Roper, this is about “knowing, thinking, hoping, feeling and believing.”

The sociocultural factor is the impact of society and culture as experienced by the individual
patient. This includes expectations and values based on class and status, and culture within the
sociocultural factor relates to the beliefs, expectations, and values held by the individual patient
for him or herself, as well as by others pertaining to independence in and ability to carry out
the activities of daily living.

The environmental factor in Roper’s theory of nursing makes it a “green” model. The theory
takes into consideration the impact of the environment on the activities of daily living, but also
examines the impact of the activities of daily living on the environment. The politicoeconomic
factor is the impact of the government, politics, and economy on the activities of daily living.
This factor addresses issues such as funding, government policies and programs, war or
conflict, availability to benefits, political reforms, interest rates, and availability of public and
private funding, among others.
  IDA JEAN ORLANDO: NURSING PROCESS THEORY
-She developed the Nursing Process Theory.
-“Patients have their own meanings and interpretations of situations and therefore nurses must
validate their inferences and analyses with patients before drawing conclusions.”
-Allows nurses to formulate an effective nursing care plan that can also be easily adapted when
and if any complexity comes up with the patient.
-According to her, persons become patients requiring nursing care when they have needs for
help that cannot be met independently because of their physical limitations, negative reactions
to an environment, or have an experience that prevents them from communicating their needs.
-The role of the nurse is to find out and meet the patient’s immediate needs for help.
 JEAN WATSON: THEORY OF HUMAN CARING
Definition of nursing
-“Nursing is concerned with promoting health, preventing illness, caring for the sick, and
restoring health.”
Mainly concerns on how nurses care for their patients, and how that caring progresses into
better plans to promote health and wellness, prevent illness and restore health.
Focus
-Focuses on health promotion, as well as the treatment of diseases.
-Caring is central to nursing practice and promotes health better than a simple medical cure.

THE 7 ASSUMPTIONS

1. Caring can be effectively demonstrated and practiced only interpersonally.

2. Caring consists of carative factors that result in the satisfaction of certain human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as what he or she may
become.
5. A caring environment is one that offers the development of potential while allowing the
person to choose the best action for himself or herself at a given point in time.
6. Caring is more “healthogenic” than is curing. A science of caring is complementary to
the science of curing.
7. The practice of caring is central to nursing.
WATSON’S THEORY METAPARADIGM

Human Being

“A valued person in and of him or herself to be cared for, respected, nurtured, understood and
assisted; in general a philosophical view of a person as a fully functional integrated self. He,
human is viewed as greater than and different from, the sum of his or her parts”.
Health:

Watson adds the following three elements to WHO definition of health:

1. A high level of overall physical, mental and social functioning.

2. A general adaptive-maintenance level of daily functioning.
3. The absence of illness (or the presence of efforts that leads its absence).

Environment/society:

According to Watson, caring (and nursing) has existed in every society. A caring attitude is
not transmitted from generation to generation. It is transmitted by the culture of the profession
as a unique way of coping with its environment.
Nursing:

“Nursing is concerned with promoting health, preventing illness, caring for the sick and
restoring health”. It focuses on health promotion and treatment of disease. She believes that
holistic health care is central to the practice of caring in nursing. She defines nursing as “a
human science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, aesthetic and ethical human transactions”.

10 PRIMARY CARATIVE FACTORS

According to Watson (1997), the core of the Theory of Caring is that “humans cannot be treated
as objects and that humans cannot be separated from self, other, nature, and the larger
workforce.The structure for the science of caring is built upon ten carative factors. These are:
 1. Embrace: Altruistic Values and Practice Loving Kindness with Self and Others
2. Inspire: Faith and Hope and Honor Others
3. Trust: Self and Others by Nurturing Individual Beliefs, Personal Growth and Practices
4. Nurture: Helping, Trusting, Caring Relationships
5. Forgive: and Accept Positive and Negative Feelings – Authentically Listen to Another’s
Story
6. Deepen: Scientific Problem Solving Methods for Caring Decision Making
7. Balance: Teaching and Learning to Address the Individual Needs, Readiness and
Learning Styles
8. Co-Create: a Healing Environment for the Physical and Spiritual Self which Respects
Human Dignity
9. Minister: To Basic Physical, Emotional and Spiritual Human Needs
10. Open: to Mystery and Allow Miracles to Enter

Strengths

• This theory places the client in the context of the family, community and culture.
• It places the client as the focus of practice rather than the technology.

Limitations

• Biophysical needs of the individual are given less importance.

• The ten carative factors primarily delineate the psychosocial needs of the person.
• Needs further research to apply in practice and may be considered too abstract.

 KATIE ERIKSSON: THEORY OF CARATIVE CARING

-“Caritative nursing means that we take ‘caritas’ into use when caring for the human being in
health and suffering.Caritative caring is a manifestation of the love that ‘just exists’.Caring
communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering
of the patient.”
-The ultimate goal of caring is to lighten suffering and serve life and health.
-Inspired many in the Nordic countries, and used as the basis of research, education, and clinical
practice.
 MYRA ESTRIN LEVINE: CONSERVATION MODEL FOR NURSING
-According to the Conservation Model, “Nursing is human interaction.”
-Provides a framework within which to teach beginning nursing students.
-Logically congruent, is externally and internally consistent, has breadth as well as depth, and
is understood, with few exceptions, by professionals and consumers of health care.
 MARTHA ROGERS: THEORY OF UNITARY HUMAN BEINGS
Definition of nursing
Rogers’ theory defined Nursing as “an art and science that is humanistic and humanitarian. It
is directed toward the unitary human and is concerned with the nature and direction of human
development. The goal of nurses is to participate in the process of change.”

Two dimensions

According to Rogers, the Science of Unitary Human Beings contains two dimensions: the
science of nursing, which is the knowledge specific to the field of nursing that comes from
scientific research; and the art of nursing, which involves using the science of nursing
creatively to help better the life of the patient.

Assumptions

The assumptions of Rogers’ Theory of Unitary Human Beings are as follows: (1) Man is a
unified whole possessing his own integrity and manifesting characteristics that are more than
and different from the sum of his parts. (2) Man and environment are continuously exchanging
matter and energy with one another. (3) The life process evolves irreversibly and
unidirectionally along the space-time continuum. (4) Pattern and organization identify the man
and reflect his innovative wholeness. And lastly, (5) Man is characterized by the capacity for
abstraction and imagery, language and thought sensation and emotion.

Major Concepts

The following are the major concepts and metaparadigm of Martha Rogers’ nursing theory:

Human-unitary human beings

A person is defined as an indivisible, pan-dimensional energy field identified by a pattern, and

manifesting characteristics specific to the whole, and that can’t be predicted from knowledge
of the parts. A person is also a unified whole, having its own distinct characteristics that can’t
be viewed by looking at, describing, or summarizing the parts.

Health

Rogers defines health as an expression of the life process. It is the characteristics and behavior
coming from the mutual, simultaneous interaction of the human and environmental fields, and
health and illness are part of the same continuum. The multiple events occurring during the life
process show the extent to which a person is achieving his or her maximum health potential.
The events vary in their expressions from greatest health to those conditions that are
incompatible with the maintaining life process.

Nursing

It is the study of unitary, irreducible, indivisible human and environmental fields: people and
their world. Rogers claims that nursing exists to serve people, and the safe practice of nursing
depends on the nature and amount of scientific nursing knowledge the nurse brings to his or
her practice

Scope of Nursing

Nursing aims to assist people in achieving their maximum health potential. Maintenance and
promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation
encompass the scope of nursing’s goals.

Nursing is concerned with people-all people-well and sick, rich and poor, young and old. The
arenas of nursing’s services extend into all areas where there are people: at home, at school, at
work, at play; in hospital, nursing home, and clinic; on this planet and now moving into outer
space.

