Nursing Theories PDF

TFN - apply all theories into practice Components of a theory 1. Purpose - explains why the theory was formulated and Fact - something that is seen happening or existing (using specifies the context and situations i...

TFN - apply all theories into practice Components of a theory 1. Purpose - explains why the theory was formulated and Fact - something that is seen happening or existing (using specifies the context and situations in which it should be five senses) applied - (an empirical observation) ~ in which you first hand experience and has a Idea - a group of interrelated facts -> which comes from connection with you your observation -> making a difference based in 2. Concepts and Definition experience - Concepts are logistic labels that are assigned to - an image or formulation of something imagined and objects or events. visualized, of something vaguely assumed, guessed or - Definition defines the concept in relation to other sensed out of related facts or observations concepts and permits the description and - a person’s conception of what is the best example of classification of phenomena. something 3. Theoretical Statements - statements about the Concept - a word or cluster of words describing an relationship between two or more concepts and are used object, idea or event to connect concepts to devise the theory - an abstraction based on observation of certain 4. Structure and Linkages behaviors or characteristics - The structure of a theory provides overall form to - describes the essence of a thing the theory. > Concrete/Empirical - specific time and place and - Theoretical linkages offer a reasoned explanation of observable why the variables in the theory may be connected in > Abstract - independent of time or place and some manner indirectly observable/not observable 5. Assumptions - based on what the theorist considers to be adequate empirical evidence to support propositions, Conceptual Framework - set of interrelated concepts on accepted knowledge, or on personal beliefs or values. that serve as building blocks of theories 6. Models - schematic representation of some aspect of - interrelated concepts or abstractions that are reality assembled together in some relational scheme by - Theoretical models represent the real world through virtue of their relevance to a common theme language or symbols and directional arrows. Hypothesis - educated guess - a statement of predicted relationships between two or Characteristics of a Theory more variables, subjected to testing in empirical studies 1. Theories can interrelate concepts in a way to create a - a temporary stand or prediction or guess while the different way of looking at a particular phenomena. investigation goes on 2. Theories must be logical in nature. Assumption - basic principles that are accepted as being 3. Theories should be relatively simple yet generalizable. true on the basis of logic or reason without proof or 4. Theories can be the bases for hypothesis that can be verification (it could be neither true or false) tested. Theory - a formal statement that is constructed in order 5. Theories contribute to and assist in increasing the to organize ideas & explain event general body of knowledge within the discipline through - a group of related concepts that propose actions that the research implemented to validate them. guide practice 6. Theories can be utilized by the practitioner to guide & - a systematic way of looking at the world in order to improve their practice. describe, explain, predict and control it 7. Theories must be consistent with other validated Nursing Theory - an organized and systematic theories, laws & principles but will leave open unanswered articulation of a set of statements related to questions that need to be investigated. questions in the discipline Theoretical Framework - a set of interrelated theories that organizes the direction of a research endeavor / scientific inquiry Purposes of Nursing Theories In Education - Theory clarifies the central meanings and improves the status of the profession. In Research - Theory sets limits on what questions to ask and what methods to use to pursue answers to the questions. In Clinical Practice Metaparadigm - global perspective of a discipline that - guides research identifies the primary phenomena of interest to that - provides the nurse with goals for assessment, diagnosis, discipline and explains how the discipline deals with those and intervention. phenomena in a unique manner - a tool that renders practice more efficient, more ~ how you use the overall theories in nursing practice effective, and goal directed Nursing metaparadigm : embodies the knowledge base, - Language of theory provides us with common grounds theory, philosophy, research, practice, and educational for communication and with labels and definitions for experience and literature phenomena - Professional autonomy and accountability are enhanced Florence Nightingale: Environmental Theory by theory use in practice. - She improved the standards of care of war casualties in Crimea that earned her the title “Lady with the Lamp”. How it all began in Nursing: Crimean War: Florence Person - defined in relation to his/her environment Nightingale as a volunteer nurse and the impact of the environment upon him/her - referred to as a patient Nursing as a Science Health - balance between human and his/her - owes much of its research-orientedness to the environment (Balance of external and internal care) systematic works of Florence Nightingale - being well and using every power (resource) to the fullest extent in living life Florence Nightingale - Disease and illness = reparative process that - May 12, 1820 - August 13, 1910 nature instituted