TFN-1.pdf

EVOLUTION OF NURSING Theory Untilization Era (21st Centry) Significant highlights of events in the history of Nursing theory guides research, practice, education & administration....

EVOLUTION OF NURSING Theory Untilization Era (21st Centry) Significant highlights of events in the history of Nursing theory guides research, practice, education & administration. nursing theory: Discipline vs Profession Florence Nightingale (1859/1992) Discipline “Notes on Nursing” presents the first nursing theory that Branch of education, a department of learning focus on the manipulation of the environment for the or a domain of knowledge. patient’s benefit. Profession The Columbia School (The 1950’s) A specialized field of practice founded on theoretical The need to prepare the nurses at the graduate level for structure of the science or knowledge of the discipline administrative & faculty positions was recognized. and accompanying practice abilities. The Yale School (The 1960’s) Significance of Nursing Theory The focus of theoretical thinking in moved from 1. It recognized nursing as an academic discipline problem/need & functional role focus to the relationship and a profession. between the nurse & the patient. 2. It led to the development of a body of substantive knowledge to guide nursing practice. The 1970’s 3. It guides critical thinking in nursing practice. Many nursing theories were first presented. Most of these 4. It recognizes that theory informs practice theories have been revised since their original presentation. and practice informs theory. 5. It is the backbone of clinical care. The 1980’s 6. It is a tool for reasoning and decision Many nursing theories were revised based on the research making for quality nursing practice. findings that expanded them. 7. It has taken nursing to higher levels of education The 1990’s and practice. Research studies that tested & expanded nursing theories Nursing Science & Theory in the Early 20th Century were numerous Rationalism Eras of Nursing Knowledge ✓ Reason is the source of all knowledge. Curriculum Era (1900-1904s) ✓ Knowledge is gained through deductive method of It emphasized on courses included in nursing programs. reasoning. Goal is to develop specialized knowledge & higher education. ✓ Knowledge is certain. ✓ Uses theory-then-research strategy. Research Era (1950s-1970s) Empiricism This era emphasizes role of nurses and what to research. ✓ The senses are the source of all knowledge. Graduate Education Era (1950s-1970s) ✓ Knowledge is gained through inductive method of reasoning. Emphasis is caving out in an advanced role & basis for ✓ Knowledge can ever be probable. nursing practice. ✓ Uses research-then-theory strategy. Theory Era (1980-1990s) Evolution of Nursing Science throughout the time The emphasis is that there are many ways to think about was further studied and tested that led to the nursing. Emergent goal is that theories guide nursing contemporary practices of nursing. research & practice. Role of nurse became more defined. As nursing is evolving it brings into being the different theories that guides clinical practice. It uses evidence-based science to support the intervention performed in the care of patients. THEORETICAL FOUNDATIONS IN NURSING CONCEPT THEORY - Building blocks of theories which can either be an empirical or abstract data. - A vision or a beholding scene - An idea formulated by the mind, or an experience - Comes from the Greek word “theoria” perceived and observed such as justice, love, war, - Is an explanation of a set of related observations or and disease. events based upon proven hypotheses and verified - Are words or phrases that are used to represent the multiple times by detached groups of research. phenomenon observed or experienced. It is a mental - A set of concepts, definitions, relationships and construct. assumptions that projects a systematic view of - Describes a phenomenon or a group of phenomenon. phenomenon (Meleis, 2007). - An organized system of accepted knowledge that is Theoretical composed of concepts, propositions and Described according to how these concepts are assumptions intended to explain a set of fact, defined in the dictionary event or phenomena. Example: Temperature – It is the homeothermic - A creative and rigorous structuring of ideas that range of a person’s internal environment maintained projects a tentative, purposeful and systemic view of by the thermoregulatory system of the human body. phenomena. - An organized, coherent & systematic articulation of a Operational set of statements related to significant questions in a discipline that are communicated in a meaningful Based on how these concepts are used or will be whole discovered or invented for describing, used within the context of the phenomenon being predicting or prescribing events or relationships observed or experienced. Example: Temperature – It is the degree of temperature measured by the oral thermometer taken for one minute under the tongue. Abstract Indirectly observed or intangible. It is independent of time and place. Example: love, care and freedom Concrete Directly observed or tangible. Relate more to a specific time or place. Example: nurse, mother or pain PROPOSITION - Explains the relationships of different concepts. Example: Children who do not want to stay in the hospital because of their fear of injections. Definition - Composed of various descriptions which convey a COMPONENTS OF THEORY general meaning and reduces the vagueness in 1. Concepts understanding a set of concepts. 2. Proposition Example: Definition of Nursing formulated by Peplau 3. Definition Assumption 4. Assumption - A statement that specifies the relationship or 5. Hypothesis connection of factual concepts or phenomena. 6. Theoretical Model - Statements that the theorists hold as factual. 