5 nursing theories in pmhn
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Liceo de Cagayan UniversityGraduate Studies
“Nursing Theory and Psychiatric Mental Health:
Analysis on Selected Nursing Theories”
In partial fulfillment of the requirements in
Master’s in Nursing: Psychology
Submitted to:Mrs. Ma Dolores Mercado, R.N., MAN
Submitted by:Ms. Whinsheil B. Gardonez, R.N.
Nursing Theory and Psychiatric Mental Health
Theory Defined
A theory is conceptual system consisting of inter-related proposition that describe, explain, and predict
selected phenomena.
No single theory can address all aspect of reality
All theories are tentative in nature and subject to change or to obsolescence
Nursing Theories
The development of theory, is necessary for the further development of nursing as a profession (Johnson, 1997)
Almost all current nursing theories can be classified as:
Interpersonal
Behavioural or
Systems-oriented
The theories of:
Hildegard Peplau
Dorothea Orem
Martha Rogers
Sister Callista Roy
Rosemarie Parse
Peplau’s Interpersonal Theory
Hildegard Peplau has been a pioneer in formulating nursing theory. She proposed an interpersonal theory applicable to nursing practice in general and psychiatric-mental health in particular. Peplau, described the interpersonal aspect of nursing as process.
The process consists of four phases:
Orientation Phase
Identification Phase
Exploitation Phase
Resolution Phase
Peplau’s Theory continued
Peplau’s Theory continued
While working with the client through these phases, the nurse assumes six roles.
StrangerInitial role of the nurse, the task of forming trust and acceptance are most prominent at this time.
Resource expert The nurse assumes this role during assessment in an effort to provide alternative ways in meeting the client’s needs and limitations.
LeaderBecause the client may be incapacitated or immobilized physically and emotionally, the nurse may assume this role to ensure the client’s needs are addressed.
SurrogateRepresents the client in terms of advocacy
Counselor The client is assisted to recall past experiences and
traumas and to work through these.
Teacher Also assumed in an attempt to assist the client to learn from present and past experiences and traumas.
Analysis of Peplau’s Theory
it appears that Peplau has taken special care to keep the theory’s generalizations closely attached and observable nursing situations.
Peplau’s theory describes, explains, predicts, and to some extent permits control of the sequence of events occurring in the nurse-client relationship
Strengths:
Weaknesses:
It is of minimal use in short-term, acute nursing care settings, in which hospitalizations last only for hours or at most for a few days,
precluding relationship development.
it is applicable only to dyadic nurse-client relationship, in which the client is a group of individuals, a family, or a community is not addressed.
Dorothea Orem’s Behavioral Nursing Theory
This theory is based on the premise that persons need a composite of self-care
action in order to survive.
Self-care action consists of all behaviour performed by individual to maintain life, health and well-being.
The capacity of the client and the client’s family to performed self-care is
referred to as self-care agency.
The need for nursing care will exist if the client’s self-care demand exceeds
the client’s self care agency.
Three types of Self-care:
Universal self-care behaviors are required to meet psychological needs.
Developmental self-care behaviours are required to undergo normal human development
Health self-care behaivors are required to meet client needs during health deviations.
The plan indicates the nursing approach needed to meet the client’s needs. These plans can be categorized as follows:
Wholly compensatory, in which the client does not participate behaviourally in self-care
Partially compensatory, in which both the client and nurse participate behaviourally in meeting the client’s self-care needs
Educative development, in which the client meets his own self-care needs with the minimal nursing assistance.
To implement the required nursing approach, the nurse uses one of five behaviours:
Acting or doing for the client
Guidance
Supporting
Providing
Teaching
Analysis of Orem’s Theory
Strength:
the emphasis on the capabilities rather than the limitations of clients.
Additionally, the theory explains the necessity of the client’s and his family’s involvement in the nursing process.
Weaknesses:
the theory’s language is somewhat confusing and unnecessarily complex. For example, the term “self-care agency” could be more simply phrased as “self-care capacity”.
the theory’s failure to address the evaluation of the effects of nursing care behaviors.
Martha Rogers’ Systems-Oriented Nursing Theory
proposed a theory concerning the nature of humankind from what she considered a unique nursing perspective.
defines nursing as a humanistic science for maintaining and promoting health, preventing illness, and caring for and rehabilitating the sick and disabled.
The theory is based on four major premises.
1. The first premise is that the human organism is characterized by openness and, as a result, is in continuous mutual interaction with the environment.
2. The human organism is conceptualized as having an energy field which is in constant mutual interaction with the energy fields of the environment and of other human organisms. This dynamic mutual interaction can be perceived as wave patterns or auras.
