Introduction to Nursing Theories This page was last updated on January 31, 2012 INTRODUCTION

Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. 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. Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr, 2008). Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories and concepts A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline.

METAPARADIGMS IN NURSING Person

Recipient of care, including physical, spiritual, psychological, and sociocultural components. Individual, family, or community

Environment

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

Health

Degree of wellness or illness experienced by the person

Nursing

Actions, characteristics and attributes of person giving care.

COMPONENTS OF A THEORY

DEFINITIONS Theory

a set of related statements that describes or explains phenomena in a systematic way. the doctrine or the principles underlying an art as distinguished from the practice of that particular art. a formulated hypothesis or, loosely speaking, any hypothesis or opinion not based upon actual knowledge. a provisional statement or set of explanatory propositions that purports to account for or characterize some phenomenon.

Concept

a mental idea of a phenomenon Concepts are the building blocks (the primary elements) of a theory.

Construct

a phenomena that cannot be observed and must be inferred Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs.

Proposition

a statement of relationship between concepts

Conceptual model

made up of concepts and propositions They epresent ways of thinking about a problem or ways of representing how complex things work the way that they do. Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.

Variables

Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation. Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program.

Middle range theory

a testable theory that contains a limited number of variables, and is limited in scope as well, yet is of sufficient generality to be useful with a variety of clinical research questions.

NURSING PHILOSOPHIES Theory Key Points Florence Nightingales Legacy of Focuses on nursing and the patient environment relationship. caring

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: o Observation o Understanding client behaviour
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o o

Identifying cause of discomfort Determining if clients can resolve problems or have a need for help

Virginia Hendersons 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. Patients problems determine nursing care Nursing care is person directed towards self love. Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Caring is central to the essence of nursing. Described systematically five stages of skill acquisition in nursing practice novice, advanced beginner, competent, proficient and expert.

Faye G.Abedellahs Typology of twenty one Nursing problems Lydia E. Hall :Care, Cure, Core model Jean Watsons Philosophy and Science of caring

Patricia Benners Novice to Expert

CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orems Self care Selfcare maintains wholeness. deficit theory in nursing Three Theories: o Theory of Self-Care o Theory of Self-Care Deficit o Theory of Nursing Systems Nursing Care: o Wholly compensatory (doing for the patient) o Partly compensatory (helping the patient do for himself or herself) o Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses role

Myra Estrin Levines: The conservation model

Proposed that the nurses use the principles of conservation of: o Client Energy o Personal integrity o Structural integrity o Social integrity A conceptual model with three nursing theories o Conservation o Redundancy o Therapeutic intention Person and environment are energy fields that evolve negentropically Nursing is 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 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: the subsystems of attachment, or the affiliative, dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems. 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
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Martha E.Rogers: Science of unitary human beings

Dorothy E.Johnsons Behavioural system model

Sister Callista: Roys Adaptation model

cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Betty Neumans : Health care systems model

Neumans 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 clients response to stressors. Transactions provide a frame of reference toward goal setting. Major concepts (interaction, perception, communication, transaction, role, stress, growth and development) Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (process of nursing). 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. Interpersonal process is maturing force for personality. Stressed the importance of nurses ability to understand own behaviour to help others identify
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Imogene Kings Goal attainment theory

Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living

Hildegard E. Peplau: Psychodynamic Nursing Theory

perceived difficulties. The four phases of nurse-patient relationships are: o 1. Orientation o 2. Identification o 3. Exploitations o 4. Resolution The six nursing roles are: o 1. Stranger o 2. Resource person o 3. Teacher o 4. Leader o 5. Surrogate o 6. Counselor Interpersonal process alleviates distress. Nurses must stay connected to patients and assure that patients get what they need, focused on patients verbal and non verbal expressions of need and nurses reactions to patients behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. Nurse reactions 3. Nursing actions 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. Growth and development of children and mother infant relationships Individual characteristics of each member influence the parentinfant system and adaptive behaviour modifies those characteristics to meet

Ida Jean Orlandos Nursing Process Theory

Joyce Travelbees Human To Human Relationship Model

Kathryn E. Barnards Parent Child Interaction Model

the needs of the system. Ramona T.Mercers :Maternal Role Attainment Katharine Kolcabas Theory of comfort

A complex theory to explain the factors impacting the development of maternal role over time. Comfort is desirable holistic outcome of care. Health care needs are needs (physical, psycho spiritual, social and environmental needs) for comfort, arising from stressful health care situations that cannot be met by recipients traditional support system. Comfort measures include those nursing interventions designed to address the specific comfort needs. 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 Indivisible beings and environment co-create health. A theory of nursing derived from Rogers 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 Promoting optimum health supersedes disease prevention. Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences,
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Madeleine Leiningers Transcultural nursing, culturecare theory

Rosemarie Rizzo Parses :Theory of human becoming

Nola J.Penders :The Health promotion; model

situational and behavioural factors that help predict in health promoting behaviour

1 ) Dorothea Orem's Self-Care Theory This page was last updated on February 4, 2012 INTRODUCTION

Theorist : Dorothea Orem (1914-2007) Born 1914 in Baltimore, US Earned her diploma at Providence Hospital Washington, DC 1939 BSN Ed., Catholic University of America 1945 MSN Ed., Catholic University of America She worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. Received honorary Doctor of Science degree in 1976. Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001.