when a person did not attend to - St. Thomas Hospital, London “Birth of Modern Nursing” health concerns -> 1900 = nursing strong emphasis on practice - Health maintenance through prevention of -> Curriculum era disease via environmental control and social -> Research era responsibility -> Theory era Environment - used by Florence Nightingale -> Nursing as “academic discipline” - described components of surroundings -> 1800 = “nursing knowledge was distinct from medical knowledge” – F. Nightingale Nursing - major component of nursing: manipulation -> 1950 = “emergence of nursing as a science” of physical environment -> 1970 = “research revealed that nursing lacked - “What nursing has to do... is to put the patient in conceptual connections & theoretical framework” the best condition for nature to act upon him.” -> 1980 = nursing theory was developed - Nursing “ought to signify the proper use of fresh -> body of nursing science for research, education, air, light, warmth, cleanliness, quiet, and the administration & practice continuous to expand proper selection and administration of diet – all at the least expense of vital power to the patient.” Nursing Paradigm - patterns or models used to show a clear relationship among the existing theoretical works in nursing  > cleanliness – personal (patient, nurse) – physical environment ~ dirty environment – source of infection Faye Glenn Abdellah: 21 Nursing Problems Individuals (Human beings) - recipients of nursing may also be families, society - areas of importance: psychological, biological & social Health - not specifically defined - purpose of nursing services - IN NURSING as a comprehensive service: Major areas of environment that can be controlled by the - “total health needs” nurse: - “a healthy state of mind and body” > Health of houses Society - does not discuss society as a patient nor – presence of pure air define society – pure water - by providing service to individuals and families, – efficient drainage society is served – light - included in “planning for optimum health on local, > Light state, national, and international levels” – direct sunlight Nursing - a comprehensive service that is based on an – purifying effect of direct sunlight upon room air art and science > Ventilation and warming - use of the problem-solving approach – breathe air that is as pure as external air; without (patient-centered approach) with key nursing chilling problems related to the health needs of people – source of the air in the patient’s room - grouped into the 21 problem areas to guide care – proper room temperature and promote the use of nursing judgment – patient’s body temperature ~ “noxious air” or “effluvia” Nursing Problems - a condition faced by the patient or ~ “building sickness” patient’s family that the nurse, through the performance > Noise of professional functions, can assist them to meet - Wake patient intentionally or accidentally during the - “nursing functions”/”nursing goals” may be : first part of sleep. > overt - whispered and long conversations > covert - unnecessary noise > bed and bedding Abdellah’s 21 Nursing Problems - Bed should be placed in the lightest part of the > To maintain good hygiene and physical comfort room and placed so the patient could see out a window. > To promote optimal activity; exercise, rest and sleep - Caregivers should never lean against, sit upon, or > To promote safety though the prevention of accident, unnecessarily shake the bed of a patient. injury, or other trauma and through the prevention of - clean, neat, and dry the spread of infection - positioning the patient for maximum comfort > To maintain good body mechanics and prevent and > variety correct deformities – need for changing color and form > To facilitate the maintenance of a supply of oxygen to – reading, needlework, writing and cleaning as all body cells activities to relieve the sick of boredom > To facilitate the maintenance of nutrition of all body cells > To facilitate the maintenance of elimination proper waste disposal, absence of injurious chemicals, > To facilitate the maintenance of fluid and electrolyte cleanliness of surroundings) on the life and balance development of a person > To recognize the physiological responses of the body to ~ “the aggregate of the external conditions and disease conditions – pathological, physiological, and influences affecting the life and development of an compensatory organism” -Webster > To facilitate the maintenance of regulatory mechanisms Nursing - The unique function of the nurse is to assist and functions the individual, sick or well, in the performance of > To facilitate the maintenance of sensory functions activities contributing to health or its recovery. > To identify and accept positive and negative expressions, feelings and reactions 14 Fundamental Need of Humans > To identify and accept the interrelatedness of emotions > breathe normally and organic illness > eat and drink adequately > To facilitate the maintenance of effective verbal and > eliminate body wastes non-verbal communication > move and maintain desirable postures > To promote the development of productive > sleep and rest interpersonal relationships > select suitable clothes > To facilitate progress toward achievement of personal > keep the body clean & well groomed ; protect the spiritual goals integument > To create and/or maintain a therapeutic environment > maintain body temperature > To facilitate awareness of self as an individual with > avoid dangers in the environment and avoid injuring varying physical, emotional, and developmental needs others > To accept the optimum possible goals in the light of > communicate with others limitations, physical and emotional > worship according to one’s