Martha Rogers Science of Unitary Human Beings Model, 1970 (USA)

(By Unknown photographer [Public domain], via Wikimedia Commons)

Martha Rogers Science of Unitary Human Beings Model, 1970 (USA)

Martha Rogers was born on 1914 and earned a bachelor’s degree in nursing from George Peabody College, master’s degree in public health nursing from Columbia University and doctorate in nursing from the John Hopkins University. She was a teacher and mentor to an impressive list of nursing scholars and theorists. Rogers continued her work and writing until her death in 1994. 

Martha Rogers described her theory of Unitary Man in 1961 and stated that person was a ‘Unitary energy system’ in ‘continuous mutual interaction with the universal energy system’, ‘dramatically influenced nursing by encouraging nurses to consider the person as a whole entity when planning and delivering care’.

She published the book in 1970 at the age of 56 years; An introduction to the theoretical basis of nursing science, Rogers outlined the five assumptions that provide the foundation for the discipline of nursing.

1. Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.
2. Man and environment are continuously exchanging matter and energy with one another.
3. The life process evolves irreversibly and unidirectionally along the space time continuum.
4. Pattern and organization identify man and reflect his innovative wholeness.
5. Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

Rogers condensed the assumptions to five blocks of the conceptual system (Rogers, 1992):

1. Energy fields
2. Pan dimensionality
3. Pattern
4. Unitary persons
5. Environment 

An energy field is defined as the distinguishing characteristics of an energy field perceived on a single wave. It is the unique configuration of relationships of a particular system. Areas of human field’s pattern that have been explored include pain, stress, hope, time etc.

She identified two energy fields of concern to nurses, which are integrated; human field and environmental field. The human field can be conceptualized as a person or groups, family or community. These fields can not be broken into sub systems. She interpreted the nursing care is holistic, meaning a summation of parts to arrive at the whole, where a nurse would assess the domains, subsystems identified, then synthesize the accumulated data to arrive at a picture of the total person. A change in one field causes alterations in other field. Both are integrated, can not be separated.

The fields are pan dimensional, defined as ‘a non linear domain with out spatial or temporal attributes’. Pan dimensional reality transcends traditional notions of space and time, which can be understood as perceived boundaries only.

Principles of homeodynamics

She defined the three principles of homeodynamics are reasoning, helicy and integrality. It describes the nature of change in the human environmental field process.

Principle of resonancy specifies the continuous change from lower to higher frequency wave pattern in human and environmental fields. Rogers elaborated: ‘individuals experience lesser diversity and greater diversity, time as slower, faster and unmoving’.

The principle of helicy is the continuous innovative unpredictable, increasing diversity of human and environmental field patterns. This describes the nature of change. The principle of integrality is continuous mutual human fields and the environmental field process. It specifies the context of change as the integral human environmental field process where person and environment are inseparable.

Together, postulates of Rogerian nursing science suggest that the human and environmental field change continuously, flow in lower and higher frequencies. Rogers believed that they serve as guides both to the practice of nursing and to research in the science of nursing.

Dorothy Johnson Behavior System Model 1968 (USA)

Dorothy Johnson Behavior System Model 1968 (USA)

Dorothy Johnson was born in Savannah, Georgia in 1919. She earned her bachelor of science in nursing from Vanderbilt University and her master’s in public health from Harvard University. At the age of 49 years, Johnson proposed the nursing care facilitated the client’s maintenance of a state of equilibrium. She said that clients were ‘stressed’ by internal and external stimulus. The nursing care should reduce the stimulus and facilitate the client’s natural defenses. She defined nursing as ‘external regulatory force which acts to preserve the organization and integration of the patient’s behavior at an optimum level under those conditions in which the behavior constitutes a threat to physical and social health or in which illness is found’.

Based on the definition, the four nursing goals are to assist the patient to become a person whose behavior is commensurate with social demands, who is able to modify his behavior in ways that support biologic imperative, who is able to benefit to the fullest extent during illness from the physician’s knowledge and skill and whose behavior does not give any evidence of unnecessary trauma as a consequence of illness.

Major concepts of the model

Person

The client is seen as a collection of behavioral subsystems that interrelate to form the behavioral subsystems. The system may be defined as those complex, overt actions or response to stimulate in the environment. Johnson has identified seven behavioral subsystems in the client. According to this, each subsystem has to be protected from noxious stimulus. Second, it must be nurtured and last, it must be stimulated to prevent stagnation of growth. 

