Frameworks for Professional Nursing Practice
Frameworks for Professional Nursing Practice
Chapter 2
Definitions
Concept
Conceptual model
Propositions
Assumptions
Theory
Metaparadigm
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Central Concepts in Nursing
Person receiving the nursing
Environment within which the person exits
Health-illness continuum within which the person falls at the time of the interaction with the nurse
Nursing actions
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Nightingale’s Environmental Theory
Person: Recipient of nursing care
Environment: External (temperature, bedding, ventilation) and internal (food, water, and medications)
Health: Not only to be well, but to be able to use well every power we have to use
Nursing: Alter or manage the environment to implement the natural laws of health
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Nightingale’s 13 Canons
Ventilation and warmth
Health of houses
Petty management
Noise
Variety
Food intake
What food?
Bed and bedding
Light
Cleanliness of rooms and walls
Personal cleanliness
Chattering hopes and advises
Observation of the sick
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Virginia Henderson: Definition of Nursing and 14 Components of Care
Person: Recipient of nursing care who is composed of biological, psychological, sociological, and spiritual components
Environment: External environment
Health: Based on the patient’s ability to function independently
Nursing: Assist the person, sick or well, in performance of activities
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Henderson’s 14 Basic Care Needs (1 of 2)
Breathe normally
Eat and drink adequately
Eliminate bodily wastes
Move and maintain postures
Sleep and rest
Dress and undress
Maintain body temperature within normal range
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Henderson’s 14 Basic Care Needs (2 of 2)
Keep body clean and protect integument
Avoid dangers
Communicate with others
Worship according to one’s faith
Work (sense of accomplishment)
Recreation
Learn and discover, leading to normal development and health, and use health facilities
Jean Watson: Philosophy and Science of Caring (1 of 2)
Goal is to help persons attain a higher level of harmony within the mind-body-spirit
Goal pursued through transpersonal caring guided by 10 caritas processes
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Jean Watson: Philosophy and Science of Caring (2 of 2)
Person (human): A unity of mind-body-spirit/nature; embodied spirit
Healing space and environment: A nonphysical energetic environment; a vibrational field integral with the person where the nurse is not only in the environment but “the nurse IS the environment”
Health (healing): Harmony, wholeness, and comfort
Nursing: Reciprocal transpersonal relationship in caring moments guided by caritas processes
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Benner’s Clinical Wisdom in Nursing Practice: 9 Domains of Critical Care Nursing
Diagnosing and managing life-sustaining physiological functions in unstable patient
Using skilled know-how to manage a crisis
Providing comfort measures for the critically ill
Caring for patients’ families
Preventing hazards in a technological environment
Facing death: End-of-life care and decision making
Communicating and negotiating multiple perspectives
Monitoring quality and managing breakdown
Using the skilled know-how of clinical leadership and the coaching and mentoring of others
Benner’s Clinical Wisdom in Nursing Practice: 6 Aspects of Clinical Judgment and Skilled Comportment (1 of 2)
Reasoning-in-transition: Practical reasoning in an ongoing clinical situation
Skilled know-how: Also known as embodied intelligent performance; knowing what to do, when to do it, and how to do it
Response-based practice: Adapting interventions to meet the changing needs and expectations of patients
Agency: One’s sense of and ability to act upon or influence a situation
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Benner’s Clinical Wisdom in Nursing Practice: 6 Aspects of Clinical Judgment and Skilled Comportment (2 of 2)
Perceptual acuity and the skill of involvement: The ability to tune into a situation and hone in on the salient issues by engaging with the problem and the person
Links between clinical and ethical reasoning: The understanding that good clinical practice cannot be separated from ethical notions of good outcomes for patients and families
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Benner’s Clinical Wisdom in Nursing Practice
Person: Embodied person living in the world who is a “self-interpreting being, that is, the person does not come into the world pre-defined but gets defined in the course of living a life”
Environment: A social environment with social definition and meaningfulness
Health: The human experience of health or wholeness
Nursing: A caring relationship that includes the care and study of the lived experience of health, illness, and disease
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Martha Rogers’s Science of Unitary Human Beings (1 of 2)
Person (human being): An irreducible, irreversible, pandimensional, negentropic energy field identified by pattern
Environment: An irreducible, pandimensional, negentropic energy field, identified by pattern and manifesting characteristics different from those of the parts and encompassing all that is other than any given human field
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Martha Rogers’s Science of Unitary Human Beings (2 of 2)
Health: Health and illness are a part of a continuum.