7. Phenomenon Example: All patients who are not able to take good care of themselves need nurses. HYPOTHESIS NURSING PARADIGM Educated guesses. Are patterns or models used to show a clear A tentative explanation for an observation, relationship among the existing theoretical works in phenomenon or scientific problem that can be tested nursing. by further investigation. A testable relationship statement. Theoretical Model or Framework A highly established set of concepts that are testable. Represents an equation that describes the path or explains the phenomenon being observed or experienced. It is typically accompanied by a pictorial representation of these variables and their Metaparadigm, came from the word “meta”, a Greek interrelationships. word which means “with” and “paradigm” which PHENOMENON means “pattern”. Occurrence or circumstance that is observed, something Nursing metaparadigm embodies the knowledge that impresses the observer as an extraordinary or a thing base, theory, philosophy, research, practice and that appears to and is constructed by the mind. educational experience and literature identified with Observable fact that can be perceived through the senses the profession. and explained. METAPARADIGM OF NURSING An empirical data that can be observed. It is concerned with how an individual person reacts using Person the human senses concerning their surrounding and The recipient of nursing care like individuals, families and assessing the different behaviors and factors that affect communities. Refers to direct receivers of care. such behaviors. In nursing, phenomena can be: Environment a) Clinical or environmental setting of nursing The external and internal aspects of life that influence the b) Disease process person. Pertains to the sum of everything outside the c) Client’s behavior person. d) Interventions e) Practices that are utilized in nursing theories and Health metaparadigm The holistic level of wellness that the person experiences. NURSING THEORY state of complete physical, mental, emotional, social and spiritual well-being and not necessarily the absence of Refers to the body of knowledge that is used to disease or infirmity.” support and maintain the practice of nursing. (Bautista, J.) NURSING Conceptualization of some aspects of nursing The interventions of the nurse rendering care in communicated for the purpose of describing, support of or in cooperation with the client. explaining, predicting or prescribing nursing care. As an ART, it involves the use of compassionate (Potter – Perry) caring, conscientious competence and A group of interrelated concepts that are developed confidence. It also involves the art of serving, from various studies of discipline and related nurturing, and caring for everyone who needs it. experiences. This aims to view the essence of nursing As a SCIENCE, it is governed by laws and theories care. that have been scientifically proven to be relevant An articulated and communicated conceptualization to the performance of nursing roles of invented or discovered reality in or pertaining to nursing for the purpose of describing, explaining, PHILOSOPHY predicting or prescribing nursing care. (Meleis, p41) Comes from the greek word “philisopia” which means love of knowledge or love of wisdom. The study of the most general and abstract features of the world and categories with which we think: mind, matter, reason, proof, truth, etc. CONCEPTUAL MODELS Are representations of an idea or body of A complete nursing theory is one that has context, knowledge based on the own understanding or content and process. (Barnum, 1994) perception of a person or researcher on a certain a) Context – resembles environment to which nursing topic, phenomena or theory. act takes place. Also called paradigms or frameworks. It is a set of b) Content – subject of the theory. concepts and statements that integrate the concepts c) Process – method by which nurses act in using nursing into a meaningful configuration. theory. They can be represented thru a diagram or in narrative form which shows how concepts are interrelated.  EDUCATION 1. Provides a general focus for curriculum design. 2. Guide curricular decision making. RESEARCH 1. Offer a framework for generating knowledge and new ideas. 2. Assist in discovering knowledge gaps in specific field of study. 3. Offer a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions. PRACTICE 1. Assist nurse to describe, explain and predict everyday experiences. 2. Serve to guide assessment, intervention and evaluation of nursing care. SCIENCE 3. Provide a rationale for collecting reliable and valid Comes from the Latin word “scientia” meaning data about the health status of clients, which are “knowledge”. essential for effective decision making and Knowledge attained through study or practice. implementation. A system of acquiring knowledge based on scientific 4. Help establish a criteria to measure the quality of method or research. nursing care. 5. Help build a common terminology to use in RESEARCH communicating with other health professionals. Ideas are developed and words defined. Use of systematic methods to study a phenomenon 6. Enhance autonomy of nursing by defining its own and create a general knowledge. (Powers and Knapp) independent functions. SCIENCE = RESEARCH + THEORY KNOWLEDGE INDUCTION Information, skills and experience acquired by a A type of reasoning that uses specific details to form person through various life experiences or a general conclusion. formal/informal learning. DEDUCTION The abstract or workable understanding of a subject or idea. A type of reasoning wherein general conclusions are What is known in a particular field or discipline or made based from specific concepts. study. EPISTEMOLOGY Facts and information or awareness or familiarity gained by experience of a fact or situation. Branch of inquiry that is concerned with the theory of knowledge or how knowledge came to be. COGNITIVE PROCESSES LAW A statement of fact that aims to explain, in brief and simple terms, an action or set of actions. It is generally accepted to be true and universal. CHARACTERISTIC OF THEORY 1. Theories can correlate concepts in such a way as to generate a different way of looking at a certain fact or phenomenon. 2. Theories must be logical in nature. 3. Theories should be simple but generally broad in nature. 4. Theories can be the source of hypothesis that can be tested for it to be elaborated. 1. PERCEPTION – achieving understanding of sensory 5. Theories contribute in enriching the general body of idea. knowledge through the studies implemented to 2. ASSOCIATION – combining two or more validate them. concepts/ideas to form a new concept, or for 6. Theories can be used by practitioners to direct and comparison. enhance their practice. 3. LEARNING – acquiring experience, skills, information 7. Theories must be consistent with other validated and values. theories, laws, and principles but will leave open 4. REASONING – mental process of seeking unanswered issues that need to be tested. conclusions through reason. 