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Theories Relevant to Nursing Practice
bs nursing
Southwestern University PHINMA
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Theories Relevant to Nursing Practice
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Maslow’s Human Needs Theory
Maslow’s concept of hierarchy of needs was first introduced in his paper “A Theory of Human Motivation” and his subsequent book Motivation and Personality in 1943. Maslow’s hierarchy of needs states that people are motivated to fulfill basic needs for physical survival, before moving on to the higher levels that consists of more advanced needs.
1. Physiological needs – according to McLeod (2018), these are biological requirements that are vital for human survival. If the requirements are not met, the human body cannot function optimally. Physiological needs are the most important in Maslow’s concept. Other examples include air, clothing, and sexual intercourse. 2. Safety needs – these are primary needs for one’s protection from elements, security, order, law, stability, freedom from fear, financial stability, and health and wellness. 3. Belongingness and love needs – these are a human being’s need for emotional relationship that drives human behavior. Examples include friendship, intimacy, trust, acceptance, and receiving and giving affection and love. 4. Esteem needs – these are the human being’s need for appreciation and respect; which Maslow classified into two categories: (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) desire for reputation and respect from other (status, prestige). 5. Self-Actualization needs – these needs are at the peak of Maslow’s hierarchy of needs, wherein a human being must realize his or her personal potential and self- fulfillment, and exploit his or her talents and capabilities.
Relationship to the Nursing Metaparadigm Relating Maslow’s hierarchy of needs to the nursing metaparadigm, the application of Maslow’s theory to their practice of patient care may be efficient to their profession. 1. Person – the nurse is able to identify the level of care that the patient needs or is required.
Von Bertalanffy General Systems Theory
This theory was developed by biologist Ludwig von Bertalanffy in 1936. General system theory describes “ how to break whole things into parts and then to learn how the parts work together in systems”. General system theory is known by different names - systems theory, theory of open systems, systems model, and family systems theory. It emphasizes the relationships between parts. A system is a complex of elements in interaction, which on first appearance does not seem interconnected or inter related. Von Bertalanffy (1969) introduced General systems theory as a universal theory applicable to many field of study which provides a way of examining interrelationship and deriving principles. It focuses on small areas of knowledge rather than trying to comprehend the whole. Nurses are enmeshed in many systems. It is to gain some basic understanding of how systems work. Nurses can effectively care for patients, families and communities when we do understand. Its subject matter is the formulation and derivation of those principles which are valid for 'systems' in general.
Relationship to the Nursing Metaparadigm 1. Person – The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. *BODY-A good understanding of the anatomy and physiology of the aging body would enable nurses to perform a holistic geriatric assessment which would assist in the early detection of disease or the development of frailty syndromes. 2. Environment – Environment has a huge factor in a patient's life which is why in order to promote health a nurse must understand and critically analyze the environmental factors in the medical setting. 3. Health – According to the general systems theory, patient safety and quality of healthcare is an emergent property of the entire healthcare system, it follows that the improvement of health care outcomes needs to be based in a systematic appreciation of the whole system that contributes to those outcomes. 4. Nursing – This refers to the importance of the systems approach lies in its potential for evaluating information to help individuals and their families’ progress toward the goal of healthy living. The nurse’s job is to assess the extent, to which all parts of the patient’s system are in working order, and to identify and correct actual or potential threats to the person’s stability.
Embracing General System’s theory in the nursing field is indispensable because it allows us to critically analyze and widen our knowledge of what is necessary to do and tackle in order to fully improve our nursing service for the sake of the satisfaction of our patient.
Kurt Lewin’s Change Theory
“One’s behavior is related both to one’s personal characteristics and to the social situation in which one finds oneself” Change is inevitable and unfortunately health is not exempted. The person’s behavior in the different changes in environment is what Kurt Lewin’s theory emphasizes.