The subsystems are:

• Attachment and affiliation
• Dependency
• Elimination
• Sexuality
• Ingestion
• Aggression
• Achievement

Attachment and affiliation–It is identified as first response systems to develop in an individual. It allows social inclusion, intimacy and the formation and maintenance of a strong bond, which provides the individual with sense of security.

Dependency- It allows and develops cooperative and independent role relationships with in human social system. They use interpersonal skills to achieve intimacy. 

Ingestion – It is related to food intake. The aim of the subsystem is to sustain life, to relieve discomfort and to obtain physical pleasure from intake of food.

Elimination- It relates to behavior surrounding the excretion of waste products from the body. It also helps the client to adjust to alterations in biological capabilities related to waste excretion while maintaining a sense of control over waste excretion.

Sexuality- It relates to procreate, to gratify or attract to fulfill expectations associated with one’s sex, to care for others and to be cared about by them.

Aggression- It relates to behaviors concerned with protection and self preservation. Johnson views the aggressive subsystem as one that generates defensive response from the individual when life or territory is threatened.

Achievement- It means mastery or control of self or the environment. Intellectual, physical, creative, mechanical, social skills are some of the areas that Johnson (1980) recognizes.

To conclude, Johnson’s behavioral system model is based on nursing care, advocates on behavioral functioning of the patient. The client is composed of 7 subsystems and each subsystem related to 4 structural characteristics: drive, set, choices and observable behavior. An imbalance in any behavioral subsystem results in diseases and nurse’s role is to assist the client to return to a state of equilibrium.

Ida Jean Orlando Nursing Process theory 1962 (USA)

(By National Cancer Institute [Public domain], via Wikimedia Commons)

Ida Jean Orlando Nursing Process theory 1962 (USA)

Ida Jean Orlando Pelletier (1926-2007) had worked as practitioner, educator,researcher and consultant in nursing. Throughout her career, she was active in various organizations including the Massachusetts Nurse’s Association and the Harvard Community Health Plan. She described the nursing process based on the interaction between patient and nurse. She has written a book “The dynamic nurse patient relationship” explains the factors which enhanced the integration of mental health of the people in the basic nursing curriculum and published in 1961 at the age of 36 years.

She defined the nursing is responsible to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting and they are found for the purpose of avoiding, relieving, diminishing or curing the individual sense of helplessness. According to her theory, nurse patient relationship includes patient behavior, nurse’s reaction and professional function.

Patient behavior
The nursing process discipline is set in motion by patient behavior. It represents a plea for help. It may be verbal or non verbal. Verbal behavior consists of patient’s language in the form of complaints, requests, demands etc. Non verbal behavior includes physiological manifestations such as heart rate, perspiration, avoiding eye contact etc. If the nurse were not able to help the patient, helplessness would be developed. It reflects the distress, physical limitations and adverse reactions to the setting and experience which the patient from communicating his needs.

Nurse’s reaction
The patient behavior stimulates a nurse’s reaction, which paves the way for beginning of nursing process discipline. The reaction is comprised of three parts. First, the nurse perceives the behavior through any of her senses. Second, the perception leads to automatic thought. Finally, the thought produces an automatic feeling. For example, the nurse sees a patient in restless, thinks that she is in pain and confirms with the patient that she has correctly identified the need for help and to identify the nursing action appropriately to resolve it.

Nurse’s action 
Once the nurse has validated her reaction of the patient’s behavior through exploration with him, she can complete nursing process discipline with the nurse’s action. The nurse can act in two ways: automatic and deliberative. Automatic actions are ‘those decided upon for reactions other than the patient’s immediate needs. For example, the nurse gives the sedative to patient to sleep because the physician ordered it. But deliberate actions result from the correct identification of patient’s needs by validation of the nurse’s reaction to patient behavior. It fulfills her professional function

Professional function
Nurses often work with other professions and supposed to coordinate the patient care with them. Naturally, at times conflicts will arise between the actions appropriate to the nurse’s profession and those required by the job. Non professional actions of nurse leads to inadequate patient care. A well defined function of the profession can help to prevent and resolve the conflict.

Comparison of the Orlando’s process discipline and nursing process

It consists of seven phases. These are assessment, diagnosis, outcomes, plan of action, implementation and evaluation.

Assessment of the nursing process corresponds to the sharing of the nurse’s reaction to the patient behavior. The collection of data includes only information relevant to identifying patient’s need for help.

