Development of Nursing Theories

Development of Nursing Theories

This page was last updated on November 4, 2010

============================================

Introduction Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. Theories are composed of concepts, definitions, models, propositions & are based on assumptions. Theory gives planners tools for moving beyond intuition to design and evaluate health behavior and health promotion interventions based on understanding of behavior.[Robert T. Croyle (2005)]. They are derived through two principal methods; deductive reasoning and inductive reasoning. Nursing theorists use both of these methods. Theory is “a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena”. A theory makes it possible to “organize the relationship among the concepts to describe, explain, predict, and control practice” Definition Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects, properties, or events & are basic components of theory. Types: Empirical concepts Inferential concepts Abstract concepts Definitions Models are representations of the interaction among and between the concepts showing patterns. Propositions are statements that explain the relationship between the concepts. Process it is a series of actions, changes or functions intended to bring about a desired result. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal. A particular theory or conceptual frame work directs how these actions are carried out. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient), the environment, health & nursing. The terms ‘model’ and ‘theory’ are often wrongly used interchangeably, which further confounds matters. In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment. Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). Their main limitation is that they are only as accurate or useful as the underlying theory. Importance of nursing theories Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978). It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964). Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). It helps to distinguish what should form the basis of practice by explicitly describing nursing. The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan 1996). The main exponent of nursing – caring – cannot be measured, it is vital to have the theory to analyze and explain what nurses do. As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge. This can be seen as an attempt by the nursing profession to maintain its professional boundaries. The characteristics of theories Theories are: interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. logical in nature. generalizable. bases for hypotheses that can be tested. increasing the general body of knowledge within the discipline through the research implemented to validate them. used by the practitioners to guide and improve their practice. consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. Basic processes in the development of nursing theories Nursing theories are often based on & influenced by broadly applicable processes & theories. Following theories are basic to many nursing concepts. General System Theory It describes how to break whole things into parts & then to learn how the parts work together in “systems”. These concepts may be applied to different kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things & to environmental conditions. Adaptation is a continuously occurring process that effects change & involves interaction & response. Human adaptation occurs on three levels : 1. The internal (self) 2. The social (others) & 3. the physical (biochemical reactions) Developmental Theory It outlines the process of growth & development of humans as orderly & predictable, beginning with conception & ending with death. The progress & behaviors of an individual within each stage are unique. The growth & development of an individual are influenced by heredity, temperament, emotional, & physical environment, life experiences & health status. Common concepts in nursing theories Four concepts common in nursing theory that influence & determine nursing practice are: The person (patient). The environment Health Nursing (goals, roles, functions) Each of these concepts is usually defined & described by a nursing theorist, often uniquely; although these concepts are common to all nursing theories. Of the four concepts, the most important is that of the person. The focus of nursing, regardless of definition or theory, is the person. Historical perspectives and key concepts Nightingale (1860): To facilitate “the body’s reparative processes” by manipulating client’s environment Peplau 1952: Nursing is; therapeutic interpersonal process. Henderson 1955: The needs often called Henderson’s 14 basic needs Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being. Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery. Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through “humanistic science of nursing” Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. King 1971: To use communication to help client reestablish positive adaptation to environment. Neuman 1972: Stress reduction is goal of system model of nursing practice. Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes. Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life. Classification of nursing theories A. Depending On Function (Polit et al 2001) Descriptive-to identify the properties and workings of a discipline Explanatory-to examine how properties relate and thus affect the discipline Predictive-to calculate relationships between properties and how they occur Prescriptive -to identify under which conditions relationships occur B. Depending on the Generalisability of their principles Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts. Grand theory: provides a conceptual framework under which the key concepts and C. Principles of the discipline can be identified. Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved. D. Based on the philosophical underpinnings of the theories “Needs “theories. “Interaction” theories. “Outcome “theories. Humanistic theories. 1. “Needs” theories These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. 2.“Interaction” theories As described by Peplau (1988), these theories revolve around the relationships nurses form with patients. Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. 3. “Outcome” theories" Oucome theories portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health. Outcome theories have been criticized as too abstract and difficult to implement in practice. 4. “Humanistic” Theories Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life. Humanistic theories emphasize a person’s capacity for self-actualization. Humanists believe that the person contains within himself the potential for healthy & creative growth. Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual. The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual, so, person-centered approach now practice in nursing. Models of nursing A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking. A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions. According to Fawcett (2000), A conceptual model “gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems” Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursinghealth. These four concepts form a metaparadigm of nursing. (goals, roles, functions); and The term metaparadigm comes from the Greek prefix “meta,” which means more comprehensive or transcending, and the word Greek word “paradigm,” which means a philosophical or theoretical framework of a discipline upon which all theories, laws, and generalizations are formulated (Merriam-Webster’s Collegiate Dictionary, 1994). Categories of Conceptual Models Ten conceptual models of nursing have been classified according to two criteria: the world view of change reflected by the model (growth or stability); and the major theoretical conceptual classification with which the model seems most consistent (systems, stress/adaptation, caring, or growth/development). 1.Systems Theory as a Framework Systems theory is concerned with changes caused by interactions among all the factors (variables) General systems theory states A system is defined as “a whole with interrelated parts, in which the parts have a function and the system as a totality has a function”. A general systems approach allows for consideration of the subsystems levels of the human being, as a total human being, and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity. Thus the human being, from the level of the individual to the level of society, can be conceptualized as the client and becomes the target system for nursing intervention (Sills & Hall, 1977). An example of systems interaction Input (Diet teaching) Throughput (Assimilation of information) Output (Food intake) Feedback (Weight record, Hb estimation etc.) Two nursing models based on systems theory: Imogene King’s systems interaction model, and Betty Neuman’s health care systems model. Major Concepts as Defined in King’s Model Person (Human Being) A personal system that interacts with interpersonal and social systems Environment A context “within which human beings grow, develop, and perform daily activities” 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 Imogene King’s Systems Interaction Model In interaction model, the purpose of nursing is to help people attain, maintain, or restore health. King’s model conceptualizes three levels of dynamic interacting systems. 1. Individuals are called “personal systems.” 2. Groups (two or more persons) form “interpersonal systems.” 3. Society is composed of “social systems.” As the person interacts with the environment, he or she must continuously adjust to stressors in the internal and external environment (King, 1981). Health assumes achievement of maximum potential for daily living and an ability to function in social roles. It is the “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” (King, 1981,). “Illness is a deviation from normal, that is, an imbalance in a person’s biological structure or in his psychological makeup, or a conflict in a person’s social relationships” (King, 1989). “The goal of nursing is to help individuals and groups attain, maintain, and restore health” Stress: “a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance” Betty Neuman’s Health Care Systems Model Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability. Normal line of defense: an adaptational level of health considered normal for an individual Lines of resistance: protection factors activated when stressors have penetrated the normal line of defense Neuman’s model, organized around stress reduction, is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. The person is a composite of physiologic, psychological, sociocultural, developmental, and spiritual variables considered simultaneously. “Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences” (Neuman, 2002). A person is constantly affected by stressors from the internal, external, or created environment. Stressors are tension-producing stimuli that have the potential to disturb a person’s equilibrium or normal line of defense. This normal line of defense is the person’s “usual steady state.” It is the way in which an individual usually deals with stressors. Stressors may be of three types: Intrapersonal: forces arising from within the person Interpersonal: forces arising between persons Extrapersonal: forces arising from outside the person Resistance to stressors is provided by a flexible line of defense, a dynamic protective buffer made up of all variables affecting a person at any given moment the person’s resistance to any given stressor or stressors. If the flexible line of defense is no longer able to protect the person against a stressor, the stressor breaks through, disturbs the person’s equilibrium, and triggers a reaction. The reaction may lead toward restoration of balance or toward death. Neuman intends for the nurse to “assist clients to retain, attain, or maintain optimal system stability” (Neuman, 1996). Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of defense, where stressors are successfully overcome or avoided by the flexible line of defense. Neuman defines illness as “a state of insufficiency with disrupting needs unsatisfied” (Neuman, 2002). Illness appears to be a separate state when a stressor breaks through the normal line of defense and causes a reaction with the person’s lines of resistance. Stress/Adaptation Theory as a Framework In contrast to systems theory, stress and adaptation theories view change caused by person–environment interaction in terms of cause and effect. The person must adjust to environmental changes to avoid disturbing a balanced existence. Adaptation theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. This theory has been widely applied to explain, predict, and control biologic (physiologic and psychological) phenomenon. Criticisms of nursing theories To understand why nursing theory is generally neglected on the wards it is necessary to take a closer look at the main criticisms of nursing theory and the role that nurses play in contributing to its lack of prevalence in practice. Summarization Definition Importance of Nursing Theories The characteristics of theories: Basic Processes in the Development Of Nursing Theories: Nursing theories are often based on & influenced ANA definition of Nursing Practice Common concepts in Nursing Theories: Historical Perspectives & Key Concepts Clasification of Nursing Theories Models Of Nursing Growth and Stability Models of Change Betty Neuman’s Health Care Systems Model Stress/Adaptation Theory as a Framework A unique body of knowledge Criticisms of nursing theories Conclusion Theory and practice are related. A theory presents a systematic way of understanding events or situations.It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables.Theories must be applicable to a broad variety of situations. They are, by nature, abstract, and don’t have a specified content or topic area. Like empty coffee cups, theories have shapes and boundaries, but nothing inside. They become useful when filled with practical topics, goals, and problems. [Robert T. Croyle (2005)] Reference Robert T. Croyle (2005). Theory at a Glance: Application to Health Promotion and Health Behavior (Second Edition). U.S. Department of Health and Human Services, National Institutes of Health. Available at www.thecommunityguide.org. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):22