Theoretical Sources Lewin adapted Gestalt principles and applied them as a theory of personality and development that is now known as the Psychological Field He translated Gestalt philosophy into social experience that involves people as a whole rather compose of parts. He focuses on human behavior and believed that it should be seen as a part of continuum and differences with individual variations from the norm as tension between perceptions and the self and of the environment. He implies that to understand and predict human behavior the psychological field or what considered as “life space” where person’s action are looked after. This idea can determine the behavior from the totality of events in the life space. He relates his theories by using map representations to graphically depict psychological forces. During his last days he focused on group research where he believed that groups changes the individual behavior of the constituents. To prove this he tried to examine the methods of leadership on group of children where concluded that small groups operates most successfully when they conducted in a democratic way. To further understand the theory, Lewin explained the organizational change using the analogy of changing the shape of the block of ice in to a pyramid. He explains the analogy by first melting the ice (Unfreeze), and then molds it into the shape you want (Change) and finally solidify it to form a new shape (Refreeze). Lewin’s Model is used for ethnographic study for the investigation of change development, mediates implementation and leadership initiatives in change of complex organizations. (Hussain et al. 2018) This mainly focuses on: 1. How knowledge sharing affects the implementation of change process 2. How employees involve in the change and the willingness to change 3. How the type of leadership affects the organizational change process in an organization
Model of Organizational Change The model of organizational change undergoes three different stages: Unfreezing- Change Process-Freezing, which mirrors the process of change implementation. This model is considered as the fundamental planned change model that explains the striving forces to maintain the status quo and the push for change (Lewin, 1947). In the “quasi-
Person and Health A person is a whole system consists of subsystems that somewhat separated but capable of interacting to one another. He developed a proposition concerning the individual as a product of interaction between inborn predispositions (nature) and life experiences (nurture). This concept is related to his mathematical equation called as Lewin’s Equation which states that behavior functions the person in an environment. He asserts that behavior of a person is driven to a goal and it is the intention that matters most.
Nursing Lewis Change Management Theory helps understand human behavior as change and pattern of resistance is interrelated. This is also referred to as Force Field Analysis and used in nursing involving the three stages; it depends on the forces of driving and resisting. Driving forces are the change agents- a person who brings changes to the nursing services. They are classified as nurse leaders or staff nurse. The resistant forces are employees who ae in contradiction to the proposed change. For Lewin, in order for the change to happen the driving force must dominate the resistant force. This type of theory contributes to changes in planning in the field of nursing. Nurses and their superiors select right change theory because some do not fit in the nursing situation. (Example: The place, the patients and the nursing-patient interaction)
Environment Lewin define environment as a factor that play a part in the human behavior. He uses the concept of “energy field” form physics in his theory called the Field Theory. According to him, the behavior does not rely on the past nor future rather does it depend
on all the present existing facts and the events and how the subject sees them. This facts are connected to the make-up of a dynamic energy field he called life space. This life space or the psychological energy field surrounds the person and perspective to reality- a subjective personal space. This field influences our behavior that even he states that if there are no changes in the field, then there won’t be any changes in the behavior. He suggests that instead of studying people and their surroundings, try to look it both on the way they impact in reality. Lewin came up with three variables to explain the idea: 1. Energy: What causes actions motivates them and when there’s need energy or the summoning of energy that brings action. All the actions have charges that can either be positive (actions that leads to other actions) or negative (to hold back). 2. Tension: Difference between person’s goal and their current state. It is the internal tension and pushes to go with intentions 3. Need: What motivates the tension to start and when the person has internal state of tension makes the person get back to initial state and satisfies the need.
The field theory explains that every person’s behaviors. Awareness of the life space helps predict about the action; simple behavior creates motivation. Tensions push- energies move-charges direct all of which has something to achieve. Kurt elaborates that action has a single fact and that is specific path and ways to remove tensions are visible. In positive charge we are into the actions we see to let the tension out. However, the negative increases the tension hence a restraining force is present. To further understand, an example in the need of recognition. A feeling of the need to be recognized motivates to get the recognition that boosts positive charge that leads to closer to the goal. This wakes up the tension between the current tension and need to be recognized. This is now the start to act for recognition; it depends now to the person.
Theoretical Criticisms Kurt Lewin’s three steps of change is classified as a fundamental approach in managing change. However, it has been criticized by scholars for having overly simplified change process but defended by others against those claims. A question was kept unanswered is the model’s foundation significance. Some scholars believed that this theory was completed after his death. On the brighter side, Lewin’s theory was praised for easily understood concept of the subfield of change management that influences change theory and practice up to this day.
Lewin’s Change Theory focuses on the human behavior and the environment as its factor of change. This theory is more on psychology in approach. In the field of nursing, Lewin’s theory emphasizes the forces that change the nurses’ intention in an organization. It is widely used in managing new plans to further apply nursing care and improve quality of life.
incorporate caring. Caring is another essential component to the nursing process by focusing on the person as a whole and ensuring that nurses will provide care to patients physically, mentally, and spiritually. Nurses establishing a relationship with their patients are essential as this can lead to gaining even more patient information, which promotes better healing. In caring, the nurse should be able to teach patients ways, to further promote the healing process.
