Pediatric nursing and nursing

theory
Ns. Yufitriana Amir., MSc., PhD
Pendahuluan
• Keperawatan anak: infants, toddlers, children, dan keluarganya untuk
mempromosikan kesehatan dan pertumbuhan perkembangannya.
• Perawatan khusus untuk setiap target perkembangan untuk
memenuhi kebutuhan pasien
• Kebutuhan anak berbeda-beda dari bayi ke remaja, di rumah sakit,
pusat rehabilitasi, di rumah dan lain-lain
Pediatric Nursing Theories and Models
Maternal Role Attainment Theory
• The Maternal Role Attainment Theory was developed to serve as a
framework for nurses to provide appropriate health care
interventions for nontraditional mothers in order for them to develop
a strong maternal identity. This mid-range theory can be used
throughout pregnancy and postnatal care, but is also beneficial for
adoptive or foster mothers, or others who find themselves in the
maternal role unexpectedly. The process used in this nursing model
helps the mother develop an attachment to the infant, which in turn
helps the infant form a bond with the mother. This helps develop the
mother-child relationship as the infant grows.
• The primary concept of this theory is the developmental and interactional process,
which occurs over a period of time. In the process, the mother bonds with the infant,
acquires competence in general caretaking tasks, and then comes to express joy and
pleasure in her role as a mother.

• The nursing process in the Maternal Role Attainment Theory follows four stages of
acquisition. They are: anticipatory, formal, informal, and personal. The anticipatory
stage is the social and psychological adaptation to the maternal role. This includes
learning expectations and can involve fantasizing about the role. The formal stage is
the assumption of the maternal role at birth. In this stage, behaviors are guided by
others in the mother's social system or network, and relying on the advice of others
in making decisions. The informal stage is when the mother develops her own
methods of mothering which are not conveyed by a social system. She finds what
works for her and the child. The personal stage is the joy of motherhood. In this
stage, the mother finds harmony, confidence, and competence in the maternal role.
In some cases, she may find herself ready for or looking forward to another child
Roy adaptation model
The factors that influenced the development of the model included:
family, education, religious background, mentors, and clinical
experience. Roy's model asks the questions:

• Who is the focus of nursing care?

• What is the target of nursing care?
• When is nursing care indicated?
• Roy explained that adaptation occurs when people respond positively
to environmental changes, and it is the process and outcome of
individuals and groups who use conscious awareness, self-reflection,
and choice to create human and environmental integration.

• The key concepts of Roy's Adaptation Model are made up of four

components: person, health, environment, and nursing.

• According to Roy's model, a person is a bio-psycho-social being in

constant interaction with a changing environment. He or she uses
innate and acquired mechanisms to adapt. The model includes people
as individuals, as well as in groups such as families, organizations, and
communities. This also includes society as a whole.
• The environment has three components: focal, which is internal or
external and immediately confronts the person; contextual, which is all
stimuli present in the situation that all contribute to the effect of the focal
stimulus; and residual, whose effects in the current situation are unclear.
All conditions, circumstances, and influences surrounding and affecting
the development and behavior of people and groups with particular
consideration of mutuality of person and earth resources, including focal,
contextual, and residual stimuli.

• The model includes two subsystems, as well. The cognator subsystem is a

major coping process involving four cognitive-emotive channels:
perceptual and information processing, learning, judgment, and emotion.
The regulator subsystem is a basic type of adaptive process that responds
automatically through neural, chemical, and endocrine coping channels.
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 goal of nursing is to promote adaptation in the four adaptive
modes. Nurses also promote adaptation for individuals and groups in
the four adaptive modes, thus contributing to health, quality of life,
and dying with dignity by assessing behaviors and factors that
influence adaptive abilities and by intervening to enhance
environmental interactions. The Four Adaptive Modes of Roy's
Adaptation Model are physiologic needs, self-concept, role function,
and interdependence.
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

