Early nursing theorists were drawing from a different experience than we do today, but today’s nursing would probably not be what it is if it were not for the early Grand theorists. Florence Nightingale, Henderson, Peplau, and King all had strong influences on nursing in their own time and continue to influence nursing and nursing theory today. This paper will discuss that influence. Florence Nightingale, though seen as Grand theorists did not really have a theory; she really had a broad philosophy.
Her basic tenet was healing and the philosophy consisted of healing, leadership, and global action (McEwen & Wills, 2007). Everything was focused on the needs of the patient. Nightingale felt that the physician was the one to write orders and it was the responsibility of the nurse to carry those orders out. She felt that anticipating and meeting the needs of the patient fell in the realm of the nurse. Though Florence Nightingales work is not well organized in its thought, it has to be remembered that she was in the process of theorizing when women were still handmaidens (Kikuchi, 2008).
Virginia Henderson was an educator and author who is known as the mother of nursing because of her influence throughout the world of nursing. She created with some of her colleagues, the basic curriculum of nursing which was centered around patient centered care which was done with nursing problems and separate from a medical diagnosis (Jasorsky, 2010). Henderson felt that here theories of nursing grew throughout her career as a nurse and evolved from patient care. She sees the patient as a sum of parts such as biopsychosocial needs. She feels the patient is not a consumer or a client.
Her major assumption of care is that nurses care for patients until patients can care for themselves. Her opinion is that patients have a desire to return to health and that nurses are willing to serve and will devote themselves to patients day and night. She lists 14 activities which are used for patient assistance. These include breathing normally, eating and drinking, eliminating, moving, sleeping, dressing, maintaining body temperature, avoiding dangers in the environment, communicating, worshiping, working, playing and learning.
She felt that the nurse conceptually should assist the patient in those things that lead to recovery or in a peaceful death. Peplau who contributed much to the development of others theories was really rather limited in the scope in which she worked. Though she was famous for her work, she was generally a psyche nurse and approached the needs of patients and nursing from that venue (Clark, 1978). Jean Orlando who is one of many built her framework and theory upon the theories of Peplau. These theories are somewhat abstract and though they are used to guide some of nursing practice, probably less so than many.
Imogene King on the other hand had a very complicated theory in which the assumptions pertain to individuals, nurse-client interactions and nursing as a whole. In the nurse-client relationship, she believes that the perceptions that each comes to the relationship with, affect that relationship. That relationship is also affected by the influence of goals, needs and values of both the client and the nurse, individuals have the right to participate in decisions and that both the client and the nurse have the right to affect their lives (Crow, 1992).
She believed that nursing was the care of human beings and that meant that the nurse must, perceive, think, related, sometimes judge, and act on the behalf of the patients. The goal of nursing is to help patients restore health. Primary Elements King believed that the nurse and patient are purposeful interacting systems, and that the interaction between a nurse and a client are influenced by perceptions that have been previously developed. Peplau determined that the need of the patient was determined by the nurse and then the nurse must find a response to the patients need.
She also felt that patients respond to nursing when there is a need and it is not always simple to discern what that need is. Henderson believed that nurses care for patients and they are willing to do that no matter what and that nursing diagnosis was separate from medical diagnosis. Florence Nightingale also felt that the job of the nurse was to care for the patient; she however felt that physicians determined what the patient needed and the nurse carried out his order ( Henderson, 2008). In some ways, these theorists all believe the same thing.
The patient is the center of the care needed and only the patient can tell you what is needed. They also believe that nursing care and physician care are separate entities which lead to different diagnosis and different methods of treatment. In relating these theories to labor and delivery and women’s services, King’s theory comes to thought first. She believes that patients come to nursing care with preconceived ideas. Where else could this be truer than in labor and delivery where the expectation is a healthy baby.
Sometimes though Peplau’s theories may need to be used because not everyone has a healthy baby and when that happens there are psychosocial issues that must be solved and only the patient can tell you how she feels. Henderson believed that nurses will work day and night to solve a patient’s issues and more than once in my career I have seen this happen as a nurse stays with a high risk patient for delivery and of course Florence Nightingale who believes that the patient is the center of all which there is no question about in the L& D.
In conclusion, the nursing Grand Theories have influenced nursing for quite some time. Each of the theories talked about here have been built upon until today’s nursing has emerged. There is still much to do and only now are we learning how to use these theories in such a way as to define nursing in a way that will continue to give the profession forward momentum in the desire to care for patients in a quality way and in the desire to be independent and accountable in our own profession. Resources Clark, J. (1982).
Development of models and theories on the concept of nursing. Journal of Advanced Nursing. 7(2). 129-134. Clark, J. (1988). 30th anniversary commentary on Henderson. The concept of nursing. 3. 113-130. Crow, R. (2982). Frontiers of nursing in the twenty first century: development of models and theories on the concept of nursing. Journal of Advanced Nursing 7(2). Fawcett, J. (2005). Evaluation of theory. Nursing Science Quarterly. 18(2). Henderson, S. , Happell, B. (2008). Impact of theory & clinical placement on
undergraduate students mental health nursing, knowledge, skills, and attitudes. International Journal of Mental Health Nursing 16(5). 116-125. Jasorsky, D. , Morrow, M. , Clementi, P. (2010). Theories in action and how nursing practice changed. Nursing Science Quarterly. 23(1). 29-30. Kikuchi, J. (2008). Cultural theories of nursing responsive to human needs and values. Journal of Nursing Scholarship. 37(4). McEwen, M. , & Wills, E. (2007). Theoretical Basis for Nursing. 2nd ed. Lippincott: Boston.
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