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Modern definitions and philosophies of nursing ⇐ ПредыдущаяСтр 9 из 9
As nursing has evolved, expanding its roles and concepts, theorists have defined nursing in many ways. Florence Nightingale addressed nursing as a discipline in 1859 and believed that the nature of nursing knowledge was distinct from medicine. Conceptual and theoretical nursing models provide knowledge to improve practice, guide research and nursing curricula, and identify the goals of nursing practice. Theory provides the nurse with goals for assessment, diagnosis, and intervention. It also provides common ground for communication and for professional autonomy and accountability. The following table describe the general focus of important theories of the philosophy of nursing. A nursing curriculum will often include one or more of these nursing theories as a part of its conceptual framework. Тема 18 NURSING THEORIES. ROLES AND FUNCTIONS OF THE NURSE
The following sections describe, in chronological order, the general focus of several important theories of the philosophy of nursing. A nursing curriculum will often include one or more of these nursing theories as a part of its conceptual framework (see Table SUMMARY OF NURSING THEORIES).
Peplau's Theory Hildegard Peplau's theory (1952) focuses on interpersonal relationships people form as they pass through developmental stages. Nursing's purpose is to educate the client and family and help the client to reach mature personality development (Chinn, Jacobs, 1991). Therefore the nurse develops a nurse-client relationship in which the nurse is a resource person, counsellor, and surrogate. When the client seeks help, the nurse discusses the nature of the problem and explains the services available. As the nurse-client relationship develops, the nurse helps the client to identify the problem and potential solutions. The client gains from this relationship by using available services to meet needs. When the original needs have been resolved, new needs may appear. Abdellah's Theory The nursing theory developed by Faye Abdellah et al. (1960) emphasises delivering nursing care for the whole person to meet physical, emotional, intellectual, social and spiritual needs. The nurse needs knowledge and skills in interpersonal relations, psychology, growth and development, communication, sociology, and the basic sciences, as well as specific nursing skills. The nurse, a problem solver and decision maker, forms an individualised view of the client's needs, which may occur in the following areas: 1. Comfort, hygiene, and safety 2. Physiological balance 3. Psychological and social factors 4. Sociological and community factors In these areas, Abdellah et al. (1960) identify 21 specific client problems (often referred to as "Abdellah's 21 nursing problems"), which emphasise the physical (e.g., maintenance of elimination or sensory function) and psychological needs (e.g., maintenance of effective verbal and non-verbal communication) of each client. The nurse helps the client meet these needs by facilitating and maintaining a healthy physical condition in the best therapeutic environment possible. The nurse uses interpersonal skills, sound medical knowledge, and community resources to provide individualised holistic care. Henderson's Theory Virginia Henderson's nursing theory involves basic needs of the whole person. Henderson (1964a) defines nursing as: assisting the individual sick or well in the performance of those activities contributing to health or its recovery (or to a peaceful death) 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. Henderson (1964) identifies specific needs, often called "Henderson's 14 basic needs," such as breathe normally, sleep, and rest. These emphasise maintaining a safe, healthy way of living, associated with good hygiene, an active social life, and personal development.
Orlando's Theory To Ida Orlando (1961), the client is an individual with a need that, when met, diminishes distress, increases adequacy, or enhances well-being (Chinn, Jacobs, 1991). Her theory focuses on nurses' reactions to client behaviour in terms of the client's immediate need (Torres, 1986). Orlando's theory describes three elements— client behaviour, nurse reaction, and nurse actions—that compose the nursing situation (Marriner-Tomey, 1994). After nurses assess the client's needs, they recognise the impact of that need on the client's level of health and then act automatically or deliberately to meet the need. Nursing acts to reduce the client's distress. Johnson's Theory 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. For Johnson the goal of nursing is to reduce stress so the client can move more easily through the recovery process. Johnson's theory focuses on basic needs in terms of the following categories or subsystems of behaviour: 1. Security-seeking behaviour 2. Nurturance-seeking behaviour 3. Mastery of oneself and one's environment according to internalised standards of excellence 4. Taking nourishment in socially and culturally acceptable ways 5. Ridding the body of waste in socially and culturally acceptable ways 6. Sexual and role identity behaviour 7. Self-protective behaviour The nurse assesses the client's needs in these categories. The client is able to function fairly effectively in the environment under normal conditions. When stress disrupts normal adaptation, however, behaviour becomes erratic and less purposeful. The nurse identifies the inability to adapt and provides nursing care to resolve problems in meeting the client's needs.
King's Theory Imogene King's theory (1971,1981) also focuses on the interpersonal relationship between the client and nurse. The nurse-client relationship is the vehicle for the nursing process, a dynamic interpersonal process in which the nurse and the client are affected by each other's behaviour and the health care system. The nurse communicates to assist the client in re-establishing or maintaining a positive adaptation to the environment. Orem's Theory Dorothea Orem's (1971) definition of nursing emphasises the self-care needs of the client. Orem describes her philosophy of nursing as follows: Nursing has as a special concern man's needs for self-care action and the provision and management of it on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects. Self-care is a requirement of every person—man, woman, and child. When self-care is not maintained, illness, disease, or death will occur. Nurses sometimes manage and maintain required self-care continually for persons who are totally incapacitated. In other instances, nurses help persons to maintain required self-care by performing some but not all care measures, by supervising others who assist patients, and by instructing and guiding individuals as they gradually move toward self-care. The goal of Orem's self-care deficit theory is helping the client achieve self-care. Nursing care is necessary when the client is unable to fulfil biological, psychological, developmental, or social needs. The nurse determines reasons a client is unable to meet self-care needs, actions that will enable the client to meet these needs, and client self-care abilities. Neuman's Theory Betty Neuman forms a total-person model by incorporating the holistic concept and the open-system approach (Marriner-Tomey, 1994). Neuman views the person as a dynamic composite of physiological, sociocultural, and developmental variables functioning as an open system (Neuman and Young, 1972). Her goal of nursing is to assist individuals, families, and groups to attain and maintain a maximal level of total wellness.
The nurse assesses, manages, and evaluates client systems and focuses on factors affecting the client's response to stressors. Nursing actions are in one of the following levels of prevention: primary, secondary, and tertiary. Primary prevention strengthens a line of defence through identification of actual or potential risk factors associated with stressors. Secondary prevention strengthens internal defences and resources by establishing priorities and treatment plans for identified needs. Tertiary prevention focuses on readaptation (Neuman, 1982). Levine's Theory Myra Levine's nursing theory (1973) views the client as an integrated being who interacts with and adapts to the environment. Conservation of energy is a primary concern. In this theory, health is viewed in terms of conservation of energy in the following areas, which Levine calls the "four conservation principles of nursing": 1. Conservation of client energy 2. Conservation of structural integrity 3. Conservation of personal integrity 4. Conservation of social integrity With this approach, nursing care involves conservation With this approach, nursing care involves conservation activities aimed at optimal use of client's resources. SUMMARY OF NURSING THEORIES
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