Provides a perspective from which: to define the what of nursing to describe the who of nursing (the client) to describe when nursing is needed

to identify the boundaries and goals of nursing’s therapeutic activities

the basic elements of a nursing theory are:1.Concept2.Proposition

basic building block of a theory complex mental formulations of one’s perceptions

of the world labels/names a phenomenon

an observable fact that can be perceived through the senses & explained

helps us to name things and occurrences in the world around us

assist us in communicating with each other about the world

Complex mental formulations of one’s perceptions of the world

A conceptual framework is a structure that links global concepts together.

Set of concepts and propositions that provide an orderly way to view phenomena

Purpose: to describe, explain, and predict phenomena

traditional definition: an organized, coherent set of concepts & their relationship to each other that offer descriptions, explanations & predictions about a phenomena

provide a framework for thought within the discipline of nursing

provide a structure for communication among nurses and other health team members

assist nursing in clarifying beliefs, values, and goals

help to define the unique contribution of nursing to the care of clients

nursing theory, research, and practice are interdependent.

Grand theory Orem’s self-care deficit theory of nursing

Middle-range theory Peplau’s theory of interpersonal relations

Micro-range theory Examines a specific phenomenon

Concepts representing global & complex phenomena

Broadest scope Most abstract level of development Addresses the broad phenomena of concern

w/in the discipline Provides overall framework for structuring

broad, abstract ideas

Addresses more concrete & more narrowly defined phenomena than a grand theory

Intended to answer questions about nursing phenomena – but doesn’t cover the full range of phenomena of concern to the discipline

Provides a perspective from which to view complex situations and a direction for interventions

The most concrete & narrow in scope Explains a specific phenomenon

work of early nursing theorists in the 1950’s focused on the tasks of nursing practice from a mechanistic point of view

in the 1960’s nursing theorists made nursing practice, theory & research fit into the prevailing view of science

global awareness of health care needs provided a new perspective that unified the notion of nursing as both an art & science

several theories that share a common view of the world can be grouped together to form a paradigm

What is a paradigm? A particular viewpoint or perspective

each discipline has a defined metaparadigm

What is a metaparadigm? The distinguishing concepts that provide the

boundaries and limitations of a discipline The major concepts that provide structure to the

domain of nursing are: 1. person2. environment3. health4. nursing

Florence Nightingale is recognized as founder of modern-day nursing. Her environmental model is based on the idea that the impetus for healing lies within the individual human being and the focus of care is to place the individual in an environment that is supportive to that healing process. Her 13 canons speak to areas that require the attention of the nurse, such as cleanliness, ventilation, warming, light, noise, variety, nutrition, “chattering hopes and advices,” and observation of the sick.

OBJECTIVES Describe the historical background of the development

of Nightingale’s environmental model Name at least three of Nightingale’s major writings Explain each of Nightingale’s 13 canons Present the relationship between the environmental

model and concepts in nursing’s metaparadigm Provide an example of use of the environmental model

in clinical practice Identify strengths and weaknesses of the environmental

model for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing the environmental model

Relate the environmental model to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the environmental model

CRITICAL THINKING Give two examples of therapeutic nursing

interventions that could arise from using Nightingale’s environmental model.  

Describe at least three current nursing or healthcare activities that are congruent with and three that are in conflict with Nightingale’s work.  

Hildegard E. Peplau, in addition to her other accomplishments, presented the first published theoretical development in nursing in the twentieth century. Her focus is on the interpersonal process between a nurse and a client and the roles played by the nurse in this process. The interpersonal process occurs in three phases: orientation, working, and termination.

OBJECTIVES Describe the historical background of the development

of Peplau’s Interpersonal Relations in Nursing Explain each of the phases in Peplau’s Interpersonal

Relations in Nursing Identify the roles that nurses may play Present the relationship between Peplau’s work and

concepts in nursing’s metaparadigm Provide an example of use of Peplau’s Interpersonal

Relations in Nursing in clinical practice Identify strengths and weaknesses of Peplau’s

Interpersonal Relations for Nursing for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing Peplau’s work Relate Peplau’s work to critical thinking, therapeutic

nursing interventions, communication, and outcomes Cite examples of the contagiousness of Peplau’s work

Critical thinking  In your own words, describe how use of

Peplau’s work can influence the outcomes of nursing care.  

