Nursing Theories: lý thuyết điều dưỡng hiện đại

Nursing Theories
Dr. Belal M. Hijji, RN, PhD
19.09.2010


Learning Outcomes
At the end of this lecture, students will be able to:
• Define the working terms and theory
• Recognise the four metaparadigms for nursing
• Discuss some of the selected nursing theories

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Defining Relevant Working Terms
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Phenomenon: Is a thing, event or activity that we perceive through
our senses. The phenomenon represents the subject matter of a
discipline. When experience and sensory and intuitive data become
coherent as a whole, we have a phenomenon. For example, when a
patient, preoperatively, is noted restless in bed, biting fingernails,
and sighing, this is a phenomenon.
Concept: Is a label used to describe a phenomenon. Therefore,
when we put a name to a phenomenon, we are identifying a
concept. In the example provided above, the phenomenon may be
labelled as ‘anxiety’.
– As a mental image, a concept is a view of reality tinted [colored] with our
perceptions and experience. Therefore, a phenomenon could be given

a different conceptual label by two different nurses. Therefore, a
concept is a tool not a reality – it facilitates observation of a real
phenomenon. Concepts are also the building blocks of theory.

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Construct: If the phenomenon is very abstract and the resultant
concept is not directly observable or measurable, it is often referred
to as a construct (‘self-esteem’).

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– A construct is a type of highly complex concept whose reality base can
only be inferred. Therefore, imagining a continuum of concepts from
concrete (thermometre) to abstract (caring, compassion), constructs would
be placed at the abstract end. All constructs are concepts but not all
concepts are constructs.
– The following example illustrates the continuum of abstraction of concepts.
A cow is a very concrete conceptualisation and we move toward more
abstract levels of conceptualisation.
– Cow
- Bessie
- livestock
- farm asset
- wealth
– Two things are noted as the concepts become more abstract; more of the
characteristics of the concept ‘cow’ are being omitted and the ability to
directly observe and measure the concept is becoming more difficult.
– Constructs could be made measurable by identifying variables. For

example, if ‘marital status’ is a construct, it could be made measurable by
breaking it into the variables ‘single’, ‘widowed’, ‘divorced’, ‘married’.

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What is a Theory?
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‘Theory’ is often defined in relation to ‘practice’. For example, a
teacher describes the process of giving an injection, as opposed to
students actually giving the injection to patient. Theory in this sense
means dealing with a topic (administration of an injection).
Theory has several definitions. At basic level, theory explains the
occurrence of phenomena. To do this, it has to explain the
relationship between variables or concepts. For example, ‘an
expansion in a bar of metal occurs when it is heated’. The
phenomenon of expansion is explained by the relationship between
the variable ‘metal’ and the variable ‘heat’.
The theory must also predict that each time the variables happen to
be in the same relationship, the same results will be obtained.
Another definition of theory is that it ‘is a set of interrelated
constructs (concepts) definitions and propositions that present a
systematic view of phenomena by specifying relations among
variables, with the purpose of explanation and prediction’.

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From the above example on the theory of metal expansion, a
number of propositions exist:
– Metals are made up of atoms
– The structure of atom is changed by heat
– Heat causes atoms to expand

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The Metaparadigm For Nursing
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Paradigm: refers to a pattern of shared understandings and
assumptions about reality and the world. We become aware of
paradigms when realities clash. In nursing we refer to qualitative vs
quantitative research paradigms.
Person, environment, health, and nursing are collectively referred to
as metaparadigm for nursing. Meta means ‘with’, while paradigm
means ‘pattern’. These four concepts are central to nursing.
– Person: The recipient of nursing care.
– Environment: The internal and external surroundings that affect the
person.
– Health: the degree of wellness or well-being that the person

experiences.
– Nursing: The attributes, characteristics, and actions of the nurse
providing care to person.

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What we need to know about these four major concepts is that their
definitions vary from one theorist to another
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Overview of Selected Nursing Theories
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Nightingale Environmental Theory: Nightingale (1860) defined
nursing as ‘the act of utilising the environment to assist the patient in
his recovery’. She linked health with five environmental factors:
“fresh air”, “pure water”, “efficient drainage”, “cleanliness” and “light,
especially direct sunlight”.
– Nightingale concepts about ventilation, cleanliness, quiet, warmth, and
diet remain integral parts of nursing and health care today.

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Orem’s General Theory of Nursing
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Consists of three related theories collectively referred to
as “Orem’s General Theory of Nursing”:

1.
2.
3.

Self-care Theory: 3 types of self-care requisites (needs)
Self-care Deficit Theory: 5 Methods of Assistance
Nursing Systems Theory: 3 types

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Orem’s Self-care Theory

• Based on the concepts of:
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SELF-CARE
SELF-CARE AGENCY
SELF-CARE REQUISITES
THERAPEUTIC SELF-CARE DEMAND

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Self-care Definition
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Self-care comprises those activities performed independently by an
individual to promote and maintain personal well-being throughout life.