MAJOR ASSUMPTIONS

People should be self-reliant and responsible for their own care and others in their family needing care People are distinct individuals Nursing is a form of action interaction between two or more persons Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health A persons knowledge of potential health problems is necessary for promoting self-care behaviors Self care and dependent care are behaviors learned within a socio-cultural context

DEFINITIONS OF DOMAIN CONCEPTS

Nursing is art, a helping service, and a technology

Actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments Encompasses the patients perspective of health condition ,the physicians perspective , and the nursing perspective Goal of nursing to render the patient or members of his family capable of meeting the patients self care needs To maintain a state of health To regain normal or near normal state of health in the event of disease or injury To stabilize ,control ,or minimize the effects of chronic poor health or disability

Health health and healthy are terms used to describe living things

It is when they are structurally and functionally whole or sound wholeness or integrity. .includes that which makes a person human,operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings

Environment

environment components are enthronement factors, enthronement elements, conditions, and developed environment

Human being has the capacity to reflect, symbolize and use symbols

Conceptualized as a total being with universal, developmental needs and capable of continuous self care A unity that can function biologically, symbolically and socially

Nursing client

A human being who has "health related /health derived limitations that render him incapable of continuous self care or dependent care or limitations that result in ineffective / incomplete care. A human being is the focus of nursing only when a self care requisites exceeds self care capabilities

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Nursing problem

deficits in universal, developmental, and health derived or health related conditions

Nursing process

a system to determine (1)why a person is under care (2)a plan for care ,(3)the implementation of care

Nursing therapeutics

deliberate, systematic and purposeful action, OREMS GENERAL THEORY OF NURSING

Orems general theory of nursing in three related parts:

Theory of self care Theory of self care deficit Theory of nursing system

A. Theory of Self Care This theory Includes:

Self care practice of activities that individual initiates and perform on their own behalf in maintaining life ,health and well being Self care agency is a human ability which is "the ability for engaging in self care" conditioned by age developmental state, life experience sociocultural orientation health and available resources Therapeutic self care demand "totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions" Self care requisites - action directed towards provision of self care. 3 categories of self care requisites areo Universal self care requisites o Developmental self care requisites o Health deviation self care requisites
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1. Universal self care requisites

Associated with life processes and the maintenance of the integrity of human structure and functioning Common to all , ADL Identifies these requisites as: o Maintenance of sufficient intake of air ,water, food o Provision of care assoc with elimination process o Balance between activity and rest, between solitude and social interaction o Prevention of hazards to human life well being and o Promotion of human functioning

2. Developmental self care requisites

Associated with developmental processes/ derived from a condition. Or associated with an event o E.g. adjusting to a new job o adjusting to body changes

3. Health deviation self care

Required in conditions of illness, injury, or disease .these include:-Seeking and securing appropriate medical assistance Being aware of and attending to the effects and results of pathologic conditions Effectively carrying out medically prescribed measures Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms of health care Learning to live with effects of pathologic conditions

B. Theory of self care deficit

Specifies when nursing is needed Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem identifies 5 methods of helping: o Acting for and doing for others
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o o o o

Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands Teaching another

C. Theory of Nursing Systems

Describes how the patients self care needs will be met by the nurse , the patient, or both Identifies 3 classifications of nursing system to meet the self care requisites of the patient:Wholly compensatory system Partly compensatory system Supportive educative system Design and elements of nursing system define Scope of nursing responsibility in health care situations General and specific roles of nurses and patients Reasons for nurses relationship with patients and Orem recognized that specialized technologies are usually developed by members of the health profession A technology is systematized information about a process or a method for affecting some desired result through deliberate practical endeavor, with or without use of materials or instruments.

Categories of technologies 1. Social or interpersonal

Communication adjusted to age, health status Maintaining interpersonal, intra group or inter group relations for coordination of efforts Maintaining therapeutic relationship in light of psychosocial modes of functioning in health and disease Giving human assistance adapted to human needs ,action abilities and limitations

2. Regulatory technologies

Maintaining and promoting life processes Regulating psycho physiological modes of functioning in health and disease
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Promoting human growth and development Regulating position and movement in space

2. OREMS THEORY AND NURSING PROCESS

Nursing process presents a method to determine the self care deficits and then to define the roles of person or nurse to meet the self care demands. The steps within the approach are considered to be the technical component of the nursing process. Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations. Orems Nursing Process Diagnosis and prescription; determine why nursing is needed. analyze and interpret make judgment regarding care Design of a nursing system and plan for delivery of care Production and management of nursing systems Step 1-collect data in six areas:

