Enfermería. Fundamentos. Teorías y Modelos de Enfermería

1) Florence Nightingale — Naturalistic model (environment-centered nursing)

Core premise/objective

• Nursing should consider the patient’s vital energy and the action of nature.
• The environment is central: a healthy environment is necessary for effective nursing care.

Key focus: the environment (5 essential points)

Ensure for patient homes/settings:

• Clean air
• Clean water (not only tap water)
• Local drainage
• Cleanliness in the home
• Access to light

Nursing as a calling/vocation

• Nursing is described as a religious calling from God and a vocation.
• Historically, nursing was primarily a women’s role.

Nursing actions/requirements

Use:

• Fresh air, light, warmth
• Cleanliness and tranquility
• Timely administration of diets

Goal:

• Minimize loss of the patient’s vital energy while exposing the patient to the best conditions for nature to act.

How Nightingale worked (evidence/observation)

• In the Crimean War, mortality was reduced by:
  • Daily study of infected patients (cleanliness, sunlight, water)
  • Implementing environment-related modifications
• Her approach emphasized observation and descriptive statistics.

Nursing and relationships (3 relationship types)

• Environment ↔ patient: environment is a primary cause of illness
• Nurse ↔ environment: nurse shapes the setting
• Nurse ↔ patient

Health vs illness (as described)

• Illness: nature’s reactions against harmful conditions.
• Nursing prevents illness by preventing harmful environmental conditions.

Home care independence and teaching

• Nurses providing home care should teach patients/families to maintain independence.

Expanded metaparadigm elements (as described)

• Person/patient: often treated as passive; nurse performs tasks and controls the environment.
• Environment: nursing helps nature heal by aligning the internal/external environment with natural laws.
• Health: well-being and ability to use one’s faculties; illness slows patients to rest and reflect.

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2) Virginia Henderson — Model of substitution of help (assistance toward independence)

Biography snapshot (as presented)

• Born 1897 in Kansas, Missouri.
• Specialized in nursing and influenced nursing theory.
• Integrates physiological and psychopathological principles.

Patient/person view

• The patient is an individual who needs help to achieve independence, integrity, or total mind–body integration.

Nursing vs medicine (emphasis)

• Nursing is independent from medical practice.
• Nursing is primarily an art.

Core structure: 14 basic human needs

Nursing assesses and supports needs so the person can become independent (prioritized in the video):

1. Breathe normally
2. Eat and drink adequately
3. Eliminate bodily wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select appropriate clothes
   • Dress; maintain normal temperature via clothing/environment adjustments
7. Maintain body temperature within a normal range
8. Keep the body clean, tidy, well cared for and protect the skin
9. Avoid dangers in the environment (avoid injuring others)
10. Communicate to express emotions, needs, fears, opinions
11. Worship according to faith
12. Work to experience a sense of accomplishment
13. Play / leisure
14. Learn, discover, satisfy curiosity
    • Supports normal development and health

How independence works (conditions stated)

Independence depends on the patient having:

• Strength
• Knowledge
• Will

If lacking, the patient becomes dependent, and nursing assists to meet needs.

Definition of nursing (as described)

• Nursing helps a sick or healthy person perform activities that contribute to health, recovery, or a peaceful death—activities they would do unaided if they had strength, will, and knowledge.

Health definition (as presented)

• Health = a margin of physical and mental vigor enabling effective work and reaching potential.
• Health is equated with ability to satisfy needs without assistance (independence).

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3) Dorothea Orem — Nursing theory (self-care framework)

Who she is (as presented)

• Lived 1914–2007.
• Ordained/educated by the Daughters of Charity.
• Worked to improve nursing in general hospitals.

Source of her theory

• Presented as grounded in collective nursing experience from nurses she interacted with.

Self-care vs dependent care

• Self-care: activities initiated by mature/maturing individuals to maintain function, development, and well-being by meeting needs for functional/developmental regulation.
• Dependent care: care for those who cannot perform self-care due to age or related factors.

Conditioning factors and determinants of self-care ability

Ten factors that condition self-care demand/ability:

• Sex
• Developmental stage
• Health status
• Lifestyle
• Health system factors
• Family system factors
• Sociocultural factors
• Resource availability
• External environmental factors
• (Video indicates “ten factors” overall; the above are the explicitly listed ones.)

