GRAND THEORIESGRAND THEORIES

MYRA LEVINEMYRA LEVINE

DOROTHEA OREMDOROTHEA OREM

MARTHA ROGERSMARTHA ROGERS

IMOGENE KINGIMOGENE KING

MYRA E. LEVINE

Received her diploma in nursing in 1944 from Cook Country School of Nursing, Chicago.

Held position as staff nurse, administrator, teacher, supervisor, clinical instructor, director of nursing services.

Levine’s Conservation Model Addresses total patient care, has components- the

conservation principles and the organismic response or pursuit of wholeness.

Her model is limited to persons already in a state of illness.

She focuses on the nursing interventions used during the adaptation and response to illness; these actions after on restoring the patient’s wholeness, integrity and well-being.

Conservation Principles o Levine bases her model on nursing intervention as

a conservation activity that maintains a person’s wholeness or totality.

o 4 CONSERVATION PRINCIPLES

1. Conservation of Energy- refers to an individual’s need for a balance of energy and a constant renewal of energy resources.

2. Conservation of structural Integrity – refers to an individual’s need for healing or maintaining and restoring the body’s elements.

3. Conservation of Personal Integrity – Refers to an individual’s need to maintain and restore self-identity and self worth.

4. Conservation of social- integrity – Refers to an individual's need for interaction with others as a social being.

Organismic Response To survive, a person must adapt to the environmentThe levels of redundant choices are part of the

person’s organismic response; some responses are immediate, whereas others are long-term.

4 Level of Organismic response

1. Fight or Flight Response- is the most primitive response to a real or perceived threat.

2. Inflammatory response – is a mechanism that protects a person from a hostile environment.

3. Response to stress – is a nonspecific bodily response in which all systems within the individual adapt (for example, the psychological and social responses to limb amputation.

4. Sensory Response- is based on a person’s perceptual awareness; causes use of the senses.

Levine’s Model and 4 concepts of the Nursing Metaparadigm

A. Person

1. is viewed by Levine as a holistic individual or open system.

2. Is everchanging organism in constant interaction with the environment and striving to maintain integrity, whereas a nursing patient is a whole person in need of assistance to conservation energy and maintain structural, personal, or social integrity.

B. ENVIRONMENT

1. Is internal (within a person, such as the body’s response to bacterial.

2. Is external ( consisting of three parts: perceptual environment, to which a person responds by using the five senses – sight, sound, smell, taste and touch; operational environment, such as pollutants or radiation to which a person responds physically; and conceptual environment including past experiences and future ideas, to which a person responds through traditions, beliefs or values)

3. Includes the nurse

C. Health1. Is a pattern of adaptation or change and it is viewed as a

continuum.

2. Involves adapting by degrees – that is, gradually rather turn by extremes.

3. Maintains a person’s unity and integrity.

D. Nursing

1. Is a discipline based on the dependence of people and their relationships with others.

2. Involves human interaction to promote the wholeness of a dependent person and to assist the person in adapting to a state of health.

3. Requires skills and scientific knowledge when interacting with a patient.

Martha Rogers

Began her nursing career after receiving a diploma in nursing from Knoxville. General Hospital School of Nursing in 1936.

Roger has held numerous staff and leadership positions in community health nursing, education and research.

“ Rogers’s Unitary Human Beings Model”

Is based on her assumptions about the person and interaction with the environment.

Four building blocks to develop her model

1. Energy fields - are the fundamental units of both living and nonliving things; they are unique, dynamic, open and infinite.

2. Universe of open systems – refers to the idea that energy

field are open, infinite and interactive (integral).

3. Pattern – is the characteristic of an energy field; it is perceived as a wave that changes continuously, becoming increasingly complex and diverse.

4. Four dimensionality – refers to a nonlinear domain without spatial or temporal attributes; its boundaries are imaginary and continuously fluctuating

Homeodynamics – as a means of understanding life and the mechanisms that affect it.

Integrality –refers to the continuous and mutual interaction between the human and environmental fields.

Resonancy – refers to the continous change from lower- frequency (longer) to higher- frequency (shorter) wave patterns in the human and environmental fields.

Helicy – refers to the continuous, probabilistic, increasing diversity of the human and environmental fields; it Is characterized by non repeating RHYTHMICITIES.

Rogers’s Model and 4 concepts of the Nursing Metaparadigm

A. Person

1. Is described as an organized energy field with a unique pattern.

2. Is viewed as a unified whole( unitary man) possesing integrity and manifesting characteristics more than and different from the sum of the parts.

B. Environment

1. Is described as an irreducible four dimensional energy field identified by pattern and having characteristics different from those of its parts.

C. Health 1. Is defined as an imposed value of society.2. Is used to describe wellness and the absence of

disease and major illness; Rogers uses the terms health and illness to identify the patterns that denote behaviors of high o low value, the value being determined by the individual and subject to cahnge based on the individuals behavior.

D. Nursing

1. Is an art and SCIENCE that seeks to study the nature and direction of unitary man’s development in constant interaction with the environment.

2. Must base its practice on a body of knowledge that is validated by research.

3. Based on scientific knowledge, abstract knowledge, intellectual judgment and compassion.

DOROTHEA E. OREMDOROTHEA E. OREM

Began her nursing career in the early 1930s after receiving her RN diploma from Providence Hospital School of Nursing, Washington, DC.

Orem has worked as a staff nurse, private nurse, nurse educator, administrator, and consultation.

OREM’S General Theory of Nursing

1. Self Care Theory-Describes, promote and explain SELF-CARE.

2. Self-Care Deficit Theory- is the central focus of Orem’s General Theory of Nursing

- Explains when nursing is needed.-Describes and explains how people can helped through nursing.

3. Nursing Systems Theory

- Refers to the series of actions a nurse takes to meet a patient’s self care requisites.

Nursing systems1. wholly compensatory nursing system- is used when a patient self care agency is so limited that the patient depends on others for well being.

2. Partly compensatory nursing- is used when a patient can meet some self-care requisites but needs a nurse to help meet others; the nurse and the patient play major roles in performing self care.

3. Supportive Educative system – is used when a patient can meet self care requisites but needs assistance with decision making, behavior control or knowledge acquisition skills.

Orem’s Theory and 4 concepts of the Nursing Metaparadigm

a. Person – is defined by Orem as the patient ( the recipient of nursing care)- a being who functions biologically symbolically, and socially and who has the potential for learning and development.

b. Environment – can positively or negatively affect a person’s ability to provide self-care.

c. Health – as a state characterized by soundness or wholeness of bodily structure and function; illness is its opposite.

d. Nursing - is viewed by Orem as a service geared toward helping the self and others.

IMOGENE KING Completed her basic nursing education in 1945 when she

received her diploma in nursing.

She has held positions in nursing education, administration, and practice.

Open systems framework- is based on the assumption that humans are open system in constant interaction with their environment.

Kings Goal attainment theory

– represents an expansion of King’s original ideas to incorporate the concept of the nurse and the patieny mutually communicating, information, establishing goals and taking Action to attain goals.

King’s Theory and 4 concepts of the Nursing Metaparadigm

a. Person – is a social, sentient, rational, perceiving, controlling, purposeful, action-oriented, time oriented being.

b. Environment – Not specifically defined by King, although she uses the terms Internal Environment and external Environment in her open system approach.

c. Health – as a dynamic state in the life cycle, illness is viewed as an interference in the continuum of the life cycle.

d. Nursing – refers to observable nurse-client interaction, the focus of which is to help the individual maintain health and function in an appropriate role.