CMPA 411 LECTURE PDF

COMPETENCY APPRAISAL 1 - LECTURE WEEK 1-2 | Nursing Theory | By: Lei & Iris Nursing Theory - Additionally, nursing theories identify a clear - Nursing theories offer frameworks that give nursing perspective separate from tha...

COMPETENCY APPRAISAL 1 - LECTURE WEEK 1-2 | Nursing Theory | By: Lei & Iris Nursing Theory - Additionally, nursing theories identify a clear - Nursing theories offer frameworks that give nursing perspective separate from that of shape to the scope of nursing care and physicians and other clinicians. practice. - This helps facilitate improved - These consist of concepts such as interdisciplinary collaboration. collaboration or respect, descriptions of ➔ When we speak of nursing theory, relationships and definitions. the very important concept that you - Nursing theories guide nurses in their practice have to understand is the four nursing and give them a foundation to make clinical metaparadigm. Why? Because this decisions. metaparadigm will help us - They also offer a systematic approach to determine/study the different works of developing key practices that promote quality our nursing theorists. patient care. - To get a stronger grasp of what nursing Nursing Metaparadigm theories are, explore how they impact a - Metaparadigms consist of concepts that nurse’s daily work, set nursing apart from other address the primary issues in a discipline, health care disciplines and shape nursing mapping out the discipline's parameters, a strategies. nursing metaparadigm contains four essential How Nursing Theories Impact What Nurses Do? components on which nursing practice is - Nursing theories impact what nurses do daily. based. - By defining characteristics of the nurse-patient - Within these concepts exist all issues central relationship, nursing theories shape how to nursing practice. nurses interact with patients. They help - These components interact and serve as a nurses: foundation for delivering holistic care. Identify who needs nursing care - They steer nurses toward viewing patients as Articulate what they do for patients whole and autonomous persons. and why they do it. - They address a patient’s health and Determine what information to gather environment, along with a nurse's Understand and assess health responsibilities. situations. The 4 Components are: Explain and anticipate patient Person responses ○ Recipient of nursing care Pinpoint actual and possible issues ○ Focuses on the multiple needs of that need consideration those receiving nursing care including Map out objectives and expected individual patients, families, and outcomes communities. Determine which interventions to ○ This area encourages nurses to look deliver at patients as emotional, spiritual, Establish best practices social beings who also have physical Select productive areas for research aspects. How Nursing Theories Separate Nursing From Nursing Other Health Care Disciplines? ○ Action of the person administering - Nursing theories define the unique position of care nursing in health care. ○ Addresses what nurses do and what - By exploring the roles of nurses, defining they know. nursing concepts, and building scholarship in ○ It consists of nursing actions and the discipline, nursing theories distinguish interventions, as well as a nurse's nursing from other health care disciplines and skills, both technical and soft. clarify the distinctive contributions of nursing. ○ Successful nursing, after all, requires more than the ability to order the right 1 | PRELIMS CMPA 411 | LECTURE  diagnostic test. It also calls for - Nursing theory is supported by four interrelated compassion and teamwork. concepts that make up the metaparadigm. ○ Additionally, the nursing These components categorize the factors that component considers a: help nurse professionals shape and define the Work experience nurse-patient relationship. Knowledge of theory and best practices Theorist and their Theories Application of professional Florence Nightingale knowledge in hands-on Patron of our nursing profession indirect patient care Foundation of Nightingale’s theory: Environment Environment ○ Internal and external conditions ○ All the external conditions and forces surrounding the patient that influence the life and development ○ Consider a patient’s surroundings, of an organism recognizing they can significantly According to her: external influences and affect well-being. conditions can prevent, suppress, or contribute ○ A patient’s surroundings can include to disease or health physical space, as well as social and Goal: To help the patient retain his own vitality emotional environments. by meeting his basic needs through control of ○ A patient’s interactions with family, the environment friends and health professionals can Physical Environment affect health. For example, negative Psychological Environment exchanges with a nurse or relatives Social Environment can stress a patient, whereas positive 4 Major Concepts of Nightingale’s Theory: exchanges often improve a patient’s Nursing – as the tool to render care state of mind. Society/Environment ○ The environment component may Human or Individual also include the following: Health/Disease Culture - a patient’s belief Metaparadigm: greatly affects how the person Person: Patient (already a sick individual). can alleviate the discomfort Affected by the environment. and how to promote their ○ Multidimensional, composed of optimum health biological, psychological, social and Economic circumstances spiritual components Technology ○ Has a vital reparative power to deal Geographic location with disease. Recovery is within the Health person’s power as long as a safe ○ Patient’s level of wellness or environment for recuperation exists. well-being Nursing: Activities that promote health which ○ Refers to a patient’s level of wellness occur in any caregiving situation. They can be when receiving nursing care. done by anyone. ○ However, the component also ○ Nursing is different from medicine and considers quality health across the goal of nursing is to place the lifespan, as health fluctuates and past patient in the best possible condition health issues that can crop up at for nature to act. different stages and present problems. Environment: Poor or difficult environments ○ The health component extends led to poor health and disease beyond physical wellness. ○ This could be altered to improve ○ It also includes a person’s emotional, conditions so that the natural laws mental, spiritual, and social health, as would allow healing to occur. well as genetic make up – all factors Health/Disease: These are the focus of nurse, nurses should consider when selecting who helps a person through the healing treatment plans. process 2 | PRELIMS CMPA 411 | LECTURE  ○ Health is not only to be well, but Nursing: Peplau considers nursing to be a maintaining well-being by using a “significant, therapeutic, interpersonal person’s power to the fullest extent. It process.” is maintained by controlling the ○ She defines it as a “human environmental factors to prevent relationship between an individual who disease. is sick, or in need of health services, ○ Disease is considered as dys-ease or and a nurse specially educated to the absence of comfort. recognize and to respond to the need Application of Nightingale’s Work in the Nursing for help.” Process Society/Environment: Although Peplau does Assessment: Nancy Smith, a 10 yrs old was not directly address society/environment, she injured in an accident related to farm does encourage the nurse to consider the machinery. She had a head injury then she patient’s culture and mores when the patient