Self-care Agency
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Definition: the individual’s ability to perform self-care activities
Consists of TWO agents:
– Self-care Agent - person who provides the self-care
– Dependent Care Agent - person other than the individual who
provides the care (such as a parent)

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Self-care Requisites (Needs)
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Definition: the actions or measures used to provide self-care. A need is
also a requirement within an individual or group which stimulates a
response to maintain integrity.
Consists of THREE categories:
– Universal - requisites/needs that are common to all individuals.
These include maintaining intake and elimination of air, water, and
food.
– Developmental - needs resulting from maturation or develop due to

a condition or event, such as adjusting to a change in body image or
to loss of spouse.
– Health Deviation - needs resulting from illness, injury & disease or
its treatment. These include actions such as seeking health care
assistance and taking prescribed medications

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Orem’s Self-care Deficit Theory
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Is the central focus of Orem’s Grand Theory of Nursing
Explains when nursing is needed
Describes and explains how people can be helped through nursing
Results when the Self-care Agency (patient) can’t meet her/his self-care
needs or administer self-care
Nursing meets these self-care needs through five methods of helping.
These are:
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Acting or doing for
Guiding
Teaching
Supporting
Providing an environment to promote the patient’s ability to meet

current or future demands
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Orem’s Nursing Systems Theory Describes...
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Nursing responsibilities
Roles of the nurse and patient
Rationales for the nurse-patient relationship
Types of actions needed to meet the patient’s demands

Orem’s Nursing Systems Theory
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Refers to a series of actions a nurse takes to meet a patient’s self-care
needs
Is determined by the patient’s self-care needs
Is composed of THREE types of nursing systems:
– Wholly compensatory: a patient’s self-care agency is so limited that
s/he depends on others for well-being.
– Partly compensatory: a patient can meet some self-care requisites
but needs a nurse to help meet others
– Supportive-educative: a patient can meet self-care requisites but
needs help in decision-making, behavior control, or knowledge

acquisition
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Henderson Definition of Nursing

“The unique function of the nurse is to assist the individual, sick or
well, in the performance of those activities contributing to health or
its recovery (or to peaceful death) that he would perform unaided if
he had the necessary strength, will, or knowledge, and to do this in
such a way as to help him gain independence as rapidly as
possible.”
“It is my contention that the nurse is, and should be legally, an
independent practitioner [as long as she is not performing the doctor’s
duties.] But the nurse is the authority on basic nursing care. Perhaps I
should explain that by basic nursing care I mean helping the patient
with the following activities…”


14 Fundamental Needs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

11.
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Breathing normally
Eating and drinking adequately
Eliminating body wastes
Moving and maintaining a desirable position
Sleeping and resting
Selecting suitable clothes
Maintaining body temperature… by adjusting cothing and
modifying the environment
Keeping the body clean and well-groomed…
Avoiding dangers in the environment and avoiding injuring others
Communicating with others in expressing emotions, needs, fears,
or opinions
Worshipping according to one’s faith
Working in such a way that one feels a sense of accomplishment
Playing or participating in various forms of recreation
Learning, discovering, or satisfying the curiosity that leads to
normal development and health, and using available health
facilities


Nurse’s Role
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Substitutive : acting for a person
Supplementary : assisting a person
Complementary : working with the person

“…with the goal of helping the person become as independent as
possible.”
“Today I see the role of nurses as givers of ‘primary health care,’ as
those who diagnose and treat when a doctor is unavailable… Nurses
may be the general (medical) practitioners of tomorrow…”

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Neuman’s Systems Model
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Neuman’s model is based on the individual’s relationship to stress,
reaction to it, and reconstitution factors. Reconstitution is the state of
adaptation to stressors.
• In this model, the client is an open system composed of a central
core of energy sources (physiologic, psychologic, sociocultural,
developmental, and spiritual) surrounded by two rings referred to as
lines of resistance. These lines represent internal factors that help
the client defend against a stressor; for example an increase in the
body white cells count to fight an infection.
• Outside the lines of resistance are two lines of defense. The normal
line of defense represents the person’s state of equilibrium or the
state of adaptation developed and maintained over time and
considered normal for the person. The flexible line of defense is
dynamic and can be rapidly altered over a short period of time. It

prevents stressors from penetrating the normal line of defense.

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Stressors in Neuman’s model are:
 Intrapersonal: Occur within an individual (infection)
 Interpersonal: Occur between individuals (Unrealistic role
expectation)
 Extrapersonal: Occur outside the person (financial concerns)
• The individual’s reaction to stress depends on the strength of lines
of defense. When these lines fail, the resulting reaction depends on
the lines of resistance.
• Nursing interventions focus on retaining or maintaining system
stability. The intervention are carried out on three preventive levels:
 Primary prevention: Focuses on protecting the normal line of
defense and strengthening the flexible line of defense.
 Secondary prevention: Focuses on strengthening internal
lines of resistance, reducing the reaction, and increases
resistance factors.
 Tertiary prevention: Focuses on readaptation and stability
and protects reconstitution or return to wellness after
treatment.
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