faith > To use community resources as an aid in resolving > work in such a way that there is a sense of problems arising from illness accomplishment > To understand the role of social problems as influencing > play or participate in various forms of recreation factors in the cause of illness > learn, discover, satisfy curiosity that leads to normal development and health and use the available health facilities Virginia Henderson: 14 Fundamental Needs Theory - “The nurse is temporarily the consciousness of the Dorothea Orem: Self-Care Deficit Theory unconscious, the love of life for the suicidal, the leg of Human Beings - distinguished from other living things; the amputee, the eyes of the newly blind, a means of have the potential for learning and developing; locomotion for the infant, knowledge and confidence integrated human functioning for the mother, the mouthpiece for those too weak or ~ Psychological, social, physical & interpersonal withdrawn to speak and so on.” Society/Environment - an external source of influence Person - a complete and independent being with in the internal interaction of a person’s different biological, sociological and spiritual components aspects Health - the ability to perform independently the 14 Health - “a state of physical, mental, and social basic needs well-being and not merely the absence of disease or ~ Health is basic to human functioning and that infirmity” promotion of health is more important than care of ~ “The physical, psychological, interpersonal and the sick. social aspects of health are inseparable in the Environmental - the effects of 7 components (light, individual.” temperature, air movement, atmospheric pressure, ~ concept of preventive health care Nursing - helping clients to establish or identify way to perform self-care activities  ~ nursing actions: geared towards independence of the Health Deviation - required in illness or injury or as a client result of medical tests or treatments to correct a ~ a distinguished human service condition ~ based on values The theory of nursing systems 3 related theories: 5 methods: - The theory of self-care 1. Acting for or doing for another - The theory of dependent care 2. Guiding and directing - The theory of self-care deficit 3. Providing physical or psychological support - The theory of nursing systems 4. Providing and maintaining an environment that supports personal development 5. Teaching Nursing AGENCY - complex property or attribute of people educated and trained as nurses that enable them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency Nursing SYSTEMS Self Care - activities that individuals carry out on their - Series and sequences of deliberate practical actions of own behalf nurses performed at times in coordination with the - deliberate, have pattern and sequence, developed actions of their patients from day-to-day living - to know and meet components of patient’s Self-care Agency - acquired ability or power to engage in therapeutic self-care demands self-care - to protect and regulate the exercise/devt. of Developmental Health deviation - the reasons for which patient’s self-care agency self-care is undertaken - express the intended or desired results Self-care requisites Universal > The maintenance of a sufficient intake of air > The maintenance of a sufficient intake of water > The maintenance of a sufficient intake of food > The provision of care associated with elimination > The maintenance of balance between activity and rest > The maintenance of a balance solitude and social interaction > The prevention of hazards to human life, human functioning, and human well-being > The promotion of human functioning and development Self-care requisites Developmental - actions to be undertaken that will provide developmental growth: > Provision of conditions that promote development > Engagement in self-development > Prevention of the effects of human conditions that threatens life  - When functioning in the care circle, the nurse applies knowledge of the natural and biological sciences. - The patient views the nurse as a potential comforter, one who provides care and comfort through the laying of hands. Core - Patient care is based on social sciences - Involves the use of therapeutic use of self, and is shared with other members of the team - By developing an interpersonal relationship with the Lydia Hall: Care, Core and Cure patient, the nurse is able to help the patient verbally - Nursing experience in clinical, education, research and express feelings regarding the disease process and its supervisor role effects. - Nursing Philosophy based on patient care - Patient is able to gain self-identity and further develop maturity. Nursing care can be delivered on three interlocking levels - Patient is able to make conscious decisions > Care Hands on bodily care > Core Using self in relationship to patient Cure > Cure Seeing the patient and family through medical - Care based on pathological and therapeutic sciences care - Nurse helps patient through the medical, surgical and - Patient care only from trained nurses rehabilitative prescriptions made by the physician - Defines nursing as care performed by a professional - The cure aspect is different from the care circle - Care focused on individuals, families and communities because many of the nurse’s actions take on a negative - Care focused on maintaining optimal health and quality of avoidance of pain rather than a positive quality quality life from birth to end of life of comforting. - Nurses' role changes from positive quality to negative quality. Interaction of all three aspects Emphasis placed on the importance of the total person. Importance placed on all three aspects functioning together All three