Nursing Process Assessment

The persons health status The physicians perspective of the persons health status The persons perspective of his or her health The health goals within the context of life history ,life style, and health status The persons requirements for self care The persons capacity to perform self care

Nursing diagnosis Step 2 Plans with Nurse designs a system that is wholly or partly scientific rationale compensatory or supportive-educative. The 2 actions are: Bringing out a good organization of the components of patients therapeutic self care demands Selection of combination of ways of helping that will be effective and efficient in compensating for/ overcoming
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patients self care deficits

Implementation evaluation

Step 3

Nurse assists the patient or family in self care matters to achieve identified and described health and health related results. collecting evidence in evaluating results achieved against results specified in the nursing system design Actions are directed by etiology component of nursing diagnosis Evaluation

Application of Orems theory to nursing process Therapeutic Adequacy of Nursing self care self care diagnosis demand agency Inadequate Potential for Air Maintain impaired effective respiratory status respiration P F fluid Adequate Water imbalance No problem Actual nutritional Inadequate Food maintain deficit r/t nausea sufficient intake Inadequate Hazards Prevent spouse abuse Promotion of Inadequate normalcy P/F injury Methods of helping

Guiding & directing

Teaching Providing physical support

Personal development Guiding & directing Guiding & directing A/d in environment Shared housing
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Inadequate Maintain developmental environment Support ed normalcy in Inadequate environment Prevent /manage dev threat Maintenance Inadequate of health status Inadequate Management of disease process Adherence to Inadequate med regimen Awareness of potential problems

Actual delay in Guiding & directing Providing psy support normal dev. R/T early parenthood Providing physical, psy support Level of education Dev deficit r/t loss of reproductive organs P/F contd. alterations in health status P/F UTI

Guiding & directing, teaching Guiding & directing, teaching

Adjust to loss of reproductive ability & dev healthy view of illness Adjust life style to cope with change

P/F adherence teaching in self catheterization & Inadequate OPD RT teaching Actual deficit in awareness of advisability of HRT & RT effects Inadequate Actual threat to Providing psy support self image Guiding & directing Actual self deficit Inadequate in planning for future needs

OREMS WORK AND THE CHARACTERISTICS OF A THEORY

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Orem's theory o interrelate concepts in such a way as to create a different way of looking at a particular phenomenon o is logical in nature. o is relatively simple yet generalizable o is basis for hypothesis that can be tested o contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them o can be used by the practitioners to guide and improve their practice o must be consistent with other validated theories ,laws and principles

Strengths

Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice nursing curricula ,nursing education administration ,and nursing research Specifies when nursing is needed Her self-care approach is contemporary with the concepts of health promotion and health maintenance

Limitations

In general system theory a system is viewed as a single whole thing while Orem defines a system as a single whole, thing. Health is often viewed as dynamic and ever changing. The theory is illness oriented.

RESEARCH ON OREM'S THEORY 1. 2. 3. 4. 5. Self-care requirements for activity and rest: an Orem nursing focus Nursing diagnoses in patients after heart catheterization--contribution of Orem Self-care--the contribution of nursing sciences to health care Self-care: a foundational science Orem's self-care deficit nursing theory: its philosophic foundation and the state of the science 6. Dorothea E. Orem: thoughts on her theory 7. Orem's theory in practice. Hospice nursing care 8. Solving the Orem mystery: an educational strategy
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9. Orem's family evaluation REFERENCES

Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc. Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M. Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States of America. Whelan, E. G. (1984). Analysis and application of Dorothea Orems Self-care Practuce Model. Retrieved October 31, 2006. 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.

3 Virginia Henderson's Need Theory This page was last updated on February 4, 2012 Nursing theories mirror different realities, throughout their development; they reflected the interests of nurses of that time.
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Introduction

The Nightingale of Modern Nursing Modern-Day Mother of Nursing. "The 20th century Florence Nightingale." Born in Kansas City, Missouri, in 1897. Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D.C. in 1921. Worked at the Henry Street Visiting Nurse Service for 2 years after graduation. In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia In 1929, entered Teachers College at Columbia University for Bachelors Degree in 1932, Masters Degree in 1934. Joined Columbia as a member of the faculty, remained until 1948. Since 1953, a research associate at Yale University School of Nursing. Recipient of numerous recognitions. Honorary doctoral degrees from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. Died: March 19, 1996. In 1939, she revised: Harmers classic textbook of nursing for its 4th edition, and later wrote the 5th; edition, incorporating her personal definition of nursing (Henderson,1991)

Theory Background

She called her definition of nursing her concept (Henderson1991) She emphasized the importance of increasing the patients independence so that progress after hospitalization would not be delayed (Henderson,1991) "assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery" (Henderson, 1966). She categorized nursing activities into 14 components, based on human needs. She described the nurse's role as substitutive (doing for the person), supplementary (helping the person), complementary (working with the person), with the goal of helping the person become as independent as possible. Her definition of nursing was:

