Significance of Theory in Nursing Profession WEEK# 2

NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

TOPIC 5. Must have developed a scientific technique

which is the result of tested experience.
The Significance of Theory in Nursing as a 6. Must require the exercise of discretion and
Profession judgment as to time and manner of the
performance of duty.
1. Criteria of Profession by W. Shepherd 7. It must have a group of consciousness
and Flexner A.
designed to extend scientific knowledge in
2. Nursing Theory and the Nurse
Practitioner technical language.
Non-Nursing Theories 8. Must have sufficient self-impelling power
to retain its members throughout life.
1. Human Needs Theory 9. Must receive its obligations to society by
2. Systems Theory insisting that its members live up to an
3. Change Theory established code of ethics.
Health as a Multifactorial Phenomenon
CRITERIA OF A PROFESSION BY FLEXNER A.
1. Concept of Health
2. Concept of Illness
1. It is intellectual and is accompanied by a
3. Concept of Wellness
high degree of individual responsibility.
2. Is based on a body of knowledge that can
LEARNING OBJECTIVES be learned and is developed and refined
through research.
At the end of the discussion, you will be able 3. Is practical, in additional to being
to: theoretical.
4. Can be taught a process of highly
1. Develop an understanding of the specialized professional education.
various criteria of a profession and how 5. Has a strong internal organization of
it relates to nursing
members and a well-developed group
2. Describe the impact of theories in the
development of nursing as a profession consciousness.
3. Provide the significance of how the non- 6. Has practitioners who are motivated by
nursing theories relate to the nursing altruism and who are responsive to public
profession interests.
4. Explain the different concepts of health,
wellness, and illness and characterize NURSING THEORY & THE NURSE
its importance in the client’s overall PRACTITIONER
status.
THEORY HELPS NURSES TO:

THE SIGNIFICANCE OF THEORY IN  Organize, examine, and analyze patient’s

NURSING AS A PROFESSION data.
 Make decisions about effective and
efficient nursing interventions.
DISCIPLINE VS PROFESSION
 Make a S.M.A.R.T. plan of care.
DISCIPLINE PROFESSION
S Specific
Specific to academia Refers to a specialized
M Measurable
and refers to a branch field of practice
of education, a founded on the A Attainable
department of theoretical structure
learning, or a domain of the science of R Realistic
of knowledge. knowledge of that
discipline and T Time-
accompanying bounded
practice abilities.

 Predict and evaluate outcomes of care.

CRITERIA OF A PROFESSION BY W.
SHEPHERD NON-NURSING THEORIES

1. Must satisfy an indispensable social need

and be based upon well established and
socially accepted scientific principles.
HUMAN NEEDS
2. Must demand adequate pre-professional THEORY
and cultural training.
3. Must demand the possession of a body of
a specialized and systematized training. NON-NURSING SYSTEMS
4. It must give evidence of needed skills THEORIES THEORY
which the public does not possess; that is,
skills which are partly inherent and partly CHANGE
acquired. THEORY

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 Significance of Theory in Nursing Profession WEEK# 2
NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