Nursing: Seeks to promote symphonic interaction between fields, to strengthen the integrity of the human field, and to direct patterning of the human and environmental fields for realization of maximum health potential
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Principle of Hemeodynamics
Helicy
Resonancy
Integrality
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Dorothea Orem’s General Theory of Nursing
Composed of three related theories:
Theory of self-care
Theory of self-care deficit
Theory of nursing systems
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Types of Self-Care Requisites
Universal self-care requisites (found in all human beings and associated with life processes)
Developmental self-care requisites (related to different stages of human life cycle)
Health-deviation self-care requisites (related to deviations in structure or function)
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Dorothea Orem’s General Theory of Nursing (1 of 2)
Person (patient): A person under the care of a nurse; a total being with universal, developmental needs and capable of self-care
Environment: Physical, chemical, biologic, and social contexts within which human beings exist; components include environmental factors, elements, and conditions, as well as the developmental environment
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Dorothea Orem’s General Theory of Nursing (2 of 2)
Health: A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning.
Nursing: Therapeutic self-care designed to supplement self-care requisites. Nursing actions fall into one of three categories: wholly compensatory, partly compensatory, or supportive educative system.
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Callista Roy’s Adaptation Model
Person (human system): A whole with parts that function as a unity
Environment: Internal and external stimuli; the world within and around humans as adaptive systems
Health: A state and process of being and becoming an integrated and whole human being
Nursing: Manipulation of stimuli to foster successful adaptation
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Roy’s 6-Step Nursing Process
Assessing behaviors manifested from the 4 adaptive modes
Assessing and categorizing stimuli
Making a nursing diagnosis
Setting goals to promote adaptation
Implementing interventions aimed at managing stimuli to promote adaptation
Evaluating achievement of adaptive goals
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Betty Neuman’s Systems Model (1 of 3)
Wellness model based on general systems theory.
Focus of the model is on the client system in relationship to stressors.
Client system is protected by a circular series of buffers known as lines of defense:
Flexible line of defense
Normal line of defense
Lines of resistance
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Betty Neuman’s Systems Model (2 of 3)
Person (client system): A composite of physiological, psychological, sociocultural, developmental, and spiritual variables in interaction with the internal and external environment
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Betty Neuman’s Systems Model (3 of 3)
Environment: All internal and external factors of influences surrounding the client system; three relevant environments identified are the internal environment, the external environment, and the created environment.
Health: A continuum of wellness to illness; equated with optimal system stability.
Nursing: Prevention as intervention; concerned with all potential stressors.
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King’s Interacting Systems Framework and Theory of Goal Attainment (1 of 3)
Conceptualizes 3 levels of dynamic interacting systems: personal systems (individuals), interpersonal systems (groups), and social systems (society).
Concepts important to understanding the theory include communication, interaction, role, stress, and transaction.
Person (human being): A personal system that interacts with interpersonal and social systems.
Environment: Can be both external and internal; the external environment is the context within which human beings grow, develop, and perform daily activities. The internal environment of human beings transforms energy to enable them to adjust to continuous external environmental changes.
King’s Interacting Systems Framework and Theory of Goal Attainment (2 of 3)
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Health: Dynamic life experiences 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.
Nursing: A process of human interaction; the goal of nursing is to help patients achieve their goals.
King’s Interacting Systems Framework and Theory of Goal Attainment (3 of 3)
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Johnson’s Behavioral System Model: 7 Subsystems of Behavior
Achievement
Affiliative
Aggressive
Dependence
Sexual
Eliminative
Ingestive
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Johnson’s Behavioral System Model (1 of 2)
Person (human being): A biopsychosocial being who is a behavioral system with 7 subsystems of behavior
Environment: Includes internal and external environment
Health: Efficient and effective functioning of system; behavioral system balance and stability
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Johnson’s Behavioral System Model (2 of 2)
Nursing: An external regulatory force that acts to preserve the organization and integrity of the patient’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found
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Parse’s Humanbecoming Theory: Themes and Processes
Three themes:
Meaning
Rhythmicity
Transcendence
Three processes:
Explicating
Dwelling
Moving beyond
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Parse’s Humanbecoming Theory
Person: An open being, more than and different than the sum of parts in mutual simultaneous interchange with the environment who chooses from options and bears responsibility for choices.
Environment: Coexists in mutual process with the person.
Health: Continuously changing process of becoming.
Nursing: A learned discipline; the nurse uses true presence to facilitate the becoming of the participant.
