Liceo de Cagayan University

Graduate Studies

“Nursing Theory and Psychiatric

 

Mental Health:
Analysis on Selected Nursing Theories”

 
In partial fulfillment of the requirements in
Master’s in Nursing: Psychology

Submitted to:
Mrs. Ma Dolores Mercado, R.N., MAN

Submitted by:
Ms. Whinsheil B. Gardonez, R.N.
Nursing Theory and Psychiatric
Mental Health
Theory Defined

A theory is conceptual system consisting of inter-related

proposition that describe, explain, and predict
selected phenomena.

No single theory can address all aspect of reality

All theories are tentative in nature and subject to change

or to obsolescence
Nursing Theories

The development of theory, is necessary for the further

development of nursing as a profession (Johnson, 1997)

Almost all current nursing theories can be

classified as:

Interpersonal

Behavioural or

Systems-oriented
The theories of:

Hildegard Peplau

Dorothea Orem

Martha Rogers

Sister Callista Roy

Rosemarie Parse
 Peplau’s Interpersonal Theory

Hildegard Peplau has been a pioneer in formulating

nursing theory. She proposed an interpersonal theory
applicable to nursing practice in general and
psychiatric-mental health in particular. Peplau,
described the interpersonal aspect of nursing as
process.
Peplau’s Theory continued

The process consists of four phases:

Orientation Phase

Identification Phase

Exploitation Phase

Resolution Phase
 Peplau’s Theory continued

While working with the client through these phases, the nurse
assumes six roles.

Stranger
Initial role of the nurse, the task of forming trust and acceptance are
most prominent at this time.

Resource expert
The nurse assumes this role during assessment in an effort to
provide alternative ways in meeting the client’s needs and limitations.

Leader
Because the client may be incapacitated or immobilized physically and
emotionally, the nurse may assume this role to ensure the client’s
needs are addressed.
 Surrogate
Represents the client in terms of advocacy

Counselor
The client is assisted to recall past experiences and
traumas and to work through these.

Teacher
Also assumed in an attempt to assist the client to learn from
present and past experiences and traumas.
Analysis of Peplau’s Theory
Strengths:

it appears that Peplau has taken special care to keep

the theory’s generalizations closely attached and
observable nursing situations.

Peplau’s theory describes, explains, predicts, and to

some extent permits control of the sequence of events
occurring in the nurse-client relationship
Weaknesses:

It is of minimal use in short-term, acute nursing

care settings, in which hospitalizations last only for
hours or at most for a few days, precluding
relationship development.

it is applicable only to dyadic nurse-client

relationship, in which the client is a group of
individuals, a family, or a community is not
addressed.
Dorothea Orem’s Behavioral Nursing Theory

This theory is based on the premise that

persons need a composite of self-care action
in order to survive.

Self-care action consists of all behaviour

performed by individual to maintain life, health
and well-being.
 The capacity of the client and the client’s
family to performed self-care is referred
to as self-care agency.

 The need for nursing care will exist if the

client’s self-care demand exceeds the
client’s self care agency.
Three types of Self-care:

Universal self-care behaviors are required to

meet psychological needs.

Developmental self-care behaviours are required

to undergo normal human development

Health self-care behaivors are required to meet

client needs during health deviations.
 The plan indicates the nursing approach needed to
meet the client’s needs. These plans can be categorized as
follows:

 Wholly compensatory, in which the client does not

participate behaviourally in self-care

Partially compensatory, in which both the client and

nurse participate behaviourally in meeting the client’s self-
care needs

Educative development, in which the client meets his

own self-care needs with the minimal nursing
assistance.
 To implement the required nursing approach, the
nurse uses one of five behaviours:

Acting or doing for the client

Guidance

Supporting

Providing

Teaching
Analysis of Orem’s Theory

Strength:

the emphasis on the capabilities rather than the limitations of

clients.
Additionally, the theory explains the necessity of the client’s
and his family’s involvement in the nursing process.

Weaknesses:

the theory’s language is somewhat confusing and

unnecessarily complex. For example, the term “self-care
agency” could be more simply phrased as “self-care
capacity”.
the theory’s failure to address the evaluation of the effects of
nursing care behaviors.
Martha Rogers’ Systems-Oriented Nursing Theory

 proposed a theory concerning the nature of

humankind from what she considered a unique
nursing perspective.

 defines nursing as a humanistic science for

maintaining and promoting health, preventing
illness, and caring for and rehabilitating the sick
and disabled.
The theory is based on four major premises.

1. The first premise is that the human organism is characterized by

openness and, as a result, is in continuous mutual interaction with the
environment.

2. The human organism is conceptualized as having an energy field

which is in constant mutual interaction with the energy fields of the
environment and of other human organisms. This dynamic mutual
interaction can be perceived as wave patterns or auras.

3. The way the energy field appears is characterized by organized

patterns or design

4. Human existence is four- rather than three-dimensional, which is

according to Rogers, is the human beings capacity to transcend
conventional concepts of time-space interaction.
Homeodynamic principles

Resonancy
-is an ordered arrangement of rhythm characterizing both human field
and environmental field that undergoes continuous dynamic
metamorphosis in the human environmental process.