What evidence can you find to support that Peplau’s theory is contagious?  

Virginia Henderson presented her definition of nursing as part of her effort to regulate nursing practice through licensure. Although all states now have licensure regulations for the practice of nursing, her definition has had far greater impact. Her 14 components of basic nursing care augment the definition to provide an overall guide to the practice of nursing.

OBJECTIVES Describe the historical background of the development of

Henderson’s definition and 14 components Identify the impetus for the development of Henderson’s

definition of nursing Discuss each of Henderson’s 14 components Present the relationship between the definition and

components and concepts in nursing’s metaparadigm Provide an example of use of Henderson’s work in clinical

practice Identify strengths and weaknesses of Henderson’s work for

clinical practice, including her views of the nursing process Discuss the appropriateness of qualitative and quantitative

research methods for testing Henderson’s work Relate Henderson’s work to critical thinking, therapeutic

nursing interventions, communication, and outcomes Cite examples of the contagiousness of Henderson’s work

1. Breath2. Eat & drink3. Eliminate4. Move & maintain

posture5. Sleep & rest6. Dress & undress7. Maintain body

temperature

8. Keep clean9. Avoid danger10. Communicate11. Worship12. Work13. Play14. learn

14 Components of Basic Nursing Care

CRITICAL THINKING Choose 4 of Henderson’s 14 components and

give an example, in your own words, of how each might be used in clinical practice.  

Henderson’s work may be used to guide nursing care. Discuss how the selection of therapeutic nursing interventions would be affected by using Henderson’s work. Are there interventions that are more or less likely to be chosen? Support your response.    

Lydia E. Hall believed that patients over the age of 16, who were past the acute stage of illness, required a different focus of care than did the acutely ill. She demonstrated the effectiveness of her theory in practice at the Loeb Center. The three components of her theory are care, core, and cure. Care is based in the natural and biological sciences, includes the intimate aspects of bodily care, and is exclusive to nursing. Core is based in the social sciences, involves the therapeutic use of self, and is shared with other members of the health care team. Cure is based in the pathological and therapeutic sciences, involves working with the patient and family in relation to the medical care, and is shared with other members of the health care team.

OBJECTIVES Describe the historical background of the development

of Hall’s care, core, and cure Identify what is unique about Hall’s theory Explain the meaning of, and who is involved in, care,

core, and cure Present the relationship between Hall’s work and

concepts in nursing’s metaparadigm Provide an example of use of care, core, and cure in

clinical practice Identify strengths and weaknesses of care, core, and

cure for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing Hall’s work Relate care, core, and cure to critical thinking,

therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of Hall’s work

CRITICAL THINKING

Give examples of outcome statements that would be congruent with Hall’s theory.  

Discuss, in writing, the strengths and weaknesses of this particular theory for use in clinical practice in this particular situation.

Dorothea E. Orem’s general theory of nursing is made up of the three interrelated theories of self-care, self-care deficit, and nursing systems. A peripheral concept, basic conditioning factors, applies to all of the theories.

The major concepts of self-care are self-care, self-care agency, self-care requisites (universal, developmental, and health deviation), and therapeutic self-care demand. A self-care deficit exists when the therapeutic self-care demand exceeds self-care agency. Nursing systems involve nursing agency and the design of nursing systems for care (wholly compensatory, partly compensatory, and supportive-educative). Orem’s nursing process is a three-step process (diagnosis and prescription, nursing system design, production and management of nursing systems).

OBJECTIVES Describe the historical background of the development of

Orem’s Self Care Deficit Nursing Theory Name the three interrelated theories in Orem’s general

theory of nursing Define the concepts related to each of the three

interrelated theories Present the relationship between Orem’s general theory

of nursing and concepts in nursing’s metaparadigm Provide an example of use of Orem’s general theory of

nursing in clinical practice, including the guidelines to be used

Identify strengths and weaknesses of Orem’s general theory of nursing for clinical practice

Discuss the appropriateness of qualitative and quantitative research methods for testing Orem’s general theory of nursing

Relate Orem’s general theory of nursing to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of Orem’s general theory of nursing

3 systems exist within this professional nursing practice model

Compensatory system -nurse provides total care

Partially compensatory system -nurse & patient share responsibility for careEducative-development system -client has

primary responsibility for personal health, with nurse acting as a consultant

CRITICAL THINKING Give three examples of the contagiousness of

Orem’s work and, in your own words, describe how they relate to her work.  