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Leininger’s 3 Modalities
Cultural care preservation and/or maintenance
Cultural care accommodation and/or negotiation
Cultural care repatterning or restructuring
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Madeleine Leininger’s Cultural Diversity and Universality Theory (1 of 2)
Person: Human being, family, group, community, or institution
Environment (environmental context): Totality of an event, situation, or experience that gives meaning to human expressions, interpretations, and social interactions in physical, ecological, sociopolitical, and/or cultural settings
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Madeleine Leininger’s Cultural Diversity and Universality Theory (2 of 2)
Health: A state of well-being that is culturally defined, valued, and practiced
Nursing: Activities directed toward assisting, supporting, or enabling with needs in ways that are congruent with the cultural values, beliefs, and lifeways of the recipient of care
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Peplau’s Theory of Interpersonal Relations (1 of 4)
Six nursing roles that emerge during the phases of a relationship:
Teacher
Resource
Counselor
Leader
Technical expert
Surrogate
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Peplau’s Theory of Interpersonal Relations (2 of 4)
Three phases in the nurse–patient relationship:
Orientation
Working
Resolution
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Peplau’s Theory of Interpersonal Relations (3 of 4)
Person: Encompasses the patient (who has problems for which expert nursing services are needed or sought) and the nurse
Environment: Forces outside the organism within the context of culture
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Peplau’s Theory of Interpersonal Relations (4 of 4)
Health: Implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living
Nursing: The therapeutic, interpersonal process between the nurse and the patient
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Pender’s Health Promotion Model: 3 Major Categories to Consider
Individual characteristics and experiences (biological factors, psychological factors, sociocultural factors)
Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect)
Behavioral outcome
Pender’s Health Promotion Model (1 of 2)
Person: The individual, who is the primary focus of the model
Environment: The physical, interpersonal, and economic circumstances in which persons live
Health: A positive high-level state
Pender’s Health Promotion Model (2 of 2)
Nursing: The role of the nurse includes raising consciousness related to health-promoting behaviors, promoting self-efficacy, enhancing the benefits of change, controlling the environment to support behavior change, and managing barriers to change
Afaf Ibrahim Meleis: Transitions Theory (1 of 3)
Transition is a process triggered by a change that represents a passage from a fairly stable state to another fairly stable state.
Transitions can be described in terms of types and patterns of transitions, properties of transition experiences, transition conditions, process indicators, outcome indicators, and nursing therapeutics.
Afaf Ibrahim Meleis: Transitions Theory (2 of 3)
Person: Persons are active beings who experience fundamental life patterns and who have perceptions of and attach meaning to transition experiences.
Environment: Environmental conditions expose persons to potential damage, problematic recovery, or delayed or unhealthy coping contributing to vulnerability related to transitions.
Afaf Ibrahim Meleis: Transitions Theory (3 of 3)
Health: Health consists of complex and multidimensional transitions that are characterized by flow and movement over time; healthy outcomes are defined in terms of the transition process.
Nursing: Nursing means being the primary caregiver for individuals and their families during the transition process and applying nursing therapeutics during transitions to promote healthy outcomes.
Swanson’s Theory of Caring (1 of 3)
Five basic processes of caring:
Maintaining belief
Knowing
Being with
Doing for
Enabling
Swanson’s Theory of Caring (2 of 3)
Person: Unique beings who are in the midst of becoming and whose wholeness is made manifest in thoughts, feelings, and behaviors
Environment: Any context that influences or is influenced by the designated client
Swanson’s Theory of Caring (3 of 3)
Health and well-being: To live the subjective, meaning-filled experience of wholeness; wholeness involves a sense of integration and becoming wherein all facets of being are free to be expressed.
Nursing: Informed caring for the well-being of others.
Kolcaba’s Theory of Comfort (1 of 4)
Comfort care encompasses 3 components:
An appropriate and timely intervention to meet the comfort needs of patients
A mode of delivery that projects caring and empathy
The intent to comfort
Kolcaba’s Theory of Comfort (2 of 4)
Comfort needs include patients’ or families’ desire for or deficit in relief, ease, or transcendence in the physical, psychospiritual, sociocultural, or environmental contexts of human experience.
Comfort measures refer to interventions that are intentionally designed to enhance patients’ or families’ comfort.