HUMAN NEEDS THEORY model that requires prior learning to be

rejected and replaced.
 Developed by Abraham Maslow  His theory states behavior as “a dynamic
 He conceptualized that the humans aim to balance of forces working in opposing
meet needs at the lowest levels before directions.”
moving up to the higher level.
 Maslow described achieving the highest- CONCEPTS:
level, self-actualization, as “becoming all
that one is capable of becoming in terms 1. Driving Forces
of talents, skills, and practice.”  These are forces that push in a
direction that causes change to occur.
 Driving forces facilitate change
because they push the person in the
desired direction.
 They cause a shift in the equilibrium
towards change
2. Restraining Forces
 These are forces that counter driving
forces.
 Restraining forces hinder change
because they push the person in the
opposite direction.
 Restraining forces cause a shift in the
SYSTEMS THEORY equilibrium which opposes change
3. Equilibrium
 First proposed by Ludwig van Bertalanffy  It is a state of being where driving
as General Systems theory forces equal restraining forces and no
 Systems theory may be considered as a change occurs
specialization of systems thinking and a  Equilibrium can be raised or lowered
generalization of systems science by changes that occur between the
 General systems theory is a general driving and restraining forces
science of ‘wholeness’.
 Has been applied in developing nursing Three-Stage Model
theories and conducting nursing research
1. Unfreezing
Characteristics of systems:  The process which involves finding a
method of making it possible for
1. “Systems” refer specifically to self- people to let go of an old pattern that
regulating systems. was counterproductive in some way.
2. Systems are self-correcting through  Unfreezing is necessary to overcome
feedback. the strains of individual resistance and
3. Systems have a structure that is defined group conformity.
by its parts and processes.  Can be achieved by the use of the
4. Systems are generalizations of reality. following three methods;
5. The various parts of a system have A. Increase the driving forces that
functional as well as structural direct behavior away from the
relationships between each other. existing situation or status quo.
6. Systems tend to function in the same way. B. Decrease the restraining forces
7. Every living organism is essentially an that negatively affect the
open system. movement from the existing
equilibrium.
Systems theory and Nursing C. Find a combination of the two
methods listed above
von Bertalanffy influenced the works of many
2. “Moving to a new level or Changing”
nursing theorists
or Movement
 Neuman’s Systems Theory  This stage involves a process of
 Roger’s Theory of Unitary Human Beings change in thoughts, feeling, behavior,
 Roy’s Adaptation Model or all three, that is in some way more
 Imogene King’s Theory of Goal Attainment liberating or more productive.
 Orem Self-care Deficit Theory 3. Refreezing
 Johnson’s Behavior Systems Model  Refreezing is establishing the change
as a new habit, so that it now becomes
CHANGE THEORY the “standard operating procedure.”
 Without this stage, it is easy to go
 Conceptualized by Kurt Lewin back to the old ways.
 His most influential theory was his model
of the change process in human systems.
 Lewin theorized a three-stage model
known as unfreezing-change-refreeze

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 Significance of Theory in Nursing Profession WEEK# 2
NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

CHANGE THEORY (APPLICATION)

COMPONENT OF WELLNESS/DIMENSIONS
 It is pertinent that the first 2 concepts OF WELLNESS:
must be analyzed before implementing a
planned change. 1. Physical - the ability to carry-out daily
tasks, achieve fitness, maintain adequate
HEALTH AS A MULTIFACTORIAL nutrition.
PHENOMENON 2. Social - ability to interact successfully
with people and within the environment
CONCEPT OF HEALTH 3. Emotional - ability to manage stress and
to express emotions appropriately.
HEALTH
4. Intellectual - ability to learn and use
information effectively for personal,
Nightingale A state of well-being and using
family, or career development.
every power the individual
5. Spiritual - the belief in some force that
possesses to the fullest extent.
serves to unit beings and provide meaning
Health is maintained through
and purpose to life.
prevention of disease via
6. Occupational - achieve balance between
environmental health factors.
work and leisure time.
WHO A state of complete physical, 7. Environmental - promote health
mental, and social well-being measures that improve the standard of
and not merely the absence of living and quality of life.
disease or infirmity.
Models of Health & Wellness
ANA A dynamic state of being in
1. Clinical Model - narrowest
which the developmental and interpretation of health
behavioral potential of an  people are viewed as physiologic
individual is realized to fullest systems with related functions and
extent possible. health is identified by the absence
of signs and symptoms of disease
Clause The ability to maintain the or injury.
Bernard internal milieu. Illness is the 2. Adaptive Model - health is a creative
process
result of failure to maintain the
 disease is a failure in adaptation
internal environment. (maladaptation)
 the aim of the treatment is to
Orem State that is characterized by restore the ability to adapt or to
soundness or wholeness of cope
developed human structures and 3. Role Performance Model - ability to
of bodily and mental function. fulfill societal roles and work
4. Eudaimonistic Model - incorporates a
Roy State and process of being and comprehensive view of health
 health is a condition of
becoming an integrated whole
actualization or realization of a
person. person's potential
 actualization is the apex of the
fully developed personality
 illness prevents self-actualization
FACTORS AFFECTING 5. Agent-Host Environment Model - also
HEALTH/DETERMINANTS OF HEALTH: called ecological model
 originated in the community
1. Income and social status health work of Leavell and Clark
2. Education  used in predicting illness
3. Physical Environment
4. Employment and working conditions
5. Social support networks Envi
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services Agent Host
10. Gender