Introduction to Nursing Theories

Introduction to Nursing Theories

This page was last updated on November 13, 2010

=================================================

INTRODUCTION Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr, 2008). Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008). Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Nursing theory is the term given to the body of knowledge that is used to support nursing practice Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories and concepts COMPONENTS OF A THEORY A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.. Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings: Metaparadigm (Person, Environment, Health & Nursing) – (Most abstract) Nursing philosophies. Conceptual models and Grand theories. Nursing theories and Middle range theories (Least abstract) NURSING PHILOSOPHIES Theory Key emphasis Florence Nightingale’s Legacy of caring Focuses on nursing and the patient environment relationship. Ernestine Wiedenbach: The helping art of clinical nursing Helping process meets needs through the art of individualizing care. Nurses should identify patients ‘need-for –help’ by: Observation Understanding client behaviour Identifying cause of discomfort Determining if clients can resolve problems or have a need for help Virginia Henderson’s Definition of Nursing Patients require help towards achieving independence. Derived a definition of nursing Identified 14 basic human needs on which nursing care is based. Faye G.Abedellah’s Typology of twenty one Nursing problems Patient’s problems determine nursing care Lydia E. Hall :Care, Cure, Core model Nursing care is person directed towards self love. Jean Watson’s Philosophy and Science of caring Caring is moral ideal: mind -body – soul engagement with one and other. Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Patricia Benner’s Primacy of caring Caring is central to the essence of nursing. It sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness. Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice – novice, advanced beginner, competent, proficient and expert. CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orem’s Self care deficit theory in nursing Self–care maintains wholeness. Three Theories: Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing Systems Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself) Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses’ role Myra Estrin Levine’s: The conservation model Holism is maintained by conserving integrity Proposed that the nurses use the principles of conservation of: Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing theories – Conservation Redundancy Therapeutic intention Martha E.Roger’s: Science of unitary human beings Person environment are energy fields that evolve negentropically Martha proposed that nursing was a basic scientific discipline Nursing is using knowledge for human betterment. The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness Dorothy E.Johnson’s Behavioural system model Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Individual as a behavioural system is composed of seven subsystems. Attachment, or the affiliative subsystems – is the corner stone of social organisations. Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems. Sister Callista: Roy‘s Adaptation model Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual. Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Betty Neuman’s : Health care systems model Reconstitution is a status of adaptation to stressors A conceptual model with two theories “Optimal patient stability and prevention as intervention” Neuman’s model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person. Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the client’s response to stressors. Imogene King’s Goal attainment theory Transactions provide a frame of reference toward goal setting. A conceptual model of nursing from which theory of goal attainment is derived. From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory. · Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing). Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living Individuality in living. A conceptual model of nursing from which theory of goal attainment is derived. Living is an amalgam of activities of living (ALs). Most individuals experience significant life events which can affect ALs causing actual and potential problems. This affects dependence – independence continuum which is bi-directional. Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope. Hildegard E. Peplau: Psychodynamic Nursing Theory Interpersonal process is maturing force for personality. Stressed the importance of nurses’ ability to understand own behaviour to help others identify perceived difficulties. The four phases of nurse-patient relationships are: 1. Orientation 2. Identification 3. Exploitations 4. Resolution The six nursing roles are: 1. Stranger 2. Resource person 3. Teacher 4. Leader 5. Surrogate 6. Counselor Ida Jean Orlando’s Nursing Process Theory Interpersonal process alleviates distress. Nurses must stay connected to patients and assure that patients get what they need, focused on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. Nurse reactions 3. Nursing actions Joyce Travelbee’s Human To Human Relationship Model Therapeutic human relationships. Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of Emerging identities Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage. Kathryn E. Barnard’s Parent Child Interaction Model Growth and development of children and mother–infant relationships Individual characteristics of each member influence the parent–infant system and adaptive behaviour modifies those characteristics to meet the needs of the system. Ramona T.Mercer’s :Maternal Role Attainment Parenting and maternal role attainment in diverse populations A complex theory to explain the factors impacting the development of maternal role over time. Katharine Kolcaba’s Theory of comfort Comfort is desirable holistic outcome of care. Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients’ traditional support system. These needs include physical, psycho spiritual, social and environmental needs. Comfort measures include those nursing interventions designed to address the specific comfort needs. Madeleine Leininger’s Transcultural nursing, culture-care theory Caring is universal and varies transculturally. Major concepts include care, caring, culture, cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. Care is the essence and the dominant, distinctive and unifying feature of nursing Rosemarie Rizzo Parse’s :Theory of human becoming Indivisible beings and environment co-create health. A theory of nursing derived from Roger’s conceptual model. Clients are open, mutual and in constant interaction with environment. The nurse assists the client in interaction with the environment and co creating health Nola J.Pender’s :The Health promotion; model Promoting optimum health supersedes disease prevention. Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. The state of art and science of nursing theory is one of continuing growth. Using the internet the nurses of the world can share ideas and knowledge, carrying on the work begun by nursing theorists and continue the growth and development of new nursing knowledge. It is important the nursing knowledge is learnt, used, and applied in the theory based practice for the profession and the continued development of nursing and academic discipline REFERENCES Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113–120. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. New York: Springer Publishing. George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002 Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.