General theory of nursing = 3 related theories

• Theory of self-care
  • Includes: universal requirements, developmental requirements, health-deviation requirements.
  • Universal care examples included in the video:
    • adequate air
    • adequate water
• Self-care deficit theory
  • People may be unable to meet therapeutic self-care needs due to limited capacities.
  • Explains when and why intervention is needed.
• Nursing systems theory
  • Nursing care is organized into 3 systems:
    1. Fully compensatory system
       • Nurse performs activities because patient cannot (e.g., stroke sequelae)
    2. Partly compensatory system
       • Nurse and patient share tasks; patient performs some self-care; nurse assists/educates (e.g., dressing with guidance)
    3. Supportive–educative system
       • Nurse educates to help patient perform self-care (e.g., diabetes self-monitoring and insulin administration)

Nursing (as described)

• Provides direct assistance in self-care required by incapacity arising from personal situations.
• Helps individuals carry out and maintain self-care to preserve health, recover, and cope with illness consequences.

Paradigm of person & environment (as stated)

• Person: rational biological organism capable of self-care (or harm).
• Environment: physical, chemical, biological, and social factors (including family and community) that influence or are influenced by the person.

Health/reciprocal health

• Health = integrity and progressive development; moving toward integration.
• Illness is not just absence of defects; health is described as restoration/integration.

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4) Dorothea Gordon — Functional health patterns (assessment framework)

Biography snapshot (as presented)

• Born 1914, died 2015 in Baltimore, Maryland.
• Created nursing assessment theory: Gordon’s Functional Health Patterns.
• Worked on standardized nursing language for global diagnostic consistency.

Purpose/approach

• Structured way to assess a patient on admission or during stay.
• Uses questions, questionnaires, and objective observational data.

Functional health patterns

• Configurations of behaviors common to most people and used for assessment across ages.
• Video lists 11 patterns:
  1. Health perception / management
  2. Nutritional and metabolic
  3. Elimination
  4. Exercise activity
  5. Sleep and rest
  6. Perception / cognition (listed as “Perfect and conscious”)
  7. Self-perception / self-concept (self-concept, mood)
  8. Role and relationships
  9. Sexuality / reproduction
  10. Adaptation and tolerance (coping/stress tolerance)
  11. Values and beliefs (including spiritual)

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5) Hildegard Peplau — Interpersonal relationship / psychodynamic nursing

Identity and influence (as presented)

• Described as the “mother of psychiatric nursing.”
• Core idea: nurse–patient relationship within a psychodynamic/interpersonal framework.

Core concept: dynamic nursing

• Using understanding of one’s own behavior to help others identify difficulties.

Nursing model foundation

• Based on psychodynamic/psychoanalytic principles.

Therapeutic relationship development (role sequence)

The nurse’s role evolves through stages:

• Stranger (initial meeting; not yet trusted)
• Resource person (provides resources for self-care, help, supplementation)
• Teacher (educates/instructs patient)
• Leader (patient depends more heavily)
• Substitute (supportive continuation of roles)
• Final stage: video implies a “finally” phase, label unclear in subtitles

Phases of the nurse–patient process

• Orientation
  • Patient clarifies difficulties/extent of need; nurse assesses
• Identification
  • Patient clarifies situation and need; collaborates
  • Nurse diagnoses and formulates care plans
• Utilization
  • Patient uses nursing services for maximum benefit
  • Care plan implemented; patient growth toward maturity
• Resolution
  • Mutual benefit: patient recovers independence; nurse grows professionally

Metaparadigm themes (as described)

• Person: developing organism seeking to reduce anxiety from needs.
• Environment: not fully explicit, but nurse considers patient culture/values in the hospital setting.
• Health: movement toward a creative, constructive, productive life.
• Nursing: significant therapeutic interpersonal process enabling health.

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6) Callista Roy — Adaptation model (psychosocial adaptation)

Biography snapshot (as presented)

• Born 1903; pediatrics-focused observations.
• Emphasized children’s adaptation to changes.
• Adaptation proposed as a conceptual framework for nursing.

