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Grand Nursing Theories

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Priscilla Henry

on 5 December 2013

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Transcript of Grand Nursing Theories

Nursing Science
Group Presentation

Group 5

Group Members :
Priscilla Henry
Patrice Thomas
Malika Bruce
Ayana Thomas - Berahzer
Nicole Clement



What is a Theory?
A theory refers to a set of logically interrelated concepts, statements, propositions and definitions, which have derived from philosophical beliefs or scientific data from which questions or hypothesis can be deduced, tested and verified.
Mc Ewen & Wills (2011)
Importance of Nursing Theories
Nursing theories provide a perspective from which to:

Define the ‘what’ of nursing.
Describe the ‘who’ of nursing (who is the client).
Describe when nursing is needed.
Identify the boundaries and goals of nursing’s therapeutic activities.

Nursing theories assist the discipline of nursing in clarifying beliefs, values, and goals, and they help to define the unique contribution of nursing in the care of clients. When the focus of nursing’s contribution is clear, then greater professional autonomy and, ultimately, control of certain aspects of practice are achieved.

In the broadest sense, nursing theory is necessary for the continued development and evolution of the discipline of nursing.


.
Grand Nursing Theories
A grand theory is a theory that is complex and broad in scope.

It attempts to explain broad areas within a discipline and may incorporate numerous other theories (McEwen & Wills 2011).

Wills (2002)
identifies three categories of grand nursing theories.
They include:
Human Needs Theories
Interactive Theories
Unitary Process Theories
Martha Rogers
Dorothy Johnson
Unitary Human Beings
The Behavioral Science Model
Type of Theory:

Dorothy Johnson’s Behavioural Science Model is considered an Interactive theory. Interactive models view persons as integrated wholes and interactive systems.

This ‘system’ interacts with many other dimensions such as family, groups and the community. All these dimensions impact health and must be addressed by nursing care.

Dorothy first proposed her model of nursing care as fostering of “the efficient and effective behavioral functioning in the patient to prevent illness".

She also stated that nursing was concerned with man as an integrated whole and this is the specific knowledge of order we require.
What is a Concept?
The basic elements that structure a nursing theory are concepts and propositions. In a theory, propositions represent how concepts affect each other.

A concept is the basic building block of a theory.
Background
Background
Born:
1919

Accomplishments:
Bachelor of Science in Nursing from Vanderbilt University (1942)
Master of Public Health from Harvard University (1948)

From 1949 till retirement in 1978 she was:
An assistant professor of pediatric nursing
An associate professor of nursing
A professor of nursing at the University of California

Johnson stressed the importance of research-based knowledge about the effect of nursing care on clients

Died:
1999
Similarities
Differences
Main Concepts
Energy field
The energy field is the fundamental unit of both the living and nonliving.
This energy field provides a way to perceive people and environment as irreducible wholes.

Openness
The human field and the environmental field are constantly exchanging their energy.
There are no boundaries or barrier that inhibit energy flow between fields.

Pattern
Pattern is defined as the distinguishing characteristic of an energy field.
Pattern is an abstraction and it gives identity to the field.


Main Concepts
Human beings have two major systems:
1.
The biological system
2.
The behavioral system.

It is role of the medicine to focus on biological system where as nursing focuses on the behavioral system.

Each subsystem composed of four structural characteristics. These include drives, set, choices and observable behavior. Any imbalance in each system results in disequilibrium. It is the nurses role to assist the client to return to the state of equilibrium.

The nursing process for the behavioral system model is known as Johnson’s nursing diagnostic and treatment process.

The components of the process include the determination of the existence of a problem, diagnosis and classification of problems, management of problems and evaluation of behavioral system balance and stability.


What is a Metaparadigm?
A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline.

A metaparadigm is the most global perspective of a discipline and “acts as an encapsulating unit, or framework, within which the more restricted…structures develop.”

Eckberg & Hill (1979)

References
Buchinger, K.L. (1992). Martha E. Rogers In: American Nursing: A Biographical Dictionary, Vol aaaaaII. V.L. Bullough, V.L., O.M. Church, & A.P.Stein, (Eds.). New York: Garland.

Malinski, V.M., and Barrett, E.A.M. (1994). Martha E. Rogers: Her Life and Work. Philadelphia: aaaaaF.A. Davis

Masters, Kathleen. Role Development in Professional Nursing Practice. Sudbury, MA: Jones and Bartlett, 2005.

Johnson, Dorothy E., and Imogene M. King. Theory Development: What, Why, How? New York: National League for Nursing, 1978.