aspects interact and change in size Size of the circles represents the degree to which the patient is progressing. Individual - Human who is 16 years older and past the acute stage of long-term illness is the focus of nursing care in Hall’s work. Care - Hall emphasizes the importance of an individual as - Nurturing component of care and is exclusive to nursing unique, capable of growth and learning, and requiring a - “mothering” (care and comfort of the person) total person approach. - Provides teaching and learning activities Health - Inferred to be a state of self-awareness with - Nurses goal is to give “care” and “comfort” to the conscious selection of behaviors. patient - Hall stresses the need to help the person explore - Nurse provides bodily care for the patient the meaning of his or her behavior to identify and - Patient may explore and share feelings with the nurse  overcome problems through developing self-identity Caring and maturity. - the essence of nursing Nursing - Identified as consisting of participation in the - responsiveness between the nurse and the person care, core, and cure aspects of patient care. - Purpose: to assist the person in gaining control and - Care is the sole function of nurses. Major purpose becoming knowledgeable, and in the process promote of care is to achieve an interpersonal relationship with health changes the individual. 3 Major Conceptual Elements Jean Watson: Theory of Transpersonal Caring > Carative Factors (evolving through “Clinical Caritas - PERSON, LIFE, SELF Practices) - Personhood = one’s soul possess a body - guide for the core of nursing - “a unity of mind/body/spirit/nature” - The carative factors honor the human dimension of - “fully functional integrated self “ nursing's work and the inner life world and subjective - “greater than and different from, the sum of his or experiences of the people we serve. her parts” > Caritas - “to cherish and to give special loving attention” Health > ”Caring factors became Clinical Caritas. - “Health is not only the absence of infirmity and disease but also a state of physical, mental and social well-being.” - WHO 3 other elements > a high level of overall physical, mental and social functioning > a general adaptive-maintenance level of daily functioning > the absence of illness (or the presence of efforts that leads its absence) Health- unity and harmony within the mind, body, and soul ILLNESS - not necessarily disease - Subjective turmoil or disharmony within the person’s inner self Environment/Society - Caring (and nursing) has existed in every society. - A caring attitude is transmitted by the culture of the profession as a unique way of coping with its environment. - Nurse’s role in the environment: attending to supportive, protective, and or corrective mental, physical, societal, and spiritual environments Nursing - Consists of knowledge, thought, values, philosophy, commitment, and action, with some degree of passion - Concerned with promoting health, preventing illness, > Transpersonal Caring Needs caring for the sick and restoring health - a special kind of human relationship dependent on :  - Nurse’s commitment on protecting and enhancing - goal: to foster equilibrium within the individual human dignity and a deeper/higher self - Nurse’s caring consciousness to preserve and honor Johnson’s Behavioral System Model the embodied spirit, thereby not reducing the - Each individual has patterned, purposeful, repetitive patient to a moral status of an object ways of acting that comprise a behavioral system specific to that individual. > Caring Occasion/Moment - has 7 subsystems - moment when the nurse and another person come - Actions or behaviors form an “organized and integrated together in such a way that an occasion for human functional unit.” caring is created - determine and limit the interaction between the - The one caring for and the one being cared for are person and his environment influenced by the choices and actions decided within - establish the relationship of the person to the the relationship. objects, events, and situations in his environment > Attachment or Affiliative Dorothy Johnson : Behavioral Systems Model - 1st response system to develop Person/Human Being - Most critical – basis for all social organization - A behavioral system with patterned, repetitive, and - functioning allows social inclusion, intimacy and the purposeful ways of behaving that link the person with the formation and maintenance of a strong social bond environment - Provides survival and security - 2 major systems: a. biological > Dependency = recognition of own weakness b. behavioral - Promotes helping behavior that calls for a nurturing Health response - an elusive, dynamic state that is influenced by - result: approval, attention or recognition & physical psychological, social, and biological factors assistance Environment - difficult to separate from affiliative - Factors that influence the behavioral system ~ Erik Erikson’s Psychosexual Theory (erogenous - All the events in the environment affect the individual’s zone’s satisfaction) behavior. > Ingestive Nursing - relates to the behavior surrounding the intake of - “an external force which acts to preserve the food organization and integration of the patient’s behavior at - related to biological system an optimal level by: - emphasis : meaning and structures of social events imposing temporary regulatory/ control mechanisms surrounding the occasion when food is eaten providing resources while the patient is experiencing > Eliminative = potty training stress (behavioral system imbalance)  - relates to behaviors surrounding the excretion of > Self-concept group identity adaptive mode waste products from body - focus: psychological & spiritual aspects > Sexual - the composite of beliefs and feelings held about - reflects behavior related to procreation oneself at a time - Begins with development of gender role identity - comprised of physical self & personal self - Includes broad range of sex-role behaviors - concerned with the need to know who one is and > Achievement how to act in society - provokes behavior that achieve to control > Role function mode environment - focus: roles the person occupies in the society - key areas: intellectual, physical, creative, mechanical - refers to the performance of duties based on & social skills given societal norms or expectations > Aggressive - basic need : social integrity - relates to behaviors concerned with protection & > Interdependence adaptive mode self preservation - interactions of people in society - defensive responses from the individual when life or - behavior pertaining to interdependent territory is threatened relationships of individuals and groups - does not include behaviors with purpose of injuring - basic need : feeling of security in relationships others Environment 3 Functional Requirements of Each Subsystem - encompasses all conditions, circumstances, and 1. must be protected from noxious influences with which influences surrounding and affecting the development the system cannot cope and behavior of humans as adaptive systems, with 2. must be nurtured thru the input of appropriate particular consideration of person and earth resources supplies from the environment - elements: represented by stimuli from within the human 3. must be stimulated for use to enhance growth & adaptive system and stimuli from around the system prevent stagnation Health - a state and a process of being and becoming an Callista Roy : Adaptation Model Sr. integrated and a whole person Person - holistic, adaptive system Nursing - an adaptive system with coping mechanisms manifested - a health care profession that focuses on human life by the adaptive modes: physiologic, self- concept, role processes and patterns function and interdependence - the science and practice that expands adaptive abilities - includes people as individuals or in groups and enhances person and environment ~ people are meant to adapt - Goal: to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity > Physiological-physical adaptive mode - Way humans interact with environment through physiological processes to meet the basic needs Adaptation - the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration > Stimulus - something that provokes a response, point of interaction for the human system and the environment Health - may be: Focal - “Health is a condition in which all parts and subparts Contextual (variables) are in harmony with the whole of the client.” Residual - the condition or degree of system stability and is > Coping Process viewed as a continuum – wellness OR illness - innate or acquired ways innate of interacting with - Health = Wellness the changing of environment - two types of systems at work: regulators and cognators > Regulator subsystem - a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels > Cognator subsystem - a major coping process involving 4 cognitive-emotive channels ✓perceptual and information processing ✓learning Environment ✓judgment - the totality of the internal and external forces which ✓emotion surround a person and with which they interact at any > Adaptive Responses given time - responses that promote integrity of the human ❑ internal environment system ❑ external environment > Ineffective Responses ❑created environment - responses that do not contribute to integrity of the Nursing human system - a unique profession that is concerned with all of the variables which influence the response a person might Betty Neuman : Systems Model have to a stressor Person - a layered multidimensional being - requires a holistic approach - Each layer consists of five person variables or - actions which assist individuals, families and groups to subsystems: ◦ Physical/Physiological maintain a maximum level of wellness ◦ Psychological - The primary concern of NURSING is to define the ◦ Socio-cultural appropriate action in situations that are stress related or ◦ Developmental in relation to possible reactions of the client or client ◦ Spiritual systems to stressors. - an open system that interacts with both internal and external environmental forces or stressors The Neuman Systems Model - in constant change - GOAL: to provide a holistic overview of the physiological, psychological, socio-cultural, and developmental aspects of human beings - 2 MAJOR COMPONENTS: stress and reaction to 5. Lines of Resistance stress - protect the basic structure and become activated when - an open system in which repeated cycles of input, environmental stressors invade the normal line of process, output and feedback constitute a dynamic defense organizational pattern 6. Reconstruction - the increase in energy that occurs in relation to the degree of reaction to the stressor - begins at any point following initiation of treatment for invasion of stressors 7. Stressors - Intrapersonal, Interpersonal & Extra personal 8. Prevention 1. Primary 2. Secondary 3. Tertiary Myra Levine : Conservation Model Human Being/Person - holistic being has a sense of identity and self worth Major Concepts of the Model - continually adapting in their interactions with their 1. Person Variables Environment - Psychological, Spiritual, Physiological, Sociocultural, & ~ you adapt according to your calling Developmental - constantly strives to preserve WHOLENESS and 2. Central Core INTEGRITY - made up of the basic survival factors Wholeness (HOLISM) - sound, organic, progressive - person’s system as an open