5. COMMUNICATION – transferring data from sender to receiver using different mediums or tools of communication TRADITIONAL Nursing practice which is passed down from generation to generation. “It has always been this way.” AUTHORITATIVE An idea by a person of authority which is perceived as true because of his or her expertise. SCIENTIFIC Type of knowledge which came from a scientific method through research. These new ideas are tested and measured systematically using objective criteria. STRUCTURE & ANALYSIS OF NURSING KNOWLEDGE Criteria in Evaluating a Theoretical Work according to Chinn & Kramer (1991) Philosophies of Nursing (Metatheory) CLARITY It set forth the general meaning of nursing and nursing phenomena through reasoning and the Semantics (study of the meaning of language, logical presentation of ideas. symbols and logic) and structure are considered They are broad and address general ideas about important. nursing. Because of their breadth, nursing Questions to be asked: philosophies contribute to the discipline by providing “Is the theory clearly stated?” direction, clarifying values and forming a foundation “How clear is the theory?” for theory development (Alligood, 2006). “Is it easily understood?” They are theoretical works that address one or more metaparadigm concepts and are philosophical in SIMPLICITY nature. They address questions such as the following Adequately comprehensive at a level of abstraction to (Alligood, 2005): offer direction however, it must have as few concepts Conceptual Models of Nursing (Grand Theories) as possible having simple relations to assist clarity. Questions to be asked: Also called paradigms or frameworks. - “How simple is the theory?” It is composed of abstract and general concepts and propositions that provide a frame of reference for GENERALITY members of the discipline. This frame of reference The scope of concepts and goals within the theory. determines how the world is viewed by the members Situation in which the theory is applicable should be of a discipline and guide the members as they boundless. The broader the scope, the greater its propose questions and make observations relevant to significance. the discipline (Fawcett, 1944). Questions to be asked: It is a set of concepts and statements that integrate - “How general is the theory?” the concepts into a meaningful configuration. - “How broad is the scope of the theory” Nursing Theories EMPIRICAL PRECISION It is a conceptualization of some aspect of reality The degree in which the defined concepts are (invented or discovered) that pertains to nursing. The observable in actual setting. It is in line with the conceptualization is articulated for the purpose of testability and ultimate use of the theory. describing, explaining, predicting or prescribing Questions to be asked: nursing care (Meleis, 2007, p.41). - “Is the theory testable?” They vary in scope and level of abstraction: - “How accessible is the theory? Middle-range theory ✓ Moderately abstract, comprehensive, DERIVABLE CONSEQUENCES organized within a limited scope and have a It should lead itself to research testing which would limited number of variables, which are result to additional knowledge that would guide testable in a direct manner practice. ✓ Have a stronger relationship with research It should give direction to research and practice, and practice. create new ideas, and ought to distinguish the focus ✓ Are specific to nursing practice and specify of nursing to other professions. It must develop and the area of practice, age range of the patient, guide practice. nursing action or intervention, and proposed outcome. Questions to be asked ✓ It focus on concepts of interest to nurses: pain, - “How important is the theory?” - “Does the theory have a significant empathy, grief, self-esteem, hope, comfort, contribution to nursing knowledge? dignity and quality of life. Observations in nursing practice, questions raised and conceptual models are formulated – leads to theory development and testing through research. Theory interacts with and guide nursing practice. Research validates and modifies theory, which then changes nursing practice. FOUR WAYS OF KNOWING ETHICAL Describes, analyzes, and clarifies moral obligation and values in nursing. The moral directions of Nursing. It requires knowledge of different philosophical positions what is good and right in making moral actions and decisions, particularly in the theoretical and clinical components of nursing. It includes all deliberate nursing actions involving and under the jurisdiction of ethics and professionalism (Kenny, 1996) The code of morals or code of ethics that leads the conduct of nurses is the main basis for Ethical Knowing. EMPIRICAL It is deeply rooted in the concept of human dignity, The scientific discipline of Nursing. service and respect for life. The science of nursing, the knowledge gained Lessening suffering, upholding and preserving through empirical research. health is one of the key elements why nursing is a It is the information source or base of knowing. core service in society. It emphasizes scientific research is important to Ethical Knowing involves the judgment of right & nursing knowledge. wrong in relation to intentions, reasons & attributes Clinical and conceptual knowledge are the keys to of individuals & situations nursing practice. PERSONAL Empirical knowing focuses on evidence-based research for effective and accurate nursing practice. Methods by which nurses approach their patients. It encompasses knowledge of the self in relation to Evidence-based Practice others and to self. It involves the entirety of the It involves accurate and thoughtful decision making Nurse-Patient Relationship. about health care delivery for clients It is focused on realizing, meeting and defining the This is based on the result of the most relevant and real, true self (self-awareness). supported evidence derived from research in It is the most difficult to master and to teach. response to preferences and expectations. It is the key to comprehending health in terms of It promotes quality care that has been demonstrated personal well-being. to be effective. It involves therapeutic use of self. It takes a lot of time to fully know the nature of AESTHETIC oneself in relation to the world around. Also known as Esthetics Knowing. It stresses that human beings are not in a fixed state Deals with the emphatic (primary form) aspect of but are constantly engaged in a dynamic state of Nursing. changes. (Kenny, 1996) The art and act of nursing and is gained through Gained through practicing nursing and interacting practice and critique. with patients and through thinking, listening and reflecting. Related to understanding what is of significance to particular patients such as feelings, attitudes, points Personal Knowledge is focused on realizing, meeting of view (Carper, 1978). & defining the real, true self. One nursing term defines this as self-awareness The manifestation of the creative and expressive styles of the nurse (Kenny, 1996) Knowing the distinctive characteristic of the individual instead of the typical, stereotype whole. Aesthetic knowing is using in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasizing use of creative and practical styles of care. FLORENCE NIGHTINGALE training; for otherwise the nurse does not know what to look for. NIGHTINGALE’S 13 CANONS 1. Ventilation and warmth- Develop a plan to keep the room airy and free of odor while METAPARADIGM IN NURSING maintaining the client’s body temperature. 