Environmental Field

“An irreducible, indivisible, pandimensional energy field identified by pattern and integral with
the human field.”

Energy Field
The energy field is the fundamental unit of both the living and the non-living. It provides a way
to view people and the environment as irreducible wholes. The energy fields continuously vary
in intensity, density, and extent.

Subconcepts

Openness

There are no boundaries that stop energy flow between the human and environmental fields,
which is the openness in Rogers’ theory. It refers to qualities exhibited by open systems; human
beings and their environment are open systems.

Pandimensional

Pan-dimensionality is defined as “non-linear domain without spatial or temporal attributes.”

The parameters that humans use in language to describe events are arbitrary, and the present is
relative; there is no temporal ordering of lives.

Synergy is defined as the unique behavior of whole systems, unpredicted by any behaviors of
their component functions taken separately.

Pattern

Rogers defined the pattern as the distinguishing characteristic of an energy field seen as a single
wave. It is an abstraction and gives identity to the field.

Principles of Homeodynamics

Homeodynamics should be understood as a dynamic version of homeostasis (a relatively steady

state of internal operation in the living system).

Homeodynamic principles postulate a way of viewing unitary human beings. The three
principles of homeodynamics are resonance, helicy, and integrality.

Principle of Reciprocy
Postulates the inseparability of man and environment and predicts that sequential changes in
life process are continuous, probabilistic revisions occurring out of the interactions between
man and environment.

Principle of Synchrony

This principle predicts that change in human behavior will be determined by the simultaneous
interaction of the actual state of the human field and the actual state of the environmental field
at any given point in space-time.

Principle of Integrality (Synchrony + Reciprocy)

Because of the inseparability of human beings and their environment, sequential changes in the
life processes are continuous revisions occurring from the interactions between human beings
and their environment.

Between the two entities, there is a constant mutual interaction and mutual change whereby
simultaneous molding is taking place in both at the same time.

Principle of Resonancy

It speaks to the nature of the change occurring between human and environmental fields. The
life process in human beings is a symphony of rhythmical vibrations oscillating at various
frequencies.

It is the identification of the human field and the environmental field by wave patterns
manifesting continuous change from longer waves of lower frequency to shorter waves of
higher frequency.

Principle of Helicy

The human-environment field is a dynamic, open system in which change is continuous due to
the constant interchange between the human and environment.

This change is also innovative. Because of constant interchange, an open system is never
exactly the same at any two moments; rather, the system is continually new or different.
Science of Unitary Human Beings and Nursing Process

The nursing process has three steps in Rogers’ Theory of Unitary Human Beings: assessment,
voluntary mutual patterning, and evaluation.

The areas of assessment are: the total pattern of events at any given point in space-time,
simultaneous states of the patient and his or her environment, rhythms of the life process,
supplementary data, categorical disease entities, subsystem pathology, and pattern appraisal.
The assessment should be a comprehensive assessment of the human and environmental fields.

 Assumptions

 The assumptions of Rogers’ Theory of Unitary Human Beings are as follows: (1) Man
is a unified whole possessing his own integrity and manifesting characteristics that are
more than and different from the sum of his parts. (2) Man and environment are
continuously

 Strengths

 Martha Rogers’ concepts provide a worldview from which nurses may derive theories
and hypotheses and propose relationships specific to different situations.

 Rogers’ theory is not directly testable due to lack of concrete hypotheses, but it is
testable in principle.

 Weaknesses

 Rogers’ model does not define particular hypotheses or theories for it is an abstract,
unified and highly derived framework.

 Testing the concepts’ validity is questionable because its concepts are not directly
measurable.
The theory was believed to be profound and was too ambitious because the concepts are
extremely abstract.

Rogers claimed that nursing exists to serve people, however, nurses’ roles were not clearly
defined.The purpose of nurses is to promote health and well-being for all persons wherever
they are. However, Rogers’ model has no concrete definition of health state.

DOROTHEA E. OREM: SELF-CARE THEORY

In her Self-Care Theory, she defined Nursing as “The act of assisting others in the provision
and management of self-care to maintain or improve human functioning at home level of
effectiveness.”
Focuses on each individual’s ability to perform self-care.
Composed of three interrelated theories:
(1) the theory of self-care
(2) the self-care deficit theory, and
(3) the theory of nursing systems, which is further classified into wholly compensatory,
partially compensatory and supportive-educative.

Assumptions of the Self-Care Deficit Theory

(1) In order to stay alive and remain functional, humans engage in constant communication
and connect among themselves and their environment.

(2) The power to act deliberately is exercised to identify needs and to make needed judgments.
(3) Mature human beings experience privations in the form of action in care of self and others
involving making life-sustaining and function-regulating actions.

(4) Human agency is exercised in discovering, developing, and transmitting to others ways
and means to identify needs for, and make inputs into, self and others. (5) Groups of human
beings with structured relationships cluster tasks and allocate responsibilities for providing care
to group members.

Major Concepts of the Self-Care Deficit Theory

Nursing

Nursing is an art through which the practitioner of nursing gives specialized assistance to
persons with disabilities which makes more than ordinary assistance necessary to meet needs
for self-care. The nurse also intelligently participates in the medical care the individual receives
from the physician.

Humans

Humans are defined as “men, women, and children cared for either singly or as social units,”
and are the “material object” of nurses and others who provide direct care.

Environment

The environment has physical, chemical and biological features. It includes the family, culture,
and community.

Health

Health is “being structurally and functionally whole or sound.” Also, health is a state that
encompasses both the health of individuals and of groups, and human health is the ability to
reflect on one’s self, to symbolize experience, and to communicate with others.

Self-Care

Self-care is the performance or practice of activities that individuals initiate and perform on
their own behalf to maintain life, health, and well-being.

Basic Conditioning Factors

Basic conditioning factors are age, gender, developmental state, health state, socio-cultural
orientation, health care system factors, family system factors, patterns of living, environmental
factors, and resource adequacy and availability.
Theories

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated

theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing
systems, which is further classified into wholly compensatory, partial compensatory and
supportive-educative.

Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals initiate and
perform on their own behalf to maintain life, health and well-being.

Self-Care Requisites

Self-care Requisites or requirements can be defined as actions directed toward the provision of
self-care. It is presented in three categories:
Universal Self-Care Requisites

Universal self-care requisites are associated with life processes and the maintenance of the
integrity of human structure and functioning.

• The maintenance of a sufficient intake of air

• The maintenance of a sufficient intake of water

• The maintenance of a sufficient intake of food

• The provision of care associated with elimination process and excrements

• The maintenance of a balance between activity and rest

• The maintenance of a balance between solitude and social interaction

• The prevention of hazards to human life, human functioning, and human well-being

• The promotion of human functioning and development within social groups in

accord with human potential, known human limitations, and the human desire to be
normal
Normalcy is used in the sense of that which is essentially human and that which is in accord
with the genetic and constitutional characteristics and the talents of individuals.

Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of universal self-care

requisites that have been particularized for developmental processes or they are new requisites
derived from a condition or associated with an event.”

Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury, or disease or
may result from medical measures required to diagnose and correct the condition.

• Seeking and securing appropriate medical assistance

• Being aware of and attending to the effects and results of pathologic conditions and
states
 • Effectively carrying out medically prescribed diagnostic, therapeutic, and
rehabilitative measures

• Being aware of and attending to or regulating the discomforting or deleterious

effects of prescribed medical measures

• Modifying the self-concept (and self-image) in accepting oneself as being in a

particular state of health and in need of specific forms of health care

• Learning to live with the effects of pathologic conditions and states and the effects
of medical diagnostic and treatment measures in a lifestyle that promotes continued
personal development

Theory of Self-Care Deficit

This theory delineates when nursing is needed. Nursing is required when an adult (or in the
case of a dependent, the parent or guardian) is incapable of or limited in the provision of
continuous effective self-care. Orem identified 5 methods of helping:

• Acting for and doing for others

• Guiding others

• Supporting another

• Providing an environment promoting personal development in relation to meet

future demands

• Teaching another

Theory of Nursing System

• This theory is the product of a series of relations between the persons: legitimate nurse
and legitimate client. This system is activated when the client’s therapeutic self-care
demand exceeds available self-care agency, leading to the need for nursing.