Comfort Theory Katharine Kolcaba

Comfort Theory

Katharine Kolcaba

This page was last updated on November 13, 2010

==================================

INTRODUCTION The comfort theory is a nursing theory that was first developed in the 1990s by Katharine Kolcaba. Comfort Theory is middle range theory for health practice, education, and research. Kolcaba's theory has the potential to place comfort once again in the forefront of healthcare.(March A & McCormack D, 2009). BACKGROUND OF THE THEORIST Born as Katharine Arnold on December 8th 1944, in Cleveland, Ohio Diploma in nursing from St. Luke's Hospital School of Nursing in 1965 Graduated from the Frances Payne Bolton School of Nursing, Case Western Reserve University in 1987 Graduated with PhD in nursing and received certificate of authority clinical nursing specialist in 1997 Specialized in Gerontology, End of Life and Long Term Care Interventions, Comfort Studies, Instrument Development, Nursing Theory, Nursing Research Currently an associate professor of nursing at the University of Akron College of Nursing Published Comfort Theory and Practice: a Vision for Holistic Health Care and Research CONCEPTS AND DEFINITIONS ( Kolcaba, 2010) Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. Also, Kolcaba described 4 contexts in which patient comfort can occur: physical, psychospiritual, environmental, and sociocultural. Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, for example, the relief of postoperative pain by administering prescribed analgesia, the individual experiences comfort in the relief sense. If the patient is in a comfortable state of contentment, the person experiences comfort in the ease sense, for example, how one might feel after having issues that are causing anxiety addressed. Lastly, transcendence is described as the state of comfort in which patients are able to rise above their challenges. Health Care Needs are those identified by the patient/family in a particular practice setting. Intervening Variables are those factors that are not likely to change and over which providers have little control (such as prognosis, financial situation, extent of social support, etc). Comfort is an immediate desirable outcome of nursing care, according to Comfort Theory Health Seeking Behavior (HSBs): Institutional Integrity - the values, financial stability, and wholeness of health care organizations at local, regional, state, and national levels. Best Policies are protocols and procedures developed by an institution for overall use after collecting evidence. DEVELOPMENT OF THE THEORY Kolcaba conducted a concept analysis of comfort that examined literature from several disciplines including nursing, medicine, psychology, psychiatry, ergonomics, and English First, three types of comfort (relief, ease, transcendence) and four contexts of holistic human experience in differing aspects of therapeutic contexts were introduced. (Kolcaba KY & Kolcaba RJ, 1991) A taxonomic structure was developed to guide for assessment, measurement, and evaluation of patient comfort. ( Kolcaba, 1991) Comfort as a product of holistic nursing art. ( Kolcaba K, 1995) A broader theory for comfort was introduced ( Kolcaba KY,(1994). The theory has undergone refinement and tested for its applicability. DESCRIPTION OF THE THEORY Nursing Nursing is described as the process of assessing the patient's comfort needs, developing and implementing appropriate nursing interventions, and evaluating patient comfort following nursing interventions. Intentional assessment of comfort needs, the design of comfort measures to address those needs, and the reassessment of comfort levels after implementation. Assessment may be either objective, such as in the observation of wound healing, or subjective, such as by asking if the patient is comfortable. Health Health is considered to be optimal functioning, as defined by the patient, group, family or community Person/Patient Patients can be considered as individuals, families, institutions, or communities in need of health care. Environment Any aspect of the patient, family, or institutional surroundings that can be manipulated by a nurse(s), or loved one(s) to enhance comfort. CONCLUSION Holistic comfort is defined as the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental) (Kolcaba, 2010) The theoretical structure of Kolcaba's comfort theory has real potential to direct the work and thinking of all healthcare providers within one institution. (March A & McCormack D, 2009). REFERENCES Kolcaba, K. (2010). An introduction to comfort theory. In The comfort line. Retrieved November 10, 2010, from http://www.thecomfortline.com/ March A, McCormack D (2009). Nursing Theory-Directed Healthcare: Modifying Kolcaba's Comfort Theory as an Institution-Wide Approach. Holistic Nursing Practice; 23:2;75-80. Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301-1310. Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship, 23(4), 237-240. Kolcaba, K. (1995). Comfort as process and product, merged in holistic nursing art. Journal of Holistic Nursing, 13(2), 117-131. Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184. Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18(1), 46-62. Kolcaba, K. (2003). Comfort theory and practice: a vision for holistic health care and research. Springer Publishing Company, New York.

