A grand theory is a systematic construction for the nature of nursing that has a clear mission and goals for nursing care. There are four categories of schools of thought within the realm of grand theories to include needs theories, interaction theories, outcome theories, and lastly caring/becoming theories. In the following tables I have highlighted a theorist from each school of thought and briefly discussed their educational background, my perception of their definition and philosophy of nursing, and the goal/purpose of their theory.
Faye Abdellah received her nursing education at Fitkin Memorial Hospital School of Nursing, Nepture, N.J. and graduated in 1942. She then went on to study chemistry at Rutgers University prior to receiving her Bachelor of Science, Master of Arts, and Doctor of Education degrees from the Teacher’s College of Columbia University, N.Y. Retrieved from http://fayeabdellah.blogspot.com/p/backgroud-publications.html
According to Meleis, her philosophy of nursing includes the use of problem solving approach to deal with 21 distinct problems related to needs of patients.
She described a problem as a condition faced by the patient for which a nurse can assist, overtly and covertly. This is done by preventative care (to include hygiene, safety, exercise, rest, sleep, and body mechanics), sustenal care (psychological), remedial care (oxygen, fluid, nutrition, and elimination), and finally restorative care (coping with the illness and life adjustment). Meleis, A.I. (2012), p. 162-164.
“Nursing is based on an art and science that moulds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs” as stated by Faye Abdellah in her Twenty-one Nursing Problems theory (1960).
To help the individual or patient meet health needs and adjust to their health problems. Meleis, A.I. (2012), p. 164.
Hildegard Peplau graduated from the diploma nursing program Pottstown, PA in 1931 and went on to be a staff nurse. Peplau then was recommended to work as a school nurse at Bennington College located in Vermont. While working there she earned her Bachelor’s Degree in Interpersonal Psychology in 1943. From there she went on to earn her Master’s and Doctoral degrees from Teacher’s College of Columbia University. In addition she became certified in psychoanalysis thru the William Alanson White Institution of New York City. Retrieved from http://nursing-theory.org/nursing-theorists/Hildegard-Peplau.php
Peplau’s philosophy of nursing focused on harnessing energy psychological disturbances such as anxiety and tension to define understanding with patients and deal with the problem at hand. She felt the goals of nursing included developing patients personalities to make illness an eventful experience. She felt nurses need to develop problem-solving skills via the interpersonal process (educational, therapeutic, and collaborative).
Peplau’s concept and view of nursing is that it is a therapeutic, interpersonal, goal oriented process that is a healing art. It involves recognizing and assisting the patient (individual who is ill or in need of health care) in achieving a common goal. This requires the nurse and patient to build a trusting relationship by way of orientation, identification, exploitation, and resolution (the phases of growing an interpersonal relationship). Meleis, A.I. (2012), p. 165-166. She identified the many roles that nurses must take in order to have a meaningful relationship with patients and that nurses must understand the relationship to provide good care.
The ultimate goal of Peplau’s theory was to understand the principles of interpersonal relationships between the nurse and patient in order to facilitate problem solving skills. This is to be done by using education and positive interactions. She went on to explain the seven nursing roles (stranger, resource, teacher, counselor, surrogate, and technical expert). These roles can be applied in different situations to provide the best care possible and goal attainment. Retrieved from http://nursing-theory.org/theories-and-models/peplau-theory-of-interpersonal-relations.php
Outcomes theorist Callista Roy
Sister Callista Roy graduated with her first degree; Bachelor of Arts in Nursing from Mount St. Mary’s College in California in 1963. Then in 1966, she went on to obtain her Master’s Degree in Pediatric Nursing from the University of California. In addition she earned a Master’s Degree in Sociology in 1973 and Doctoratal degree in Sociology in 1977. Retrieved from http://nursing-theory.org/nursing-theorists/Sister-Callista-Roy.php
From what I can see from Roy’s writing’s she believes that the focus of nursing to her is a focus on clients’ stimuli and the effect it has on them for adaptation. Adaption modes include physiologic, self-concept, role function, and interdependence. Goals of nursing include promoting these changes/adaption in the above mentioned areas by way of manipulating the stimuli (focal, residual, and contextual) by way of positive coping. ). Meleis, A.I. (2012), p. 169-172.