was admitted to PICU. Because of the PICU adjusts to the hospital routine. environment, she had interrupted sleep and Health: defined as “a word symbol that implies she became increasingly confused. Her leg forward movement of personality and other has become infected. ongoing human processes in the direction of Analysis of data: includes data gap creative, constructive, productive, personal, Nursing Diagnosis: Impaired sleep pattern and community living.” related to environmental light and noise and Four Phases of the therapeutic nurse-patient separation from family. relationship: Planning and Implementation: nursing 1. Orientation Phase actions focused on changing the environment The nurse’s orientation phase involves to support more normal sleep patterns, that is, engaging the client in treatment, being awake during the day and sleeping at providing explanations and night. information, and answering questions. Evaluation: After 2 nights of uninterrupted ○ Problem defining phase sleep, normal sounds, and parental ○ It starts when the client meets encouragement, Nancy should demonstrate the nurse as a stranger. increased orientation to place being able to ○ Defining the problem and identify that she is in the hospital. deciding the type of service needed Hildegard Peplau ○ Client seeks assistance, Theory: Interpersonal Relations Theory conveys needs, asks interpersonal process of therapeutic questions, shares interactions between an individual who is sick preconceptions and or in need of health services and a nurse expectations of past especially educated to recognize, respond to experiences. the need for help.” It is a “maturing force and ○ Nurse responds, explains an educative instrument” involving an roles to the client, identifies interaction between two or more individuals problems, and uses available with a common goal. resources and services. In nursing, this common goal provides the ➔ Usually what’s very important in this phase is incentive for the therapeutic process in which the establishment of rapport. If the nurse the nurse and patient respect each other as and patient were able to establish rapport the individuals, both of them learning and growing trust is developed and it would lead to a much due to the interaction. An individual learns higher percentage in the treatment. when she or he selects stimuli in the environment and then reacts to these stimuli. ‘ Metaparadigm Man/Person: An organism that “strives in its own way to reduce tension generated by needs.” The client is an individual with a felt need. 3 | PRELIMS CMPA 411 | LECTURE  ○ Patient may fluctuate on independence. ○ Nurse must be aware of the various phases of communication. ○ Nurse aids the patient in exploiting all avenues of help, and progress is made towards the final step. 4. Resolution Phase The client no longer needs professional services and gives up dependent behavior. The relationship 2. Identification Phase ends. Begins when the client works ○ Termination of professional interdependently with the nurse, relationship expresses feelings, and begins to feel ○ The patient’s needs have stronger. already been met by the ○ Selection of appropriate collaborative effect of patient professional assistance and nurse. ○ Patient begins to have a ○ Now they need to terminate feeling of belonging and a their therapeutic relationship capability of dealing with the and dissolve the links between problem, which decreases the them. feeling of helplessness and ○ Sometimes may be difficult for hopelessness. both as psychological ➔ The most important thing that we have to dependence persists. emphasize to the patient is the active ○ The patient drifts away and involvement and participation. The problem breaks the nurse’s bond, and should be identified by the patient itself. After a healthier emotional balance that, they can come up with a resolution or is demonstrated, and both intervention that will help them resolve their become mature individuals problem. 3. Exploitation Phase Interpersonal Theory and Nursing Process The client makes full use of the Assessment: Orientation services offered. Continuous data Non-continuous data ○ Use of professional assistance collection and analysis collection for problem-solving May not be a felt need Felt need alternatives Definite needs ○ Advantages of services are used based on the needs and Nursing Diagnosis & Identification Planning: Interdependent goal interests of the patients. Mutually set goals setting ○ The individual feels like an integral part of the helping Implementation: Exploitation environment. Plans initiated towards Patient actively ○ They may make minor achievement of mutually seeking and drawing requests or attention-getting set goals help May be accomplished Patient-initiated techniques. by a patient, nurse, or ○ The principles of interview significant other. techniques must be used to explore, understand and Evaluation: Resolution adequately deal with the Based on mutually Occurs after other underlying problem. expected behaviors phases are completed May led to termination successfully 4 | PRELIMS CMPA 411 | LECTURE  4. Move and maintain desirable postures and initiation of new Leads to termination plans. 5. Sleep and rest 6. Select suitable clothes – dress and undress 7. Maintain body temperature within normal Strengths range by adjusting clothing and modifying the - Peplau’s theory helped later nursing theorists environment and clinicians develop more therapeutic 8. Keep the body clean and well groomed and interventions regarding the roles that show the protect the integument dynamic character typical in clinical nursing. 9. Avoid dangers in the environment and avoid - Its phases provide simplicity regarding the injuring others nurse-patient relationship’s natural Sociological: progression, which leads to adaptability in any 10. Communicate with others in expressing nurse-patient interaction, thus providing emotions, needs, fear and opinions generalizability. 11. Worship according to one’s faith Weaknesses 12. Work in such a way that there is a sense of - Though Peplau stressed the nurse-client accomplishment relationship as the foundation of nursing 13. Play or participate in various forms or practice, health promotion and maintenance recreation were less emphasized. Component: - Also, the theory cannot be used in a patient 14. Learn, Discover or satisfy the curiosity that who doesn’t have a felt need, such as with leads to normal development and health and withdrawn patients. use the available health facilities Nursing- caring for a sick individual until they Virginia Henderson are able to care for themselves independently. Theory: Nursing Need Theory Environment - includes an individual's emphasizes the importance of patient relationship with family, friends , and independence so that the patient will continue community involvement. to progress after being released from the Health - fourteen basic needs which require an hospital. individual to perform effectively. Role of the nurse as one following: ○ emphasizes the importance of ○ Substitutive — doing something for promoting health and preventing patient disease because optimal health may ○ Supplementary — helping the patient be difficult for & obtain. with something Strengths ○ Complementary — working with the - concept of nursing is complex rather than patient to do something simplistic All of these roles are to patient become as - concepts are broad in scope - functions of independent as possible nurses in an interrelationship with patients Metaparadigm - promoted conceptual development of other Person - made up of fourteen basic needs that theories can be grouped in biological, psychological, - influenced curriculum development sociological, and spiritual components. - promoted the importance of research in ○ requires knowledge and strength to practice perform activities of living and have Weaknesses the essentials for survival. - did not develop operational definitions or the ○ The sick or well individual requires interrelated theoretical statements that enable help to become healthy, independent a theory to be tested empirically. peacefully and there is a connection - concepts are not measurable via research between mind and body 14 Basic Needs Faye Abdellah Physiological: Theory: 21 Nursing Problems Theory 1. Breathe normally She used Henderson's 14 human needs and 2. Eat and drink adequately nursing research to establish the classification 3. Eliminate body wastes of nursing problems. 