system mutuality between diversified functions and parts within an entirety, the boundaries of which are open and fluent Integrity - oneness of the individual, emphasizing that they respond in an integrated, singular fashion to environmental challenges ~doing something right even when no one’s looking Environment - completes the wholeness of the individual - internal and external environment 3. Flexible Lines of Defense > Internal Environment - acts as a cushion - accordion-like as it expands away from or contracts closer to the normal line of defense - dynamic 4. Normal Line of Defense - represents system stability over time - considered to be the usual level of stability in the system - can change over time in response to coping or responding to the environment  2. Principle of conservation of structural integrity > External Environment - focusing attention on healing by maintaining or restoring structural and functional integrity through conservation in defense of wholeness 3. Principle of conservation of personal integrity - maintaining or restoring the individual patient's sense of identity, self-worth 4. Principle of conservation of social integrity - Health is socially determined. - acknowledging patients as social beings Health - the goal of conservation - the ability to function in a reasonably normal manner - “a wholeness and successful adaptation” Conservation - the product of adaptation - describes how complex systems continue to function in the face of severe challenges Madeleine Leininger : Culture Care: Diversity Model and Universality Theory What is transcultural nursing? – “A substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human Adaptation - a life process by which people maintain conditions, illness, or death in culturally meaningful their wholeness or integrity as they respond to ways.”(P.58) environmental challenges Basic Tenets of the Theory Nursing ▪ Care - human interaction ▪ Caring - goal : to promote adaptation and maintain wholeness ▪ Culture - Goal is accomplished through the use of the ▪ Cultural care conservation principles: energy, structure, personal, and ▪ Cultural care diversity social integrity. ▪ Nursing ▪ Worldview Four Principles of Conservation ▪ Cultural and social structure dimensions 1. Principle of conservation of energy ▪ Health - balancing the patient's energy output and energy ▪ Cultural care Presentation(maintenance) input to avoid excessive fatigue ▪ Cultural care accomodation ▪ Cultural care repatterning (restructuring): Assumption of Theory ▪ Care - central focus of nursing. ▪ Caring - essential for health and well-being, healing, growth. ▪ Culture care - broad, wholistic perspective to guide nursing care practices. ▪ Nursing’s central purpose is to serve human beings in health, illness, and dying. ▪ There are similarities and difference in culture care ▪ No cure without the giving and receiving care ▪ Awareness of folk remedies ▪ Influence of practices by cultural beliefs, practices, worldview, religious, among others Reason for the theory Leininger’s Mandala – Increase migration – Realizes patient of different cultures required different needs – -Cultural shock- at children guidance center – Doctoral work in cultural anthropology Goal of the theory – To provide cultural congruent care or care that fits the culture – Comprehensive approach in patient care – Consideration of Cultural dynamics Sunrise Enabler – Patient involvement in his or her care- culturally Method to assess culture and healthcare determinants congruent care Level 1: Worldview – Should focus on patient values, beliefs, and practices Level 2: Individual’s view Level 3: Health Culturally Competent Care Traditional beliefs, practices – Incorporate client beliefs and practices into the plan of Level 4; How patient should be cared care – Provides wholistic, cultural based care – Integrate appropriate cultural practices into patient care – Knowledgeable about culture differences. Cupping  – Nurses should ask about each client cultural practices and preferences when providing care. – Integrate the client’s cultural needs/beliefs, practices, into the plan of care when necessary. – Respect and recognize cultural diversity. – Be more knowledgeable and sensitive with cultural diversity – Failure to be congruent with client’s ,values, beliefs can lead to cultural conflict, stress, noncompliance, ethical moral concern. Reference theories: Case Study https://onlinedegrees.bradley.edu/blog/nursing-theories - Which nursing action is most appropriate? /#:~:text=Nursing%20theories%20offer%20frameworks – Which characteristics of culture should the nurse %20that,foundation%20to%20make%20clinical%20decisi consider when planning culturally competent care? ons. Application of Theory in practice https://nurseslabs.com/faye-g-abdellahs-21-nursing-prob – As nurses working on medical oncology, we encounter a lems-theory/ lot of patient with different culture, beliefs and practices. It is therefore important to be knowledgeable https://nurseslabs.com/dorothea-orems-self-care-theor about these beliefs and practices to be able to provide y/#h-dorothea-orem-s-self-care-deficit-theory individualized care. – An element in the ANA Code of Ethics Analysis of Theory using Barnum Internal Criticism > Clarity - it is easy to understand > Consistency - defined key concepts throughout the theory > Adequacy - It’s adequate, no gaps > Logically developed External Criticism > Reality convergence - represents real world > Appropriate in all healthcare settings > Complexity - very straight forward > Significance - it is very relevant to nursing > Discrimination - have precise and clear boundaries > Scope of theory - very broad Conclusion – Culture affects nurse- patient interactions.