Helicy
-describes the unpredictable, but continuous, nonlinear evolution of
energy fields as evidenced by non repeating rhythmicties.

Integrality
-the mutual, continuous relationship of the human energy field and the
environmental field. Changes occur by the continuous re-patterning of the
human and environmental fields by resonance waves.
Analysis of Rogers’ Theory

Strengths:

 the theory is holistic and takes into the account the entire
field of phenomena associated with nursing.

 Rogers theory addresses the spirituality of human

existence by attempting to explain the four-
dimensionality of the universe and the occurrence of
paranormal experiences.
Analysis of Rogers’s Theory cont’d.

Weaknesses:

Rogers’s theory have an overly complex terminology.

Additionally, the absence and weakness of logical

bridges or transitions between or among its
conceptual component obfuscates the theory’s content.
Sister Callista Roy’s Theory of Adaptation

It was modelled from behavioral theory and states

that human use coping mechanisms to adapt to both
internal and external stimuli.

Types of stimuli: focal, contextual and residual

Two major internal coping mechanisms are the

regulator and cognator.
 The Four Modes of Adaptation

Physiologic-Physical Mode
Physical and chemical processes involved in the function and
activities of living organisms; the underlying need is physiologic
integrity as seen in the degree of wholeness achieved through
adaptation to change in needs.

Self-concept- Group Identity Mode

Focuses on psychological and spiritual integrity and sense of unity,
meaning, and purposefulness in the universe.

Role Function Mode

Roles that individuals occupy in society, fulfilling the need for
social integrity. It is knowing who one is in relation to others.

Interdependence Mode
The close relationships of people and their purpose, structure and
development individually and in groups and the adaptation potential of
these groups.
 Analysis of Roy’s Adaptation Model (RAM)

Strength:

Is focus on the whole person or group. The four modes

provide an opportunity for consideration of multiple aspects of
the human adaptive system and support gaining an
understanding of the whole system

Weaknesses:

 the need for consistent definitions of the concepts and

terms within the RAM, as well as for more research based on
such consistent definitions.

 Also, in a practice area that is increasingly challenged with

time constraints, the amount of time required to fully
implement the two areas of RAM assessment may be viewed
as insurmountable
 Rosemarie Parse’s Theory of Human Becoming

The Parse theory of human becoming guides nurses

In their practice to focus on quality of life as it is described
and lived (Karen & Melnechenko, 1995).

Parse presents an alternative to both the

conventional biomedical approach and the biopsycho-
social-spiritual approach of most other theories of nursing.
 Three Major Assumptions of Human Becoming

1. 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
Man and environment cocreate

2. Rhythmicity
Human Becoming is cocreating rhythmical patterns
of relating in mutual process with the
universe.
Man and environment cocreate ( imaging, valuing,
languaging) in rhythmical patterns
Major Assumptions cont’d.

3. Transcendence

Human Becoming is cotranscending

multidimensionally with emerging possibles.

Refers to reaching out and beyond the limits that a

person sets

One constantly transforms

 Analysis of Parse’s Theory
Strengths:

Focuses on clients experiences and not problems

Provides framework to guide inquiry of other theories

(grief, hope, laughter, etc.)

Weaknesses:

Negates the idea that each person engages in a

unique lived experience

Not applicable to acute, emergent care

Journal Reading:
Application of Orem’s Self-Care deficit theory in the Nursing Profession

By Rosinee Rosales

As a staff nurse in a medical ward in Riyadh Military Hospital, many of our patients have
respiratory and heart problems. All of them present different health problems and needs, some of
them are intubated and some of them are in comatose condition after cerebrovascular accident or
cardiac arrest. These patients will not be able to verbalize their concerns and feelings. Orem ’s
concept of self-care specified different self-care requisites, being acquainted in these concepts, it ’s
easier for me to assess and recognize the needs of my patients and it will facilitate me in selecting
particular nursing interventions based on their needs. Orem’s theory of nursing systems is also
evident in my current practice. The concepts of wholly compensatory, partly compensatory, and
supportive-educative systems are relevant to various interventions that I perform based on different
needs and abilities of my patients thus it creates individualized nursing care. In the case of
bedridden patients, wholly compensatory nursing system is appropriate to them, “the nurse is their
hands and their feet”. Patients who had liver biopsy are not allowed to ambulate 24 hours after the
procedure. In this event, partly compensatory nursing system can be applied. Supportive-educative
nursing system is appropriate to patients who have diabetes mellitus, they should be taught to
correct their diet and lifestyle and how to check their blood sugar and to administer insulin if needed.
These are some of the things how Orem’s theory could be beneficial in my current nursing practice.
Her contributions are indeed significant in our nursing profession.

(I hold no title or right for the copyright of this article. Source:

http://networkedblogs.comhttp://upoun207tfn.blogspot.com/)
Thank you!