WELLNESS 3 dynamic interactive elements

6. Health Illness Continuum

 The maximizing of personal potential and (Grids/Graduated Scales)
a state of well- being.  can be used to measure a person's
 Involves attitudes and behaviors that perceived level of wellness
enhance the quality of life.
 The loving acceptance of one's self. good health ➞ normal health ➞ poor health ➞
extremely poor health ➞ death
Components of Wellness

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 Significance of Theory in Nursing Profession WEEK# 2
NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

A. Dunn's High Level Wellness Grid. 4. Social support method

 Describes a grid in which health
axis and environmental axis HEALTH BELIEFS MODELS
intersect
 This explores the concept of
wellness as it relates to the family Health Locus of Control Model
 He believes that family wellness
enhances wellness in individuals. Locus of Control
 a concept from social learning theory that
nurses use to determine whether clients
are likely to take action regarding health,
that is, whether clients believes that their
health status is under their own or client's
control
1. Internals
 people who believe that they
have a major influence on their
own health status
2. Externals
 people who believe their health
us largely controlled by outside
forces.
B. Travis’ Illness Continuum
Rosenstock's and Becker's Health Model
 1950 they proposed a health belief model
intended to predict which individual would
or would not use, such as preventive
measures as screening for early detection
of cancer.
Becker - modified the health belief model to
include three (3) components:
Health continuum according to Travis (Travis,
1984) 1. Individual Perception
C. 4+ Model of Wellness
 perceived susceptibility;
perceived seriousness; perceived
4 Domains of Elements of the
threat
Inner Self Outer Systems
Physical Environment 2. Modifying Factors
Spiritual Culture  demographic variables;
Emotional Nutrition sociopsychologic variables;
Intellectual Society structural variables; cues to
Other elements action
3. Variables likely to affect initiating
Variables Influencing Health Status, Beliefs, action
and Practices  perceived benefits to action;
perceived barriers to action
Health Status
 state of health of an individual at a given HEALTH CARE ADHERENCE
time.
Adherence
Health Beliefs
 concepts about health that an individual
 The extent to which an individual’s
believes
behavior coincide with medical or health
Health Behaviors advice.
 the actions people take to understand their
health state, maintain an optimal state of Factors Influencing Adherence:
health, prevent illness and injury, and
reach their maximum and mental 1. Client motivation
potential.
2. Degree of lifestyle change
Internal Variables 3. Perceived severity of the health care
 described as non-modifiable variables;
problem
consists of the following dimensions:
1. Biologic Dimension 4. Values placed on reducing the threat of
 genetic make up, sex, age, and illness
developmental level
2. Psychologic Dimension
5. Difficulty in understanding and performing
specific behaviors.
 mind-body interactions and self-
concept 6. Degree of inconvenience of the illness
3. Cognitive Dimension itself or of the regimens.
 lifestyle choices, spiritual and
religious beliefs 7. Beliefs that the prescribed therapy or
regimen will or will not help.
External Variables 8. Complexity, side effects, and duration of
1. Environment the proposed therapy.
2. Standards of living
3. Family and cultural beliefs

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 Significance of Theory in Nursing Profession WEEK# 2
NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

9. Specific cultural heritage that may make Undergoing speech therapy after laryngectomy.
adherence difficult.
ILLNESS AND DISEASE
10.Degree of satisfaction and quality and type
of relationship with the health care ILLNESS
providers.  a state in which the person's physical,
emotional, intellectual, developmental, or
11.Overall cost of prescribed therapy. spiritual function are decreased or
diminished. BON
When a nurse identifies non-adherence, it
is important to take the following steps: DISEASE
 an alteration in body functions which
1. Establish why the client is not causes reduced capacities or a shortened
following the regimen. lifespan.