2. Light- Develop and implement adequate Person light in the client’s room without placing the The one who is receiving care; a dynamic and client in direct light. complex being. 3. Cleanliness of rooms and walls-Keep the Refers to it as the patient. room free from dust, dirt, mildew, and It comprises physical, intellectual, emotional, dampness. social and spiritual components. 4. Health of houses- Assess the surrounding Nurses should perform tasks to and for the environment for pure air, pure water, patient as well as control the patient’s drainage, cleanliness, and light. environment (passive); but if can perform self- 5. Noise- Asses the noise level in the client’s care asks preference. room and surrounding area. 6. Bed and bedding- Keep the bed dry, wrinkle- Health free, and at the lowest height to ensure the Being well and using every power that the client’s comfort. person has to the fullest extent. 7. Personal cleanliness- Frequent assessment of DISEASE – a reparative process that nature the client’s skin is needed to maintain instituted from a want of attention. adequate skin moisture. 8. Variety- Attempt to stimulate variety in the Prevention and health promotion through room and with the client. environmental control is added to nursing 9. Chattering hopes and advices- Avoid talking patients from illness to health. without reason or giving advice that is ENVIRONMENT without a fact. 10. Taking food- Assess the diet of the client. Anything that can be manipulated to place a 11. What food- Attempt to ensure that the client patient in the best possible condition for nature always has some food or drink available that to act. he or she enjoys. Both physical and psychological. 12. Petty Management- Petty management Physical components: ventilation, warmth, ensures continuity of care. light, nutrition, medicine, stimulation, room 13. Observation of the Sick- Observations temperature and activity. should be factual and not merely opinions. Psychological components: avoiding chattering hopes and advices and providing variety. CONCEPTS AND DEFINITIONS NURSING Central to the theory is “Environmental Sanitation” It is a spiritual calling. Nurses were to assist It includes proper ventilation, adequate nature to repair the patient. lighting, cleanliness, adequate warmth, Types: “nursing proper” (nursing the sick), quiet and diet. Management is rarely “general nursing” (health promotion) and associated. “midwifery nursing” Viewed the manipulation of the physical Viewed nursing the “Science of Environmental environment as a major component of Management” nursing. Nurses are to use common sense, observation, These are the physical, social & and ingenuity to allow nature to effectively psychological aspects of the environment. repair the patient. It is believed that when one or more aspects “Observation may always be improved with of the environment are out of balance, the training --- will seldom be present without  client must use increased energy to counter BED & BEDDINGS the environment stress. - Keep beddings clean, neat & dry & position the patient for maximum CONCEPTS AND DEFINITIONS comfort. These stresses drain the client of energy needed DIET or NUTRITION & TAKING FOOD for healing. - Assess the meal schedule and its effects HEALTHY ENVIRONMENT or HEALTH OF on the patient, as well as dietary intake. HOUSES Variety of food served & on time. No - Pure air, pure water, efficient drainage, distraction while eating. cleanliness and light. CHATTERING HOPES & ADVICE PROPER VENTILATION or VENTILATION & - Should not give false hopes, it worries WARMING patients & become fatigue, Avoid - Keeping the air that patient breathes personal talk. Talk to the client as a pure as external air without necessarily person & stimulate their minds. chilling him. Normal body warmth OBSERVATION OF THE SICK through positioning, opening the - Obtaining accurate information about windows and regulate room the patient – it should be precise, specific temperature. & individualized. Assure that appropriate ADEQUATE LIGHT actions are taken. - Direct sunlight has “… quite a real and PETTY MANAGEMENT tangible effects on the human body … - Ways to assure that “what you do when who has not observed the purifying you are there, shall be done when you are effect of light, and especially direct not there.” The house & hospital needed to sunlight, upon the air of a room?” be well-managed. CLEANLINESS of ROOMS & WALLS - Specifically focused on the patient, the nurse and the environment. A well- ventilated environment is nothing if the environment itself is dirty. Recognized the presence of organic matter in a dirty environment which can contribute to the development of diseases. Taking a bath daily is emphasized. NOISE (Quiet) - Unnecessary noise can be harmful to the patient who is ill. Patients should never be waked intentionally or accidentally during the first part of sleep. PERSONAL CLEANLINESS - Function of the skin is important. Taking a bath daily is emphasized. Keep patient dry & clean. Advocated that personal cleanliness extended to the nurse & that every nurse ought to wash her hand very frequently during the day. VARIETY - The mind greatly affects the body. Change of color & form, advocates reading, writing & cleaning, needlework & other activities that could relieve sick of boredom. INTERACTIVE THEORIES 1953, Doctor of Education in Curriculum NURSE PATIENT-RELATIONSHIP OR Development. THERAPEUTIC RELATIONSHIP Career started late 1930’s, she worked - The professional interaction of the nurse to tirelessly to advance nursing education and her client that is aimed towards the practice. promotion of wellness and health of the latter. - The most essential part of nursing care Saved ANA from bankruptcy and moved the rendered to the health consumers. nursing profession towards scientific recognition. - Forming a strong relationship with the Member, Army Nurse Corps healthcare team is also essential. Worked in the following: - It enhances