Throughout the nursing process, the nurse and other health care professionals
should make adaptations to the nursing care plan based on the patient's
progress toward health.
Casey’s Model of nursing
• Anne Casey is an English nurse who developed a nursing theory known as
Casey's Model of Nursing. The model was developed in 1988 while she was
working in pediatric oncology at the Great Ormond Street Hospital in London.
• Casey's Model of Nursing focuses on the nurse working in partnership with
the child and his or her family. It was one of the earliest attempts to develop a
nursing model designed specifically for child health nursing.
• The five aspects of this nursing theory are child, family, health, environment,
and the nurse.
• The philosophy of Casey's model is that the best people to care for the child
are the members of the family, with health care professionals assisting. This
necessitates a relationship between the parent(s) and nurse.
Betty Neuman’s Systems Model
• Betty Neuman’s Systems Model provides a comprehensive holistic
and system-based approach to nursing that contains an element of
flexibility. The theory focuses on the response of the patient system to
actual or potential environmental stressors and the use of primary,
secondary, and tertiary nursing prevention intervention for retention,
attainment, and maintenance of patient system wellness.
Kolcaba;s theory of comfort
• Kolcaba's Theory of Comfort was first developed in the 1990s. It is a middle-
range theory for health practice, education, and research. This theory has
the potential to place comfort in the forefront of healthcare. According to
the model, comfort is an immediate desirable outcome of nursing care.
• The Theory of Comfort was developed when Katharine Kolcaba conducted a
concept analysis of comfort that examined literature from several
disciplines, including nursing, medicine, psychology, psychiatry, ergonomics,
and English. After the three forms of comfort and four contexts of holistic
human experience were introduced, a taxonomic structure was created to
guide for the assessment, measurement, and evaluation of patient comfort.
According to Kolcaba, comfort is the product of holistic nursing art.
• Kolcaba described comfort existing in three forms: relief, ease, and
transcendence. If specific comfort needs of a patient are met, the patient
experiences comfort in the sense of relief. For example, a patient who
receives pain medication in post-operative care is receiving relief comfort.
Ease addresses comfort in a state of contentment. For example, the
patient's anxieties are calmed. Transcendence is described as a state of
comfort in which patients are able to rise above their challenges. The four
contexts in which patient comfort can occur are: physical, psychospiritual,
environmental, and sociocultural.
• The Theory of Comfort considers patients to be individuals, families,
institutions, or communities in need of health care. The environment is
any aspect of the patient, family, or institutional surroundings that can be
manipulated by a nurse or loved one in order to enhance comfort. Health
is considered to be optimal functioning in the patient, as defined by the
patient, group, family, or community.
• In the model, nursing is described as the process of assessing the patient's comfort
needs, developing and implementing appropriate nursing care plans, and
evaluating the patient's comfort after the care plans have been carried out. Nursing
includes the intentional assessment of comfort needs, the design of comfort
measures to address those needs, and the reassessment of comfort levels after
implementation. Assessment can be objective, such as the observation of wound
healing, or subjective, such as asking the patient if he or she is comfortable.
• Kolcaba includes definitions of key elements of her nursing theory, as well. Health
care needs are defined as those needs identified by the patient and/or family in a
particular nursing practice setting. Intervening variables are factors that are not
likely to change, and over which health care providers have little control. These
variables include prognosis, financial situation, social support, and others. Health-
seeking behaviors are the behaviors of a patient in an effort to find health.
Institutional integrity is the value, financial stability, and wholeness of health care
organizations at the local, regional, state, and national levels. Finally, best policies
are protocols and procedures developed by an institution for overall use after the
collection of evidence.
Rogers’Theory of Unitary Human Beings
• Theory of Unitary Human Beings views nursing as both a science and an
art.
• The uniqueness of nursing, like any other science, is in the phenomenon
central to its focus.
• The purpose of nurses is to promote health and well-being for all
persons wherever they are.
• The development of Rogers' abstract system was strongly influenced by
an early grounding in arts, as well as a background in science and
interest in space.
• The science of unitary human beings began as a synthesis of ideas and
facts.
Erickson’s Modeling and Role Modeling
Theory
• The Modeling and Role Modeling Theory was developed by Helen
Erickson, Evelyn M. Tomlin, and Mary Anne P. Swain. It was first
published in 1983 in their book Modeling and Role Modeling: A Theory
and Paradigm for Nursing . The theory enables nurses to care for and
nurture each patient with an awareness of and respect for the
individual patient's uniqueness. This exemplifies theory-based clinical
practice that focuses on the patient's needs.
• The theory draws concepts from a variety of sources. Included in the
sources are Maslow's Theory of Hierarchy of Needs, Erikson's Theory of
Psychosocial Stages, Piaget's Theory of Cognitive Development, and
Seyle and Lazarus's General Adaptation Syndrome.
Orlando’s Nursing Process Discipline Theory
• The major dimensions of the model explain that the role of the nurse is to
find out and meet the patient's immediate needs for help. The patient's
presenting behavior might be a cry for help. However, the help the patient
needs may not be what it appears to be. Because of this, nurses have to use
their own perception, thoughts about perception, or the feeling
engendered from their thoughts to explore the meaning of the patient's
behavior. This process helps nurses find out the nature of the patient's
distress and provide the help he or she needs.

The concepts of the theory are: function of professional nursing, presenting

behavior, immediate reaction, nursing process discipline, and improvement.
Parse’s Human Becoming Theory
• Parse's Human Becoming Theory guides the practice of nurses to
focus on quality of life as it is described and lived. The human
becoming theory of nursing presents an alternative to both the
conventional bio-medical approach as well as the bio-psycho-social-
spiritual approach of most other theories and models of nursing.
Parse's model rates quality of life from each person's own perspective
as the goal of the practice of nursing. Rosemarie Rizzo Parse first
published the theory in 1981 as the "Man-living-health" theory, and
the name was changed to the "human becoming theory" in 1992.
• The assumptions underpinning the theory were synthesized from works by
European philosophers. The theory is structured around three abiding
themes: meaning, rhythmicity, and transcendence.
• The model makes assumptions about man and becoming, as well as three
major assumptions about human becoming.
The Human Becoming Theory makes the following assumptions about man:
1) The human is coexistent while co-constituting rhythmical patterns with
the universe.
2) The human is open, freely choosing meaning in a situation, as well as
bearing responsibility for decisions made.
3) The human is unitary, continuously co-constituting patterns of relating.
4) The human is transcending multidimensionally with the possibles.
• The three major assumptions about human becoming are: meaning, rhythmicity, and
transcendence.