Core model: adaptation

• Humans are psychosocial beings in constant interaction with the environment.
• Stimuli trigger reactions; outcomes depend on whether adaptation occurs.

Stimulus types

• Focal stimuli: most immediate/internal/external influences (e.g., flu-like state)
• Contextual stimuli: other contributing stimuli (e.g., ambient temperature)
• Residual stimuli: less defined influences, often linked to past values/beliefs/experiences (e.g., home treatment ideas)

Regulator and cognator (subsystems)

• Regulator subsystem
  • automatic/neurophysiologic regulatory processes
• Cognator subsystem
  • cognitive and emotional processing (sensory information, learning, emotions)

Modes of adaptation

Video indicates physiological and self-concept/role-related adaptation modes, including examples such as:

• regulating temperature/heart rate
• reducing activity
• changing elimination/behavior to cope

Effectiveness

• Effective adaptation supports integrity and helps achieve adaptation goals (survival, growth, reproduction, control).
• Ineffective adaptation fails to achieve goals and threatens integrity/health.

Health and nursing goals (as presented)

• Health: process and reflection of adaptation (not absence of disease/stress).
• Nursing aims to:
  • improve adaptation level in children/people
  • contribute to good health, quality of life, and dying with dignity

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7) Martha Rogers — Unitary Human Model (energy field theory)

Biography snapshot (as presented)

• Worked in public health/rural home health nursing.
• Later held academic leadership; authored books/articles.

Four cornerstones (as described)

• Energy field: fundamental unit for living matter (dynamic, multidimensional, infinite).
• Human and environmental fields: both are energy fields.
• Pattern: distinctive characteristic of the energy field; continuous innovative movement; unique patterns integrate.
• Universe of open systems: fields are infinite, open, and in continuous exchange.

Paradigm of person and environment

• Humans are unified wholes with integrity—not mechanical aggregates.
• Environment is an infinite, pan-dimensional energy field.
• Human and environment continuously change creatively.

Nursing role

• Foster harmonious interaction between the human field and environment to reinforce integrity/pattern and maximize health potential.

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8) Conservation model theory (Levine) — Conservation, integrity, adaptation

Identity (as presented)

• Recognized for conservation/probability ideas and the importance of nursing teaching in medical-surgical nursing.

Core principles

• Result of adaptation is conservation.

Main concepts

• Integrity: uniqueness of the individual and singular responses to challenges.
• Adaptation: change process that maintains integrity within internal/external reality.
• Conservation: maintaining integrity through preserving essential capacities.

Primary responses to conserve (as listed)

• Fight-or-flight (described as the most primitive)
• Other responses mentioned:
  • grandparent syndrome (term as shown in subtitles; exact meaning unclear)
  • inflammatory responses as defense mechanisms during threats/illness/hospitalization
  • predictable changes / wear-and-tear over time (structural/hormonal changes)

Key idea about environment control

• The conservation model emphasizes controlling the environment to support healing.

Postulates (as listed)

1. Conserve energy
   • balance energy to maintain vital activities; avoid unnecessary expenditure
2. Conserve structural integrity
   • restore structural/functional integrity; promote physical healing tasks
3. Conserve personal integrity
   • protect self-esteem; support vulnerable patients to preserve uniqueness
4. Conserve social integrity
   • help families maintain social/common bonds and support self-esteem

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Common themes across the models (as concluded)

• The video groups theories into philosophies/trends (as stated):
  • Naturalistic
  • Interrelationship
  • (and implies additional trends, with emphasis on unity of phenomena and structured nursing frameworks)
• Many theories share the idea of:
  • viewing the person holistically
  • considering environmental influence (directly, or through relationship/adaptation)
  • supporting health through nursing’s role, such as:
    • shaping the environment
    • assisting toward independence/self-care
    • therapeutic interpersonal process
    • using structured assessment patterns
    • conserving vital capacities

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Speakers / sources featured (as named in the subtitles)

1. Florence Nightingale
2. Virginia Henderson
3. Dorothea Orem
4. Dorothea Gordon (Gordon’s Functional Health Patterns)
5. Hildegard Peplau
6. Callista Roy
7. Martha Rogers
8. Levine (conservation model / conservation theory)