"The unique function of the nurse is to assist the individual, sick or well, in the performance
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of those activities contributing to health or its recovery (or to 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, 1966). The 14 components

Breathe normally. Eat and drink adequately. Eliminate body wastes. Move and maintain desirable postures. Sleep and rest. Select suitable clothes-dress and undress. Maintain body temperature within normal range by adjusting clothing and modifying environment Keep the body clean and well groomed and protect the integument Avoid dangers in the environment and avoid injuring others. Communicate with others in expressing emotions, needs, fears, or opinions. Worship according to ones faith. Work in such a way that there is a sense of accomplishment. Play or participate in various forms of recreation. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

The first 9 components are physiological. The tenth and fourteenth are psychological aspects of communicating and learning The eleventh component is spiritual and moral The twelfth and thirteenth components are sociologically oriented to occupation and recreation Assumption The major assumptions of the theory are:

"Nurses care for patients until patient can care for themselves once again. Patients desire to return to health, but this assumption is not explicitly stated. Nurses are willing to serve and that nurses will devote themselves to the patient day and night A final assumption is that nurses should be educated at the uni versity level in both arts and sciences.

Hendersons theory and the four major concepts

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1. Individual

Have basic needs that are component of health. Requiring assistance to achieve health and independence or a peaceful death. Mind and body are inseparable and interrelated. Considers the biological, psychological, sociological, and spiritual components. The theory presents the patient as a sum of parts with biopsychosocial needs.

2. E n v i r o n m e n t

Settings in which an individual learns unique pattern for living. All external conditions and influences that affect life and development. Individuals in relation to families Minimally discusses the impact of the community on the individual and family. Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided

3. H e a l t h

Definition based on individuals ability to function independently as outlined in the 14 components. Nurses need to stress promotion of health and prevention and cure of disease. Good health is a challenge -affected by age, cultural background, physical, and intellectual capacities, and emotional balance Is the individuals ability to meet these needs independently.

4. Nursing

Temporarily assisting an individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14 basic needs. Assists and supports the individual in life activities and the attainment of independence. Nurse serves to make patient complete whole", or "independent." The nurse is expected to carry out physicians therapeutic plan Individualized care is the result of the nurses creativity in planning for care. Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver. In the Nature of Nursing Nurse role is, to get inside the patients skin and supplement
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his strength will or knowledge according to his needs. Hendersons and Nursing Process Summarization of the stages of the nursing process as applied to Hendersons definition of nursing and to the 14 components of basic nursing care. Nursing Process Hendersons 14 components and definition of nursing Nursing Hendersons 14 components Assessment Nursing Diagnosis Analysis: Compare data to knowledge base of health and disease. Nursing plan Identify individuals ability to meet own needs with or without assistance, taking into consideration strength, will or knowledge. Nursing Document how the nurse can assist the individual, sick or well. implementation Nursing Assist the sick or well individual in to performance of activities in implementation meeting human needs to maintain health, recover from illness, or to aid in peaceful death. Nursing process Implementation based on the physiological principles, age, cultural background, emotional balance, and physical and intellectual capacities. Carry out treatment prescribed by the physician. Nursing evaluation Hendersons 14 components and definition of nursing Use the acceptable definition of ;nursing and appropriate laws related to the practice of nursing. The quality of care is drastically affected by the preparation and native ability of the nursing personnel rather that the amount of hours of care. Successful outcomes of nursing care are based on the speed with which or degree to which the patient performs independently the activities of daily living Comparison with Maslow's Hierarchy of Need

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Maslow's

Henderson Breathe normally Eat and drink adequately Eliminate by all avenues of elimination Move and maintain desirable posture Sleep and rest Select suitable clothing Maintain body temperature Keep body clean and well groomed and protect the integument Avoid environmental dangers and avoid injuring other Communicate with others worship according to one's faith Work at something providing a sense of accomplishment Play or participate in various forms of recreation Learn, discover, or satisfy curiosity

Physiological needs

Safety Needs Belongingness and love needs

Esteem needs

Characteristic of Hendersons theory

There is interrelation of concepts. Concepts of fundamental human needs, biophysiology, culture, and interaction, communication are borrowed from other discipline.Eg.. Maslows theory. Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal. Relatively simple yet generalizable. Applicable to the health of individuals of all ages. can be the bases for hypotheses that can be tested. assist in increasing the general body of knowledge within the discipline. Her ideas of nursing practice are well accepted. can be utilized by practitioners to guide and improve their practice.

Limitations

Lack of conceptual linkage between physiological and other human characteristics. No concept of the holistic nature of human being.
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If the assumption is made that the 14 components prioritized, the relationship among the components is unclear. Lacks inter-relate of factors and the influence of nursing care. Assisting the individual in the dying process she contends that the nurse helps, but there is little explanation of what the nurse does. Peaceful death is curious and significant nursing role.