5 | PRELIMS CMPA 411 | LECTURE  falls into three categories: 2. Sort out relevant and significant dat. ○ physical, sociological, and emotional 3. Make generalizations about available data in needs of patients relation to similar problems presented by other ○ types of interpersonal relationships patients between the patient and nurse 4. Identify the therapeutic plan. ○ common elements on patient care 5. Test generalizations with the patient 6. Validate the patient’s conclusions 21 Nursing Problems 7. Continue to observe and evaluate the patient 1. To maintain good hygiene and physical comfort over a period of time to identify any attitude 2. To promote optimal activity: Exercise, Rest and and clues affecting his or her behavior Sleep 8. Explore the patient and his her family’s 3. Promote safety through prevention of accident, reactions to the therapeutic plan and involve injury, or other trauma, and through the them in the plan prevention of spread of infection 9. Identify how the nurses feel about the patient’s 4. To maintain good body mechanics and prevent nursing problems and correct deformity 10. Discuss and develop a comprehensive nursing 5. To facilitate the maintenance of a supply of care plan oxygen to all body cells 6. To facilitate the maintenance of nutrition of all 11 Nursing Skills body cells 1. Observation of health status 7. To facilitate the maintenance of elimination 2. Skills of communication 8. To facilitate the maintenance of fluid and 3. Application of knowledge electrolyte balance 4. The teaching of patients and families 9. To recognize the physiological responses of 5. Planning and organization of work the body to the disease conditions – 6. Use of resource materials pathological, physiological and compensatory 7. Use of personnel resources 10. To facilitate the maintenance of regulatory 8. Problem-solving mechanisms and functions 9. The direction of work of others 11. To facilitate the maintenance of sensory 10. Therapeutic uses of the self function 11. Nursing procedure 12. To identify and accept positive and negative expressions, feelings and reactions 13. To identify and accept interrelatedness of emotions and organic illness 14. To facilitate the maintenance of effective verbal and non-verbal communication 15. To promote the development of productive interpersonal relationships 16. To facilitate progress toward achievement and personal spiritual goods 17. To create or maintain a therapeutic movement 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs Metaparadigm 19. To accept the optimum possible goals in the Individual/Person - as individuals (and light of limitations, physical and emotional families), although she did not delineate her 20. To use community resources as an aid in beliefs or assumption: the nature of human resolving problems that arise from illness beings 21. To understand the role of social problems as Nursing- The client's health needs can be influencing factors in the cause of illness viewed as problems, overt as an apparent condition, covert as a hidden or concealed 10 Steps to Identify the Patient’s Problem one. Faye Abdellah ○ Because covert problems can be 1. Learn to know the patient emotional, sociological, and 6 | PRELIMS CMPA 411 | LECTURE  interpersonal in nature are often Environment- she completely disregarded the missed or misunderstood. environment in her theory, only focusing the Society/Environment - society is included in patient's immediate need and nurse-pt "planning for optimum health on local, state, relationship and international levels." However, as Abdellah Strengths further delineates her idea, the focus of - patients will be treated as individuals is very nursing service is clearly the individual. much applied Health - purpose of nursing services; "total - Each pt will have an active and constant input health needs" and "a healthy state of mind and into their own care. body." Weaknesses ○ dynamic pattern functioning whereby - The lack of operational definitions of the there is a continued interaction with society environment was evident, limiting the internal and external forces results in development of the research hypothesis. the optimal use of necessary - Focuses on short-term care, particularly aware resolutions to minimize vulnerabilities. and conscious individuals, the virtual absence Strengths of reference groups or family members. - has interrelated the concepts of nursing problems, and problem solving. Dorothy Johnson - problem solving is an activity that is inherently Theory: Behavioral System Model in nature. Her nursing model states that “each individual - framework focus on nursing practice and has patterned, purposeful, repetitive ways of individual acting that comprises a behavioral system - results of testing such hypotheses would co to specific to that individual” the general body of nursing knowledge. It advocates the fostering of efficient and - Easy to apply in practice. effective behavioral functioning in the patient to Weaknesses prevent illness. The patient is defined as a - The major limitation: very strong nurse- behavioral system composed of the 7 centered orientation. She rather behavioral subsystems: affiliative, dependency, conceptualizes nurses' actions in nursing care ingestive, eliminative, sexual, aggressive, and which is contradictory to her aim. achievement. - limits the ability to generalize although the Each subsystem also has three functional problem-solving approach is readily general to requirements, which include (1) protection from clients with specific health needs nursing noxious influences, (2) provision for nurturing the environment, and (3) stimulation for Ida Jean Orlando growth. An imbalance in each system results Theory: Deliberative Nursing Process Theory in disequilibrium. The nurse’s role is to help the stresses the relationship between patient and patient maintain his or her equilibrium. nurse. What does the nurse and the patient say and do affects them? nursing's professional function: finding out and meeting the patient's immediate need for help. Metaparadigm Human Being/Person - humans in need are the focus of nursing practice; emphasizes individuality and the dynamic nature of the nurse-patient relationship. Nursing- unique and independent in its concerns for an individual need for help in an immediate situation. ○ individual's need for are carried out in an interactive situation in a disciplined manner that requires proper training 7 | PRELIMS CMPA 411 | LECTURE Metaparadigm the potential for continued utility in nursing Human Beings / Person - human beings as valued nursing goals. having two major systems: the biological system and the behavioral system. It is the role Weaknesses of medicine to focus on the biological system, - The theory is potentially complex because whereas