• Under the assumption meaning, human becoming is freely choosing personal meaning
in situations in the intersubjective process of living value priorities. Man's reality is
given meaning through lived experiences. In addition, man and environment co-create.

• Rhythmicity states that human becoming is co-creating rhythmical patterns of relating

in mutual process with the universe. Man and environment co-create (imaging,
valuing, languaging) in rhythmical patterns.

• Transcendence explains that human becoming is co-transcending multidimensionally

with emerging possibilities. It refers to reaching out and beyond the limits a person
sets, and that one constantly transforms.
• These three themes are permeated by four postulates: illimitability, paradox,
freedom, and mystery. Illimitability is "the indivisible unbounded knowing extended
to infinity, the all-at-once remembering and prospecting with the moment." Paradox
is "an intricate rhythm expressed as a pattern preference." Paradoxes are not
"opposites to be reconciled or dilemmas to be overcome but, rather, lived rhythms."
Freedom is "contextually construed liberation." People are free to continuously
choose ways of being with their situations. Mystery is "the unexplainable, that which
cannot be completely known."

• The nursing model defines the person (referred to as "man" throughout the theory)
as an open being who is more than and different from the sum of the parts. The
environment is everything in the person and his or her experiences. The environment
is inseparable from the person, as well as complementary to and evolving with the
person. Health is the open process of being and becoming, and involves the synthesis
of values. Nursing is described as a human science and art that uses an abstract body
of knowledge to help people.
• The theory provides a transformative approach to all levels of nursing.
It differs from the traditional nursing process, particularly in that it
does not seek to "fix" problems. The model gives nurses the ability to
see the patient's perspective. This allows the nurse to be "with" the
patient, and guide him or her toward the health goals. The nurse-
patient relationship co-creates changing health patterns. Nurses live
the art of human becoming in presences with the unfolding of
meaning, synchronizing rhythms, and transcendence.
•
Rosemarie Rizzo Parse's Human Becoming Theory includes the Totality Paradigm,
which states that man is a combination of biological, psychological, sociological, and
spiritual factors. It also includes the simultaneity paradigm, which states that man is a
unitary being in continuous, mutual interaction with the environment.

Parse's theory includes a symbol with three elements:

The black and white colors represent the opposite paradox significant to ontology of
human becoming, while green represents hope.
• The joining in the center of the symbol represents the co-created mutual human
universe process at the ontological level, and the nurse-patient process.
• The green and black swirls intertwining represent the human-universe co-creation as
an ongoing process of becoming.
• Like any theory, Parse's Human Becoming Theory has strengths and
weaknesses. The model differentiates nursing from other disciplines,
it provides guidance of care and useful administration, and is useful in
education. The model also provides research methodologies, and
provides a framework to guide inquiry of other theories. However, the
research is considered a "closed circle." The results are rarely
quantifiable. That is, the results are difficult to compare to other
research studies since there is no control group or standardized
questions. The theory does not utilize the nursing process, and
negates the idea that each patient engages in a unique lived
experience. It is not accessible to new nurses, and is inapplicable to
acute, emergent care.
Nightingale’s Environmental Theory
There are seven assumptions made in the Environment Theory, which focuses on taking
care of the patient's environment in order to reach health goals and cure illness. These
assumptions are:

• natural laws
• mankind can achieve perfection
• nursing is a calling
• nursing is an art and a science
• nursing is achieved through environmental alteration
• nursing requires a specific educational base
• nursing is distinct and separate from medicine
Watson’s Philosophy and Science of Caring
• The Philosophy and Science of Caring has four major concepts: human
being, health, environment/society, and nursing.
• Jean Watson refers to the human being as "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. Human is viewed as greater than and different from the sum of his or
her parts."
• Health is defined as a high level of overall physical, mental, and social
functioning; a general adaptive-maintenance level of daily functioning;
and the absence of illness, or the presence of efforts leading to the
absence of illness.
Watson's model makes seven 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 the patient as he or she is now, as well as what he or she
may become.
5.A caring environment is one that offers the development of potential while
allowing the patient to choose the best action for him or herself at a given point in
time.
6.A science of caring is complementary to the science of curing.
7.The practice of caring is central to nursing.
References
http://www.nursing-theory.org/theories-and-models/mercer-matern
al-role-attainment-theory.php