Conclusion

Henderson provides the essence of what she believes is a definition of nursing. Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs. Her definition of nursing and the 14 components of basic nursing care are uncomplicated and self-explanatory. Theory of Florence Nightingale Date of last revision January 31, 2012

The goal of nursing is to put the patient in the best condition for nature to act upon him. Nightingale Introduction

Born - 12 May 1820 Founder of mordern nursing. The first nursing theorist. Also known as "The Lady with the Lamp" She explained her environmental theory in her famous book Notes on Nursing: What it is, What it is not . She was the first to propose nursing required specific education and training. Her contribution during Crimean war is well-known. She was a statistician, using bar and pie charts, highlighting key points. International Nurses Day, May 12 is observed in respect to her contribution to Nursing. Died - 13 August 1910 Assumpations of Nightingale's Theory

Natural laws
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Mankind can achieve perfection Nursing is a calling Nursing is an art and a science Nursing is achieved through environmental alteration Nursing requires a specific educational base Nursing is distinct and separate from medicine Nightingales Canons: Major Concepts

1. Ventilation and warming 2. Light, Noise 3. Cleanliness of rooms/walls 4. Health of houses 5. Bed and bedding 6. Personal cleanliness 7. Variety 8. Chattering hopes and advices 9. Taking food. What food? 10.Petty management/observation Nursing Paradigms

Nightingale's documents contain her philosophical assumptions and beliefs regarding all elements found in the metaparadigm of nursing. These can be formed into a conceptual model that has great utility in the practice setting and offers a framework for research conceptualization. (Selanders LC, 2010) Nursing

Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act. Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation. They can be done by anyone." Person

People are multidimensional, composed of biological, psychological, social and

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spiritual components. Health

Health is not only to be well, but to be able to use well every power we have. Disease is considered as dys-ease or the absence of comfort. Environment

"Poor or difficult environments led to poor health and disease". "Environment could be altered to improve conditions so that the natural laws would allow healing to occur." Nightingale's Theory and Nursing Practice Application of Nightingale's theory in practice:

"Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to reduce noise, to relieve patients anxieties, and to help them sleep." As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care. Criticisms

She emphasized subservience to doctors. She focused more on physical factors than on psychological needs of patient. Applications of Nightingale's Theory

Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations Incorporating Florence Nightingale's theory of nursing into teaching a group of preadolescent children about negative peer pressure. Conclusion

Florence Nightingale provided a professional model for nursing organization. She was the first to use a theoretical founation to nursing.
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Her thoghts have influenced nursing significantly.

Theory of Interpersonal Relations This page was last updated on January 31, 2012 Introduction

Theorist -Hildegard. E. Peplau Born in Reading, Pennsylvania [1909], USA Diploma program in Pottstown, Pennsylvania in 1931. BA in interpersonal psychology - Bennington College in 1943. MA in psychiatric nursing from Colombia University New York in 1947. EdD in curriculum development in 1953. Professor emeritus from Rutgers university Started first post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952 1968 :interpersonal techniques-the crux of psychiatric nursing Worked as executive director and president of ANA. Worked with W.H.O, NIMH and Nurse Corps. Died in 1999. Theory of interpersonal relations is a middle range descriptive classification theory. The theory was influenced by Harry Stack Sullivan's theory of inter personal relations (1953). The theorist was also influenced by Percival Symonds, Abraham Maslow's and Neal Elger Miller. Peplau's theory is also refered as psychodynamic nursing, which is the understanding of ones own behavior. Major Concepts

The theory explains the purpose of nursing is to help others identify their felt
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difficulties. Nurses should apply principles of human relations to the problems that arise at all levels of experience. Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. The attainment of goal is achieved through the use of a series of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the process. Definitions

Person: A developing organism that tries to reduce anxiety caused by needs. Environment: Existing forces outside the organism and in the context of culture Health: A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living. Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities. Roles of nurse

Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Teacher: who imparts knowledge in reference to a need or interest Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way
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Additional Roles include: 1. Technical expert 2. Consultant 3. Health teacher 4. Tutor 5. Socializing agent 6. Safety agent 7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher Phases of interpersonal relationship Identified four sequential phases in the interpersonal relationship: 1. Orientation 2. Identification 3. Exploitation 4. Resolution Theory of Interpersonal Relations This page was last updated on January 31, 2012 Introduction