Wholly Compensatory Nursing System

• This is represented by a situation in which the individual is unable “to engage in those
self-care actions requiring self-directed and controlled ambulation and manipulative
 movement or the medical prescription to refrain from such activity… Persons with
these limitations are socially dependent on others for their continued existence and
well-being.”

• Example: care of a newborn, care of client recovering from surgery in a post-anesthesia

care unit

Partial Compensatory Nursing System

• This is represented by a situation in which “both nurse and perform care measures or
other actions involving manipulative tasks or ambulation… [Either] the patient or the
nurse may have a major role in the performance of care measures.”

• Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal tray
for client who can feed himself

Supportive-Educative System

This is also known as supportive-developmental system, the person “is able to perform or can
and should learn to perform required measures of externally or internally oriented therapeutic
self-care but cannot do so without assistance.”

Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client
on more adaptive coping strategies.

Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and to define the roles
of persons or nurse to meet the self-care demands.

Assessment

• Diagnosis and prescription; determine why nursing is needed. Analyze and interpret
by making a judgment regarding care.

• Design of a nursing system and plan for delivery of care.

 • Production and management of nursing systems.
Step 1 – Collect Data in Six Areas

1. The person’s health status

1. The physician’s perspective of the person’s health status

2. The person’s perspective of his or health health

3. The health goals within the context of life history, lifestyle, and health status.

4. The person’s requirements for self-care

5. The person’s capacity to perform self-care

Nursing Diagnosis & Care Plans

Step 2

• The nurse designs a system that is wholly or partly compensatory or supportive-

educative.

• The two actions are: (1) Bringing out a good organization of the components of
patients’ therapeutic self-care demands. (2) Selection of combination of ways of
helping that will be effective and efficient in compensating for/overcoming patient’s
self-care deficits.

Implementation & Evaluation

Step 3

• Nurse assists the patient or family in self-care matters to achieve identified and
described health and health-related results. Collecting evidence in evaluating results
achieved against results specified in the nursing system design.

• Actions are directed by etiology component of nursing diagnosis.

Analysis of the Self-Care Deficit Theory

There is a superb focus of Orem’s work which is self-care. Even though there is a wide range
of scope seen in the encompassing theory of nursing systems, Orem’s goal of letting the readers
view nursing care as a way to provide assistance to people was apparent in every concept
presented.

From the definition of health which is sought to be rigid, it can now be refined by making it
suitable to the general view of health as a dynamic and ever-changing state.

The role of the environment to the nurse-patient relationship, although defined by Orem was
not discussed.

The role of nurses in maintaining health for the patient was set by Orem with great coherence
in accordance with the life-sustaining needs of every individual.

Strengths

• A major strength of Dorothea Orem’s theory is that it is applicable for nursing by

the beginning practitioner as well as the advanced clinicians.

• Orem’s theory provides a comprehensive basis for nursing practice. It has utility for
professional nursing in the areas of nursing practice, nursing education and
administration.

• The terms self-care, nursing systems, and self-care deficit are easily understood by
the beginning student nurse and can be explored in greater depth as the nurse gains
more knowledge and experience.

• She specifically defines when nursing is needed: Nursing is needed when the
individual cannot maintain continuously that amount and quality of self-care
necessary to sustain life and health, recover from disease or injury, or cope with
their effects.

• Her self-care approach is contemporary with the concepts of health promotion and
health maintenance.
 • Three identifiable nursing systems were clearly delineated and are easily
understood.

Limitations

• Orem’s theory, in general, is viewed as a single whole thing while Orem defines a
system as a single whole thing.

• Orem’s theory is simple yet complex. The use of self-care in multitudes of terms,
such as self-care agency, self-care demand, self-care deficit, self-care requisites, and
universal self-care, can be very confusing to the reader.

• Orem’s definition of health was confined in three static conditions which she refers
to a “concrete nursing system,” which connotes rigidity.

• Throughout her work, there is limited acknowledgement of the individual’s

emotional needs.

• Health is often viewed as dynamic and ever-changing.

 IMOGENE M. KING: THEORY OF GOAL ATTAINMENT

Theory of goal attainment was first introduced by Imogene King in the early 1960’s.Theory
describes a dynamic, interpersonal relationship in which a person grows and develops to attain
certain life goals.

· Factors which affect the attainment of goal are:

→ Roles
→ Stress
→ space
→ time

Definition of nursing
“Nursing is a process of action, reaction and interaction by which nurse and client share
information about their perception in a nursing situation” and “a process of human interactions
between nurse and client whereby each perceives the other and the situation, and through
communication, they set goals, explore means, and agree on means to achieve goals.”
Goal Attainment Theory Conceptual Framework

It includes:

• Several basic assumptions

• Three interacting systems
• Several concepts relevant for each system

Basic assumptions

• Nursing focus is the care of human being.

• Nursing goal is the health care of individuals & groups.
• Human beings: are open systems interacting constantly with their environment.

Interacting systems:

• Personal system
• Interpersonal system
• Social system
METAPARADIGM

• Nursing

Nursing is a process of action, reaction, and interaction whereby nurse and client share
information about their perceptions in the nursing situation. The nurse and client share specific
goals, problems, and concerns and explore means to achieve a goal.

• Health

Health is a dynamic life experience of a human being, which implies continuous adjustment to
stressors in the internal and external environment through optimum use of one’s resources to
achieve maximum potential for daily living.

• Individual

Individuals are social beings who are rational and sentient. Humans communicate their
thoughts, actions, customs, and beliefs through language. Persons exhibit common
characteristics such as the ability to perceive, to think, to feel, to choose between alternative
courses of action, to set goals, to select the means to achieve goals, and to make decisions.

• Environment

Environment is the background for human interactions. It is both external to, and internal to,
the individual.

 Betty Neuman: Neuman’s Systems Model

Definition

Betty Neuman describes the Neuman Systems Model as “a unique, open-system-based

perspective that provides a unifying focus for approaching a wide range of concerns. A system
acts as a boundary for a single client, a group, or even a number of groups; it can also be defined
as a social issue. A client system in interaction with the environment delineates the domain of
nursing concerns.”

The Neuman Systems Model views the client as an open system that responds to stressors in
the environment. The client variables are physiological, psychological, sociocultural,
developmental, and spiritual. The client system consists of a basic or core structure that is
protected by lines of resistance. The usual level of health is identified as the normal line of
defense that is protected by a flexible line of defense. Stressors are intra-, inter-, and
extrapersonal in nature and arise from the internal, external, and created environments. When
stressors break through the flexible line of defense, the system is invaded and the lines of
resistance are activated and the system is described as moving into illness on a wellness-illness
continuum. If adequate energy is available, the system will be reconstituted with the normal
line of defense restored at, below, or above its previous level.

Nursing interventions occur through three prevention modalities. Primary prevention occurs
before the stressor invades the system; secondary prevention occurs after the system has reacted
to an invading stressor; tertiary prevention occurs after secondary prevention as reconstitution
is being established.

Assumptions

The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:

• Each client system is unique, a composite of factors and characteristics within a

given range of responses.

• Many known, unknown, and universal stressors exist. Each differs in its potential
for disturbing a client’s usual stability level or normal line of defense. The particular
interrelationships of client variables at any point in time can affect the degree to
which a client is protected by the flexible line of defense against possible reaction
to stressors.
 • Each client/client system has evolved a normal range of responses to the
environment that is referred to as a normal line of defense. The normal line of
defense can be used as a standard from which to measure health deviation.

