CHAPTER 16

NURSING THEORIES

Jean Watson’s Theory of Human Caring

Jean Watson refers to the human being as "a valued person in and of him or
herself to be cared for, respected, nurtured, understood and assisted; in general, a
philosophical view of a person as a fully functional integrated self. Human is viewed as
greater than and different from the sum of his or her parts."
Health is defined as a high level of overall physical, mental, and social
functioning; a general adaptive-maintenance level of daily functioning; and the absence
of illness, or the presence of efforts leading to the absence of illness.
Watson's definition of environment/society addresses the idea that nurses have
existed in every society, and that a caring attitude is transmitted from generation to
generation by the culture of the nursing profession as a unique way of coping with its
environment.
The nursing model states that nursing is concerned with promoting health,
preventing illness, caring for the sick, and restoring health. It focuses on health
promotion, as well as the treatment of diseases. Watson believed that holistic health care
is central to the practice of caring in nursing. She defines nursing as "a human science of
persons and human health-illness experiences that are mediated by professional, personal,
scientific, esthetic and ethical human transactions."

Watson's model makes seven assumptions:

1. Caring can be effectively demonstrated and practiced only interpersonally.
2. Caring consists of carative factors that result in the satisfaction of certain human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept the patient as he or she is now, as well as what he or she may
become.
5. A caring environment is one that offers the development of potential while allowing
the patient to choose the best action for him or herself at a given point in time.
6. A science of caring is complementary to the science of curing.
7. The practice of caring is central to nursing.

APPLICATION:
Using Watson’s theory of transpersonal caring will enable the nurses to
effectively provide holistic care to the patients. By focusing on the patient’s wishes the
nurses can achieve higher levels of cooperation with the patients and family and in the
process, achieve greater efficiency, profitability and patient satisfaction scores. Effective
communication with the patient at all levels focusing on the progress of treatment,
timelines and the possible nature of upcoming procedures; addressing the patients fear
and anxiety; understanding the patient’s needs and undertaking to provide for them such
as spiritual and emotional support.

Sister Callista Roy’s Adaptation Theory

Sister Callista Roy’s Adaptation Theory views a person as an adaptive system
with coping processes. She described the person, as a whole comprised of parts which
functions as a unity for some purposes.
The patient should be the one to identify his capabilities and needs in the human
adaptive system. He should be able to select appropriate approaches for her and
implement it as well as to evaluate whether it had helped him in his daily living. Nurses
serve as a guide in helping the patients in this cycle, which we call the nursing process
starting from assessing what is the major problem up to evaluating the outcome.
The patient should adapt to the 4 adaptive modes, which includes the physiologic-
physical, self-concept group identity, role function and interdependence. In the
physiologic- physical, being physically fit is not always consider as healthy and therefore
in the case of our client, we must remind him that by eating the right kind of food that are
not contraindicated by his physician.
The last adaptive mode is interdependence, which includes the giving and receiving of
love form his family, also having rest and towards to society and have the core values
through effective relations and communications with his significant other.
APPLICATION:
In relation to our patient, we think that our patient needs to adapt to the changes
related to his disease and that it is a need to undergo into some modification when it
comes to his health because we, as a part of the medical team desires to give the best
possible care to our patients. As a student nurse, the interventions we perform ultimately
elicit a response from our patients. It is on how we render service to our clients and how
we treat them individually and on the nature and extent of the nursing intervention. Our
patients may or may not actually adapt according to our expectations. This theory
assumes that a person should be aware about his or herself and the environment he is
into.

Hildegard Peplau’s Interpersonal Relations Theory

The nursing model identifies four sequential phases in the interpersonal
relationship: orientation, identification, exploitation, and resolution.
The orientation phase defines the problem. It starts when the nurse meets the
patient, and the two are strangers. After defining the problem, the orientation phase
identifies the type of service needed by the patient. The patient seeks assistance, tells the
nurse what he or she needs, asks questions, and shares preconceptions and expectations
based on past experiences. Essentially, the orientation phase is the nurse's assessment of
the patient's health and situation.
The identification phase includes the selection of the appropriate assistance by a
professional. In this phase, the patient begins to feel as if he or she belongs, and feels
capable of dealing with the problem, which decreases the feeling of helplessness and
hopelessness. The identification phase is the development of a nursing care plan based on
the patient's situation and goals. The exploitation phase uses professional assistance for
problem-solving alternatives. The advantages of the professional services used are based
on the needs and interests of the patients. In the exploitation phase, the patient feels like
an integral part of the helping environment, and may make minor requests or use
attention-getting techniques. When communicating with the patient, the nurse should use
interview techniques to explore, understand, and adequately deal with the underlying
problem. The nurse must also be aware of the various phases of communication since the
patient's independence is likely to fluctuate. The nurse should help the patient exploit all
avenues of help as progress is made toward the final phase. This phase is the
implementation of the nursing plan, taking actions toward meeting the goals set in the
identification phase.
The final phase is the resolution phase. It is the termination of the professional
relationship since the patient's needs have been met through the collaboration of patient
and nurse. They must sever their relationship and dissolve any ties between them. This
can be difficult for both if psychological dependence still exists. The patient drifts away
from the nurse and breaks the bond between them. A healthier emotional balance is
achieved and both become mature individuals. This is the evaluation of the nursing
process. The nurse and patient evaluate the situation based on the goals set and whether
or not they were met.
The goal of psychodynamic nursing is to help understand one's own behavior,
help others identify felt difficulties, and apply principles of human relations to the
problems that come up at all experience levels. Peplau explains that nursing is therapeutic
because it is a healing art, assisting a patient who is sick or in need of health care. It is
also an interpersonal process because of the interaction between two or more individuals
who have a common goal. The nurse and patient work together so both become mature
and knowledgeable in the care process.

APPLICATION:
There are many different ways a nurse can approach each patient and situation.
Patients utilize the emergency room not only for critical care but also for minor ailments
due to inability to get in with primary care practitioners. It is vital that in order to deliver
high quality care to these patients, we must evaluate all aspects of patient’s lifestyle. The
first step, the orientation phase, is identifying problems that can affect their care or
outcome. Not only will their living arrangements play a role in the time needed to
recover, but ability to afford prescriptions recommended. During the identifying stage,
the nurse and patient can work together to determine a feasible goal. As part of the
exploitation stage, patients and families are reaching out, seeking care that we as nurses
can assist them to find what works best for them. We are able to provide patients and
families with resources available for long-term care if needed. These are examples of
problem solving techniques finalizing the resolution phase.