2. Demonstrate caring ETIOLOGY

3. Encourage healthy behaviors through  causation of disease
positive reinforcement
4. Use aids to reinforce teaching ACUTE ILLNESS
5. Establish a therapeutic relationship of  severe symptoms of relatively short-term
freedom, mutual understanding and duration
mutual responsibility with the client
and support persons. CHRONIC ILLNESS
 lasts for an extended period, usually 6
HEALTH PROMOTION months or longer and often for the
person's life
 Activities undertaken for the purpose of
COMMON CAUSES OF ILLNESS:
achieving a higher level of health and well-
1. Biologic agents
being.
2. Inherited genetic defect
Types of Health Promotion Programs:
3. Developmental defect
4. Physical agents
1. Information dissemination
5. Chemical agents
2. Health appraisal and wellness assessment
programs
6. Tissue response to irritation or injury
7. Faulty chemical or metabolic process
3. Lifestyle and behavior change programs
8. Emotional or physical reaction to stress
4. Worksite wellness programs
5. Environmental control programs ILLNESS BEHAVIOR
 a coping mechanism; involves ways
BEHAVIORS ASSOCIATED WITH THE LEVELS individuals describe, monitor, and
OF PREVENTION interpret their symptoms, take remedial
actions, and use the behavior.
1. Primary Prevention
Quit smoking Take adequate fluids Parson's 4 Aspects of the Sick Role:

Avoid/limit alcohol Avoid over exposure 1. Clients are not held responsible for their
intake condition
2. Clients are excused from certain social
roles and tasks
Exercise regularly Maintain ideal body 3. Clients are obliged to try to get well as
weight quickly as possible
4. Clients or families are obliged to see
Eat well-balanced diet Complete competent help
immunization program
Suchman 5 Stages of Illness:
Reduce fat and Wear hazard devices
increase fiber in diet in work site Stage 1: Symptom experience
 person begins to believe that something is
wrong
2. Secondary Prevention
3 Aspects:
Have annual physical examination
1. The physical exposure to the
Regular Pap's test for women symptoms
Monthly BSE for women who are 20 years old and 2. The cognitive aspect
above
3. Emotional response
Sputum examination for TB
Annual stool guaiac test and rectal examination for Stage 2: Assumption of the sick role
clients over age 50 years.  accept the sick role and seek confirmation
from family and friends
3. Tertiary Prevention
Self-monitoring of blood glucose among diabetes Stage 3: Medical care contact
Physical therapy after CVA (stroke); participation  seek advice from a health professional
in Cardiac Rehabilitation after MI
3 Types of information being asked:
Attending self-management education for diabetes
1. Validation of real illness

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 Significance of Theory in Nursing Profession WEEK# 2
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2. Explanation of the symptoms in E. Venereal

understandable terms
3. Reassurance that they will be alright
or prediction of outcome LEAVELL AND CLARK'S 3 LEVELS OF
PREVENTION:
Stage 4: Dependent client role
 client becomes dependent on the 1. Primary Prevention
professional help  to encourage optimal health and to
increase the person's resistance to illness.
Stage 5: Recovery or Rehabilitation
 client recovers and attempt to optimize 2. Secondary Prevention
whatever capabilities are left in him  health maintenance.

