Conceptual Models of Nursing

### Conceptual Models of Nursing

• Provide organizational structures for critical thinking about the nursing processes
• Models are less abstract and more formalized than philosophies
• Models are more abstract than theories
• Focus on patient’s capacity for self-care

Dorothea Orem's Self-Care Model

• Focuses on the patient's capacity for self-care
• Identifies deficits the patient may have in providing their own self-care

Imogene King’s Interacting System Framework Theory and Theory of Goal Attainment

• Nurse focus on goal attainment for and by the patient
• Explore goals the nurse and patient can set together to restore the patient to health

### Callista Roy’s Adaptation Model

• Offers a comprehensive understanding of nursing from the perspective of adaptation
• Focuses on how the nurse can modify the patient’s environment to facilitate adaptation

### Grand to Middle Range Theories

• Grand theory is a broad conceptualization of nursing phenomena
• Middle Range theory is narrower in focus and connects grand theories with nursing practice
• Middle Range theory focuses on a specific aspect of nursing, incorporating a limited number of concepts
• Middle range theories typically merge practice and research, merging empirical research into a larger theory
• Theories are less abstract than models and propose specific outcomes

Peplau’s Theory of Interpersonal Relations in Nursing

• Relationship between the patient and nurse is the focus of attention
• Focuses on the relationship, rather than only the patient

### Orlando’s Nursing Process Theory

• Deals with specific nurse-patient interactions
• Goal of the nurse is to determine and meet patient’s immediate needs to improve their condition by relieving distress or discomfort
• Emphasizes deliberate actions rather than automatic reactions based on observation of the patient’s verbal and nonverbal behavior, which lead to inferences
• Inferences are confirmed or disconfirmed by the patient, which helps the nurse identify the patient’s needs and provide effective nursing care

### Leininger’s Theory in Practice: The Sunrise Model

• Nursing outcome is culturally congruent nursing care for the patient
• Guides assessment of cultural data to understand its influence on the patient's life
• Nurse plans care while recognizing the health beliefs and folk practices of the patient’s culture
• Focuses on cultural care preservation, accommodation, or repatterning, depending on the patient’s needs

### Examples of Middle Range Theories of Nursing

• Swanson’s Caring Theory
• Mishel’s Uncertainty in Illness Theory
• Jezewski’s Cultural Brokering Theory
• Dobratz Theory

### Using Theory: Theory-Based Education

• Nursing curricula are built around specific conceptual models of concepts
• Nurses intentionally structure practice around a particular nursing theory to guide them in their assessment, planning, diagnosis, intervention, and evaluation
• Nursing evolved from a vocation dependent on knowledge from other disciplines to a profession with its own knowledge base
• This growth has stimulated the development of the nursing PhD degree, generating new, discipline-specific knowledge, and focusing on the philosophy of nursing science, the generation of nursing knowledge, theory testing, and the development of new theory
• Doctor of Nursing Practice (DNP) or Masters of Science in Nursing (MSN) are primary providers in advanced practice focused on specific patient nursing outcomes
• BSN nurses are introduced to the research process, evidence-based practice, and use of theory to guide nursing practice
• Associate Degree nurses use nursing theory to teach the unique perspective of nursing
• Theory shapes, facilitates, contributes, and helps develop nursing practice

### Nursing Theory Ultimate Goal

• Support excellence in practice

### Nursing Research

• Tests and refines the knowledge base of nursing
• Improves the quality of care and understanding of how evidence-based practice influences improved patient outcomes

### Scientific Method

• Systematic way of thinking and solving problems

### Bias

• Refers to systematic distortion of a finding from data, often resulting from a problem with the sample

### Quantitative Research

• Uses measurable variables with outcomes from standardized experimental designs and hypothesis

### Qualitative Research

• Relies on data collection techniques like narrative interviews and participant observation

### Mixed Methods

• Combining qualitative and qualitative research

### Science

• Pure Science explains the universe without regard to if the information is useful
• Applied Science is the practical application of scientific theories and laws
• Translational Research takes findings discovered in the lab and research to develop bedside applications

### Inductive Reasoning

• Small to big
• Proceeds from particular experiences to generalizations
• Inferences are made that lead to further research

### Deductive Reasoning

• Big to small
• Conclusions are drawn by logical inference from given premises

### Limitations of Strict Definition of Scientific Method in Nursing

• Healthcare settings are not comparable with laboratories
• Human beings are more than a collection of parts that can be dissected and examined
• The claim for objectivity

### Where Does Nursing Research Come From?

• Clinical Practice
• Theories
• Literature

### Nursing Research

• Systematic investigation of phenomena related to improving patient care
• A problem may be amenable to being addressed by research if:
  • A conceptual framework exists or can be constructed
  • Based on related research findings
  • Designed carefully

### State Boards of Nursing and Nursing Education

• Set and enforce minimum criteria for nursing education
• Applicants for licensure must graduate from a state-approved nursing education program
• Schools of nursing must have state approval to operate
• State approvals are less stringent than national accreditation standards
• Some states require national accreditation to achieve state approval

### State Boards of Nursing and Sanctions

• Prohibit, suspend, or revoke nursing license
• Most common reason for disciplining nurses is practicing while under the influence of alcohol or drugs
• State boards have the power to sanction nurses for performing professional functions that are dangerous to patients or the general public

### Rehabilitation of Nurses Who Are Impaired By Mental Health Issues or Substance Abuse

• ANA (1990) and Nursing Disciplinary Diversion Act
• NCSBN (2015) Substance Abuse Disorder of Nursing
• Comprehensive resource to assist with evaluation, treatment, and management of nurses with substance problems

### NCLEX

• Minimum of 75 questions, maximum of 265 questions
• Duration of 6 hours
• Licensure exam is updated regularly and tests critical thinking and nursing competence in all phases of the nursing process

### Licensure by Endorsement

• RN can practice in different states without having to take another licensing exam
• Requirements: proof of licensure in another state and a licensure fee
• Compact
  • NCSBN (2000) developed the Nurse Licensure Compact
  • 2015: NLC adopted by 24 states, 6 states with pending legislation, 1 state enacted but implementation is pending
  • Each state wishing to participate in the compact must pass legislation enabling the board of nursing to enter into the interstate NLC

### Homeostasis

• Internal stability

### Systems and Nursing Practice

• Hospital system

### Maslow’s Hierarchy of Needs

• Published in 1954
• Hierarchy of needs: Physiological needs, safety, social, esteem, and self-actualization
• Rejected Freud and Pavlov
• Presented human needs theory motivated by intrinsic needs
• Assumptions about needs:
  • Needs vary
  • Homeostasis is threatened when needs are not met

### Environmental Systems

• Family
  • Most direct influence on a person
• Cultural
  • Increased number of diverse groups
  • Ethnocentrism: Making judgments
• Social
  • Increased illness following social change
  • Support and social networks
• Community, National, and the World
  • Impact of nurses and hospitals
  • National and global influence

### Health

• WHO Definition: State of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity
• Holistic View
  • Focuses on the interrelationship of all parts that make up the person
  • Nursing embraces a holistic view of health
  • Jan Christian Smuts: modern western model; harmony between people and nature