an atmosphere of - Neuropsychiatric Hospital in London, UK COOPERATION. - Bellevue & Chestnut Lodge Psychiatric - Processes involved: Roles and phases nurse Facilities and patient go through; communication - With renowned psychiatrists Freida techniques to achieve therapeutic results and Fromm-Riechman & Harry Stack Sullivan. elements needed in providing a lasting and a - “Interpersonal Relations in Nursing”, first maturing experience for the patient. book in 1952 HILDEGARD PEPLAU (1952) - Received numerous awards. METAPARADIGM IN NURSING “Theory of Interpersonal Relations” PERSON A man who is an organism that lives in an unstable balance of a given system. HEALTH It symbolizes movement of the personality and other ongoing human processes that directs the person towards creative, constructive, productive and community living. To achieve and maintain health, needs must be met. These are physiological demands and interpersonal conditions. ENVIRONMENT Was born in Reading, Pennsylvania on Sept. Forces outside the organism and in the 1, 1909. context of the socially approved way of living, Died March 7, 1999, at the age of 89, at from which vital human social processes are Sherman Oaks, California. derived such as norms, customs and beliefs. The Psychiatric Nurse of the Century. It also includes interpersonal process. 1931, graduated from Pottstown, NURSING Pennsylvania Hospital School of Nursing later A significant, therapeutic interpersonal worked as an OR supervisor at Pottstown process. It functions cooperatively with Hospital. human processes that present health as a 1943, Bachelor of Arts in Interpersonal possible goal for individuals. Psychology from Bennington College, Working with health care team, they offer Vermont. health services projecting health holistically. 1947, Master of Arts in Psychiatric Nursing Uses interpersonal model to explore and to from Teacher’s College, Columbia New York. identify the needs of the person seeking professional help.  - Patient earns independence over his care INTERPERSONAL RELATIONS THEORY as he gradually puts aside old goals and Described the nurse-patient relationship as a formulates new ones. four-phase phenomenon. - Even though the patient and the nurse It can be viewed as separate entities; end the relationship, it is very apparent however, it overlaps with each other over the that the experience leaves a lasting course of the interaction. impression on the patient since illness Each phase is unique and has distinguished and assuming a dependent role is a contributions on the outcome of the nurse- unique human experience. patient interaction. INTERPERSONAAL THERAPEUTIC PROCESS Important in the practice of Psychiatric Based on the theory proposed by Peplau and Nursing. particularly useful in helping psychiatric She also discussed four (4) psychological patients become receptive for therapy. experience that compel destructive or Referred as “PSYCHOLOGICAL constructive responses. These includes MOTHERING” needs, frustrations, conflicts and anxieties. Includes the following steps: Her work was greatly influenced by the works - Patient is accepted unconditionally as a of Sigmund Freud (Psychoanalytic Theory), participant in a relationship that satisfies Abraham Maslow (Hierarchy of Needs Model) his needs. and Harry Sullivan (Interpersonal Relationship - There is recognition of and response to Theory) the patient’s readiness for growth, as his PHASES IN NURSE-PATIENT RELATIONSHIP initiative. - Power in the relationships shifts to the ORIENTATION PHASE patient, as the patient can delay - Initial interaction between the nurse and gratification and to invest in goal the patient who has a felt need and achievement. expresses the desire for professional NURSING ROLES assistance. STRANGER ROLE - Nurse assists in recognizing and - During the initial contact, nurse and understanding the “patient” experience. patient are strangers to one another. IDENTIFICATION PHASE - As nurse attempts to know patient better, - The patient identifies with those who can he is treated with outmost courtesy, which help him/ her. includes acceptance of the patient as a - The nurse permits exploration of feelings person and due respect to his to aid the patient in undergoing illness as individuality. an experience that reorients feelings and - This coincides with the Identification strengthens positive forces in the Phase. personality and provides needed RESOURCE PERSON satisfaction. - Patient assumes a dependent role. EXPLOITATION PHASE - Nurse provides specific answers to these - Patient derives the full value of the queries - health information, advice and relationship as he moves from dependent simple explanation regarding care. to independent role. - Nurse should appropriately change her - New goals are projected by the nurse, buy responses to the patient’s level of the power is shifted to the patient as understanding. these goals would be achieved through personal or self-effort. TEACHING ROLE RESOLUTION PHASE  - As interaction progresses, nurse gives importance for self-care and in helping patient understand the therapeutic plan. - Nurse should determine how the patient understands the subject at hand. - Nurse must develop her discussion around the interest of the patient and his ability of using the information provided. LEADERSHIP ROLE - Nurse acts on behalf of the patient’s best interest and the same time enable him to make decisions over his own care. - This is achieved through cooperation and active participation. SURROGATE ROLE - The patient’s dependency for his care gives the nurse a surrogate (temporary care giver) role. - Helping client clarify domains of dependence, interdependence and independence and acts on clients’ behalf as advocate. COUNSELING ROLE - It strengthens the nurse patient relationship as nurse becomes a listening friend, an understanding family member and someone who gives sound and emphatic advises. - The core of the interpersonal technique is for the patient to remember and to understand the experience and how could it be integrated into his daily life. VIRGINA HENDERSON (1955) Care given by the nurse must empower the patient to gain independence, to be “complete” “Nursing Need Theory” or “whole”. Both knowledgeable in both biological and social sciences and must have the ability to assess basic human needs. In the Nature of Nursing “that the nurse is and should be legally, an independent practitioner and able to make independent judgments as long as s/he is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physicians function.” “Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.” In