Taylor, Carol R., Carol Lillis, Priscilla LeMone, and Pamela Lynn. Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia: Lippincott Williams & Wilkins, 2008.

Born:
May 12, 1914, Dallas, Texas, USA

Accomplishments:
Diploma: Knoxville General Hospital School of Nursing (1936)
Graduation in Public Health Nursing: George Peabody College (1937)
Master of Arts: Columbia University (1945)
Master of Public Health: Johns Hopkins University, Baltimore (1952)
Doctorate in Nursing: Johns Hopkins University (1954)

Died:
March 13 , 1994
Type of Theory:

Martha Rogers’ theory of Unitary Human Beings is considered a Unitary Process theory. Rogers' model provides the way of viewing the unitary human being.

Humans are viewed as integral with the universe: the unitary human being and the environment are one. The basic concepts of the theory include unitary human being, environment, and homeodynamic principles.

Patients are considered “unitary human beings,” who cannot be divided into parts, but have to be looked as a whole.

Illness and health are part of the same continuum, and the events occurring throughout the patient's life show how the patient is achieving his or her health potential.
Pan dimensionality
Pan dimensionality covers discussion of all aspects of philosophy in the physical universe which our senses are unable to detect.

The parameters that human use in language to describe events are random.
The present is relative, there is no temporal ordering of lives.

Homeodynamic principles
The principles of homeodynamic suggests the way of perceiving unitary human beings.
Three principle of homeodynamics:
Resonancy
Helicy
Integrality

Resonance
Resonance is an ordered arrangement of rhythm characterizing both human field and environmental field that undergoes continuous change in the human environmental process.

Helicy
Helicy describes the unpredictable, but continuous, evolution of energy fields as evidenced by non repeating rhythmicties.

Integrality
The mutual, continuous relationship of the human energy field and the environmental field .

Changes occur by by the continuous repatterning of the human and environmental fields by resonance waves.


The seven subsystems consists of:
1.
Attachment or Affiliative
- this serves the need for security through social enclosure or understanding.
This subsystem forms the basis for social organization. Its consequences are social inclusion, intimacy, and the formation and maintenance of strong social bonds.

2.
Dependency
- behaviors designed to get attention, acknowledgment, and physical assistance.
The dependency subsystem promotes helping or nurturing behaviours.

3.
Ingestive
- fulfills the need to supply the biologic requirements for food and fluids.
The ingestive subsystem has to do with when, how, what, how much, and under what conditions we eat.

4.
Eliminative
- The eliminative system addresses when, how and under what conditions we eliminate.

5.
Sexual
– serves the biologic requirements of procreation and reproduction.
The sexual subsystem has the function of gratification and includes identification of gender role identity and gender role behaviours

6.
Aggressive
– functions in self and social protection and preservation.

7.
Achievement
– functions to master and control the self or the environment.
The achievement subsystem functions to control an aspect of self or environment to achieve a standard.

Metaparadigms in Nursing
Person
The recipient of care.
Example: the individual, family, or community.

Environment
All internal and external conditions, circumstances, and influences affecting the person.

Health
The degree of wellness or illness experienced by the person.

Nursing
Encompasses the actions, characteristics
and attributes of person giving care.
Metaparadigm
Person
(Unitary Human Being)
A unitary human being is an irreducible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts.

Environment
An irreducible, pandimensional energy field that is identified by pattern and manifesting characteristics different from those of the parts encompassing all that is other than any given human field. The fields coexist and are integral.


Health
Health and illness are part of a continuum. They are the characteristics and behaviour emerging out of the mutual, simultaneous interaction of the human and environmental fields.

The multiple events taking place along life's axis denote the extent to which man is achieving his maximum health potential and very in their expressions from greatest health to those conditions which are incompatible with the maintaining life process.

Nursing
Nursing seeks to promote symphonic interactions between human and environmental fields, to strengthen the integrity of the human field, and to direct and redirect patterning of the human and environmental fields for realization of maximum health potential.
Metaparadigm
Person
(Human Being)
A bio-psychosocial being who is a behavioral system with seven subsystems of behaviour.
There is recognition of the reciprocal actions that occur between the biological and behavioral systems when some type of dysfunction occurs in one or the other of the systems.

Environment
Includes internal and external environment. An individual’s behavior is influenced by all the events in the environment. Cultural influences on the individual’s behavior are viewed as profound.


Health
Efficient and effective functioning of system; behavioural system balance and stability.

Health is an elusive state that is affected by social, psychological, biological, and physiological factors. Johnson’s behavioral model supports the idea that the individual is striving to retain some balance or equilibrium.

