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.

(I hold no title or right for the copyright of this article. Source: http://networkedblogs.comhttp://upoun207tfn.blogspot.com/)

Thank you!