the Nature of Nursing Nurse role is,” to get “First Lady of Nursing” inside the patient’s skin and supplement his “First Truly International Nurse” strength will or knowledge according to his Renowned researcher, teacher and scholar. needs.” “The Nightingale of Modern Nursing” “Modern-Day Mother of Nursing” 14 BASIC HUMAN NEEDS The 20th Century Florence Nightingale” She conceptualized the 14 Fundamental Needs of METAPARADIGM IN NURSING humans upon which nursing care is based. Her philosophy is greatly influenced by the PERSON psychologist Thorndike and nurse theorist Ida Jean Orlando’s conceptualization of deliberate Referred to a person a patient. nursing action. Her prior experience in the field of An individual who requires assistance to achieve rehabilitation nursing helped her refine her health and independence or a peaceful death. models of nursing as a profession with The mind and body of the person as autonomous functions. inseparable. She defined nursing in terms of the function of Viewed as a holistic being which is composed of the nurse: “the unique function of the nurse is to physical, psychological, sociological and spiritual assist the individual sick or well, in the dimensions. performance of those activities contributing to HEALTH health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary A quality of life and is very basic for a person to strength or will or knowledge and to do this in function fully, which is outlined in the 14 such a way as to help him gain independence as components. rapidly as possible.” (Harmer & Henderson, 1955) As a vital need it requires independence and Emphasized the need to view the patient and his interdependence. family as a single unit (to meet his need for Nurses need to stress promotion of health and support system – emotional needs). prevention and cure of disease. Postulated that nurses’ functions in relation Good health is considered a challenge and is with the patient, physician and other members affected by age, cultural background, physical and of the health team and each type of relationship intellectual capacities and emotional balance. gives nurses specific responsibilities and roles. ENVIRONMENT Settings in which an individual learns unique pattern for living. All external conditions and influences that affect life and development. If they get sick, nurses help patient manage the surroundings to protect him from harm and mechanical injury. Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided NURSING Nurses function independently from the physician, but they promote the treatment plan prescribed by the physician. Coordinate with the therapeutic plan developed by the health care team. Helps both the sick and the well individual. This includes people from all walks of life, from well to sick, from newborn to dying. CATEGORIZATION Physiological – first 9 components. Psychological aspects of communicating and learning – 10th and 14th components. Spiritual and moral aspects - 11th component Sociologically oriented to occupation and recreation – 12th & 13th component. NURSE-PATIENT RELATIONSHIP Comprising 3 Levels: Substitute for the patient - doing for the patient (substitutive). Helper to the patient - helping the patient or assisting patient meet his needs (supplementary). Partner with the patient - working with the patient (complementary). NURSE-PHYSICIAN RELATIONSHIP Nurse function independently from physicians. As partners, nurses implement plan of care in such a way that will promote the physician’s plan of care. Nurses do not follow doctor’s orders; rather they follow in a philosophy which allows physicians to give orders to patients or other healthcare team members. Many nursing roles overlap with that those of the physicians. NURSE as a MEMBER of the HEALTH TEAM To work harmoniously, every member must work interdependently. Nurses works and contributes to carrying out the total program of care. Working interdependently does not include taking other’s roles and responsibilities. JOYCE TRAVELBEE “Human-to-Human Relationship Model of Nursing” Human-to-Human Relationship Model Also called “Interpersonal Aspects of Nursing Theory” Her theory was greatly influenced by her experiences in nursing education and practice in Catholic charity institutions – whereby she concluded care rendered lacked compassion. Thought nursing care needed a “humanistic revolution” – a return to focus on the caring function towards the ill person. In her model, the nurse and patient undergoes the following series of interactional phases: (a) Original Encounter (b) Emerging identities A psychiatric nurse, educator and writer. Born in (c) Empathy 1926. (d) Sympathy 1956, completed her Bachelor of Science Degree in (e) Rapport Louisiana State University. ORIGINAL ENCOUNTER 1959, Master of Science Degree in Nursing, Yale - First impression by the nurse of the sick person University. and vice-versa. 1973, pursued doctoral degree in Florida but not - Nurse and patient see each other in able to finish for she died later that year (age 47). stereotyped or traditional roles. 1970, Project Director at Hotel Dieu School of EMERGING IDENTITIES Nursing, New Orleans. - Nurse and patient perceiving each other as Director of Graduate Education, Louisiana State unique individuals. University School of Nursing - The link of relationship begins to form. EMPHATY METAPARADIGM IN NURSING - Similarities of experience and the desire to understand another person. PERSON - The ability to share in the person’s experience. Defined as a human being. - Results with the ability to expect the behavior Both nurse and patient are human beings. of the individual with whom he or she Human being is a unique, irreplaceable individual empathized. who is in the continuous process of becoming, SYMPATHY evolving and changing. - Nurse wants to lessen the cause of the HEALTH patient’s suffering. Measured subjectively and objectively. - “When one sympathizes, one is involved but Subjective health status is an individually defined not incapacitated by the involvement”. state of wellbeing in accord with self-appraisal or - It goes beyond empathy. physical, emotional, spiritual status. RAPPORT Objective health, an absence of discernable - Nursing interventions that lessens the patient’s disease, disability or defect as measured by suffering. Nurse and the sick person are physical examinations, laboratory tests, assessment relating as human being to human being. by spiritual director or psychological counselor. - There’s trust and confidence in the nurse. ENVIRONMENT - Nurse is able to establish rapport because she Human