nursing focuses on the behavioral there are several possible interrelationships system. among the behavioral system, its subsystems, Nursing- seen as “an external regulatory force and the environment. Potential relationships that acts to preserve the organization and have been explored, but more empirical work integrate the patient’s behavior at an optimal is needed. Johnson’s work has been used level under those conditions in which the extensively with people who are ill or face the behavior constitutes a threat to physical or threat of illness. However, its use with families, social health or in which illness is found.” groups, and communities is limited. Though Environment - is not directly defined, but it is the 7 subsystems identified by Johnson are implied to include all elements of the human said to be open, linked, and interrelated, there system’s surroundings and includes interior is a lack of clear definitions for the stressors. interrelationships among them, making it Health - is seen as the opposite of illness, and difficult to view the entire behavioral system as Johnson defines it as “some degree of an entity. The problem involving the regularity and constancy in behavior, the interrelationships among the concepts also behavioral system reflects adjustments and creates difficulty following the logic of adaptations that are successful somehow, and Johnson’s work. to some degree… adaptation is functionally efficient and effective.” Martha Rogers Theory: Science of Unitary Human Being The theory views nursing as both a science and an art as it provides a way to view unitary beings, who are integral with the universe. The unitary human being and his or her environment are one. Nursing focuses on people and the manifestations that emerge from the mutual human–environmental field process. The are eight concepts in Rogers’ nursing theory: “energy field, openness, pattern, pattern, pan-dimensionality, hemodynamic principles, resonance, helicy, and integrality Strengths - Dorothy JOhnson’s theory guides nursing practice, education, and research, generates new ideas about nursing; and differentiates nursing from other health professions. It has been used in inpatient, outpatient, and community settings as well as in nursing administration. It has always been useful to nursing education and has been used in educational institutions in different parts of the world - Another advantage of the theory is that Johnson provided a frame of reference for nurses concerned with specific client Metaparadigm behaviors. It can also be generalized across Human/Person-Unitary Human Beings - A the lifespan and cultures. The theory also has person is defined as an indivisible, pan-dimensional energy field identified by a 8 | PRELIMS CMPA 411 | LECTURE  pattern and manifesting characteristics specific 3. The theory of nursing systems to the whole. That can’t be predicted from knowledge of the parts. A person is also unified whole, having its own distinct characteristics that can’t be viewed by looking at, describing, or summarizing the parts. Nursing - is the study of unitary irreducible, indivisible human and environmental fields: people and their worlds. Rogers claims that nursing exists to serve people, and the safe practice of nursing depends on the nature and amount of scientific nursing knowledge the nurse brings to his or her practice. Environment - “An irreducible, indivisible, pan-dimensional energy field identified by Human/Person pattern and integral with the human field” - Humans are defined as “men, women, and Health - Rogers defines health as an children cared for either singly or as social expression of the life process. The units” and are the “material object” of nurses characteristics and behavior coming from and others who provide direct care environmental fields and health and illness are Nursing part of the same continuum. The multiple - Nursing is an art through which the practitioner events occurring during the life process show of nursing gives specialized assistance to how a person is achieving his or her maximum persons with disabilities, making more than health potential. The events may vary in their ordinary assistance necessary to meet expressions from greatest health to those self-care needs. The nurse also intelligently incompatible with the maintaining life process. participates in the medical care the individual Strength receives from the physician - Rogers’ concepts provide a worldview from Environment which nurses may derive theories and - The environment has physical, chemical, and hypotheses and propose relationships specific biological features. It includes the family, to different situations. culture, and community - Rogers’ theory is not directly testable due to a Health lack of concrete hypotheses, but it is testable - “Being structurally and functionally whole or in principle. sound” Weaknesses - Also, health is a state that encompasses both - Rogers’ model does not define particular the health is the ability to reflect on oneself, hypotheses or theories, for it is an abstract, symbolize experience, and communicate with unified, and hooghly deprivation framework others - Testing the concept's validity is questionable Strengths because its concepts are not directly - A major strength of Dorothea Orem’s theory is measurable. that it is applicable for nursing by the beginning practitioner and the advanced clinicians Dorothea Orem - Orem’s theory provides a comprehensive basis Theory: Self-Care Deficit for nursing practice. It has utility for Focuses on each “individual’s ability to perform professional nursing in the areas of nursing self-care, defined as “the practice of activities practice, nursing education, and administration that individuals initiate and perform on their - The terms self-care, nursing systems, and own be half in maintaining life, health, and self-care deficit are easily understood by the well-being” beginning student nurse and can be explored Composed of 3 Interrelated Theories in greater depth as they gain more knowledge Which is further classified into wholly compensatory, and experience partially compensatory and supportive-educative - She specially defines when nursing is need; 1. The theory of self-care Nursing is needed when the individual cannot 2. The self-care deficit theory maintain continuously that amount and quality 9 | PRELIMS CMPA 411 | LECTURE  of self-care necessary to sustain life and characteristics such as the ability to perceive, health, recover from disease or injury, or cope think, feel, choose between alternative courses with their effects of action, set goals, select the means to - Her self-care approach is contemporary with achieve goals, and make decisions the concepts of health promotion and health Environment maintenance - Is the background for human interactions. - Three identifiable nursing systems were clearly - It is both external to, and internal to, and the delineated and are easily understood individual Limitations Health - Orem’s theory, in general, is viewed as a - Is a dynamic life experience of a human being single whole thing, while Orem’s defines a which implies continuous adjustment to system as a single whole thing stressors in their internal and external - Orem’s theory is simple yet complex. The use environment through optimum use of one’s of self-care demand, self-care deficit, self-care resources to achieve maximum daily living requisites, and universal self-care, can be very potential confusing to the reader Strengths - Orem’s definition of health was confined to - A major strong point of King’s conceptual three static conditions, which refers to as a system