EFFECT OF ILLNESS 3. Tertiary Prevention

Impact on the client  to support the client's adaptation to known

 behavioral and emotional changes; risks, optimal reconstitution, and/or
changes on self-concept and body image, establishment of high-level wellness.
and lifestyle changes; family interactions

Nurses must help make adjustments with TERMINOLOGIES

lifestyle changes by:
1. Providing explanations
2. Making arrangements possible to Ecology - the science of organisms as affected by
accomplish client's lifestyle factors in their environment. Deals with the
3. Encourage other health care professionals relationship between disease and geographical
to be aware and to support healthy environment.
aspects of those lifestyles.
4. Reinforce desirable Epidemiology - study of the patterns of health
and disease, its occurrence and distribution in
Impact on the family man, for the purpose of control and prevention of
 depends on 3 factors: disease.
1. the member who is ill
Morbidity - condition of being diseased.
2. seriousness and length of illness
3. cultural and customs of the family Morbidity rate - the proportion of disease to
health in a community
Changes:
1. Roles Mortality - condition or quality of being subject to
2. Task assignments death.
3. Increased stress due to anxiety
4. Financial problems Susceptibility - the degree of resistance the
5. Loneliness due to separation and pending potential host has against the pathogen.
loss
6. Change in social customs Etiologic agent -one that possesses the potential
for producing injury or disease.
CLASSIFICATION OF DISEASES
Virulence - relative power or the degree of
1. According to Etiologic Factors pathogenicity of the invading microorganism, the
A. Hereditary F. Allergic ability to produce poisons that repel or destroy
phagocytes.
B. Congenital G. Neoplastic
Symptomatology - study of symptoms
C. Metabolic H. Idiopathic
Symptom - any disorder of appearance, sensation
or function experienced by the patient indicative of
D. Deficiency I. Degenerative
a certain phase of a disease.
E. Traumatic J. latrogenic
Sign - An objective symptom or objective
evidence or physical manifestation made apparent
by special methods of examination or use of
2. According to Duration or Onset senses.
A. Acute Illness
B. Chronic Illness Syndrome - a set of symptoms, the sum of which
o Remission constitutes a disease.
o Exacerbation
C. Sub-acute Pathology - the branch of medicine which deals
with the cause, nature treatment, and resultant
3. Others. Diseases may also be classified as: structural and functional changes of disease.
A. Organic F. Epidemic
Pathogenesis - method of origin and
B. Functional G. Endemic development of a disease, including sequence of
processes or events from inception to the
development of characteristic disease.
C. Occupational H. Pandemic
Diagnosis - art or act of determining the nature
D. Familial I. Sporadic
of a disease, recognition of a diseased state.

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 Significance of Theory in Nursing Profession WEEK# 2
NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

Sequela - the consequence that follows the

normal course of illness.

Complication - a condition that occurs during or

after the course of an illness.

Prognosis - prediction of the course and end of a

disease, medical opinion as to the outcome of a
disease process.

Recovery - implies that a person has no

observable or known after-effects from his illness.

REFERENCES

Health continuum according to Travis. (2011,

January). ResearchGate.
https://www.researchgate.net/figure/Hea
lth-continuum-according-to-Travis-Travis-
1984_fig1_289874075

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 Significance of Theory in Nursing Profession WEEK# 2
NCM 100 | Theoretical Foundations of Nursing (10/07/2022) Ms. Bernadette Orpeza

NOTES:

THE SIGNIFICANCE OF THEORY IN NURSING SYSTEMS THEORY

AS A PROFESSION
The General Systems Theory
DISCIPLINE VS PROFESSION
 Specialization of systems theory
DISCIPLINE PROFESSION  Focuses on a person as a whole
 Applied in nursing research
- Education - Practice
CHARACTERISTICS OF SYSTEMS
- A branch of - Field of knowledge
1.
education

Ex: To implement a change, you must acquire

- Domain of - Application of
feedback to improve or change your practices.
knowledge knowledge/theory
CHANGE THEORY

 Improve processes in human systems

CRITERIA OF A PROFESSION BY W.
 Requires prior learning
SHEPHERD
CONCEPTS
5. The procedures that will be demonstrated will
follow a step by step procedure/checklist.
1. It facilitates the change because they push
equilibrium.
6. You must have a sound judgment to become a
professional.
2. Hinder change because they push forces to the
opposite direction.
Ex: In a clinical setting, you have to decide
whether to perform a procedure because it is what
3. Stationary
the patient needs or not because it is not what the
patient’s desire (e.g. DNR). THREE STAGE MODEL

9. You have to think of the benefits that the patient 1. If it is not helpful then you must find new ways
will receive from the procedure. to change.