Health As Expanding Consciousness Margaret Newman

Health As Expanding Consciousness

Margaret Newman

This page was last updated on November 13, 2010

============================================

“Health is the expansion of consciousness.” - Newman, 1983

INTRODUCTION The theory of health as expanding consciousness stems from Rogers' theory of unitary human beings. The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible, (Newman, 2010). The theory has progressed to include the health of all persons regardless of the presence or absence of disease, (Newman, 2010). The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world, (Newman, 2010). BACHGROUND OF THE THEORIST Born on October 10, 1933. Bachelor’s degree - University of Tennessee in 1962 Master’s degree - University of California in 1964 Doctorate - New York University in 1971 She has worked in - University of Tennessee, New York University, Pennsylvania State University, University of Minnesotat, University of Minnesota Link to her Biography THEORY DEVELOPMENT She was influenced by following theorists: Martha Rogers Martha Roger’s theory of Unitary Human Beings was the main basis of the development of her theory, Health as Expanding Consciousness Itzhak Bentov – The concept of evolution of consciousness Arthur Young – The Theory of Process David Bohm – The Theory of Implicate ASSUMPTIONS Health encompasses conditions heretofore described as illness, or, in medical terms, pathology These pathological conditions can be considered a manifestation of the total pattern of the individual The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes Removal of the pathology in itself will not change the pattern of the indivdual If becoming ill is the only way an individual's pattern can manifest itself, then that is health for that person Health is an expansion of consciousness. DESCRIPTION OF THE THEORY “The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world” (Newman, 2010). Humans are open to the whole energy system of the universe and constantly interacting with the energy. With this process of interaction humans are evolving their individual pattern of whole. According to Newman understanding the pattern is essential. The expanding consciousness is the pattern recognition. The manifestation of disease depends on the pattern of individual so the pathology of the diseases exists before the symptoms appear so removal of disease symptoms does not change the individual structure. Newman also redefines nursing according to her nursing is the process of recognizing the individual in relation to environment and it is the process of understanding of consciousness. The nurse helps to understand people to use the power within to develop the higher level of consciousness. Thus it helps to realize the disease process, its recovery and prevention. Newman also explains the interrelatedness of time, space and movement. Time and space are the temporal pattern of the individual, both have complementary relationship. Humans are constantly changing through time and space and it shows unique pattern of reality. NURSING PARADIGMS Health “Health and illness are synthesized as health - the fusion on one state of being (disease) with its opposite (non-disease) results in what can be regarded as health”. Nursing Nursing is “caring in the human health experience”. Nursing is seen as a partnership between the nurse and client, with both grow in the “sense of higher levels of consciousness” Human “The human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary field” “Persons as individuals, and human beings as a species are identified by their patterns of consciousness”… “The person does not possess consciousness-the person is consciousness”. Persons are “centers of consciousness” within an overall pattern