conditions and life experiences possesses the necessary knowledge and skills encountered by all men as sufferings, hope, pain required to assist ill persons and able to and illness. These are associated to the perceive, respond to, and appreciate the environment. uniqueness of the ill human being. NURSING COMMUNICATION An interpersonal process whereby the - The vehicle through which nurse-patient professional nurse practitioner assists an individual, relationships are established. family or community to prevent or cope with the RELATIONSHIP experience of illness and suffering and, if - A mutually significant meaningful relationship necessary, to find meaning in these experiences. through which the nursing needs of the individual or family member are met. It is an interpersonal process because it is an experience that occurs between the nurse and an individual or group of individuals. BETTY NEUMAN CLIENT VARIABLES – one or combination of physiological, sociocultural, developmental and NEUMAN SYSTEM MODEL spiritual. “Health Care Systems Model” ✓ Physiological – body structure and function ✓ Psychological – mental processes in interaction Born in 1924 on a farm near Lowell, Ohio. with environment Growing in a rural area, she developed love for the land ✓ Sociocultural – effects of social condition and compassion for people in need. ✓ Developmental – age-related processes 1947, received her RN Diploma from Peoples Hospital ✓ Spiritual – beliefs and influences related to School of Nursing, Akron, Ohio. Moved to California spirituality and gained experience as a hospital staff and head CORE – basic survival factors or energy resources of nurse; school nurse and industrial nurse; and as a the client. clinical instructor in medical-surgical, critical care and LINES OF RESISTANCE – act when the normal line of communicable disease nursing. defense is invaded by too much stressor, producing 1957, attended the University of California at Los alterations in the client’s health. Angeles (UCLA) with double major in psychology and NORMAL LINE OF DEFENSE – to achieve stability of public health. Received her BS in Nursing from UCLA. the system, this line must act in coordination with 1966, received master’s degree in Mental Health, Public the normal wellness state. Health Consultation from UCLA. FLEXIBLE LINE OF DEFENSE – serves as boundary for 1985, received her Doctoral Degree in Clinical the normal line of defense to adjust to situations Psychology from Pacific Western University. that threaten the imbalance within the client’s 1970, the conceptual model was designed in response stability. to request from UCLA graduate students who wanted a course emphasizing breadth rather than depth in understanding the variables in nursing. SYSTEMS THEORY Emphasizes on the components and dynamic interaction of the elements that comprise the nature of Nursing. Goal-centered phenomenon that relies on the interplay of and continuous change of the parts of the system. PARTS OF THE SYSTEM ✓ INPUT – data that go through and are integrated in the system. ✓ OUTPUT – end product of the input that is HEALTH processed in the system. ✓ FEEDBACK – the re-evaluated and changed Dynamic in nature. output that goes as input back into the system. Equated with stability of normal line of defense. A person’s health depends upon which state of the SYSTEMS MODEL IN NURSING PRACTICE health continuum they are in line with, whether in the Incorporated the concept of the whole person and an state of wellness or illness. open system approach. WELLNESS – stable condition when the parts of the Aims to develop the person in a state of wellness to client system interact in harmony with the whole function optimally. system. Role of the nurse is to help individual adapt with ILLNESS – needs are not satisfied. environmental stimuli back to wellness. Components – stress and reaction to stress. METAPARADIGMS IN NURSING PERSON An individual, family or community or the society. A person is an OPEN SYSTEM that works together with other parts of its body as it interact with the environment. A dynamic composite of the interrelationship of five variables: (1) physiological, (2) psychological, (3) sociocultural, (4) developmental, and (5) spiritual has protective mechanisms for the basic structure, and maintains client’s system stability: (1) flexible line of defense, (2) normal line of defense, and (3) lines of resistance ENVIRONMENT INTRAPERSONAL – emotions and feelings, hypertension, low blood glucose INTERPERSONAL – role expectations, perception of care given EXTRAPERSONAL – job and financial pressure NEGENTROPY - towards stability or wellness. EGENTROPY OR ENTROPY – set towards disorganization of system > illness CONCET AND DEFINITIONS STRESSORS - forces that produce tensions, alterations or potential problems causing instability within the client’s system. LEVELS OF PREVENTION REACTION PRIMARY PREVENTION – maintain optimum level of - outcomes or produced results of certain stressors functioning (health promotion & disease prevention) and actions of the lines of resistance of a client. SECONDARY PREVENTION – early detection of disease NURSING and prompt treatment; aims to avoid further decline of functioning. A unique profession that requires holistic approach – TERTIARY PREVENTION – prevent the regression and considers all factors affecting a client’s health. recurrence of illness, rehabilitation Aims to promote optimal wellness to its client through retention, attainment, or maintenance of the stability of client’s system. Nurse helps the different levels of clientele: individual, family, and groups in achieving and maintaining an optimal wellness through intervention with the goal of reducing stress factors and its adverse effects to the optimal functioning of an individual in any given situation. Nursing consists of intervention modalities of prevention which can be: (1) primary, (2) secondary, (3) tertiary. CONCEPTS AND DEFINITIONS PREVENTION – used to attain balance within the continuum of health. ✓ PRIMARY PREVENTION – focuses on foreseeing the result of an act or situation and preventing its unnecessary effects as possible. ✓ SECONDARY PREVENTION – helping alleviate the actual existing effects of an action that altered the balance of health of a person. ✓ TERTIARY PREVENTION – actual treatments or adjustments to facilitate the strengthening of a person after being exposed to a certain disease or illness. RECONSTITUTION – adjustment state from the degree of reaction. Going back to the actual state of health before illness. Once an individual is exposed to stress, the flexible line