• When the flexible line of defense is no longer capable of protecting the client/client
system against an environmental stressor, the stressor breaks through the normal
line of defense.

• The client, whether in a state of wellness or illness, is a dynamic composite of the

interrelationships of the variables. Wellness is on a continuum of available energy
to support the system in an optimal state of system stability.

• Implicit within each client system are internal resistance factors known as lines of
resistance, which function to stabilize and realign the client to the usual wellness
state.

• Primary prevention relates to general knowledge that is applied in client assessment

and intervention, in identification and reduction or mitigation of possible or actual
risk factors associated with environmental stressors to prevent possible reaction.

• Secondary prevention relates to symptomatology following a reaction to stressors,

appropriate ranking of intervention priorities, and treatment to reduce their noxious
effects.

• Tertiary prevention relates to the adjustive processes taking place as reconstitution

begins and maintenance factors move the client back in a circular manner toward
primary prevention.

• The client as a system is in dynamic, constant energy exchange with the

environment. (Neuman, 1995)

Major Concepts of Neuman Systems Model

In this section, we will define the nursing metaparadigm and the major concepts in Betty
Neuman’s Neuman Systems Model.
Human being

Human being is viewed as an open system that interacts with both internal and external
environment forces or stressors. The human is in constant change, moving toward a dynamic
state of system stability or toward illness of varying degrees.

Environment

The environment is a vital arena that is germane to the system and its function. The
environment may be viewed as all factors that affect and are affected by the system. In Neuman
Systems Model identifies three relevant environments: (1) internal, (2) external, and (3)
created.

• The internal environment exists within the client system. All forces and interactive
influences that are solely within boundaries of the client system make up this
environment.
 • The external environment exists outside the client system.

• The created environment is unconsciously developed and is used by the client to

support protective coping.

Health

In Neuman’s nursing theory, Health is defined as the condition or degree of system stability
and is viewed as a continuum from wellness to illness. When system needs are met, optimal
wellness exists. When needs are not satisfied, illness exists. When the energy needed to support
life is not available, death occurs.

Nursing

The primary concern of nursing is to define the appropriate action in situations that are stress-
related or in relation to possible reactions of the client or client system to stressors. Nursing
interventions are aimed at helping the system adapt or adjust and to retain, restore, or maintain
some degree of stability between and among the client system variables and environmental
stressors with a focus on conserving energy.

Open System

A system in which there is a continuous flow of input and process, output and feedback. It is a
system of organized complexity, where all elements are in interaction.

Basic Stricture and Energy Resources

The basic structure, or central core, is made up of those basic survival factors common to the
species. These factors include the system variables, genetic features, and strengths and
weaknesses of the system parts.

Client Variables

Neuman views the individual client holistically and considers the variables simultaneously and
comprehensively.

• The physiological variable refers to the structure and functions of the body.
 • The psychological variable refers to mental processes and relationships.

• The sociocultural variable refers to system functions that relate to social and
culturalexpectations and activities.

• The developmental variable refers to those processes related to development over

the lifespan.

• The spiritual variable refers to the influence of spiritual beliefs.

Flexible line of defense

A protective accordion-like mechanism that surrounds and protects the normal line of defense
from invasion by stressors.

Normal line of defense

An adaptational level of health developed over time and considered normal for a particular
individual client or system; it becomes a standard for wellness-deviance determination.

Lines of resistance

Protection factors activated when stressors have penetrated the normal line of defense, causing
a reaction synptomatology.

Subconcepts of Neuman Systems Model

Stressors

A stressor is any phenomenon that might penetrate both the flexible and normal lines of
defense, resulting in either a positive or negative outcome.

• Intrapersonal stressors are those that occur within the client system boundary and
correlate with the internal environment.

• Interpersonal stressors occur outside the client system boundary, are proximal to the
system, and have an impact on the system.
 • Extrapersonal stressors also occur outside the client system boundaries but are at a
greater distance from the system that are interpersonal stressors. An example is
social policy.

Stability

A state of balance or harmony requiring energy exchanges as the client adequately copes with
stressors to retain, attain, or maintain an optimal level of health thus preserving system
integrity.

Degree of Reaction

The amount of system instability resulting from stressor invasion of the normal line of defense.

Entropy

A process of energy depletion and disorganization moving the system toward illness or possible
death.

Negentropy

A process of energy conservation that increases organization and complexity, moving the
system toward stability or a higher degree of wellness.

Input/Output

The matter, energy, and information exchanged between the client and environment that is
entering or leaving the system at any point in time.

Reconstitution

The return and maintenance of system stability, following treatment of stressor reaction, which
may result in a higher or lower level of wellness.

Prevention as Intervention
Intervention modes for nursing action and determinants for entry of both client and nurse into
the health care system.

• Primary prevention occurs before the system reacts to a stressor; it includes health
promotion and maintenance of wellness. Primary prevention focuses on
strengthening the flexible line of defense through preventing stress and reducing risk
factors. This intervention occurs when the risk or hazard is identified but before a
reaction occurs. Strategies that might be used include immunization, health
education, exercise, and lifestyle changes.

• Secondary prevention occurs after the system reacts to a stressor and is provided in
terms of existing symptoms. Secondary prevention focuses on strengthening the
internal lines of resistance and, thus, protects the basic structure through appropriate
treatment of symptoms. The intent is to regain optimal system stability and to
conserve energy in doing so. If secondary prevention is unsuccessful and
reconstitution does not occur, the basic structure will be unable to support the system
and its interventions, and death will occur.

• Tertiary prevention occurs after the system has been treated through secondary
prevention strategies. Its purpose is to maintain wellness or protect the client system
reconstitution through supporting existing strengths and continuing to preserve
energy. Tertiary prevention may begin at any point after system stability has begun
to be reestablished (reconstitution has begun). Tertiary prevention tends to lead back
to primary prevention. (Neuman, 1995)

Strengths

• The major strength of the Neuman Systems Model is its flexibility for use in all
areas of nursing – administration, education, and practice.

• Neuman has presented a view of the client that is equally applicable to an individual,
a family, a group, a community, or any other aggregate.

• The Neuman Systems Model, particularly presented in the model diagram, is

logically consistent.
 • The emphasis on primary prevention, including health promotion, is specific to this
model.

• Once understood, the Neuman Systems Model is relatively simple, and has readily
acceptable definitions of its components.

Weaknesses

• The major weakness of the model is the need for further clarification of terms used.

• Interpersonal and extrapersonal stressors need to be more clearly differentiated.

 SISTER CALLISTA ROY: ADAPTATION MODEL OF NURSING
In Adaptation Model, Roy defined nursing as a “health care profession that focuses on human
life processes and patterns and emphasizes promotion of health for individuals, families,
groups, and society as a whole.”

The Adaptive Model makes ten explicit assumptions:

1. The person is a bio-psycho-social being.

2. The person is in constant interaction with a changing environment.

3. To cope with a changing world, a person uses coping mechanisms, both innate and acquired,
which are biological, psychological, and social in origin.

4. Health and illness are inevitable dimensions of a person’s life.

5. In order to respond positively to environmental changes, a person must adapt.

6. A person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.

7. The person’s adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.

8. The person has four modes of adaptation: physiologic needs, self-concept, role function,
and interdependence.

9. Nursing accepts the humanistic approach of valuing others’ opinions and perspectives.
Interpersonal relations are an integral part of nursing.

10. There is a dynamic objective for existence with the ultimate goal of achieving dignity and
integrity.
There are also four implicit assumptions which state:

1. A person can be reduced to parts for study and care.

2. Nursing is based on causality.

3. A patient’s values and opinions should be considered and respected.

4. A state of adaptation frees a person’s energy to respond to other stimuli.

The Adaptation Model includes a six-step nursing process.