Discuss how using Orem’s work in clinical practice can demonstrate the use of critical thinking.  

Faye Glenn Abdellah conducted research to identify ways to promote patient-centered comprehensive nursing care. As a result of the first three of these studies, 21 basic nursing problems were identified. The problems may be overt or covert, and problem solving is to used by the nurse. The nursing process as a problem-solving process is compatible with this approach.

OBJECTIVES Describe the historical background of the

development of Abdellah’s patient-centered approaches

Discuss the 21 nursing problems, overt and covert problems, and problem solving

Present the relationship between Abdellah’s patient-centered approaches and concepts in nursing’s metaparadigm

Provide an example of use of Abdellah’s patient-centered approaches in clinical practice, including effectiveness criteria

Identify strengths and weaknesses of Abdellah’s patient-centered approaches for clinical practice

Discuss the appropriateness of qualitative and quantitative research methods for testing Abdellah’s patient-centered approaches

Relate Abdellah’s patient-centered approaches to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of Abdellah’s patient-centered approaches

CRITICAL THINKING

What guidelines or support do the 21 nursing problems provide for therapeutic nursing interventions?  

How nursing care delivery would be influenced by using the indicated theory—for example, does the theory provide a specific guide to practice or to areas of practice? would certain assessment data be collected or missed? Are there certain kinds of actions that would or would not be taken? Would evaluation be included?

Dorothy E. Johnson presents the Behavioral System Model in which the patient’s behaviors are the nurse’s objects of analysis. As a behavioral system, the human being has seven subsystems—attachment or affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement.

The behavior of each subsystem arises from a drive related to a desired goal, a set of likely responses specific to the individual, a group of choices as to effective responses, and the observable outcomes identified as behavior. Others have indicated nursing diagnoses in the Behavioral System Model may deal with insufficiency, discrepancy, incompatibility, or dominance.

OBJECTIVES Describe the historical background of the development of

Johnson’s Behavioral System Model Discuss the relationship between Johnson’s definition of

nursing and the assumptions of the Behavioral System Model

Define each of the seven subsystems in the Behavioral System Model

Present the relationship between the Behavioral System Model and concepts in nursing’s metaparadigm

Provide an example of use of the Behavioral System Model in clinical practice

Identify strengths and weaknesses of the Behavioral System Model for clinical practice

Discuss the appropriateness of qualitative and quantitative research methods for testing the Behavioral System Model

Relate the Behavioral System Model to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the Behavioral System Model

CRITICAL THINKING

In what ways is communication influenced by use of the Behavioral System Model?

Would you describe the Behavioral System Model as contagious? Provide rationale for your response.  

Ida Jean Orlando developed the nursing process discipline through the study of numerous nurse-patient interactions. She identified that the difference between a good outcome and a bad outcome was the sharing of the nurse’s reaction to the patient’s behavior with the patient. She describes nursing as unique and independent with a focus on the patient’s immediate need for help.

The patient’s expressed need for help leads to a reaction in the nurse. This automatic reaction consists of a perception, thought, or feeling, which is shared with the patient and owned as the nurse’s. After validating or correcting the accuracy of the reaction with the patient, the need for help is identified and a deliberative action is taken. A deliberative action occurs in an effort to meet the patient’s need; an automatic action occurs for some other reason.

OBJECTIVES Describe the historical background of the development

of Orlando’s Nursing Process Discipline Define each of Orlando’s key concepts and relate them

to the Nursing Process Discipline Present the relationship between the Nursing Process

Discipline and concepts in nursing’s metaparadigm Provide an example of use of the Nursing Process

Discipline in clinical practice Identify strengths and weaknesses of the Nursing

Process Discipline for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing the Nursing Process Discipline

Relate the Nursing Process Discipline to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the Nursing Process Discipline

Give an example of the use of critical thinking in carrying out the disciplined nursing process.  

Describe the role of communication in the disciplined nursing process.

Imogene M. King developed a general systems framework and a theory of goal attainment. The framework speaks to three levels of systems—individual or personal, group or interpersonal, and society or social. The theory of goal attainment speaks to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space.