of defense will be “alarmed” to protect the normal (solid) line of defense to keep the system free from stressor reactions. However, if this individual is continuously exposed to stress and if the flexible line of defense is unable anymore to cope up with the stressors, the normal line of defense will be altered. If this happens, there will be a threat to the wall that protects the basic structure of the individual and therefore causing instability of the systems and illness develops. DOROTHY JOHNSON (1960, 1980) NURSING “Behavioral System Model” An external force that acts to preserve the organization of the patient’s behavior by means of imposing regulatory mechanisms or by providing resources while the patient is under stress. BEHAVIORAL SYSTEM MODEL Proposed that nursing care facilitated the client’s maintenance of a state of equilibrium. Proposed that clients were “stressed” by a stimulus of either an internal or external nature. These stressful stimuli created such disturbances or “tensions”, in a patient that a state of disequilibrium occurred. To return to a state of equilibrium, 2 areas were identified: Born on August 21, 1919, in Savannah Georgia. a) reduce stressful stimuli 1942, received her BSN degree from Vanderbilt b) support natural & adaptive processes University, Nashville, Tennessee. Her theory springs from Nightingale’s belief that 1948, finished her MPH from Harvard University, nursing’s goal is to help the individuals prevent or Boston. recover from disease or injury. 1949 until her retirement in 1978, she was n assistant That the science and art of nursing should focus on professor of Pediatric Nursing, an associate professor the patient as an individual and not on the specific of Nursing and a Professor of Nursing at the disease entity. University of California in Los Angeles. She had an influence on nursing through her publications since the 1950s. And she stressed the importance of research-based knowledge about the effects of nursing care on clients. 1968, first proposed her model of nursing care as fostering of “the efficient and effective behavioral functioning in the patient to prevent illness.” Also stated that Nursing was “concerned with man as an integrated whole and this is the specific knowledge of order we require. 1980, she published her conceptualization of “behavioral system model for nursing”, her first work which explicates her definitions of the behavioral system model. METAPARADIGM IN NURSING PERSON It has two major systems: the biological and the behavioral system. It is a behavioral system with patterned repetitive, and purposeful ways of behaving that link the person to his environment. HEALTH Is an elusive state that is affected by social, psychological, biological and physiological factors. Balance stability of the subsystems. ENVIRONMENT Consists of all factors that are not part of the individual’s behavioral system but influence the system. Factors vary from culture to culture however outcomes are the same. ASSUMPTIONS OF BEHAVIORAL SYSTSEM MODEL 7. ACHIEVEMENT SUBSYSTEM - Behavior associated with mastery of oneself 1. “From the form the behavior takes and the and one’s environment for the purpose of consequences it achieves can be inferred what “drive” producing a desired effect. has been stimulated or what “goal” is being sought. - Includes problem solving activity 2. Each individual has a “predisposition to act with - Knowledge of personal strengths and reference to the goal, in certain ways rather that the weaknesses. other ways.” This predisposition is called as “set”. 8. RESTORATIVE 3. Each subsystem has a repertoire of choices or “scope - concerned with rest, sleep, comfort/freedom of action”. from pain. 4. It produces “observable outcome” that is the individual’s behavior. 3 FUNCTIONAL REQUIREMENTS OF EACH SUBSYSTEMS 1. It must be “protected” from noxious influences with which system cannot cope. 2. It must be “nurtured” through the input of appropriate supplies from the environment. 3. It must be “stimulated” for use to enhance growth and prevent stagnation. CONCEPTS AND DEFINITIONS Behavior – is the output of intraorganismic structures 8th Subsystem: and processes as they coordinated and articulated by Restorative – concerned with rest, sleep, responsive to changes in sensory stimulation. comfort/freedom from pain Systems – is a whole that functions as a whole by 7 SUBSYSTEMS virtue of the interdependence of its parts 1. AFFILIATIVE or ATTACHMENT SUBSYSTEMS characterized by organization, interaction, - Behavior associated with the development and interdependency and integration. maintenance of interpersonal relationship with Behavioral system – encompasses the patterned, parents, peers, authority figures. repetitive and purposeful ways of behaving. The - Establish a sense of relatedness and belonging system is flexible enough to allow influences that with others including attachment behavior, affect it. interpersonal relationships and communication Subsystems – are mini systems with its own goal and skills. function that can be maintained as long as its - Goal attainment relationship to the other subsystems or the 2. DEPENDENCY SUBSYSTEMS environment is not changed or disturbed. - Behavior associated with obtaining assistance Equilibrium – is a stabilized but more or less from others in the environment for completing transitory, resting state where the person is in tasks and emotional support. harmony with himself and with his environment. - Includes seeking of attention, approval, Tension – is the state of being stretched or strained recognition, basic self-care skills and and can be viewed as an end product of a disturbance emotional security. in equilibrium. 3. INGESTIVE SUBSYSTEM Stressor – is a stimuli, either internal or external, that - Behaviors associated with the intake of needed produce tension and result in a degree of instability. resources from the external environments, including food, fluid, information, knowledge and objects for the propose of establishing an effective relationship with the environment. 4. ELIMINATIVE SUBSYSTEM - Behavior associated with the release of physical waste products from the body. - Express feelings 5. SEXUAL SUBSYSTEMS - Behavior associated with a specific gender- based identity for the purpose of ensuring pleasure/procreation, and knowledge and behavior being congruent with biological sex. 6. AGGRESSIVE PROTECTIVE SUBSYSTEM - Behavior associated with real or potential threat in the environment for the purpose of ensuring survival. - Protection of self through direct or indirect acts. - Identification of potential danger.