The theory Caring as the Core of Nursing gives emphasis to the “act of caring” as the extensive capital for nursing practice. Caring and nursing are so intertwined that nursing would not be nursing without the act of caring. Caring is a “feeling and exhibiting concern and empathy for others; showing or having compassion” (The Free Dictionary, 2015). The act of caring requires action and as nurse, caring is identified as a foundational value for nursing. Care needs to recognize every person as human beings whose experiences affect health and wellbeing directly. Nurses need to develop the “head, hand and heart” approach, which incorporates practical know-how with empathic understanding and technical knowledge to provide humane and sensitive care. Nurses need to be taught about caring and what attitudes they need to achieve it safely and with dignity for everyone involved (Hemingway, 2013). When we provide nursing in a respectful manner, with dignity and care, then everything we do for and with those human beings will reflect that. All the issues faced by the patient will be handled to the best of our ability with a caring attitude. The nurse’s thoughts and actions will be controlled by a desire to do things in a way that would be acceptable for ourselves, our partners, our families, and our friends. Nurses need to consider how best to develop their ability to “walk a mile in another’s shoes.” We need to ensure that everyone who works with vulnerable ill people has an attitude that enables them to empathize, listen to, and learn from another’s experiences.
Roach’s 7 C’s of Caring
Sister Simone Roach was renowned for developing the first code of ethics for the nursing profession - in Canada, year 2002 - thus giving motivation to several nurses across many generations. Around 10 years before, 1992, she asked a rather intriguing question, “What is a nurse actually doing when he or she is caring?” She established the seven C’s of caring (2002) with the purpose of answering the aforementioned question. The seven C’s are:
1. Compassion – empathy and sensitivity to other people’s emotions, making one understand what it means to be in that person’s shoes. 2. Competence – is acquiring and using evidence-based scientific and humanistic knowledge and skill in the application of therapeutic interventions in the current practice of nursing 3. Conscience – is the application of legal and ethical principles based on professional nursing standards while recognizing personal limitations, exhibiting integrity, and valuing the contributions of others. 4. Confidence – is the belief that our skilled, professional presence can make a difference, and the belief in our own ability to create caring environments that serve as a catalyst for improvement in the field of nursing. 5. Commitment – is maintaining and elevating the standards and obligations of the nursing profession and assuring the delivery of excellence in nursing care, and dedicating oneself to a lifelong learning. 6. Comportment – is the professional presentation of us as nurses to others in behaviour, attitude, appearance, dress and language that communicate a caring presence. It includes the need for self-awareness, awareness of impact of self on others, and accepting responsibility for our actions. 7. Creativity – is having a vision of how nursing care can be, and making it better. It results in integrating new insights into existing nursing knowledge and awareness.
Relationship to the Nursing Metaparadigm
1. Person – If a patient is nursed by someone with the qualities of the 7 C’s of caring, he is able to enjoy a better and safer caring method, that will automatically ensure his speedy but sure recovery. This patient would also tend to develop a good interpersonal relationship with a nurse of this calibre, which also helps in his recovery. 2. Environment –The better the caring environment is for the patient, the better his recovery would take place. A nurse equipped with the Seven C’s of Caring is able to discern better which type of environment for which type of patient in a given situation would be best for that specific patient, thus aiding significantly in his recovery.
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Online Articles:
researchgate/publication/ bizfluent/way-5908638-effective-communication-organizational-change.html mindtools/pages/article/newPPM_94.html study/academy/lesson/lewins-3-stage-model-of-change-unfreezing-changing- refreezing google/amp/s/rapidbi.com/kurt-lewin-three-step-change-theory/amp/ currentnursing/nursing_theory/change_theory.html toolshero/change-management/lewin-change-model/ sciencedirect/science/article/pii/S2444569X16300087#bbib bizfluent/way-5908638-effective-communication-organizational-change.html psychologynoteshq/psychological-field-theory/ britannica/biography/Kurt-Lewin journals.sagepub › pdf change as three steps: Rethinking Kurt Lewin's legacy for
Theories Relevant to Nursing Practice
Course: bs nursing
University: Southwestern University PHINMA
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