and theory of goal attainment is how “concrete nursing system” which connotes nurses can understand goal attainment theory rigidity and describe a logical sequence of events - Throughout her work, there is a limited - For most parts, concepts are concretely acknowledgement of the individual’s emotional defined and illustrated needs - King’s definitions are clear and are - Health is often viewed as dynamic and ever conceptually derived from the research changing literature. Her theory of goal attainment presents 10 major concepts Imogene King - The concepts are easily understood and Theory: Goal Attainment derived from the research literature which - States that “Nursing is a process of action, clearly establishes King’s work as important for reaction, and interaction whereby nurse and knowledge building in nursing client share information about their perception Weaknesses in the nursing situation” - Theory of goal attainment has been criticized - The model focuses on the attainment of certain for having limited application in nursing areas life goals. It explains that the nurse and patient in which patients are unable to interact go hand-in-hand in communicating information, competently with the nurse. King maintained set goals together, and then take actions to the broad use of the theory in most nursing achieve those goals situations 3 Interacting Systems of Theory of Goal Attainment - Another limitation relates to the lack of 1. Personal system development of applying the theory in 2. Interpersonal system providing nursing care to groups, families, or 3. Social system communities - King’s theory also contains some inconsistencies: 1. She indicates that nurses are concerned about groups’ health care but concentrates her discussion on nursing as occurring in a dyadic relationship 2. King says that the nurse and client are Individual/Person strangers, yet she speaks of their - Individuals are social beings who are rational working together for goal attainment and sentient. Humans communicate their and the importance of health thoughts, actions, customs, and beliefs maintenance through language. Person exhibit common 10 | PRELIMS CMPA 411 | LECTURE Betty Neuman that are solely within the client system’s Theory: Neuman Systems Model boundaries make up this environment - The Neuman Systems Model views the client - External Environment: exists outside the as an open system that responds to stressors client system in the environment. The client variables are - Created Environment: is unconsciously physiological, psychological, sociocultural, developed and is used by the client to support developmental, and spiritual protective coping - The client system consists of a basic or core Strengths structure that is protected by a flexible line of - The Neuman Systems Model’s major strength defense. Stressors are intra-, inter-, and extra is its flexibility for use in all areas of nursing personal in nature and arise from the internal, (administration, education, and practice) external, and created environments - Neuman has presented a view of the client - When stressors break through the flexible line equally applicable to an individual, a family, a of defense, the system is invaded, and the group, a community, or any other aggregate lines of resistance are activated. The system is - The Neuman Systems Model particularly described as moving into illness on a presented in the model diagram is logically wellness-illness continuum consistent - If adequate energy is available, the system will - The emphasis on primary intervention be reconstituted with the normal defense line including health promotion is specific to this restored at, below, or above its previous level model - Once understood, the Neuman Systems Model is relatively simple and has readily acceptable definitions of its components Weaknesses - The major weakness of the model is the need for further clarification of the terms used - Interpersonal and extrapersonal stressors need to be more clearly differentiated Sister Callista Roy Theory: Adaptation Model of Nursing - The prominent nursing theory aims to explain or define the provision of nursing. In her story, Roy’s model sees the individual as set of interrelated systems that maintain a balance Human Being/Person between these various stimuli - Is an open system that interacts with internal Characteristics of a system: and external environment forces or stressors. Inputs The human is constantly changing, moving Outputs toward a dynamic state of system stability or Controls illness of varying degrees Feedback Nursing - Nursing’s primary concern is to define the appropriate action in situations that are stress-related or concerning possible reactions of the client or client system to stressors. Nursing interventions aim to help the system adapt or adjust and retain, restore, or maintain some degree of stability between the client system variables and environmental stressors, focusing on conserving energy Environment - Internal Environment: exists within the client system. All forces and interactive influences 11 | PRELIMS CMPA 411 | LECTURE  person and health resources that includes focal, contextual and residual stimuli” - Focal Stimuli: are that confront the human system and require the most attention - Contextual Stimuli: are characterized as the rest of the stimuli present with the focal stimuli and contribute to its effect - Residual Stimuli: are the additional environmental factors present within the situation but whose effect is unclear. This can previous experience with certain stimuli Health - Is defined as the state where humans can continually adapt to stimuli. Because illness is part of life, health results from a process where health and illness can coexist. If a human can continue to adapt holistically, they will maintain Person health to reach completeness and unity within - Humans are holistic beings that are in constant themselves. If they cannot adapt accordingly, interaction with their environment. Humans use the integrity of the person can be affected a system of adaptation, both innate, to respond negatively to the environmental stimuli they experience. - “Health is not freedom from the inevitability of Human systems can be individuals or groups death, disease, unhappiness, and stress but such as families, organizations, and the whole the ability to cope with them in a competent global community way” - “Human systems have thinking and feeling Strengths capacities, rooted in consciousness and - The Adaptation Model of Callista Roy suggests meaning, by which they adjust effectively to the influence of multiple causes in a situation changes in the environment and, in turn, affect which is a strength when dealing with the environment” multi-faceted human beings Nursing - The sequence of concepts in Roy’s mode - Nurses are facilitators of adaptation. They follows logically. In the presentation of each of assess the patient’s behaviors for adaptation, the key concepts, there is the recurring idea of promote positive adaptation by enhancing adaptation to maintain integrity. Every concept environment interactions and helping patients was operationally defined react positively to stimuli. Nurses eliminate - The concepts of Roy’s model are stated in ineffective coping mechanisms and eventually relatively simple terms lead to better outcomes - A major strength of the model is that it guides - “The goal of nursing is the promotion of nurses to use observation and interviewing adaptation for individuals and groups in each skills in doing an individualized assessment of of the four adaptive modes, thus contributing to each person. The concepts