Nursing
An external regulatory force that acts to preserve the organization and integrity of the patient’s behaviour at an optimal level under those conditions in which the behaviour constitutes a threat to physical or social health or in which illness is found.

The primary goal of nursing is to cultivate equilibrium within the individual, which allows for the practice of nursing with individuals at any point in the health-illness continuum.
Acknowledgment
We, the members of Group 5, would like to express special thanks to our lecturer Mrs. Beryl Brewster who gave us the opportunity to carry out this enlightening project on various nursing theorists and their theories.

We are especially thankful to our group members, each of whom pulled their weight and played an important role in finishing this project within the stipulated time frame.

Johnson can be quoted as saying "Human was defined as a behavioral system that strives to make continual adjustments to achieve, maintain or regain balance to the steady-state that is adaptation."
(McEwen & Wills 2011)

This can be broken down to say this: Patients and their care givers work together, hand in hand.

This is also seen in Rogers' theory, where she states, "Irreducible, indivisible, multidimensionality energy fields identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from the knowledge of the parts."
(McEwen & Wills 2011)

Person
Both Johnson and Rogers have the view that, just thinking of ways to help the individual is not enough, but actions must precede these said thoughts.

Johnson states "An external regulatory force which acts to preserve the organization and integration of the patient’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found."

Rogers: “The study of unitary, irreducible, indivisible human and environmental fields: people and their world.”
(McEwen & Wills 2011)
Nursing
Environment
Health
Johnson: “Not directly defined, but it is implied to include all elements of the surroundings of the human system and includes interior stressors.”
(McEwen & Wills 2011)

Rogers also went on that same line, "An irreducible, indivisible, pan dimensional energy field indentified by pattern and integral with the human field."
(McEwen & Wills 2011)

They both believe that there are external and internal situations that can affect the health of an individual and prevent that individual from getting to some sort of stability in their health.

Johnson says "Some degree of regularity and constancy in behavior, the behavioral system reflects adjustments and adaptations that are successful in some way and to some."
(McEwen & Wills 2011)

This refers to the fact that the patient along with the care giver must know that there must stability and balance that it must encompass all aspects of the individual’s life.

Rogers also believes that the patient should not be viewed as pieces but as a whole taking into consideration the mental and physical state of the individual.

"Unitary human health signifies an irreducible human field manifestation. It cannot be measured by the parameters of biology or physics or of the social sciences."
(McEwen & Wills 2011)
Person
Environment
Nursing
Health
Rogers believed that humans are essentially whole when she states that they are “Irreducible, indivisible, multidimensional energy fields identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from the knowledge of the parts.”
(McEwen & Wills 2011)

Johnson believed that 'person' is seen as different parts of a behavioural system.

Rogers also refers to 'person' as an individual, group or community that is a unified whole which is deemed neither sick nor well and always changing whereas Johnson refers to 'person' as the recipient of care who is hospitalized or ill-stricken and the giver of care.

In Johnson's theory, the patient's behaviour can be transformed to achieve equilibrium but in Rogers’ theory, the behaviour of the patient cannot be conformed because the patient is set in their way.

Rogers states that environment is “An irreducible, indivisible, pan dimensional energy field identified by pattern and integral with the human field.”
(Rogers 1970)


Humans including their exterior stressors are essentially whole and cannot be known by conceptually reduced to parts or separated are always evolving.

Therefore, if environment is compromised in any way, then man will also be compromised.

In contrast Johnson's environment was "Not directly defined, but it is implied to include all elements of the surroundings of the human system and includes interior stressors"
(Johnson 1959)
which should be patterned, organized, regular and constant for reformed behavior or healing to take place.

Rogers claims that “Unitary human health signifies an irreducible human field manifestation. It cannot be measured by the parameters of biology or physics or of the social sciences.”
(Rogers 1970)

In that the continuum from wellness to illness is related to all aspects of ones being and therefore is impossible to transform or reverse.

While
(Johnson 1961)
claims the need for "some degree of regularity and constancy in behavior," the behavioral system reflects adjustments and adaptations that are successful in some way and can be reversed and brought under the control of authority.
Johnson's theory was traditional in its activities in regards to the ethical standards within the nursing process as she says that the giver of care must have some form of certificate in order to “Preserve the organization and integration of the patient’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health, or in which illness is found.”
(Johnson 1959)


Whilst Rogers theory “the study of unitary, irreducible, indivisible human and environmental fields: people and their world”
(Rogers 1970)
is seen from the holistic world view as she says that it does not need a certificate but rather it takes a group or community to accomplish the same concept.
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