1. The first level of assessment, which addresses the patient’s behavior

2. The second level of assessment, which addresses the patient’s stimuli

3. Diagnosis of the patient

4. Setting goals for the patient’s health

5. Intervention to take actions in order to meet those goals

6. Evaluation of the result to determine if goals were met

Major Concepts of the Adaptation Model

The following are the major concepts of Callista Roy’s Adaptation Model including the
definition of the nursing metaparadigm as defined by the theory.

Person

“Human systems have thinking and feeling capacities, rooted in consciousness and meaning,
by which they adjust effectively to changes in the environment and, in turn, affect the
environment.”

Based on Roy, humans are holistic beings that are in constant interaction with their
environment. Humans use a system of adaptation, both innate and acquired, to respond to the
environmental stimuli they experience. Human systems can be individuals or groups, such as
families, organizations, and the whole global community.

Environment
The environment is defined as conditions, circumstances, and influences that affect the
development and behavior of humans as an adaptive system. The environment is a stimulus or
input that requires a person to adapt. These stimuli can be positive or negative.

Roy categorized these stimuli as focal, contextual, and residual. Focal stimuli are that which
confronts the human system and requires the most attention. Contextual stimuli are
characterized as the rest of the stimuli that present with the focal stimuli and contribute to its
effect. Residual stimuli are the additional environmental factors present within the situation,
but whose effect is unclear. This can include previous experience with certain stimuli.

Health

Health is defined as the state where humans can continually adapt to stimuli. Because illness
is a part of life, health is the result of a process where health and illness can coexist. If a human
can continue to adapt holistically, they will be able to maintain health to reach completeness
and unity within themselves. If they cannot adapt accordingly, the integrity of the person can
be affected negatively.

Nursing

In Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s behaviors
for adaptation, promote positive adaptation by enhancing environment interactions and helping
patients react positively to stimuli. Nurses eliminate ineffective coping mechanisms and
eventually lead to better outcomes.

Adaptation

Adaptation is the “process and outcome whereby thinking and feeling persons as individuals
or in groups use conscious awareness and choice to create human and environmental
integration.”

Internal Processes

Regulator
The regulator subsystem is a person’s physiological coping mechanism. It’s the body’s attempt
to adapt via regulation of our bodily processes, including neurochemical, and endocrine
systems.

Cognator

The cognator subsystem is a person’s mental coping mechanism. A person uses his brain to
cope via self-concept, interdependence, and role function adaptive modes.

Four Adaptive Modes

The four adaptive modes of the subsystem are how the regulator and cognator mechanisms are
manifested; in other words, they are the external expressions of the above and internal
processes.

Physiological-Physical Mode

Physical and chemical processes involved in the function and activities of living organisms.
These are the actual processes put in motion by the regulator subsystem.
The basic need of this mode is composed of the needs associated with oxygenation, nutrition,
elimination, activity and rest, and protection. The complex processes of this mode are
associated with the senses, fluid and electrolytes, neurologic function, and endocrine function.

Self-Concept Group Identity Mode

In this mode, the goal of coping is to have a sense of unity, meaning the purposefulness in the
universe, as well as a sense of identity integrity. This includes body image and self-ideals.

Role Function Mode

This mode focuses on the primary, secondary and tertiary roles that a person occupies in
society, and knowing where he or she stands as a member of society.

Interdependence Mode

This mode focuses on attaining relational integrity through the giving and receiving of love,
respect and value. This is achieved with effective communication and relations.

Levels of Adaptation

Integrated Process

The various modes and subsystems meet the needs of the environment. These are usually stable
processes (e.g., breathing, spiritual realization, successful relationship).

Compensatory Process

The cognator and regulator are challenged by the needs of the environment, but are working to
meet the needs (e.g., grief, starting with a new job, compensatory breathing).

Compromised Process

The modes and subsystems are not adequately meeting the environmental challenge (e.g.,
hypoxia, unresolved loss, abusive relationships).

Six-Step Nursing Process

A nurse’s role in the Adaptation Model is to manipulate stimuli by removing, decreasing,
increasing or altering stimuli so that the patient

1. Assess the behaviors manifested from the four adaptive modes.

2. Assess the stimuli, categorize them as focal, contextual, or residual.

3. Make a statement or nursing diagnosis of the person’s adaptive state.

4. Set a goal to promote adaptation.

5. Implement interventions aimed at managing the stimuli.

6. Evaluate whether the adaptive goal has been met.

Analysis

As one of the weaknesses of the theory that application of it is time-consuming, application of

the model to emergency situations requiring quick action is difficult to complete. The
individual might have completed the whole adaptation process without the benefit of having a
complete assessment for thorough nursing interventions.

Adaptive responses may vary in every individual and may take a longer time compared to
others. Thus, the span of control of nurses may be impeded by the time of the discharge of the
patient.

Unlike Levine, although the latter tackled on adaptation, Roy gave much focus on the whole
adaptive system itself. Each concept was linked with the coping mechanisms of every
individual in the process of adapting.

The nurses’ roles when an individual presents an ineffective response during his or her
adaptation process were not clearly discussed. The main point of the concept was to promote
adaptation but none were stated on how to prevent and resolve maladaptation.

Strengths of the Roy’s Adaptation Model

• The Adaptation Model of Callista Roy suggests the influence of multiple causes in
a situation, which is a strength when dealing with multi-faceted human beings.
 • The sequence of concepts in Roy’s model follows logically. In the presentation of
each of the key concepts, there is the recurring idea of adaptation to maintain
integrity. Every concept was operationally defined.

• The concepts of Roy’s model are stated in relatively simple terms.

• A major strength of the model is that it guides nurses to use observation and
interviewing skills in doing an individualized assessment of each person.The
concepts of Roy’s model are applicable within many practice settings of nursing.

Weaknesses

• Painstaking application of the model requires significant input of time and effort.

• Roy’s model has many elements, systems, structures and multiple concepts.

 NOLA PENDER: HEALTH PROMOTION MODEL

Health Promotion Model
Describes the interaction between the nurse and the consumer while considering the role of the
environment in health promotion.
Focuses on three areas: individual characteristics and experiences, behavior-specific cognitions
and affect, and behavioral outcomes.
Describes the multidimensional nature of persons as they interact within their environment to
pursue health.

Major Concepts of the Health Promotion Model

Health promotion is defined as behavior motivated by the desire to increase well-being and
actualize human health potential. It is an approach to wellness.

On the other hand, health protection or illness prevention is described as behavior motivated
desire to actively avoid illness, detect it early, or maintain functioning within the constraints of
illness.

Individual characteristics and experiences (prior related behavior and personal factors).
Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to
action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational
influences).

Behavioral outcomes (commitment to a plan of action, immediate competing demands and

preferences, and health-promoting behavior).

Subconcepts of the Health Promotion Model

Personal Factors

Personal factors categorized as biological, psychological and socio-cultural. These factors are
predictive of a given behavior and shaped by the nature of the target behavior being considered.

• Personal biological factors. Include variables such as age gender body mass index
pubertal status, aerobic capacity, strength, agility, or balance.

• Personal psychological factors. Include variables such as self-esteem, self-

motivation, personal competence, perceived health status, and definition of health.

• Personal socio-cultural factors. Include variables such as race, ethnicity, acculturation,

education, and socioeconomic status.

Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

Anticipated, imagined or real blocks and personal costs of understanding a given behavior.

Perceived Self-Efficacy

Judgment of personal capability to organize and execute a health-promoting behavior.

Perceived self-efficacy influences perceived barriers to action so higher efficacy results in
lowered perceptions of barriers to the performance of the behavior.
Activity-Related Affect

Subjective positive or negative feeling that occurs before, during and following behavior based
on the stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the more positive
thesubjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy
can generate a further positive affect.