Theorist -Hildegard. E. Peplau Born in Reading, Pennsylvania [1909], USA Diploma program in Pottstown, Pennsylvania in 1931. BA in interpersonal psychology - Bennington College in 1943. MA in psychiatric nursing from Colombia University New York in 1947. EdD in curriculum development in 1953. Professor emeritus from Rutgers university Started first post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952 1968 :interpersonal techniques-the crux of psychiatric nursing Worked as executive director and president of ANA.
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Worked with W.H.O, NIMH and Nurse Corps. Died in 1999. Theory of interpersonal relations is a middle range descriptive classification theory. The theory was influenced by Harry Stack Sullivan's theory of inter personal relations (1953). The theorist was also influenced by Percival Symonds, Abraham Maslow's and Neal Elger Miller. Peplau's theory is also refered as psychodynamic nursing, which is the understanding of ones own behavior. Major Concepts

The theory explains the purpose of nursing is to help others identify their felt difficulties. Nurses should apply principles of human relations to the problems that arise at all levels of experience. Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. The attainment of goal is achieved through the use of a series of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the process. Definitions

Person: A developing organism that tries to reduce anxiety caused by needs. Environment: Existing forces outside the organism and in the context of culture Health: A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living. Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities.

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Roles of nurse

Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Teacher: who imparts knowledge in reference to a need or interest Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way

Additional Roles include: 1. Technical expert 2. Consultant 3. Health teacher 4. Tutor 5. Socializing agent 6. Safety agent 7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher Phases of interpersonal relationship Identified four sequential phases in the interpersonal relationship: 1. Orientation 2. Identification 3. Exploitation 4. Resolution

Interrelation of concepts
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Four phases interrelate the different components of each phase. Applicability o The nurse patient interaction can apply to the concepts of human being, health, environment and nursing. Theories must be logical in nature o This theory provides a logical systematic way of viewing nursing situations o Key concepts such as anxiety, tension, goals, and frustration are indicated with explicit relationships among them and progressive phases Generalizability o This theory provides simplicity in regard to the natural progression of the NP relationship. Theories can be the bases for hypothesis that can be tested o Peplau's theory has generated testable hypotheses. Theories can be utilized by practitioners to guide and improve their practice. o Peplaus anxiety continuum is still used in anxiety patients Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. o Peplau's theory is consistent with various theories
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Limitations

Personal space considerations and community social service resources are considered less. Health promotion and maintenance were less emphasized Cannot be used in a patient who doesnt have a felt need eg. With drawn patients, unconscious patients Some areas are not specific enough to generate hypothesis

Research Based on Peplaus Theory

Hays .D. (1961). Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method, the patients were able to apply the concept of anxiety after the group was terminated. Burd .S.F. Develop and test a nursing intervention framework for working with anxious patients: Students developed competency in beginning interpersonal relationship. 5 Faye Glenn Abdellah's Theory Twenty-One Nursing Problems

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This page was last updated on October 31, 2011 INTRODUCTION.

"Nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people , sick or well, cope with their health needs." - Abdellah

Abdellah explained nursing as a comprehensive service, which includes: 1. Recognizing the nursing problems of the patient 2. Deciding the appropriate course of action to take in terms of relevant nursing principles 3. Providing continuous care of the individuals total needs 4. Providing continuous care to relieve pain and discomfort and provide immediate security for the individual 5. Adjusting the total nursing care plan to meet the patients individual needs 6. Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body 7. Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations 8. Helping the individual to adjust to his limitations and emotional problems 9. Working with allied health professions in planning for optimum health on local, state, national and international levels 10.Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet the health needs of people (In 1973, the item 3, - providing continuous care of the individuals total health needs was eliminated.) ABOUT THE THEORIST AND THEORETICAL SOURCES

Birth:1919 Abdellahs patient - centred approach to nursing was developed inductively from her practice and is considered a human needs theory. The theory was created to assist with nursing education and is most applicable to
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the education of nurses. Although it was intended to guide care of those in the hospital, it also has relevance for nursing care icommunity settings.

MAJOR ASSUMPTIONS, CONCEPTS & RELATIONSHIPS

She uses the term she for nurses, he for doctors and patients, and refers to the object of nursing as patient rather than client or consumer. She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses prerogative.

Assumptions were related to

change and anticipated changes that affect nursing; the need to appreciate the interconnectedness of social enterprises and social problems; the impact of problems such as poverty, racism, pollution, education, and so forth on health care delivery; changing nursing education continuing education for professional nurses development of nursing leaders from under reserved groups

Abdellah and colleagues developed a list of 21 nursing problems.They also identified 10 steps to identify the clients problems. 11 nursing skills to be used in developing a treatment typology 10 steps to identify the clients problems

Learn to know the patient Sort out relevant and significant data Make generalizations about available data in relation to similar nursing problems presented by other patients Identify the therapeutic plan Test generalizations with the patient and make additional generalizations Validate the patients conclusions about his nursing problems Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior Explore the patients and familys reaction to the therapeutic plan and involve
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them in the plan Identify how the nurses feels about the patients nursing problems Discuss and develop a comprehensive nursing care plan

11 nursing skills

Observation of health status Skills of communication Application of knowledge Teaching of patients and families Planning and organization of work Use of resource materials Use of personnel resources Problem-solving Direction of work of others Therapeutic use of the self Nursing procedure

21 NURSING PROBLEMS Three major categories

Physical, sociological, and emotional needs of clients Types of interpersonal relationships between the nurse and patient Common elements of client care

BASIC TO ALL PATIENTS

To maintain good hygiene and physical comfort To promote optimal activity: exercise, rest and sleep To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection To maintain good body mechanics and prevent and correct deformity

SUSTENAL CARE NEEDS

To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells
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To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiological responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function.