of Roy’s model are health, quality of life, and dying with dignity” applicable within many practice settings of Environment nursing - Is defined as conditions, circumstances, and Weaknesses influences that affect humans’ development - Painstaking application of the model requires a and behavior as an adaptive system. The significant input of time and effort environment is a stimulus or input that requires - Roy’s model has many elements, systems, a person to adapt. These stimuli can be structures, and multiple concepts positive or negative - “The conditions, circumstances and influences Jean Watson surrounding and affecting the development Theory: Human Caring and behavior of persons or groups, with - Caring can be demonstrated and practiced by particular consideration of the mutuality of nurses. Caring for patients promotes growth; a 12 | PRELIMS CMPA 411 | LECTURE  caring environment accepts a person as they - Is the unity and harmony within the mind, body, are and looks to what they may become and soul - Nursing model states that “nursing is - Health is associated with the degree of concerned with promoting health, preventing congruence between the self and the self as illness, caring for the sick, and restoring experienced. health” - It is defined as high level of overall physical, - It focuses on health promotion as well as the mental, and social functioning; a general treatment of diseases. According to Watson, adaptative-maintenance level of daily caring is central to nursing practice and functioning; and the absence of illness, or the promotes health better than a simple medical presence of efforts leading to the absence of cure. She believes that a holistic approach to illness health care is central to the practice of caring Strengths in nursing - Many find it easy to understand. The model can guide and improve practice as it can help healthcare providers with the most satisfying aspects of practice and provide the client with holistic care - Using nontechnical, sophisticated, fluid, and evolutionary language to artfully describe her concepts, such as caring-love, carative factors, and caritas. Paradoxically, abstract and simple concepts such as caring-love are difficult to practice yet practicing and experiencing them leads to greater understanding - The theory is logical - Theory is best understood as a moral and philosophical basis for nursing - The theory addresses aspects of health promotion, preventing illness, and Person experiencing peaceful death, thereby - Human being is valued person to be cared for increasing its generally. The carative factors respected, nurtured, understood, and assisted provide guidelines for nurse-patient - In general, a philosophical view of a person as interactions, an important aspect of patient a fully functional integrated self care - A human is viewed as greater than and Weakness different from the sum of his or her parts - The theory does not furnish explicit direction Nursing about what to do to achieve authentic - Is a human science of persons and human caring-healing relationships. Nurses who want health-illness experiences mediated by concrete guidelines may not feel secure when professional, personal, scientific, esthetic, and trying to use this theory alone. Some have ethical human care transactions suggested that it takes too much time to Society/Environment incorporate the Caritas into practice, and some - The society provides the values that determine note that Watson’s personal growth emphasis how one should behave and what goals one is a quality “that while appealing to some may should strive toward not appeal to others” - Watson states: “Caring (and nursing) has existed in every society. Every society has had Madeleine Leininger some people who have cared for others. A Theory: Transcultural Nursing Theory caring attitude is not transmitted from - Identified a lack of cultural and care knowledge generation to generation by genes. The culture as the missing component to a nurse’s of the profession transmits it as a unique way understanding of the many variations required of coping with its environment” inpatient care to support compliance, healing, Health and wellness 13 | PRELIMS CMPA 411 | LECTURE  - Leininger’s theory main focus is for nursing Health care to fit with or have beneficial meaning and - It is a state of well-being that is culturally health outcomes for people of different or defined, valued, and practiced. It reflects similar cultural backgrounds individuals’ (or groups) ability to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways Strengths - Leininger has developed the Sunrise Model in a logical order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity and Universality - Leininger’s theory is essentially parsimonious in that the necessary concepts are incorporated in such a manner that the theory and its model can be applied in many different settings - It is highly generalizable. The concepts and relationships presented are at a level of abstraction, which allows them to be applied on many different situations - Though not simple in terms it can be easily understood upon the first contact Weakness - The theory and model are not simple in terms Person - Being concerned about others’ needs, well-being, and survival. Leininger also indicates that nursing as a caring science should focus beyond traditional nurse-patient interactions and dyads to includes families, groups, communities, total cultures, and institutions Nursing - Is defined as a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities to assist, support, facilitate, or enable individuals or groups to maintain or regain their well-being (or health) in culturally meaningful and beneficial ways or to help people face handicaps or death Society/Environment - Leininger did not define these terms; she speaks instead of worldview, social structure, and environmental context 14 | PRELIMS CMPA 411 | LECTURE COMPETENCY APPRAISAL 1 - LECTURE WEEK 3 | Pharmacology | By: Lei & Iris Medications meaningful; used for discussions and - Are substances prescribed by the client’s textbooks prescribing practitioner to help in the treatment, relief, or cure of the cause of the 2 Classes client’s health alterations or in the prevention a. Approved Name - of such alterations. given by bodies like - Medication Management: requires the United States Adopted collaborative efforts of many health care Name Council (USAN) providers and British Approved - Once prescribed, pharmacists are licensed to Name (BAN) soon prepare and dispense medications after its introduction. - Nurses are responsible for administering Sometimes referred to medications as generic name, however used to Types of Medications Action designate a chemical 1. Therapeutic Effect - the desired effect intended or pharmacologic for that medication (from pain to no pain) class such as 2. Side Effect - this are the unintended effect of Sulfonamide or the medication, and the effect we are to Penicillin monitor with the client after taking the b. Official Name - medication name approved by a 3. Adverse Effect - this are the severe side effect National that are fatal to the client Pharmacopoeia Commission; it must be identical to the approved name 3. Proprietary Name - given by the pharmaceutical firm which sells the drug. Written with capital initial letter distinguished by superscript Drug Nomenclature and Classification - Nomenclature implies that there are several names that can be used to identify a drug - 3 Different Names 1. Chemical Name - is given when a Classification Based on Chemical Nature new chemical entity (NCE) is 1. Inorganic Drugs developed; it