Interpersonal Influences

Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences

include norms (expectations of significant others), social support (instrumental and emotional
encouragement) and modeling (vicarious learning through observing others engaged in a
particular behavior). Primary sources of interpersonal influences are families, peers, and
healthcare providers.

Situational Influences

Personal perceptions and cognitions of any given situation or context that can facilitate or
impede behavior. Include perceptions of options available, demand characteristics and
aesthetic features of the environment in which given health promoting is proposed to take place.
Situational influences may have direct or indirect influences on health behavior.

Commitment to Plan of Action

The concept of intention and identification of a planned strategy leads to the implementation
of health behavior

Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which individuals have low control
because there are environmental contingencies such as work or family care responsibilities.
Competing preferences are alternative behaviors over which individuals exert relatively high
control, such as choice of ice cream or apple for a snack

Health-Promoting Behavior
A health-promoting behavior is an endpoint or action outcome that is directed toward attaining
positive health outcomes such as optimal wellbeing, personal fulfillment, and productive
living.

Major Assumptions in Health Promotion Model

• Individuals seek to actively regulate their own behavior.

• Individuals in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment and being transformed over time.
• Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons throughout their life span.
• Self-initiated reconfiguration of person-environment interactive patterns is essential to
behavior change.

Propositions

• Prior behavior and inherited and acquired characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
• Persons commit to engaging in behaviors from which they anticipate deriving
personally valued benefits.
• Perceived barriers can constrain commitment to action, a mediator of behavior as well
as actual behavior.
• Perceived competence or self-efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance of the behavior.
• Greater perceived self-efficacy results in fewer perceived barriers to a specific health
behavior.
• Positive affect toward a behavior results in greater perceived self-efficacy, which can,
in turn, result in increased positive affect.
• When positive emotions or affect are associated with a behavior, the probability of
commitment and action is increased.
• Persons are more likely to commit to and engage in health-promoting behaviors when
significant others model the behavior, expect the behavior to occur, and provide
assistance and support to enable the behavior.
 • Families, peers, and health care providers are important sources of interpersonal
influence that can increase or decrease commitment to and engagement in health-
promoting behavior.
• Situational influences in the external environment can increase or decrease commitment
to or participation in health-promoting behavior.
• The greater the commitments to a specific plan of action, the more likely health-
promoting behaviors are to be maintained over time.
• Commitment to a plan of action is less likely to result in the desired behavior when
competing demands over which persons have little control require immediate attention.
• Commitment to a plan of action is less likely to result in the desired behavior when
other actions are more attractive and thus preferred over the target behavior.
• Persons can modify cognitions, affect, and the interpersonal and physical environment
to create incentives for health actions.

Strengths and Weaknesses

Strengths

• The Health Promotion Model is simple to understand yet it is complex in structure.

• Nola Pender’s nursing theory gave much focus on health promotion and disease
prevention making it stand out from other nursing theories.
• It is highly applicable in the community health setting.
• It promotes the independent practice of the nursing profession being the primary source
of health promoting interventions and education.

Weaknesses

• The Health Promotion Model of Pender was not able to define the nursing metapradigm
or the concepts that a nursing theory should have, man, nursing, environment, and
health.
• The conceptual framework contains multiple concepts which may invite confusion .
• Its applicability to an individual currently experiencing a disease state was not given
emphasis.
 RAMONA T. MERCER: MATERNAL ROLE ATTAINMENT—BECOMING A
MOTHER
“Nursing is a dynamic profession with three major foci: health promotion and prevention of
illness, providing care for those who need professional assistance to achieve their optimal level
of health and functioning, and research to enhance the knowledge base for providing excellent
nursing care.”
“Nurses are the health professionals having the most sustained and intense interaction with
women in the maternity cycle.”
Maternal role attainment is an interactional and developmental process occurring over time in
which the mother becomes attached to her infant, acquires competence in the caretaking tasks
involved in the role, and expresses pleasure and gratification in the role. (Mercer, 1986).
Provides proper health care interventions for nontraditional mothers in order for them to
favorably adopt a strong maternal identity.

Mercer believes that nurses can play a vital role in promoting health of families and
children. Mercer stated in her book Becoming a Mother: Research on Maternal Identity from
Rubin to the Present that “nurses are the health professionals having the most sustained and
intense interaction with women in the maternity cycle” (1995, p. xii). Mercer’s theory is
practice
oriented and has consistently evolved over time because of her commitment to connect research
to practice.
In addition to the renaming of maternal role attainment stages, the model has undergone
ongoing revision since its original publication. The work of Walker, Crain, and Thompson
indicated that a change was needed because the term role attainment indicated an end to the
process as a final goal. Mercer began to reexamine her theory and felt the need to revise the
model’s title to “Becoming a Mother” in order to connote a continued growth in mothering
throughout the lifespan (Mercer, 2004).
Stages of Becoming a Mother
The concepts of Mercer’s theory center on the bond between mother and child which
fosters competency, confidence and joy in the motherhood role (Role Attainment, 2005).
Mercer’s original maternal role attainment theory follows a process that has four stages. In
2004 Mercer revised the terms of these stages although the stages themselves remain basically
the same.
First is the “commitment, attachment, and preparation” stage during pregnancy when the
mother makes psychological adjusts and prepares for the expectations of her new role. Second
is the “acquaintance, learning, and physical restoration” stage which begins with the infant’s
birth when the role of mother is assumed and learned in the contexts of her social system. Third
is the “moving toward a new normal” stage in the first few months of the infant’s life where
the mother makes her new role fit her lifestyle in a personal way instead of in context with a
social system.

Global Nursing Concepts

There are four global concepts that Ramona Mercer portrays in her model. The first one
is human being. Mercer describes human being as seeing themselves as an individual and
separates itself from other roles. Mercer focuses this first concept on the maternal self. Having
self confidence and self-esteem are factors that play into motherhood. Values and morals also
play a role in the way that problems are handled .
The next concept is environment. Mercer describes environment as it has an impact on
the maternal role. There are issues outside the family that will impact how the maternal role is
played. There will be settings and changes that happen to put stress on the maternal role and
there has to be a balancing act. Playing the role of a maternal person they need to be able to
accommodate for the outside influences along with not ignoring the issues at hand (Meighan,
2010).
The third concept is health. Mercer defines health as a background of the mother’s and
father’s health history then as it relates to the future children they might have. When it comes
to bringing a child into the world there are a lot of factors that need to be addressed. The
mother
and father need to look at their current health along with any concerns that their lifestyle brings
about in regards to their health history
Theory Application and Implications
The origins of Ramona Mercer’s theory are primarily inspired by her nursing experience
early nursing educator mentor, Reva Rubin, but her passion for evidence based research caused
her work to be influenced by other interactionist social psychology models .
Mercer’s theory has a specific, concrete focus rather than an abstract, universal application.
“Middle range theory has an even more specific focus and is more concrete than nursing theory
in its level of abstraction” (Alligood, 2010, p. 7). Maternal role attainment focuses specifically
in the area of parent-child nursing and is applicable mainly in pediatric and maternal-child
nursing. However even though the focus of this theory is narrowed to maternal child nursing,
it can be generalized to a wide range of ages, situations and environments (Meighan, 2010).
Because of the specialized focus of this model, it is not generally applicable to other nursing
 Katharine Kolcaba: Theory of Comfort
“Comfort is an antidote to the stressors inherent in health care situations today, and when
comfort is enhanced, patients and families are strengthened for the tasks ahead. In addition,
nurses feel more satisfied with the care they are giving.”
Patient comfort exists in three forms: relief, ease, and transcendence. These comforts can occur
in four contexts: physical, psychospiritual, environmental, and sociocultural.
As a patient’s comfort needs change, the nurse’s interventions change, as well.
CHERYL TATANO BECK: POSTPARTUM DEPRESSION THEORY
Theory is an attempt to explain the world around us. It is defined as a set of concepts,
definitions, and propositions that projects a view of phenomena by designating specific
interrelationships among concepts for purposes of describing, explaining and predicting
phenomena.