REMEDIAL CARE NEEDS

To identify and accept positive and negative expressions, feelings, and reactions To identify and accept the interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and non verbal communication To promote the development of productive interpersonal relationships To facilitate progress toward achievement of personal spiritual goals To create and / or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical , emotional, and developmental needs

RESTORATIVE CARE NEEDS

To accept the optimum possible goals in the light of limitations, physical and emotional To use community resources as an aid in resolving problems arising from illness To understand the role of social problems as influencing factors in the case of illness

ABDELLAHS THEORY AND THE FOUR MAJOR CONCEPTS NURSING

Nursing is a helping profession. Nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs, increasing or restoring self-help ability, or alleviating impairment. Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. Nursing to be comprehensive service.

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PERSON

Abdellah describes people as having physical, emotional, and sociological needs. Patient is described as the only justification for the existence of nursing. Individuals (and families) are the recipients of nursing Health, or achieving of it, is the purpose of nursing services.

HEALTH

In PatientCentered Approaches to Nursing, Abdellah describes health as a state mutually exclusive of illness. Although Abdellah does not give a definition of health, she speaks to total health needs and a healthy state of mind and body in her description of nursing as a comprehensive service.

SOCIETY AND ENVIRONMENT

Society is included in planning for optimum health on local, state, national, and international levels. However, as she further delineated her ideas, the focus of nursing service is clearly the individual. The environment is the home or community from which patient comes.

CHARACTERISTICS OF THE THEORY

Abdellahs theory has interrelated the concepts of health, nursing problems, and problem solving. Problem solving is an activity that is inherently logical in nature. Framework focus on nursing practice and individuals. The results of testing such hypothesis would contribute to the general body of nursing knowledge Easy to apply in practice.

USE OF 21 PROBLEMS IN THE NURSING PROCESS

ASSESSMENT PHASE

Nursing problems provide guidelines for the collection of data. A principle underlying the problem solving approach is that for each identified problem, pertinent data are collected. The overt or covert nature of the problems necessitates a direct or indirect approach, respectively.

NURSING DIAGNOSIS

The results of data collection would determine the clients specific overt or covert problems. These specific problems would be grouped under one or more of the broader nursing problems. This step is consistent with that involved in nursing diagnosis

PLANNING PHASE

The statements of nursing problems most closely resemble goal statements. Once the problem has been diagnosed, the nursing goals have been established.

IMPLEMENTATION

Using the goals as the framework, a plan is developed and appropriate nursing interventions are determined.

EVALUATION

The most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals..

Progressive Patient Care :: Models of Nursing Care Delivery CONCLUSION

Using Abdellahs concepts of health, nursing problems, and problem solving, the theoretical statement of nursing that can be derived is the use of the problem solving approach with key nursing problems related to health needs of people.
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From this framework, 21 nursing problems were developed.

Abdellahs theory provides a basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies. Care, Cure and Core

The Three Cs of Lydia Hall This page was last updated on January 27, 2012 LYDIA HALL AND HER THEORY

Lydia Hall was born in New York City on September 21, 1906. She promoted involvement of the community in health-care issues. She derived from her knowledge of psychiatry and nursing experiences in the Loeb Center the framework she used in formulating her theory of nursing. The theory contains of three independent but interconnected circles: 1. the core, 2. the care and 3. the cure The core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person. The core behaved according to his feelings, and value system. The cure is the attention given to patients by the medical professionals. The theory contains of three independent but interconnected circlesthe core, the care and the cure. .According to the theory, the core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person, and that these goals need to be achieved. The core, in addition, behaved according to his feelings, and value system. The cure, on the other hand is the attention given to patients by the medical professionals. The model explains that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or curing the patient from whatever illness or disease he may be suffering from. The care circle explains the role of nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the
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motherly care provided by nurses, which may include imited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed. It is easy to understand from the model that in all of the circles of the model, the nurse is always presents the bigger role she takes belongs to the care circle where she acts a professional in helping the patient meet his needs and attain a sense of balance.

Orlando's Nursing Process Theory This page was last updated on February 4, 2012

INTRODUCTION About the Theorist

Ida Jean Orlando - born in 1926. wrote about the nursing process. Nursing diploma - New York Medical College BS in public health nursing - St. John's University, NY, MA in mental health nursing - Columbia University, New York. Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing. Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum. published in her 1961 book, The Dynamic Nurse-Patient Relationship and revised 1972 book: The Discipline and Teaching of Nursing Processes A board member of Harvard Community Health Plan.