is useful for chemist as it - Metals & their salts (ferrous sulfate & provides an exact arrangement of zinc sulfate, magnesium sulfate) atom/atomic groups in the molecules - Non-metals (sulfur) 2. Non-Proprietary Name - given to 2. Organic Drugs drug that is not subject for proprietary - Alkaloids (atropine, morphine, rights; should be concise and strychnine) 15 | PRELIMS CMPA 411 | LECTURE  - Glycosides (digitoxin, digoxin) - Proteins (insulin, oxytocin) Classification Based on Source Types of Medication Order 1. Natural Source 1. Standing Order a. Plants: Morphine, Atropine, Digitoxin - referred to in practice as an “order set” b. Animals: Insulin or a “protocol” c. Microorganism: Penicillin - standardized prescriptions for nurses d. Mineral: Sodium Chloride to implement to any patient in clearly 2. Synthetic Source: Sulfonamide, Procaine defined circumstances without the 3. Non-Synthetic Source: Amoxicillin, Ampicillin, need to initially notify a provider Doxycycline - Example: patients visiting an urgent 4. Bio-Synthetic Source: Recombinant Human care clinic reporting chest pain is to Erythropoietin immediately administer four chewable aspirin, establish intravenous (IV) Classification Based on Target Organ access, and obtain an 1. Drug acting on CNS: Diazepam, electrocardiogram (ECG) Phenobarbital 2. Single or One-Time Order 2. Drug acting on Respiratory System: - Is a prescription for a medication to be Bromhexine administered only once 3. Drug acting on CVS: Digitoxin, Digoxin - An example of a one-time order is a 4. Drug acting on GIT: Omeprazole prescription for an IV dose of 5. Drug acting on Urinary System: Magnesium antibiotics to be administered Sulfate, Furosemide immediately prior to surgery 6. Drug acting on Reproductive System: - Routine Order Oxytocin, Estrogen Is a prescription that is followed until another order Classification Based on Mode of Action cancels it 1. Inhibitor of Bacterial Wall Synthesis: Example: “Lisinopril 10 mg PO Penicillin daily” 2. Inhibitor of Bacterial Protein Synthesis: 3. PRN Order Tetracycline - is a prescription for medication to be 3. Calcium Channel Blocker: Verapamil, administered when it is requested by, Nifedipine or as needed, by the patient - PRN orders are typically administered Classification Based on Therapeutic Use based on patient symptoms, such as 1. Antimicrobials/Antibiotic: Penicillin, pain, nausea, or itching Streptomycin, Quinolones, Macrolides - Example: pain medication is 2. Antihypertensives: Beta-blocker, Calcium “Acetaminophen 500 mg PO every 4-6 Channel Blocker, Nitrates, Diuretics hours as needed for pain” 3. Antidiarrheals: Loperamide 4. STAT Order 4. Antiemetics: Domperidone, Metoclopramide - is a one-time order that is administered without delay due to the Classification Based on Physiological System urgency of the circumstances 1. Sympathomimetics: Adrenaline, - Example: Benadryl 50 mg PO stat” for Noradrenaline a patient having an allergic reaction 2. Parasympathomimetics: Pilocarpine, 5. Prescription/Doctor’s Order Neostigmine - The written direction for the 3. Neuromuscular Blockers: Suxamethonium preparation and administration of a drug Classification Based on Physical Effects - Important information in a doctor’s 1. Emollients: Lanoline, Vaseline order 2. Caustics: Silver Nitrate Name of the patient 3. Demulcents: Zinc Oxide, Tannic Acid Age or Date of Birth 16 | PRELIMS CMPA 411 | LECTURE  Date and Time of the Order - Acceptable patient identifiers include, Drug Name but are not limited to, the patient’s full Dose, Frequency, and Route name, an identification number Name/Signature of the assigned by the hospital, or date of Prescriber birth. A patient’s room number must Weight of the patient to never be used as an identifier because facilitate dose calculation a patient may change rooms. when applicable Identifiers must be confirmed by the - Note: dose patient wristband, patient identification calculations are based card, patient statement (when on metric weight: kg possible), or other means outlined in for children/adults or the agency policy grams for newborns 2. Right Drug/Medication Dose calculation - The nurse ensures the medication to requirements, when applicable be administered to the patient matches Exact strength or the order and check your patient's concentration, when allergy status. Also, check the applicable expiration date of the medication. Quantity and/or duration of the - Beware of look-alike and sound-like prescription, when applicable medication names, as well as Specific instructions for use, high-alert medications that bear a when applicable heightened risk of causing significant patient harm if they are used in error. Terminologies The nurse also be aware of what Pharmacotherapeutic - is the clinical purpose medication can be crushed and hose or indication for giving a drug. that cannot be crushed. Pharmacokinetic - is the effect of the body on 3. Right Dose the drug. It is made up of four phases: - Ensures the dosage of the medication absorption, distribution, metabolism, and matches the prescribed dose, verifies excretion. the correct dosage range of for the a. Absorption - is the movement of the age and medical status of the patient, drug from the site of administration and also confirms that the prescription into the bloodstream. itself does not reflect an unsafe b. Distribution - is movement of the drug dosage through the bloodstream and - Example: medication errors commonly eventually into the cells. occur in children, who typically receive c. Metabolism - refers to the changing of a lower dose of medication than an the drug into another substance or adult. Medication errors also substances (i.e, metabolites). commonly occur in older patients who d. Excretion - is the removal of the drug have existing kidney or liver disease or its metabolites from the body. and are unable to metabolize or Metabolism and excretion are excrete typical doses of medications considered together as elimination of a 4. Right Time and Frequency drug. - Drug timing is important, especially Pharmacodynamics - (sometimes described with some drugs like antibiotics, to as what a drug does to the body) is the study achieve cure and prevents resistance. of the biochemical, physiologic, and molecular Some drugs must be given on empty effects of drugs on the body and involves stomach (e.g. antituberculosis drugs; receptor binding (including receptor and some after meal) sensitivity), postreceptor effects, and chemical 5. Right Route interactions. - Nurses must administer medications via the route indicated in the order. If a 10 Rights in Giving Medications nurse discovers an error in the order 1. Right Patient or believes the route is unsafe for a 17 | PRELIMS CMPA 411 | LECTURE  particular patient, the route must be clarified with the prescribing provider before administration (IV, IM, SQ, ID, Inhalation, etc.) 6. Right Documentation - After administering medication, it is important to immediately document the administration to avoid potential errors from an unintended repeat dose/medication/errors 7. Right History and Assessment - Nurses should be aware of the patient's allergies, as well as any history of any drug interactions. Additionally, nurses collect appropriate Universal Formula assessment data regarding the D/H x Q or D/S x Q patient’s history, current status, and - D: desired amount recent lab results to identify any - H: amount on hand contraindications for the patients to - Q: quantity receive the prescribed medication 8. Right Drug Interactions Examples - Patient’s history should be reviewed Oral Dose for any potential interactions with Cephalexin (Keflex) 