The product of the nursing process analysis is nursing diagnosis. The statement of the nursing process includes formally written problem related to etiological factors and signs and symptoms.

The outcome and plan of action phase involves writing outcomes, goals and objectives and deciding on appropriate nursing action.

The implementation phase involves the final selection of actions and carries out it. The evaluation phase asks whether the outcomes achieved or not.

This theory has much to offer to nursing. It guides nurses through their interactions with patients and ensure that they will be treated as individuals and focuses on patient’s needs rather than the demands of professional setting. Orlando should be considered as a nursing theorist who made significant contribution to the advanced nursing practice. She helped nurses to focus on patient needs rather than institutional demands. Here, nurse is viewed as a ‘care giver’ for the patient, not a ‘hand maiden’ for the physician. 

Faye Glenn Abdellah 21 Nursing Problems Theory 1960 (USA)

Faye Glenn Abdellah 21 Nursing Problems Theory 1960 (USA) 

Faye Abdellah was one of the first nursing theorists. She earned her bachelor’s degree, master’s and doctorate of nursing from Colombia University. She has been awarded many academic honors from civilian and military sources. Abdellah’s patient centered approach to nursing was developed inductively from her clinical practice at the age of 41 years and is considered as human needs theory. It is also relevant to community setting also. She considered the object of nursing as ‘patient’ rather than client or consumer. She developed the concept of nursing diagnosis in nursing care plan.

Abdellah and colleagues (1960) developed a list of 21 nursing problems.

To maintain good hygiene and physical comfort

To promote optimal activity, exercise, rest and sleep

To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection

To maintain good body mechanics and prevent and correct deformities

To facilitate the maintenance of supply of oxygen

To facilitate the maintenance of nutrition

To facilitate the maintenance of elimination

To facilitate the maintenance of fluid and electrolyte balance

To recognize the physiologic responses of the body to disease conditions

To facilitate the maintenance of regulatory mechanics and functions

To facilitate the maintenance of sensory function

To identify and accept positive and negative expressions, feelings and reactions

To identify and accept the interrelatedness of emotions and organic illness

To facilitate the maintenance of effective verbal and nonverbal communication

To promote the development of interpersonal relationships

To facilitate progress toward achievement of personal spiritual goals

To create and maintain a therapeutic environment

To facilitate awareness of self as an individual with varying physical, emotional and developmental needs

To accept the optimum possible goals in the light of physical and emotional limitations

To use community resources as an aid in resolving problems arising from illness

To understand the role of social problems as influencing factors in the cause of illness

They also identified a list of 10 steps and skills in nursing to be used in developing nursing care plan.

Know the patient

Differentiate the significant data

Make generalizations from the data

Identify the therapeutic plan

Test the generalizations with the patient and make additional generalizations

Validate the patient’s conclusions regarding the problem

Frequent evaluation and follow up

Explore the patient and family reaction to therapeutic plan

Identify the nurse’s reaction to patient and family

Develop a comprehensive nursing care plan based on the needs

This patient centered approach is very useful in nursing practice and education. She categorized nursing problems based on the individual needs and developed a typology of nursing care and skills. It is widely considered as major contributions to nursing into Nightingale’s ideal of becoming a profession.

­­­­­­­Virginia Henderson 14 basic need theory 1955 (USA)

(By Mennonite Church USA Archives [No restrictions], via Wikimedia Commons )

Virginia Henderson 14 basic need theory 1955 (USA) 

Virginia Henderson was born in Missouri and graduated in nursing from Colombia University. She was a well known nursing educator and author. She developed a concept of nursing from her educational and practical experiences at the age of 55 years. She stated nursing as a “Nursing is primarily assisting the individual (sick or well) in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. It is likewise the unique contribution of nursing to help the individual to be independent of such assistance as soon as possible” (Harmer and Henderson, 1955).

The major assumption of the theory that the nurse care for patients until they can care for themselves. She defined the patient who needs nursing care with supportive environment. The concept of this theory involved the nurse attending 14 activities to assist the individual towards independence.

Breathe normally

Eat and drink adequately

Eliminate body wastes

Move and maintain desirable postures

Sleep and rest

Select suitable clothes

Maintain body temperature with in normal range by adjusting clothing and modifying environment

Keep the body cleaned and well groomed and protect the integument

Avoid dangers in the environment

Communicate with the others in expressing emotions, needs or fears

Worship according to one’s faith

Work in such a way that there is a sense of accomplishment

Play and participate in various forms of recreation

Learn, discover or satisfy the curiosity that leads to normal development and health and use the available health facilities.