Callista Roy is known to believe that nursing is a system of knowledge based on theory that views the client (sick or potentially sick) as a biopsychosocial being. Clients adapt to changes within their environment and as nurses we provide care through the nursing process to help promote adaption to state of well-being. In order to do this we must ensure that the client have effective coping mechanisms and responses to avoid disruption in the integrity of the client.
The goal and purpose of Roy’s theory is to promote client adaptation by nursing interventions such as facilitation of adaptive tasks via counseling, effective nurse-client communication, health education, active manipulation, support, and by identifying resources for the client. Roy states that by adapting that the patient is then freed for “him to respond to other stimuli which may be present” The Roy adaptation model: Comment (as sited by Meleis, A.I. (2012), p. 494.
Caring/Human Becoming theorist Rosemarie Parse
Rosemarie Parse initially was educated at Duquesne University of Pittsburgh. She then went on to get her MSN and Ph.D. from the University of Pittsburgh.
The goal of nursing to Parse appears to be co-creating meaning and finding way of being. This is done by not focusing on the illness or problem in itself, but by transforming in new ways deliberately through the human universe process. Nurses are to illuminate meaning, synchronize rhythms and mobilize transcendence by connecting and truly understanding and being present with patients. Decision making is done together with the patient and nurse. Meleis, A.I. (2012), p. 172-174.
Parse’s definition of nursing is that it is a human science and art that uses knowledge to help people. Nurses should not focus on fixing problems, but rather view the patient as a whole living experiences through their environment which help them evolve. She believes that nurses must help guide patients co-create their own health and deal with illness.
The goal or purpose of Parse’s Human Becoming Theory of Nursing is to focus of the quality of life from each separate person’s perspective. It does not focus on bio-medical or bio-psycho-social-spiritual approaches as with most theories, but instead views the patient as a person and combination of all aspects. Retrieved from http://nursing-theory.org/nursing-theorists/Rosemarie-Rizzo-Parse.php
I agree with all of the above listed schools of thought and have incorporated each in my own personal nursing care practice. Abdellah thoughts that nursing is centered on problem solving on the needs of patients in order to assist them in restoring health are near and dear to my heart. Depending on the field you work in this can include a multitude of cares. I personally work mainly in obstetrics and medical aesthetics.
In the obstetric realm I provide care to help patients have a happy and healthy delivery of a child whereas in my medical spa my goal is help clients improve their aesthetic appearance, thus helping them feel more attractive and confident. Both have a goal, although widely different. This school of thought mostly is incorporated in my obstetric care as I assist patients to understand and incorporate preventative care, sustenal care, remedial care, and obviously restorative care as becoming a parent is a huge adjustment in life.
Peplau brought out the importance of building a therapeutic interpersonal relationship with patients in order to facilitate their skills in coping with the problem at hand. Peplau’s interaction school of thought is also very congruent with my nursing philosophy as I feel it is of upmost importance to build a solid trusting interpersonal relationship with patients/clients no matter what area of nursing one is working in. Without doing so, the patient/client will not believe and trust what we are trying to accomplish with them. The event of birthing a child and learning how to care for them is a very personal process where the nurse-client relationship is of upmost importance. Also in aesthetics the client must feel comfortable with me as a nurse in order to trust me in helping them attain their goals.
Roy’s theory is seeding in the outcomes school of thought which is also easy to incorporate into nursing care as adaption is required with all processes of life. As nurses we truly do help our clients adapt to their health status and can assist them to become able to care for themselves independently. In obstetrics parents must adapt to having and caring for a newborn infant. The mother has been thru months of adaption to being pregnant, and now must instantly step into a new role that is often times scary and confusing! As a nurse I am responsible to ensure that they are prepared and adapting to this change prior to discharge.
Lastly the caring/human becoming school of thought is probably the most utilized type of grand theory that I personally use. Parse points out that we should not focus on “fixing” the problem, but concentrate on the whole of the patient including experiences lived and how this has helped them evolve. Basically we must think of the patients’ quality of life, especially from the patients’ point of view. This can be applied in all fields of nursing as we strive to help patients have the quality of life that they want and deserve.
In conclusion I’d like to think that as a nurse I practice from a variety of theories to incorporate the best, quality care possible for patients no matter what the purpose of treatment may be. I try to tailor my approaches taking into account their medical history, environment, and family. Nursing is ever changing and so is the patient population. We must as nurses continue to educate ourselves and evolve with time, never becoming stagnant.
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