750 mg PO every 12 medications previously given or with hours is ordered. THe pharmacy stocks 250 the patient’s diet. It is also important to mg tablets. How many tablets should be verify the medication’s expiration date administered per dose? before administration - D/H = 750 mg/250 mg x 1 tab 9. Right Education and Information = 3 tab - Information should be provided to the Intravenous Dose patient about the medication, including An order for digoxin 0.5 mg IV daily is placed. the expected therapeutic effects, as Digoxin 0.25 mg/mL is available from the well as the potential adverse effects. pharmacy. How many mL will you need to The patient should be encouraged to administer a 0.5 mg dose? report suspected side effects to the - D/H = 0.5mg/0.25mg x 1mL nurse and/or prescribing provider. If = 2mL the patient is a minor, the parent may Subcutaneous Dose also have a right to know about the Heparin 7500 units subcutaneously every 12 medication in many states, depending hours is ordered. The pharmacy provides a upon the circumstances. heparin vial with a concentration of 5000 10. Right of Refusal units/mL. How many mL will you need to - After providing education about the administer 7500 units? medication, the patient has the right to - D/H = 7500 units/5000 units x 1 mL refuse to take medication in = 1.5 mL accordance with the nursing code of ethics and respect for individual Dosage Calculations patient autonomy Flow rate - If patient refuses to take the Cc/no hrs = cc/hr medication after proper education has ○ Divide the 60 seconds by 4, so you'll been performed, the event should be only need to count for 15 seconds to documented in the patient chart and measure the rate in cc/hr. the prescribing provider notified Infusion rate Vol in cc x df/ no of hrs (60) = macrodrop Documentation Vol in cc x no of hrs = microdrop - Transcribing doctor’s orders 18 | PRELIMS CMPA 411 | LECTURE COMPETENCY APPRAISAL 1 - LECTURE WEEK 4 | Fundamentals of Nursing | By: Lei & Iris Traditional Medical Model - Ancient Indian and Chinese medicine and adapt and to self manage” includes the Greek medicine “The concept of health as a ability of people to adapt to their balance between a person and the situation as key to health; environment, the unity of soul and body, and acknowledges the subjective element the natural origin of disease, was the of health backbone of the perception of health.” - 5th century BC, Pindar defined health as Dimensions of Health “harmonious functioning of the organs.” = the 1. Physical - refer to any of the aspects that are physical dimension of health, the physical body needed to keep your body in perfect condition and the overall functionality, accompanied by 2. Mental - finding a way to engage in creative the feeling of comfort and absence of pain and stimulating activities that allow you to - Plato (429-347 BC) in his book “Dialogues” the share your ideas and expand your knowledge ideal of ancient Greek philosophy “a healthy is essential for intellectual health mind in a healthy body” could be achieved if 3. Emotional - focuses on ensuring that you are people established internal harmony and attentive to your feelings, thoughts and harmony with the physical and the social behavior environment 4. Social - ability to interact with people, respect yourself and others, develop meaningful Modern Medical Model relationships and develop quality - Consistent with the bio psychosocial model of communication skills; helps to create a health which considers physiological, balance between their community and psychological and social factors in health and environment illness, and interactions between these factors 5. Spiritual - sense of fulfillment and satisfaction - Health is more than the absence of disease = with own lives, system of values, self maximum capacity of the individual for self confidence and self esteem, self awareness, realization and self fulfillment peacefulness, morality and truthfulness, selflessness, positive emotions, compassion Concept of Health and willingness to help and support others, - Relative state in which one is able to function responsibility and contribution to the common well physically, mentally, socially and spiritually good, and successful management of to express the full range of oneʼs unique everyday life problems and demands and potentialities within the environment in which social stress as well one lives Health is more than freedom from illness and Definition of Health disease - According to W.H.O. (1948) - 50 years ago, WHO defined health as being - State of complete physical, mental and more than freedom from illness, disease, and social well being and not merely an debilitating conditions absence of disease infirmity” - In recent years, public health experts have - Health is not merely to live happy, identified wellness as “a sense of well being” wealthy, successfully and absence of and “quality of life” disease but is a state of mind and body that can survive in the worst Health & Wellbeing condition - Wellbeing refers to a positive rather than - Links health explicitly with wellbeing, neutral state, framing health as a positive and conceptualizes health as a human aspiration = was adapted by the 1986 Ottawa right requiring physical and social charter, which describes health as a “resource resources to achieve and maintain for everyday life, not the object of living” Huber et. al. (2011) “the ability to 19 | PRELIMS CMPA 411 | LECTURE  - Perspective health is a means to living well, emotional quality of an individual experiences; which highlights the link between health and influenced by a variety of demographic, participation in society economic and situational factors a. Skills contributing to emotional Concept of Wellbeing wellbeing Positive outcome that is meaningful for people i. happiness and for many sectors of society, it tells us that ii. mindfulness people perceive that their lives are going well iii. positive thinking Every aspect of our life influence our state of iv. emotional stability well being v. resilience skills (ability to withstand or recover quickly Meaning of Wellbeing from difficult situation) not just the absence of disease or illness, it is 4. Occupational Wellbeing - ability to pursue a complex combination of a personʼs physical, our interests, values, and purpose in order to mental, emotional and social health factors gain meaning, happiness, and enrichment strongly linked to happiness and life professionally\ satisfaction includes global judgments of life satisfaction Factors Affecting Wellbeing and feelings ranging from depression to joy happy intimate relationship with a partner the feeling of you about yourself includes: network of close friends ○ presence of positive emotions and enjoyable and fulfilling career moods (contentment, happiness) enough money ○ absence of negative emotions regular exercise (depression, anxiety) nutritious diet ○ satisfaction with life, fulfillment and sufficient sleep positive functioning spiritual or religious belief fun hobbies and leisure pursuits Dimensions of Wellbeing healthy self esteem 1. Physical Wellbeing - ability to improve the optimistic outlook functioning of our body thru healthy eating and realistic and achievable goal good exercises habits a sense of belongingness a. Things for boosting Physical ability to adapt to change Wellbeing living in a fair and democratic society i. eating nutritious food ii. avoiding junk food Definition iii. correcting nutritional 1. Human needs a number of essentials to deficiencies survive iv. detoxing your body a. Needs are a kind of natural, mental 2. Societal Wellbeing - ability to communicate,