Importance:

• Beck identified a significant gap in maternal care specifically in regard to maternal

blues, she wrote: “What has not been given equal priority in postpartum follow-up care,
however, is the mother’s psychological status, more specifically, the phenomenon of
maternity blues.
• Early discharge mothers are at home when the blues usually occurs during the first
week after delivery. Specific assessment for maternity blues should routinely be part of
the nurse’s assessment of these mothers during home visits”.
• Beck, after reviewing research on the topic of maternity blues began clarifying the
differences among the concepts of postpartum psychosis, postpartum depression, and
maternity blues.

CRITICAL ELEMENTS
The critical element of the Postpartum Depression Theory is loss of control. From that
core element came four stages of attempted coping. The four stages are:
 • Encountering Terror – Horrifying anxiety, obsessive thinking and enveloping
fogginess

• Dying of Self – Alarming “unrealness”, isolation of self, contemplating self-

destruction

• Struggling to Survive – battling the system, praying for relief, seeking solace

• Regaining Control – making transitions, mounting lost time, and attaining a guarded
recovery *

From this Beck identified a list of predictors for Postpartum Depression and created the
Postpartum Depression Predictors Inventory (PDPI).

POSTPARTUM DEPRESSION THEORY APPLICATION

All nurses and health care professionals need to get in the habit of screening for PPD
using Beck's Postpartum Depression Predictors Inventory (PDPI). The most common fields
involved are; Labor and Delivery, Postpartum, Antepartum, Nursery, NICU, Pediatrics,
Mental Health, and those working in both Pediatric and OBGYN offices. APRNs should
ensure that all students and/or staff under their guidance are aware of all risk factors and
warning signs to screen for when interacting with women before or after delivery.

METHODS OF PREVENTION

Early detection and interventions may help protect both the mother and her child
from the damaging effects of postpartum depression. During the prenatal stage, it is often
possible to identify the women at highest risk. These women would be candidates for more
intensive monitoring following the birth of their baby. Early patient awareness of risk factors
and available resources may help. Pamphlets and other educational materials should be
readily available and given out freely at pediatric offices, OBGYN offices and during hospital
stays. For patients with severe early warning signs, a prophylactic antidepressant may be
prescribed for after delivery.
 METHODS OF SCREENING

• Observation of behaviors and moods

• One on one interviews which can be done prenatally, upon discharge from the hospital/birthing
center, during postpartum check ups or during pediatric appointments
• Paper or electronic surveys given to new mothers regarding PPD risk factors

METHODS OF NURSING INTERVENTION

• Report any signs of PPD to the patient's doctor and/or social worker
• Document all concerning statements or interactions
• Make mothers aware of available resources (i.e. telephone hotlines, support groups, etc.)
• Therapeutic conversation
• Therapeutic touch
• Urging the patient to ask for help when it is needed
• Encouraging new mothers to practice open communication with their partners and family
members regarding their needs

 KRISTEN M. SWANSON:THEORY OF CARING

“Caring is a nurturing way of relating to a valued other toward whom one feels a personal sense
of commitment and responsibility.”
Defines nursing as informed caring for the well-being of others.
Offers a structure for improving up-to-date nursing practice, education, and research while
bringing the discipline to its traditional values and caring-healing roots.
ABOUT THE CARING THEORY
This theory states that caring proceeds in a sequence of five categories: knowing, being with,
doing for, enabling, and maintaining belief. When applied to nursing practice, each of these
five stages stimulates the caregiver’s attitude and improves the overall patient well-being. The
theory aims at helping nursing personnel to deliver care that promotes dignity, respect, and
empowerment. This model was framed to ensure consistent caring behaviors which would, in
turn, improve patient satisfaction.

Definitions & Concepts:

• Caring: a nurturing way of relating to a valued other towards whom one feels a personal
sense of commitment and responsibility. More specifically, caring is growth and health-
producing (nurturing) occurs in relationships (relating) to the one cared-for (a valued
other); individualized and intimate (personal), with a sense of commitment (passion),
accountability and duty (responsibility). Together with this, nurturing is delivered as a
set of interrelated processes that evolve from the nurse’s own convictions, knowledge,
and interaction with a patient. The caring process: being with, doing for, enabling, and
maintaining belief, moreover, are grounded in real nursing behaviors.
• Maintaining Belief: an orientation to caring begins with a fundamental belief in persons
and their capacity to get through events and transitions and face their future with
meaning. Importantly, this conviction is the base or foundation for the practice of nursing
care. Besides, whatever health conditions the patient is facing, a nurse believes in her/his
the capacity and power to accept or welcome upcoming days with meaning. Such an
orientation intensifies his/her commitment to serve humanity in general, and each patient
specifically. For this reason, Swanson describes maintaining belief as holding others in
esteem and believing in their ability to achieve their goal. It involves accepting others in
high regard and more importantly with a hope-filled attitude.
• Knowing: in knowing, one perceives events according to the meaning they have in the
life of the other. It involves a thorough assessment of all the aspects of a patient’s
condition and reality, engaging the self or person-hood of the nurse as well as the patient,
in a caring style of approach. The important nursing behaviors for knowing are; a
humanistic view of the other, nurturing, understanding of his/her situation, analysis, and
interpretation, compassion, empathy, insight, academic cognition and imagination,
assessment and communication skills, respect for individual differences and recognition
of the other as a significant being. When the process knowing occurs there develops a
bond of empathy and understanding between the care provider and the care recipient The
course of knowing also includes esteem for demographic differences such as age, gender,
marital status, education, and social influences from cultural backgrounds, health care
experiences, length of stay, environmental and economic resources.
• Being-with: being with, as well as being emotionally present conveys to patients the
message that they and their experiences are significant to the nurse. Similarly, emotional
presence is a technique by which the nurse shares the meanings, feelings and lived
experience of the one-cared for. The nurse assures the patients of her readiness and
willingness to be in their reality. it’s a side-by-side physical presence of clearly
 conveying one’s availability. Basically, the message is, “you are not alone, what happens
to you matters to us and we are here for you”. Actually, being with, is giving time to the
other for authentic presence, attentive listening, and reflective responses. Since being
with is regarded as a personal relationship, emotional adaptability and progressive
availability to patients in both joyful and painful experiences goes further than knowing.
Consequently, the impact of being with is measured not only by interpersonal warmth
and friendly interaction but also by proficient nursing practice. Therefore, nurses are to
be interested in authentic presence as well as standard nursing practice. Moreover,
sensitive and kind-hearted nursing caregivers through interpersonal compassion place
themselves into the shoes of patients to get into their thoughts and feelings. In a nutshell,
the qualities of being with include mutual trust, availability, mutual linking, faithfulness,
patience, and compliance. In being emotionally present, a health professional attempts
to calm fears through their action of making themselves present to the patients. As said
above, being with, encapsulates traits like showing interest, concern and commitment,
compassion and empathy, sympathy, honesty, sincerity, and sensitivity. Additionally,
other key factors in being with are protective and anticipative behaviour in avoiding harm
and danger. Being with also consists of daring, being firm and doing even things that the
patient does not like.
• Doing for: the real meaning of doing for is found in the definition of nursing: The unique
function of a nurse is to assist the individual, sick of well, in the performance of those
activities contributing to health or its recovery (or to peaceful death) that s/he would
perform unaided it s/he had the necessary strength, will, or knowledge and to do this in
such a way as to help her/him gain independence as rapidly as possible. In other words,
doing for refers to the activities in which a nurse engages with patients for what they
would do for themselves if at all it were possible to them. Doing for as seen in the above
definition, involves on the part of the nurse, measures that are performed on behalf of a
patient’s long term welfare. They include comforting patients, anticipating their needs,
performing procedures skilfully, protecting them from harm and ultimately preserving
their human dignity.
• Enabling: facilitating the other’s passage through life transitions and unfamiliar events.
As in the case of doing for, enabling fosters an environment of self-healing. Such an
enabling process enhances the patient’s capacity to heal, actualize oneself and in
particular practice self-care. Moreover, self-care animated by intrinsic motivation, self-
determination and competence are the results of empowering that means, a nurse by
 positively altering one’s self-concept, knowledge, attitude and skill–level empowers
patients in order to facilitate healing. Even more, the external environment such as
provisions of safety devices, removal of physical, social or emotional threats or obstacles
also contributes to the healing process. Here, patients are partners, with knowledge and
self-management skills. The cornerstone of enabling is appropriate communication with
patients and their families. This involves regular and frequent contacts with patients,
qualified by empathy and sensitivity to family dynamics, cultural and religious beliefs
and previous experience, along with the nature of illness. Communication also embodies
providing information, explanation about the given care, medications, tests, and the
overall condition of the patient. Written materials, phone calls, emails, internet use,
independent learning with software and counseling could also be encouraged as well in
the process of enabling the patients. Nursing care, ultimately involve enabling patients
to carry out self care. The process of enabling entails training, informing, illuminating,
supporting during painful experiences, guiding in issues through helping to generate
alternatives, offering advice and authenticating patient reality. With regards to enabling,
the objective is a patient’s enduring well-being.