King emphasizes that both the nurse and the client bring important knowledge and information to the relationship and that they work together to achieve goals. Research has supported that when the nurse and client communicate and work together toward mutually selected goals, the goals are more likely to be attained.

OBJECTIVES Describe the historical background of the development of

King’s framework and theory Differentiate between King’s framework and theory Define the concepts in King’s theory Present the relationship between King’s theory and

concepts in nursing’s metaparadigm Provide an example of use of the theory of goal

attainment in clinical practice Identify strengths and weaknesses of the theory of goal

attainment for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing the theory of goal attainment

Relate the theory of goal attainment to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the theory of goal attainment

CRITICAL THINKING How does King’s Theory of Goal Attainment

influence communication in clinical practice?   Are there any therapeutic nursing

interventions that would be either eliminated or mandated when using King’s Theory of Goal Attainment? Support your response.  

Martha E. Rogers developed the Science of Unitary Human Beings as nursing’s unique body of knowledge. Human beings and their environments are infinite energy fields in continuous motion. They produce patterns and are unitary. Rogers’ three principles are the principles of resonancy (continuous change from lower to higher frequency), helicy (increasing diversity), and integrality (continuous process of the human and environmental fields).

OBJECTIVES Describe the historical background of the development

the Science of Unitary Human Beings Explain paradigm shift Define the five building blocks and three principles of

Rogers’ conceptual system Present the relationship between the Science of Unitary

Human Beings and concepts in nursing’s metaparadigm Provide an example of use of the Science of Unitary

Human Beings in clinical practice Identify strengths and weaknesses of the Science of

Unitary Human Beings for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing the Science of Unitary Human Beings

Relate the Science of Unitary Human Beings to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the Science of Unitary Human Beings

Critical Thinking Provide examples of the contagiousness of

Rogers’ work. What are the implications of Rogers’ theory

for identifying and achieving outcomes?  

Sister Callista Roy developed the Roy Adaptation Model, which is based on the belief that the human being is an open system. The system responds to environmental stimuli through the cognator and regulator coping mechanisms for individuals and the stabilizer and innovator control mechanisms for groups. The responses occur through at least one of four modes—physiological-physical, self-concept-group identity, role function, and interdependence.

The responses in these modes are usually visible to others and can be identified as adaptive or ineffective. Adaptive behaviors that need support and ineffective behaviors are then analyzed to identify the associated stimuli. The major stimulus leading to one of these behaviors is the focal stimulus; other stimuli that are verified as being involved are contextual, and stimuli that might be involved but have not been verified are residual. Nursing care focuses on altering stimuli or strengthening adaptive processes to result in adaptive behaviors.

OBJECTIVES Describe the historical background of the

development of the Roy Adaptation Model (RAM) Name at least three of Roy’s major writings Identify the assumptions basic to the RAM Define the major concepts of the RAM Present the relationship between the RAM and

concepts in nursing’s metaparadigm Provide an example of use of the RAM in clinical

practice for an individual and for a group Identify strengths and weaknesses of the RAM for

clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing the RAM Relate the RAM to critical thinking, therapeutic

nursing interventions, communication, and outcomes Cite examples of the contagiousness of the RAM

Critical Thinking Discuss the strengths and weaknesses of this

particular theory for use in clinical practice in a particular situation.

How nursing care delivery would be influenced by using the indicated theory—for example, does the theory provide a specific guide to practice or to areas of practice? would certain assessment data be collected or missed? Are there certain kinds of actions that would or would not be taken? Would evaluation be included?

Betty Neuman developed the Neuman Systems Model to provide a structure for integrating information about humans in a wholistic manner. The model consists of a core or basic structure and energy resources that provide for basic survival. Surrounding the core are the lines of resistance that are activated when a stressor invades the system. Outside of the lines of resistance is the normal line of defense, the system’s usual level of wellness that protects from the negative impact of stressors. Finally, the flexible line of defense is the outer boundary and provides the initial response to stressors.

Each of these levels also incorporates the five client variables—physiological, psychological, sociocultural, developmental, and spiritual. There are three environments—internal, external, and created—and three levels of prevention—primary, secondary, and tertiary. Less clearly defined are reaction and reconstitution. Neuman presents her own process, which is compatible with the nursing process.