Kolcaba’s Theory of Comfort (3 of 4)
Person: Recipients of care may be individuals, families, institutions, or communities in need of health care
Environment: Includes any aspect of the patient, family, or institutional setting that can be manipulated by the nurse, a loved one, or the institution to enhance comfort
Kolcaba’s Theory of Comfort (4 of 4)
Health: Considered optimal functioning of the patient, the family, the healthcare provider, or the community
Nursing: The intentional assessment of comfort needs, design of comfort interventions to address those needs, and reassessment of comfort levels after implementation compared with baseline
Reed’s Self-Transcendence Theory (1 of 3)
Three major concepts are central to the theory of self-transcendence:
Self-transcendence
Well-being
Vulnerability
Additional concepts include:
Moderating–mediating factors
Points of intervention
Reed’s Self-Transcendence Theory (2 of 3)
Person: Human beings who develop over the life span through interactions with other persons and within an environment
Environment: Composed of family, social networks, physical surroundings, and community resources
Reed’s Self-Transcendence Theory (3 of 3)
Health (well-being): A sense of feeling whole and healthy, according to one’s own criteria for wholeness and health
Nursing: The role of nursing activity is to assist persons through interpersonal processes and therapeutic management of their environment to promote health and well-being
Merle Mishel: Uncertainty in Illness Theory (1 of 4)
Uncertainty is defined as the “inability to determine the meaning of illness-related events inclusive of inability to assign definite value and/or to accurately predict outcomes.”
Second central concept, cognitive schema, defined as a “person’s subjective interpretation of illness-related events.”
Merle Mishel: Uncertainty in Illness Theory (2 of 4)
The revised theory incorporates two new concepts: self-organization and probabilistic thinking
Uncertainty in illness theory is organized around 3 themes:
Antecedents of uncertainty
Appraisal of uncertainty
Coping with uncertainty
Merle Mishel: Uncertainty in Illness Theory (3 of 4)
Person: The concept of the person is the central focus of the theory and may be an individual or the family of an ill individual; the individual is viewed as a biopsychosocial being who is an open system exchanging energy with the environment.
Environment: Not explicitly defined, but is acknowledged to exchange energy with the person system.
Merle Mishel: Uncertainty in Illness Theory (4 of 4)
Health: Defined in terms of uncertainty in the context of the illness experience, with the concept of health or well-being being congruent with the formulation of a new life view and probabilistic thinking.
Nursing: Nurses are viewed as a part of the antecedent variable of structure providers.
Cheryl Tatano Beck: Postpartum Depression Theory (1 of 3)
Two major concepts: Postpartum mood disorders and loss of control
Four stages in the coping process
Postpartum Depression Screening Scale (PDSS) used in screening
Cheryl Tatano Beck: Postpartum Depression Theory (2 of 3)
Person: Described in terms of wholeness with biological, sociological, and psychological aspects, with personhood understood in the context of family and community
Environment: Viewed broadly in terms of individual factors and external factors
Cheryl Tatano Beck: Postpartum Depression Theory (3 of 3)
Health: Not defined explicitly; traditional ideas of physical and mental health are viewed as a consequence of women’s responses to the contexts of their lives and environments.
Nursing: A caring profession with caring obligations; the nurse accomplishes the goals of health and wholeness through interpersonal interactions.
Synergy Model for Patient Care (1 of 4)
Framework for designing practice competencies to care for critically ill patients
Goal of optimizing outcomes for patients and families
Optimal outcomes realized when the competencies of the nurse match the patient and family needs
Synergy Model for Patient Care (2 of 4)
8 patient characteristics: resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability
8 nurse characteristics: clinical judgment, advocacy, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and facilitation of learning
Synergy Model for Patient Care (3 of 4)
Persons: Viewed in the context of patients who are biological, social, and spiritual entities who are present at a particular developmental stage.
Environment: The concept is not explicitly defined; however, included in the assumptions is the idea that environment is created by the nurses for the care of the patient.
Synergy Model for Patient Care (4 of 4)
Health: The concept of health is not explicitly defined; an optimal level of wellness as defined by the patient is mentioned as a goal of nursing care.
Nursing: The purpose of nursing is to meet the needs of patients and families and to provide safe passage through the healthcare system during a time of crisis.
Overview of Selected Nonnursing Theories
General system theory (von Bertalanffy)
Social cognitive theory (Bandura)
Stress and coping process theory (Lazarus)
General adaptation syndrome (Selye)
Guide for Selecting a Framework for Theory-Based Practice (1 of 3)
Consider the values and beliefs that you truly hold in nursing.
Write a philosophy of nursing that clarifies your beliefs related to person, environment, health, and nursing.
Survey definitions of person, environment, health, and nursing in nursing models.
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Guide for Selecting a Framework for Theory-Based Practice (2 of 3)
Select 2 or 3 frameworks that best fit with your beliefs related to the concepts of person, environment, health, and nursing.
Review the assumptions of the frameworks that you have selected.
Make applications of those frameworks in a selected area of nursing practice.
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Guide for Selecting a Framework for Theory-Based Practice (3 of 3)
Compare the frameworks on client focus, nursing action, and client outcome.
Review the nursing literature written by persons who have used the frameworks.
Select a framework and develop its use in your nursing practice.
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