Strengths

The structure of caring in ‘Swanson’s Middle Range Caring Theory’ enlightens nursing
caregivers on the significance of caring. Caring process and its observable and practical
criterion are distinguishing humanitarian behaviors which are mandatory in nursing. The highly
significant qualities that were highlighted were those of compassion, knowledge, optimism,
reflection, concern and commitment, communication skills, focus on the others experience,
respect for individual dignity/worth and being present to the other. If this theory could
effectively be used to guide clinical practice, the nurses can ensure a personal approach to care.

APPROACHES IN OBG
Person-centred approaches:

A person-centred approach to nursing focuses on the individual’s personal needs, wants,

desires and goals so that they become central to the care and nursing process. This can mean
putting the person’s needs, as they define them, above those identified as priorities by
healthcare professionals. The term person-centred care is used to indicate a strong interest in
the patient’s own experience of health, illness, injury or need. It infers that the nurse works
with the person’s definition of the situation, as well as that presented through a medical or other
diagnosis’.

There are a number of different frameworks that have been developed by nurse academics to
help practising nurses implement person-centred care. While these frameworks are all slightly
different, they all share some key components:

• knowing the patient as an individual

• being responsive
• providing care that is meaningful
• respecting the individual’s values, preferences and needs
• fostering trusting caregiving relationships
• emphasising freedom of choice
• promoting physical and emotional comfort
• involving the person’s family and friends, as appropriate.

History and examination are a modification of a standardized history taking designed for
→ Elucidation of presenting problem
→ Concluding provisional and differential diagnosis
→ Planned for further management
History taking
Depending on the presenting complaints:
• Age of menarche or menopause
• Marital status- infertility
• LMP
• Length of menstruation and cycle
• Frequency and regularity of cycle
• Menstrual loss, presence of clots and flooding
• Duration of dysmenorrhea, and relation to period
• Abnormal bleeding
→ Intermenstrual
→ Postcoital
 → Postmenopausa
• Abnormal PV discharge
→ Color,pruritis, offensive odour
• Sexual history
→ Dyspereunia
→ Contraception
→ Previous STD

• Hormonal therapy
→ Oral/Injectable
→ HRT
• Menopausal symptoms
• Pain
→ Onset, duration, nature, site
→ Relation to menstrual cycle
• Symptoms of prolapse, uncomfortable lumps in vagina
• Urinary problems
→ Incotinence( stress, urge)
→ Frequency, nocturia or dysuria

• Other systemic review

• Past obstetric and gynaecology history
• Past medical and surgical history
• Social history
• Drug history
• Smoking, alcohol consumption
Physical examination
• Always begin with
→ Inspection
→ Palpation
→ Percussion
→ Auscultation
• General examination
 • Specific examination
• Genital examination
→ Inspection of genitalia and urethral meatus
→ Evidence of estrogen deficiency, prolapse or abnormal masses
→ Presence of abnormal bleeding or discharge
• Speculum examination
→ Inspection of cervix and vagina
→ Taking of cervical cytology or microbiology swab
• Assess uterovaginal prolapse and incontinence
• Perform bimanual examination
-Assess uterine size , shape, mobility of uterus , anteverted or retroverted
-Tenderness – cervical motion, POD, adenexas
-Presence of abnormal masses at adenexa or POD
-Uterosacral ligament (presence of nodule)
-Thickness of therectovaginal space
Management
→ Differential diagnosis
→ Reverse/prioritise diagnosis
→ Investigations
→ Treatment or management
Common procedures in gynecology
• Ultrasound
• PAP smear for cervical smear
➢ Cheap
➢ Acceptable
➢ Good sensitivity and specificity
➢ Achieved of screening(70 to 80%)
➢
• Colposcopy procedure
➢ A tool for screening as well as treatment of cervical pathology especially at
preinvasive and early stage
➢ Need training and practice
➢ Available
 • Visual inspection tests
➢ VIA (Visual Inspection with acetic acid)
➢ VILI (Visual inspection with Lugol’s iodine)

BARRIERS TO APPLYING A NURSING THEORY

Misapplication of General Theories

Nursing "grand theories" are general concepts that pertain to the overall nature and goals of
professional nursing. A grand theory, and there are many, is a synthesis of scholarly research,
professional experience and insights from theoretical pioneers (such as Florence Nightingale).
While there are many benefits to knowing and understanding grand theories, these
constructions are often abstract and do not lend themselves to empirical testing or problems in
specific nurse settings. Therefore it would be a mistake, or a barrier to effective application, if
a nurse were to employ a grand theory when encountering a unique patient situation or problem.

Limitations of Middle-range Theories

Middle-range nursing theories are models that can be applied to professional practice. They
also serve as frameworks for research. Middle-range theories include specific concepts and
provide strategies for delivering quality patient care. While middle-range theories are much
less abstract than grand theories, the biggest problem in effective implementation of middle-
range theories is that they do not deal with specific populations of patients and any specific
problems. Therefore, while these theories will offer valuable guidelines for nurses, they cannot
be applied to unique or particular health care issues.

Expecting Too Much From Practical Theories

Nurse practice theories are constructions that deal with questions that pertain to particular and
specific issues, settings and populations. They are very valuable for day-to-day experiences.
However, their limitation is that they have little connection to foundational nursing theories
and research. Problems are often solved with new or improvised methods. While these methods
may prove effective, much time can be lost with such improvisation. Often patients in
emergency situations do not have time to lose.
Lack of a Complementary Philosophy

Professional nurses, in all fields and levels of leadership, must adopt a complementary
approach to patient care. One type of theory cannot be applied to all types of patient conditions.
Unfortunately, many nurses do not have an adequate enough understanding of the types of
nursing theories to employ them effectively. This lack of understanding may point to an
inadequate educational background and lead to unsatisfactory patient care.

Conclusion
Nursing theory is defined as "a creative and rigorous structuring of ideas that project a tentative,
purposeful, and systematic view of phenomena". Through systematic inquiry, whether in
nursing research or practice, nurses are able to develop knowledge relevant to improving the
care of patients.

REFERENCES
• Nursing theory - Wikipedia Available
from:en.wikipedia.org/wiki/Nursing_theory,cited on 5 th May 2020
• Available from:https://www.nursing-theory.org/theories-and-models.Available,Cited
on 6 th May