Historical Development Of Theories

HISTORICAL DEVELOPMENT OF THEORIES PRIOR TO 1960s Florence Nightingale Notes on Nursing (mid 19th century) – reflected her beliefs, observations and practice of nursing Her work paved way for modern nursing 1st one to insist that formal education is needed in the preparation of a nurse PRIOR TO 1960s She stressed the importance of observations and recording She recorded her observations and used statistics to support her request for reforms Nightingale’s theory focused on the control of the environment of individuals requiring nursing care PRIOR TO 1960s She believed that disease was a reparative process, that it was nature’s effort to remedy a process of poisoning or decay, or a reaction against the conditions in which a person was placed In order to prevent the disease or hasten the healing process, the nurse must provide a clean and quiet environment with proper ventilation and lighting, clean air free from foul odor and unnecessary noise. PRIOR TO 1960s She also stressed the importance of room temperature She emphasized the need for appropriate nutrition in promoting a person’s well-being. Her major concepts of ventilation, light, warmth, noise, cleanliness, and diet in relation to nursing are still valid today. PRIOR TO 1960s Publication of the journal of Nursing Research (1952) Encouraged nurses to pursue research, thus developing questioning attitudes and inquiries that set the stage for conceptualization of nursing practice 1960s-1970s Emergence of Scientific era (1960s) The nature of practice was debated as nursing leaders recognized the need to define nursing practice, develop nursing theory, and create a substantive body of knowledge Literature on Philosophy of nursing, as well as conceptual models and frameworks proliferated The role of the nurse came under scrutiny during this period, what they do, for whom, where and when were determined

1960s-1970s Emergence of Scientific era (1960s) The process of theory development was also discussed and was the subject of writings of a number of nurse scholars Symposia were also held dealing with subjects such as Theory Development in Nursing, Nature of Science and Nursing 1960s-1970s 1969 – first conference on nursing theory was first held Conferences brought leading scholars and theorists together to discuss and debate on issues regarding nursing science and theory development in nursing 1960s-1970s Writings of Dickoff, James and Wiedebach on “Theory in a Practice Discipline” (1968) influenced the development of theoretical thinking in nursing they presented a definition of nursing theory and goals for theory development in nursing their approaches discussed iin many writings and conferences reflecting gorwing and evolving interest in developing nursing theory 1980s characterized by acceptance of the significance of the theory in nursing there were less debates on whether or not to use theory, whether it is practice or basic theory, borrowed or nursing theory 1980s to the PRESENT characterized by publication of nurmerous books and articles on analysis, application, evaluation and further development of nursing theories graduate schools of nursing developed courses on how to analyze and apply theories Types of theories According to orientation or focus of the theory 1. Client-centered – are those focused on the needs and problems of clients which are met, resolved or alleviated by nursing interventions. Examples: Nightingale Abdellah Henderson Orem Pender Roy Levine Hall

According to orientation or focus of the theory 2. Nurse-client dynamics – focus on interaction between the nurse and client. Examples: Peplau Watson King Orlando According to orientation or focus of the theory 3. Nurse-client-environment –focus on the interaction between nurse and client in an environment that includes broader dimensions of time and space, as well as culture, cultural diversity, and universality Examples: Neuman Leininger FRAMEWORK TO ANALYZE A NURSING THOERY 1. CONCEPTS, KEY CONCEPTS AND SUB-CONCEPTS Person Nursing Health Environment FRAMEWORK TO ANALYZE A NURSING THOERY 2. STRUCTURE 3. FOCUS Client-centered Nurse-client dynamics Nurse-client-environment dynamics 4. APPLICATION 5. LIMITATIONS FRAMEWORK TO ANALYZE A NURSING THOERY HENDERSON’S THEORY – DEFINITION OF NURSING MAJOR CONCEPTS A. PERSON/ PATIENT/ CLIENT An individual person or client is a whole, complete and independent being with biological, sociological, and spiritual components which are operationalized in the 14 fundamental or basic human needs 14 fundamental or basic human needs

1. Breathe normally 2. Eat and drink adequately

3. 4. 5. 6. 7.

Eliminate body wastes Move and maintain desirable position/posture Sleep and rest Select suitable clothes – dress and undress Maintain body temperature within normal range by adjusting clothing and modifying the environment 8. Keep the body clean & well groomed & protect the skin 9. Avoid dangers in the environment and avoid injuring others 10.Communicate with others, expressing emotions, needs, fears, or opinions 11.Worship according to one’s faith 12.Work in such a way that there is a sense of accomplishment 13.Play or participate in various forms of recreation 14.Learn, discover or satisfy the curiosity that leads to normal development and health, and use available health facilities B. HEALTH - Health is equated with independence Individuals will achieve or maintain health if they have the necessary strength, will or knowledge Health is viewed in terms of the patient’s ability to independently perform the 14 basic needs B. HEALTH It is the “quality of health rather than the life itself, that margin of metal physical vigor that allows the person to work most effectively and to reach his highest potential level of satisfaction in life.” She described health as basic to human functioning and that promotion of health is more important than care of the sick C. NURSING Nursing is assisting the individual, sick or well, in the performance of those activities contributing to the health or its recovery (or to peaceful death) so 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 D. ENVIRONMENT Is the “aggregate (combination) of all the external conditions and influences affecting life and the development of an organism”

UNDERLYING ASSUMPTIONS Independence is valued by the nurse and the patient , more than dependence Health has a meaning shared by the society at large Individuals desire health or peaceful death and will act in such a way to achieve this Individuals will perform activities leading to health if they have the knowledge, capacity or will The individual’s goal and the nurse’s goal are congruent (similar) UNDERLYING ASSUMPTIONS The 14 basic needs represent the nursing’s basic functions Nursing’s goal may be subsumed into the medical treatment plan The major explicit assumption of Henderson’s contention that the nurse is an independent practitioner. However, she also contends that the nurse is a primary helper in carrying out physician’s prescriptions RELATIONSHIP OF CONCEPTS ➢

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Role of nurse - Has a complementary-supplementary role to maintain or restore independence in the satisfaction of the client’s 14 fundamental or basic needs Source of difficulty In a client-centered model, the source of difficulty resides with the client and not with the nurse. Clients in health care agencies have health problems that may be subcategorized as medical, nursing, dietary, etc. To Henderson, the source of difficulty is the lack of strength, will or knowledge of the client

RELATIONSHIP OF CONCEPTS ➢ Intervention focus - To Henderson, this is the deficit that is the source of the client difficulty ➢ Modes of intervention - These are actions to replace, complete, substitute, add, reinforce, or increase strength, will or knowledge ➢ Consequences of nursing activity These include 1. Increased independence in satisfaction of the client’s 14 fundamental or basic needs 2. Peaceful death INTERRELATIONSHIP BETWEEN CONCEPTS