OBJECTIVES Describe the historical background of the development

of the Neuman Systems Model Define the major aspects of the Neuman Systems Model Identify the propositions of the Neuman Systems Model Present the relationship between the Neuman Systems

Model and concepts in nursing’s metaparadigm Provide an example of use of the Neuman Systems

Model in clinical practice Identify strengths and weaknesses of the Neuman

Systems Model for clinical practice Discuss the appropriateness of qualitative and

quantitative research methods for testing the Neuman Systems Model

Relate the Neuman Systems Model to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the Neuman Systems Model

CRITICAL THINKING Discuss the contagiousness of the Neuman

Systems Model.   What therapeutic nursing interventions would

be most compatible with the Neuman Systems Model?  

Jean Watson proposed that the ultimate aim of nursing is caring with the purpose of preserving the dignity and wholeness of humans. She emphasizes that caring may occur without curing, but curing cannot occur without caring. Nursing as a discipline is devoted to caring, to health, and to healing in their many meanings and interpretations.

Nursing occurs in caring occasions or moment through the use of ten carative factors in a nurse-patient relationship known as transpersonal caring. The practice of nursing is both a science and an art and focuses on the goals of growth, meaning, and self-healing rather than the problem solving seen in the use of the nursing process.

OBJECTIVES Describe the beliefs underlying Watson’s theory of

Transpersonal Caring Name at least three of Watson’s major writings Discuss postmodern, transpersonal caring relationship,

carative factors, caring occasion/caring moment Present the relationship between the theory of

Transpersonal Caring and concepts in nursing’s metaparadigm

Provide an example of use of the theory of Transpersonal Caring in clinical practice

Identify strengths and weaknesses of the theory of Transpersonal Caring for clinical practice

Discuss the appropriateness of qualitative and quantitative research methods for testing the theory of Transpersonal Caring

Relate the theory of Transpersonal Caring to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of the theory of Transpersonal Caring

10 carative factors:1. Formation of a humansitic-altruistic system of

values2. Nurturing of faith-hope3. Cultivation of sensitivity to one’s self and to

others4. Developing a helping-trusting, human caring

relationship5. Promotion & acceptance of the expression of

positiver and negative feelings6. Use of creative problem solving method

process7. Promotion of transpersonal teaching & learning8. Provision for a supportive, protective, or

corrective mental, physical, sociocultural, and spiritual environment

9. Assistance with gratification of human needs10. Allowance for existential-phenomenological

forces

CRITICAL THINKING Discuss the contagiousness of Watson’s

theory of Transpersonal Caring.   Discuss the types of communication to be

used with Watson’s theory. Are these similar to those of any of the other theorists?  

Madeleine M. Leininger recognized the importance of an understanding of culture—both the nurse’s and the client’s—to effective nursing practice. She believes that all cultures have practices related to caring. Those practices that are common across cultures are culture care universalities, and those that are specific to a given culture are culture care diversities. Research findings indicate there is more diversity than universality. Leininger’s Sunrise Model depicts the dimensions of Culture Care Diversity and Universality.

The cultural and social structure dimensions include technological, religious, philosophic, kinship, social, value and lifeway, political, legal, economic, and educational factors. These factors influence the patterns and expressions of caring in relation to the health of individuals, families, groups, and communities. The involved health systems include folk systems, nursing, and other professional systems. To achieve culture congruent care, nursing actions are to be planned in one of three modes: culture care preservation/maintenance, culture care accommodation/negotiation, or culture care repatterning/restructuring.

OBJECTIVES Describe the historical background of the development of

Leininger’s theory of Culture Care Diversity and Universality

Discuss the relationship between care, culture, and nursing

Present the relationship between Culture Care Diversity and Universality and concepts in nursing’s metaparadigm

Provide an example of use of Culture Care Diversity and Universality in clinical practice

Identify strengths and weaknesses of Culture Care Diversity and Universality for clinical practice

Discuss the appropriateness of qualitative and quantitative research methods for testing Culture Care Diversity and Universality

Relate Culture Care Diversity and Universality to critical thinking, therapeutic nursing interventions, communication, and outcomes

Cite examples of the contagiousness of Culture Care Diversity and Universality

CRITICAL THINKING Discuss why a focus on the human being

could be problematic in using Leininger’s work.  

Leininger proposes that there are cultural universalities and cultural diversities. Which are more common? Why do you say this?