To conclude, Henderson’s work is parsimonious in its presentation, but complex in its scope. The 14 statements cover the whole of the practice of nursing and her vision about the nurse’s role on patient care contributed to that complexity.

Peplau's Interpersonal Relations Theory 1952 (USA)

Peplau's Interpersonal Relations Theory 1952 (USA)

A pioneer in nursing, named Dr.Hildegard Peplau published the book 'Interpersonal Relations in Nursing' in 1952 at the age of 43 years . Nursing is a therapeutic healing art, assists the individual who is sick and in need of health care. The relationship between nurse and patients develops based on need or problems from one of them, they begin to develop goal and objectives, prepares plan of action, implement to solve a problem. They approach this course of action from diverse backgrounds and with individual uniqueness. 

Peplau divided the interpersonal relationship into four phases. 

1. Orientation
2. Identification
3. Exploitation 
4. Resolution

In 1997, Peplau wrote that the nurse patient relationship is composed of three phases such as orientation, working and termination phases.

Orientation Phase

In the initial phase, the nurse and patient meet as two strangers. The person are in the need of help and the other side, the person who are ready to help. Both of them are deeply influenced by values, culture, race, preconceived ideas, beliefs, past experiences and expectations. While understanding this, the nurse, the patient and the family work together to recognize, clarify and define existing problem. In the beginning, they are strangers. At the end of the stage, they are working together to identify the problem and providing comfortable environment with one another.

Working Phase

This is otherwise described as identification and exploitation phase. During identification phase, both the patient and the nurse clarify each other's perceptions and expectations, build a working relationship for identifying the problem and choosing appropriate assistance. Once the problem is identified and the goals are set, both of them move to working phase, in which the patient takes advantage of all services available.Thus, the nurse and the patient utilize the available services to solve it.Progress is made toward the final step, the termination phase.

Termination Phase

It is in the process of terminating a professional relationship. Once the problems are solved and the goals are met, both of them move into termination phase. During successful termination, the patient drifts away from identifying with the helping person, the nurse. The patient becomes independent from the patient. Termination occurs only with the successful completion of the previous phase. 

To conclude, Peplau stressed that both the patient and the nurse mature as the result of therapeutic interaction. When two persons are met in a creative relationship, there is a continuing sense of mutuality and togetherness throughout the experiences. She has developed a unique view for understanding the nurse patient relationship.

Theory of Florence Nightingale 1860 (United Kingdom)

Florence Nightingale

Nursing: Notes on Nursing

Florence Nightingale, born in 1820, considered as the founder of nursing. During her career, she proposed a model regarding nursing, what it is and what it is not. Here, she explained very well regarding the factors influencing patient's health and various ways to modify it to achieve the optimum health.

She proposed four major concepts with ten canons at the age of 40 years. The major concepts and canons are

• Physical Environment- It consists of external factors in which patient is being influenced such as
• Ventilation and warming
• Light and noise
• Cleanliness of the rooms
• Health of the houses
• Bedding
• Personal cleanliness
• Variety

• Psychological Environment- It consists of factors which influences the emotional status of the patient such as  chattering hopes and advices. It doesn't mean to assure the patient regarding his/her disease condition falsely but, the nurses can keep the patient active by indulging him/her in activities.
• Nutritional Status- She noted the importance of taking healthy foods at frequent intervals rather than heavy meals. The food should be easily digestible, healthy and tasty for the patient.
• Nursing Care Plan and Management- It signifies the importance of planning the patient care with the proper use of fresh air, light, warmth, cleanliness, calm environment and proper diet.

She identified the five major environmental factors for optimal health such as pure fresh air, pure water, effective drainage, cleanliness and especially direct sunlight. This theory emphasis on attending the patient with nursing care objectives, assess the negative factors in the environment, prepare a plan to manipulate the negative into positive ones, for example provide a wrinkle free bed, change the bed linen daily, open the windows for fresh air, keep dim lights in the night etc, implement it and evaluate the progress of the patient by frequent follow up.

Strengths and weakness

This theory had written in detail regarding the nursing: what it is. It paves the ways for the nursing administrators to propose policies and protocols for nursing care in hospitals and community.

I feel that this theory is not applicable to unconscious patients. Nowadays, patients are being treated in cool environment by using air conditioning method in hospitals, which is optimum temperature to curb the growth of micro organisms and for fresh air rather than out door polluted air and harmful ultraviolet radiations from the sun.