Fundamentals of Nursing I

Introduction:

From Topic 2 to Topic 4 will introduces the nursing theorist as nursing theory is essential concept used in nursing education, research and clinical setting.

 

Topic Learning Outcome (TLOs):

By the end of this topic, you should be able to:

1. Discuss selected nursing theories clearly

·         Nightingale’s Environmental Theory

·         Virginia Henderson’s Need Theory

·         Watson’s Human Caring Theory

·         Orem’s General Theory of Nursing

Nightingale’s Environmental Theory

Environmental Theory is the first nursing theorist. “Act of utilizing the environment of the patient to assist him in his recovery” (Nightingale, 1860/1969). Involves five environmental factors: Pure or fresh air; Pure water; Efficient drainage; Cleanliness; and Light, esp. direct sunlight. Deficiency in these factors will lead to lack of health and illness. She stressed the importance keeping the client warm, maintaining noise-free environment; Diet intake of client and Timeliness of food. So, the general concept of health in this theory are, Ventilation, Cleanliness, Quiet environment and Diet. Nightingale’s Environmental Theory remains the integral part of nursing and health care today.

Virginia Henderson’s Need Theory

In 1966, Henderson uniquely defined nursing separating it from medicine and concerned both in healthy and ill individual. She developed the 14 Fundamental needs:

1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining a desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within normal range adjusting and modifying the environment
8. Avoiding dangers in the environment and avoiding injuring others
9. Keeping the body clean and well-groomed to protect the integument
10. Communicating with others in expressing emotions, needs, fears and emotions
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of accomplishment
13. Playing or participating in various forms of recreations
14. Learning, discovering or satisfying the curiosity that leads to normal development and health and using available facilities

•      Besides, Henderson put emphasis on nursing independence, interdependence with other health care discipline. She was one of the first modern nurses to define nursing as “The unique function of the nurse is to assist the individual, sick or well in the performance of those activities contributing to the health or its recovery. (or to peaceful death)”. Means he would perform unaided if he had the necessary strength, will or knowledge and to do such a way as to help him gain independence as rapidly as possible. Therefore, Henderson (1966) described nursing in relation to client and the client’s environment as compared to nightingale, Henderson saw the nurse as concerned with both the healthy and the ill individual.

Watson’s Human Caring Theory

Jean Watson (1979), unifying focus for practice of caring is center in nursing. She highlights that nursing intervention to human care are referred to as Carrative Factors. There are 10 Core of Nursing in her theory:

1. Forming a humanistic –altruistic system of values
2. Instilling faith and hope
3. Cultivating sensitivity to one’s self- and others
4. Developing a helping-trust (human care) relationship
5. Promoting and accepting the expression of positive and negative feelings
6. Systematically using the scientific problem-solving method for decision making
7. Promoting interpersonal teaching-learning
8. Providing a supportive, protective or corrective mental, physical, sociocultural and spiritual environment
9. Assisting with the gratification of human needs
10. Allowing for existential-phenomenological spiritual forces

Watson’s theory of human care received worldwide recognition and major force in redefining nursing as a caring healing health care.

Orem’s General Theory of Nursing

Dorothea Orem’s General Theory of Nursing was first published in 1971. Orem believe that” patient wish to care for themselves. Recovery is quick if they are allowed to perform their own self care activities to the best of their ability or at least incorporated in taking care of themselves”. Three related concepts: Self-care, Self-deficit and Nursing system. The explanation is as following:

Ø  There are Four concepts in Self-Care theory

1. Self-care activities is activities an individual performs independently throughout life to promote and maintain personal well-being
2. Self-care agency is individual’s ability to perform self-care activities. There are two agents: Self-care agent (individual who can perform self-care independently) and Dependent care agent (person other than the individual who provides the care).
3. Self-care requisites, divided to three categories:

·         Universal requisites are common to all people (Maintaining intake and elimination of air, water, and food. balancing rest, social interaction, preventing hazard to life and well-being).

·         Developmental requisites (Maturation or as associated with conditions or events like: adjusting to a change in body image or loss of a spouse)

·         Health deviation requisites (result from illness, injury or disease or its treatment like: seeking health and carrying our prescribed therapies learning to live with the effects of illness or treatment).

4.      Therapeutic self-care demand, refers to all self-care activities required to meet existing self-care requisites.

 

Ø  Self-Care deficit, results when self-care agency is not adequate to meet the known self-care demand. Five methods of helping; Acting or doing for; Guiding; Teaching; Supporting; providing an environment that promotes the individual’s abilities to meet current and future demands.

Ø  Orem identified three types of nursing systems: Wholly compensatory system; Partly compensatory; Supportive-educative (developmental).