Nursing models and theories aim to describe, establish and examine the phenomena that make up the practice of Nursing. It is assumed by the discipline that in order to determine that a nursing theory exists, it must contain the elements of the Nursing metaparadigm. Each discipline makes its own the terms related to theory and its development in order to provide it with a body of knowledge that allows it to guide the exercise of the discipline. In Nursing, the following terms are considered:
- Philosophy.
- Science: It is both the body of knowledge specific to a discipline and the skills and methodology that make said discipline progress.
- Knowledge: It is the perception of reality that we acquire through learning and research.
- Theory: It consists of a set of concepts, definitions and propositions that allow us a systematic vision of the phenomena, establishing specific relationships between the concepts in order to write, explain, predict and/or control said phenomena. The usefulness of theory for Nursing lies in the fact that it allows you to increase knowledge about your own discipline, by systematically using a work method.
- Model: This is the symbolic representation of reality. Models are developed using related concepts that have not yet progressed into a theory. The model serves as a link in the development of a theory. Nursing models are, therefore, representations of the reality of Nursing practice. They represent the factors involved and the relationship they have with each other.
Nursing as a profession has existed since Florence Nightingale, in the mid-19th century, expressed the firm conviction that Nursing required knowledge different from medical knowledge. She described what for her was the proper function of Nursing: putting the patient in the best conditions so that nature can act on them; She defined the concepts of health and illness in relation to Nursing, the objective of care and its praxis.
It is from the decade of the 50s of the 20th century when Nursing professionals begin to develop conceptual models. These can be classified according to their main center of interest. They represent different points of view and explanations about the nature of Nursing objectives and methods, because they are based on different theories about the person. Three types of approaches can be made to develop Nursing theory:
- Use the conceptual framework of other disciplines applying it to Nursing. But there are theories that are difficult to apply to Nursing.
- Use an inductive approach, that is, through observation, arrive at theories that explain important topics in Nursing.
- Use a deductive approach. Search for the compatibility of a general Nursing theory with various aspects of it.
A conceptual model:
- Generates knowledge that facilitates improving practice.
- Organize information into logical systems.
- Discover knowledge gaps in the specific field of study.
- Discover the basis for collecting reliable and truthful data on the health status of clients, which is essential for the decision and its compliance to be effective.
- It provides a measure to evaluate the effectiveness of nursing care.
- Develop an organized way of studying Nursing.
- Guides research in Nursing to expand knowledge of the same.
The implementation of a conceptual framework or model is a way of approaching a discipline in an unequivocal way, which includes a common language communicable to others. The difference between conceptual model and theory is the level of abstraction. A conceptual model is an abstract system of interrelated concepts. A theory is based on a conceptual model, but is more limited in scope, containing more concrete concepts with detailed definitions and explanations of the premises or hypotheses.
Nursing theories are still being developed, and each one is named after the person or group who developed it, reflecting their ideas.
NATURALISTIC MODELS
Its main representative is Florence Nightingale. In 1859 she tried to define the nature of nursing care in her book Notes on nursing ; «There is a tendency to believe that medicine cures.- Nothing is less true, medicine is the surgery of functions as true surgery is the surgery of organs, neither one nor the other cures, only nature can cure. – What nursing care does in both cases is to put the patient in its work.
Florence Nightingale (1820-1910)
Florence Nightingale had already understood the need to have a reference scheme, a conceptual framework. From this first attempt at conceptualization, until this question is formally asked again, almost a century passes. It is the simplest of all the models
SUBSTITUTION OR HELP MODELS
The nursing role consists of replacing or helping to carry out the actions that the person cannot carry out at a moment in their life, actions that preserve life, both promoting self-care on the part of the person.
The two most important representatives of this trend are Virginia Henderson and Dorothea Orem.
Dorothea Orem. (1914-2007).
For Virginia Henderson, nursing is: “Helping the healthy or sick individual in carrying out activities that contribute to their health, recovery or achieving a dignified death. Activities that he would carry out by himself if he had the necessary strength, will and knowledge. Have him help achieve independence from him as soon as possible.” The Nurse’s priority is to help people and their families (which she considered as a unit). Therefore, the nurse is the owner of the care. In the postulates that support the model, we discover the point of view of the patient who receives the care of the nurse.
It revolutionized the world of nursing by redefining its concept and cataloging the 14 basic needs, with which we still work today, trying to completely cover the patient’s needs in the way possible; needs that would be common to every person, sick or healthy. The first nine needs refer to the physiological level. The tenth and fourteenth are psychological aspects of communication and learning. The eleventh need is on the moral and spiritual level. Finally, the twelfth and thirteenth needs are sociologically oriented to the occupational and recreational level. For Henderson, the patient’s independence to the extent possible is basic and fundamental, and he directs his care so that he achieves it as quickly as possible. The patient, according to Virginia, has to be helped in the functions that he himself would perform if he had strength, will and knowledge.
INTERRELATION MODELS
In these models, the role of the nurse consists of promoting the person’s adaptation in a changing environment, promoting the relationship, whether interpersonal (nurse-patient) or the patient’s relationships with his or her environment. The most representative models are those of Hildegarde Peplau, Callista Roy, Martha Rogers and Mira Levine.
Hildegarde Peplau (1909-1999).
The essence of Peplau’s model, organized in the form of a process, is the human relationship between an individual who is sick, or who requires health care, and a nurse specially educated to recognize and respond to the need for help. This model, first published in 1952, describes four phases in the relationship between nurse and patient: Orientation, Identification, Exploitation, and Resolution. Peplau recognizes the science of Nursing as a human science, which focuses care on the interpersonal relationship.