3. The way the energy field appears is characterized by organized patterns or design
4. Human existence is four- rather than three-dimensional, which is according to Rogers, is the human beings capacity to transcend conventional concepts of time-space interaction.
Homeodynamic principles
Resonancy-is an ordered arrangement of rhythm characterizing both human
field and environmental field that undergoes continuous dynamic metamorphosis in the human environmental process.
Helicy-describes the unpredictable, but continuous, nonlinear 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 the continuous re-patterning of the human and environmental fields by resonance waves.
Analysis of Rogers’ Theory
Strengths:
the theory is holistic and takes into the account the entire field of phenomena associated with nursing.
Rogers theory addresses the spirituality of human existence by attempting to explain the four-dimensionality of the universe and the occurrence of paranormal experiences.
Analysis of Rogers’s Theory cont’d.
Weaknesses:
Rogers’s theory have an overly complex terminology.
Additionally, the absence and weakness of logical bridges or transitions between or among its conceptual component obfuscates the theory’s content.
Sister Callista Roy’s Theory of Adaptation
It was modelled from behavioral theory and states that human use coping mechanisms to adapt to both internal and external stimuli.
Types of stimuli: focal, contextual and residual
Two major internal coping mechanisms are the regulator and cognator.
The Four Modes of Adaptation
Physiologic-Physical ModePhysical and chemical processes involved in the function and
activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to change in needs.
Self-concept- Group Identity ModeFocuses on psychological and spiritual integrity and sense of
unity, meaning, and purposefulness in the universe.
Role Function ModeRoles that individuals occupy in society, fulfilling the need for
social integrity. It is knowing who one is in relation to others.
Interdependence ModeThe close relationships of people and their purpose, structure
and development individually and in groups and the adaptation potential of these groups.
Analysis of Roy’s Adaptation Model (RAM)
Strength:
Is focus on the whole person or group. The four modes provide an opportunity for consideration of multiple aspects of the human adaptive system and support gaining an understanding of the whole system
Weaknesses:
the need for consistent definitions of the concepts and terms within the RAM, as well as for more research based on such consistent definitions.
Also, in a practice area that is increasingly challenged with time constraints, the amount of time required to fully
implement the two areas of RAM assessment may be viewed as insurmountable
Rosemarie Parse’s Theory of Human Becoming
The Parse theory of human becoming guides nurses In their practice to focus on quality of life as it is described and lived (Karen & Melnechenko, 1995).
Parse presents an alternative to both the conventional biomedical approach and the biopsycho-social-spiritual approach of most other theories of nursing.
Three Major Assumptions of Human Becoming
1. MeaningHuman Becoming is freely choosing personal
meaning in situations in the intersubjective process of living value priorities.
Man’s reality is given meaning through lived experiencesMan and environment cocreate
2. RhythmicityHuman Becoming is cocreating rhythmical patterns
of relating in mutual process with the universe.Man and environment cocreate ( imaging, valuing,
languaging) in rhythmical patterns
Major Assumptions cont’d.
3. Transcendence
Human Becoming is cotranscending multidimensionally with emerging possibles.
Refers to reaching out and beyond the limits that a person sets
One constantly transforms
Analysis of Parse’s TheoryStrengths:
Focuses on clients experiences and not problems
Provides framework to guide inquiry of other theories (grief, hope, laughter, etc.)
Weaknesses:
Negates the idea that each person engages in a unique lived experience
Not applicable to acute, emergent care
Journal Reading:Application of Orem’s Self-Care deficit theory in the Nursing Profession
By Rosinee Rosales
As a staff nurse in a medical ward in Riyadh Military Hospital, many of our patients have respiratory and heart problems. All of them present different health problems and needs, some of them are intubated and some of them are in comatose condition after cerebrovascular accident or cardiac arrest. These patients will not be able to verbalize their concerns and feelings. Orem ’s concept of self-care specified different self-care requisites, being acquainted in these concepts, it ’s easier for me to assess and recognize the needs of my patients and it will facilitate me in selecting particular nursing interventions based on their needs. Orem’s theory of nursing systems is also evident in my current practice. The concepts of wholly compensatory, partly compensatory, and supportive-educative systems are relevant to various interventions that I perform based on different needs and abilities of my patients thus it creates individualized nursing care. In the case of bedridden patients, wholly compensatory nursing system is appropriate to them, “the nurse is their hands and their feet”. Patients who had liver biopsy are not allowed to ambulate 24 hours after the procedure. In this event, partly compensatory nursing system can be applied. Supportive-educative nursing system is appropriate to patients who have diabetes mellitus, they should be taught to correct their diet and lifestyle and how to check their blood sugar and to administer insulin if needed.These are some of the things how Orem’s theory could be beneficial in my current nursing practice. Her contributions are indeed significant in our nursing profession.
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