of expanding consciousness” Environment Environment is described as a “universe of open systems” STRENGTHS AND WEAKNESSES Strengths Can be applied in any setting “Generates caring interventions” W eaknesses Abstract Multi-dimensional Qualitative Little discussion on environment CRITIQUE Clarity Semantic clarity is evident in the definitions, descriptions, and dimensions of the concepts of the theory. Simplicity The deeper meaning of the theory of health as expending consciousness is complex. The theory as a whole must be understood, nut just the isolated concepts. Generality The theory has been applied in several different cultures It is applicable across the spectrum of nursing care situations. Empirical Precision Quantitative methods are inadequate in capturing the dynamic, changing nature of this theory. Derivable Consequences Newman's theory provides an evolving guide for all health-related disciplines. CONCLUSION Newman's theory can be conceptualized as A grand theory of nursing Humans can not be divided into parts Health is central to the theory and is seen “and is seen as a process of developing awareness of self and the environment” “Consciousness is a manifestation of an evolving pattern of person-environment interaction” PUBLICATIONS & REFERENCES Newman, M. A. (1972). Nursing's theoretical evolution. Nursing Outlook, 20(5), 449-453. Newman, M.A. (1979). Theory development in nursing. Philadelphia: F.A. Davis. Newman, M. A. (1982). Time as an index of expanding consciousness with age. Nursing Research, 31(5), 290-293. Newman, M. A. (1984). Nursing diagnosis: Looking at the whole. American Journal of Nursing, 84(12), 1496-1499. Newman, M.A. (1986). Health as Expanding Consciousness. St. Louis: Mosby. Newman, M. A. (1987). Aging as increasing complexity. Journal of Gerontological Nursing, 13(9), 16-18. Newman, M.A. (1990). Newman's theory of health as praxis. Nursing Science Quarterly, 3(1), 37-41 Newman, M. A. (1990). Toward an integrative model of professional practice. Journal of Professional Nursing, 6(3), 167-173. Newman, M. A., Lamb, G. S., & Michaels, C. (1991). Nurse case management: The coming together of theory and practice. Nursing & Health Care, 12(8), 404-408. Newman, M. A., Sime, A. M., & Corcoran-Perry, S. A. (1991). The focus of the discipline of nursing. Advances in Nursing Science, 14(1), 1-6. Newman, M. A. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10-14. Newman, M. A. (1994). Health expanding consciousness (2nd ed.). New York: National League for Nursing. Newman, M.A. (1994). Theory for nursing practice. Nursing Science Quarterly, 7(4), 153-157. Newman, M. A. (1995). A developing discipline: Selected works of Margaret Newman.New York: National League for Nursing. Newman, M. A. (1997). Experiencing the whole. Advances in Nursing Science, 20(1), 34-39. Newman, M. A. (1997). Evolution of the theory of health as expanding consciousness.Nursing Science Quarterly, 10(1), 22-25. Newman, M. A. (1999). The rhythm of relating in a paradigm of wholeness. Image:Journal of Nursing Scholarship, 31(3), 227-230. Newman, M. A. (2002). Caring in the human health experience. International Journal for Human Caring. 6(2), 8-12. Newman, M. A. (2002). The pattern that connects. Advances in Nursing Science, 24(3), 1-7. Newman, M. A. (2003). A world of no boundaries. Advances in Nursing Science, 26(4), 240-245. Newman, M. A. (2008). It's about time. Nursing Science Quarterly, 21(3). 225-227. Newman, M. A. (2008). Transforming Presence/ The Difference That Nursing Makes. Philadelphia: F. A. Davis. Newman, M. (2010). Health as expanding consciousness. Retrieved on November 13, 2010, from health as expanding consciousness: http://www.healthasexpandingconsciousness.org/home/

Human-To-Human Relationship Model Joyce Travelbee(1926-1973)