CRITERIA OF A PROFESSION BY FLEXNER A. 2. Change in feelings, thoughts, behaviors that

(1915) help you become productive.

1. You are responsible for your actions. 3. Establishing the change

2. Encourage practices that has solid evidence or  A new habit

evidence-based practices. Every action should be  Standardized
proven to be effective.
HEALTH AS A MULTIFACTORIAL
4. You will undergo a 4-year training to become a PHENOMENON
nurse.
OREM
5.
 A state that is characterized by
Ex: You can’t be called a professional if you don’t
soundness
belong to an organization (e.g. PNA).
ROY
6.
 Stated that health is a state of process
Public Health – community
DETERMINANTS OF HEALTH
Clinical – hands on patient care
1. Access to medical care allows you to live
NURSING THEORY AND THE NURSE
a healthy lifestyle since you will be able
PRACTITIONER
to manage your health and be able to
prolong your life.
Every time you plan an
2. Genetics – Determines the type of health
intervention/procedure, you are going to
that you will have.
customize it according to the patient’s conditions.
CONCEPT OF WELLNESS
Time-bounded – not always applicable but is
critical in delivering nursing care.
1. Physical – If you are not dependent on
someone, then you are well.
Theory always allows you to evaluate the
2. Emotional – coping mechanisms.
effectiveness of a procedure.
How you respond to a diagnosis.
NON-NURSING THEORIES
MODELS OF HEALTH AND WELLNESS

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 Significance of Theory in Nursing Profession WEEK# 2
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1. Clinical Model Treatment: Blood transfusion

- People are viewed as physiologic system
- Describe your body physically Newborn Screening
No symptoms = healthy
 Detects genetic defects
Normal range laboratory = healthy and
 Early diagnosis for disease management
well
2. Adaptive Model
CLASSIFICATION OF DISEASES
- The aim of treatment is to restore the
ability to cope. According to Etiologic Factors
Ex: A person diagnosed with a disease
that is able to manage his disease.  Neoplastic – abnormal growth of cells
3. Role Performance Model (e.g. cancer)
Ex: If you can’t perform your function,  Degenerative
then you are not well. Ex: osteoarthritis
 Iatrogenic
VARIABLES INFLUENCING HEALTH STATUS, Ex: Developing hyperthyroidism after
BELIEFS, AND PRINCIPLES thyroid surgery

INTERNAL VARIABLES According to Duration

 Non modifiable variables A. Acute Illness

 Difficult for a person to change (e.g. - severe
genetics) - affect functioning of any dimension
A. Biologic - short in duration but strong
Ex: Age, Sex manifestation
B. Psychologic Ex: appendicitis
Ex: Lifestyle choices B. Chronic Illness
Remission – period wherein the disease is
EXTERNAL VARIABLES
controlled where there is less symptoms
C. Sub-acute
 Can be modified
Ex: Endocarditis
 You can do something
Others
HEALTH BELIEFS MODEL
B. Functional – no changes
HEALTH LOCUS OF CONTROL
C. Occupation – caused by occupation
 Whether the patient will take care of their engaged by the patient
health status D. Familial – family medical history
E. Venereal – caused by sexual relation (e.g.
HEALTHCARE ADHERENCE HIV, AIDS)
F. Epidemic – attacks individuals in
 How people coincide with a diagnosis community (e.g. Chistosomiasis, Dengue)

NON-ADHERENT PATIENT

 You have to establish a therapeutic

approach for the patient to be
encouraged to follow the health
management.

LEVELS OF PREVENTION

1. Primary Prevention
- resistant to illness
Ex: Knowing the patient’s family health
history.
2. Secondary Prevention
- disease management
Ex: Physical exam
3. Tertiary Prevention
Ex: Self-monitoring among diabetic
patients

COMMON CAUSES OF ILLNESS

Genetic defect

Ex: G6PD

 The body is unable to make the RBC work

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