Major Dimensions

The role of the nurse is to find out and meet the patient's immediate need for help. The patient's presenting behavior may be a plea for help, however, the help needed may not be what it appears to be. Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with patients the meaning
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of their behavior. This process helps nurse find out the nature of the distress and what help the patient needs.

Terms

Distress is the experience of a patient whose need has not been met. Nursing role is to discover and meet the patients immediate need for help. o Patients behavior may not represent the true need. o The nurse validates his/her understanding of the need with the patient. Nursing actions directly or indirectly provide for the patients immediate need. An outcome is a change in the behavior of the patient indicating either a relief from distress or an unmet need. o Observable verbally and nonverbally.

CONCEPTS

Function of professional nursing - organizing principle Presenting behavior - problematic situation Immediate reaction - internal response Nursing process discipline investigation Improvement - resolution

Function of professional nursing - organizing principle

Finding out and meeting the patients immediate needs for help

"Nursing.is responsive to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing or curing the individuals sense of helplessness." - Orlando Presenting behavior - problematic situation

To find out the immediate need for help the nurse must first recognize the situation as problematic The presenting behavior of the patient, regardless of the form in which it
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appears, may represent a plea for help The presenting behavior of the patient, the stimulus, causes an automatic internal response in the nurse, and the nurses behavior causes a response in the patient

Immediate reaction - internal response

Person perceives with any one of his five sense organs an object or objects The perceptions stimulate automatic thought Each thought stimulates an automatic feeling Then the person acts The first three items taken together are defined as the persons immediate reaction

Nu r s i n g p r o c e s s d i s c i p l i n e i n v e s t i g a t i o n

Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate until she checks the validity of it in exploration with the patient The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does . When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops

Improvement - resolution

It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met. In each contact the nurse repeats a process of learning how to help the individual patient.

ASSUMPTIONS

When patients cannot cope with their needs without help, they become
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distressed with feelings of helplessness Patients are unique and individual in their responses Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child Nursing deals with people, environment and health Patient need help in communicating needs, they are uncomfortable and ambivalent about dependency needs Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and feelings The nurse patient situation is dynamic, actions and reactions are influenced by both nurse and patient Human beings attach meanings to situations and actions that are not apparent to others Nurses are concerned with needs that patients cannot meet on their own

DOMAIN CONCEPTS 1. Nursing is responsive to individuals who suffer or anticipate a sense of helplessness 2. Process of care in an immediate experience.. for avoiding, relieving, diminishing or curing the individuals sense of helplessness. Finding out meeting the patients immediate need for help 3. Goal of nursing increased sense of well being, increase in ability, adequacy in better care of self and improvement in patients behavior 4. Health sense of adequacy or well being . Fulfilled needs. Sense of comfort 5. Environment not defined directly but implicitly in the immediate context for a patient 6. Human being developmental beings with needs, individuals have their own subjective perceptions and feelings that may not be observable directly 7. Nursing client patients who are under medical care and who cannot deal with their needs or who cannot carry out medical treatment alone 8. Nursing problem distress due to unmet needs due to physical limitations, adverse reactions to the setting or experiences which prevent the patient from communicating his needs 9. Nursing process the interaction of 1)the behavior of the patient, 2) the reaction of the nurse and 3)the nursing actions which are assigned for the patients benefit 10.Nurse patient relations central in theory and not differentiated from nursing
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therapeutics or nursing process 11.Nursing therapeutics Direct function : initiates a process of helping the patient express the specific meaning of his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the help he requires so that his distress may be relieved. 12.Indirect function calling for help of others , whatever help the patient may require for his need to be met 13.Nursing therapeutics - Disciplined and professional activities automatic activities plus matching of verbal and nonverbal responses, validation of perceptions, matching of thoughts and feelings with action 14.Automatic activities perception by five senses, automatic thoughts, automatic feeling, action CHARACTERISTICS OF THE THEORY

Orlando's theory interrelate concepts Orlando's theory has a logical nature Orlando's theory is simple and applicable in the daily practice. Orlando's theory contribute to the professional knowledge. Orlando's theory is applicable in clinical practice

STRENGTHS

Use of her theory assures that patient will be treated as individuals and that they will have active and constant input into their own care Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with the patient Assertion of nursings independence as a profession and her belief that this independence must be based on a sound theoretical frame work Guides the nurse to evaluate her care in terms of objectively observable patient outcome

NURSING PROCESS

Assessment Diagnosis Planning Implementation

Evaluation

CONCLUSION TO THEORY

Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was to define the function of nursing. (Faust C., 2002) Orlando's theory remains one the of the most effective practice theories available. The use of her theory keeps the nurse's focus on the patient. The strength of the theory is that it is clear, concise, and easy to use. While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other theories while caring for the patient

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