Human-To-Human Relationship Model

Joyce Travelbee(1926-1973)

This page was last updated on December 19, 2010

==========================

“The nurse is responsible for helping the patient avoid and alleviate the distress of unmet needs.” - Travelbee Introduction Joyce Travelbee (1926-1973) developed the Human-to-Human Relationship Model presented in her bookInterpersonal Aspects of Nursing (1966, 1971). She dealt with the interpersonal aspects of nursing. She explains “human-to-human relationship is the means through which the purpose of nursing if fulfilled” Abou the Theorist A psychiatric nurse, educator and writer born in 1926. 1956, she completed her BSN degree at Louisiana State University 1959, she completed her Master of Science Degree in Nursing at Yale University. 1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans. Later in Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi. Travelbee died at age 47. Development of the Theory Travelbee based the assumptions of her theory on the concepts of existentialism by Soren Kierkegaard and logotherapy by Viktor Frankl. Existential theory believes that that humans are constantly faced choices and conflicts and is accountable to the choices we make in life Logotherapy theory was first proposed by Viktor Frankel, a survivor of Auschwitz, in his book Man's Search for Meaning (1963). Logotherapy Basic Concepts Suffering "An experience that varies in intensity, duration and depth ... a feeling of unease, ranging from mild, transient mental, physical or mental discomfort to extreme pain and extreme tortured ..." Meaning Meaning is the reason as oneself attributes Nursing is to help man to find meaning in the experience of illness and suffering. has a responsibility to help individuals and their families to find meaning. The nurses' spiritual and ethical choices, and perceptions of illness and suffering, is crucial to helping to find meaning. Hope Nurse's job is to help the patient to maintain hope and avoid hopelessness. Hope is a faith that can and will be change that would bring something better with it. Hope's core lies in a fundamental trust the outside world, and a belief that others will help someone when you need it. Six important factors charecteristics of hope are: It is strongly associated with dependence on other people. It is future oriented. It is linked to elections from several alternatives or escape routes out of its situation. The desire to possess any object or condition, to complete a task or have an experience. Confidence that others will be there for one when you need them. The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward towards its goal Communications "a strict necessity for good nursing care" Using himself therapeutic " one is able to use itself therapeutic." Self-awareness and self-understanding, understanding of human behavior, the ability to predict one's own and others' behavior are imporatnt in this process. Targeted intellectual approach Nurse must have a systematic intellectual approach to the patient's situation. Nursing Metaparadigms Person Person is defined as a human being. Both the nurse and the patient are human beings. Health Health is subjective and objective. Subjective health is an individually defined state of well being in accord with self-appraisal of physical-emotional-spiritual status. Objective health is an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor. Environment Environment is not clearly defined. Nursing "an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or illness and suffering, and if necessary to find meaning in these experiences.” Description of the theory Travelbee believed nursing is accomplished through human-to-human relationships that begin with the original encounter and then progress through stages of emerging identities, developing feelings of empathy, and later feelings of sympathy. The nurse and patient attain a rapport in the final stage. For meeting the goals of nursing it is a prerequisite to achieving a genuine human-to-human relationships. This relationship can only be established by an interaction process. It has five phases. The inaugural meeting or original encounter Visibility of personal identities/ emerging identities. Empathy Sympathy Establishing mutual understanding and contact/ rapport Travelbee's ideas have greatly influenced the hospice movement in the west. Conclusion Travelbee's theory has significantly influenced nursing and health care. Travelbee's ideas have greatly influenced the hospice movement in the west. Publications& References Travelbee, J. (1963). Humor survives the test of time. Nursing Outlook, 11(2), 128. Travelbee, J. (1963). What do we mean by rapport? American Journal of Nursing, 63(2), 70-72. Travelbee, J. (1964). What's wrong with sympathy? American Journal of Nursing, 64(1), 68-71. Travelbee, J. (1966). Interpersonal aspects of nursing. Philadelphia: F.A. Davis. Travelbee, J. (1969). Intervention in psychiatric nursing: Process in the one-to-one relationship.Philadelphia: F.A. Davis. Travelbee, J. (1971). Interpersonal aspects of nursing (2nd ed.). Philadelphia: F.A. Davis. Travelbee, J., & Doona, M. E. (1979). Intervention in psychiatric nursing (2nd. ed). Philadelphia: F.A. Davis.