MIDTERM PDF - Theoretical Foundations in Nursing

Should be stated explicitly or at least be THEORETICAL FOUNDATIONS IN identifiable in the text of the theory. NURSING 2. Concepts Should be linguistically expressed CONCEPT...

Should be stated explicitly or at least be THEORETICAL FOUNDATIONS IN identifiable in the text of the theory. NURSING 2. Concepts Should be linguistically expressed CONCEPT 3. Definitions building blocks of theories Meanings of concepts are conveyed in phenomena of interest (Kaplan, theoretical definitions; these definitions give 1964 as cited by Alligood, 2014) character to the theory an empirical phenomena or any 4.Relationships abstraction of how a person Concepts are structured into a stematic perceived an object that is not form that links each concept with others physically present or observed 5. Structure It enhances one's capacity to The relationships are linked to form a whole understand phenomena as it define when the ideas of the theory interconhect; the meaning of a word "structure makes it possible to follow the reasoning of the theory CHARACTERISTICS OF A THEORY 6. Assumptions 1. Theory can correlate concepts in Refer to underlying truths that determine the such a way as to generate a nature of concepts, definitions, purpose, different way of looking at a certain relationship, and structure; may not be fact or phenomenon. explicitly stated 2. It must be logical in nature. 3. It should be simple but generally NURSING THEORY broad in nature. Is a group of related concepts that 4. It can be the source of hypotheses derive from the nursing models and that can be tested for it to be other disciplines. elaborated. It guides practice, education; and 5. It contributes in enriching the research (Alligood, 2014; Chinn & general body knowledge through the Kramer, 2011; Fawcett, 2005; studies implemente validate them. Meleis, 2007) 6. Theory can be used by practitioners NURSING as an ART relies on knowledge to direct and enhance their practice. gained from practice and reflection of past 7. NoIt must be consistent with other experiences.. validated theories, laws, and. principles but will leave open. As a SCIENCE, it is based on scientifically unanswered issues that need to be tested knowledge that is applied in the tested. practice setting. COMPONENTS AND CHARACTERISTICS EDUCATION OF A THEORY (CHINN AND KRAMER, prepare students for practice as 1999) members of the professional community." 1. Purpose 11 10 9  8 development of nursing knowledge 7 or nursing science 6 serve to guide assessment, 5 4 intervention and evaluation of 3 nursing care 2 assist nurses to describe, explain 1 and predict everyday experiences 1 provide rationale for collecting 2 reliable and valid data about the 3 4 health status of clients which are 5 essential for effective 6 decisión-making 7 help to establish criteria to measure 8 the quality of nursing care 9 10 help build a common nursing Outline terminology to use in communicating with other health professionals Headings you add to the document will enhance autonomy of nursing appear here. through defining its own. independent functions Facilitates reflection, questioning, studying the models or paradigms is and thinking about what nurses do. an orientation to the approaches Introduction to any framework. used in practice: encourages nurses to reflect on, It is by studying theories and question, and think about what they practicing with them that students do provide and invaluable service learn their trade. RESEARCH CLASSIFICATION OF THEORY offer a framework for generating (ALLIGOOD, 2017) knowledge and new ideas Nursing Philosophy - the most abstract Helps connect the perceived gap type and sets forth the meaning of nursing between theory and practice phenomena through analysis, reasoning, offer a systematic approach.to and logical presentation. Works of. identify questions for study select Nightingale, Watson, Ray, and Benner are variables, interpret findings, and categorized under this group. validate nursing interventions. Nursing Conceptual Model - are CLINICAL PRACTICE comprehensive nursing theories that are guide critical thinking of nurses regarded by some as pioneers in nursing. represent status of nursing as a These theories address the nursing discipline and profession metaparadigm and explain the relationship used as a framework for structuring between them. Conceptual models of nursing practice with predictable Levine, Rogers, Roy, King, and Orem are outcomes and deriving new middle under this group. range theories to test in nursing. research Grand Nursing Theories- Are works whom the person interacts; an open derived from nursing philosophies, system.with boundaries that permit conceptual models; and other grand the exchange of matter, energy, and theories that are generally not as specific as information, with human beings. middle-range theories. Works of Levine, Health Rogers, Orem, and King are some of the the degree of wellness or well-being theories under this category. that the client experiences. Middle-Range Theories - Are precise and is the ability to function answer specific nursing practice questions. independently; successful They address the specifics of nursing adaptation to life's stressors, situations within the perspective of the achievement of one's full life model or theory from which they are potential; and unity of mind, body derived. Examples of Middle-Range and soul. theories are that of Mercer, Reed, Mishel, Nursing and Barker. the attributes, characteristics, and actions of the nurse providing care NURSING PARADIGM on behalf of, or in conjunction with, Conceptual models the client. Conceptual Framework is a science, an art, and a practice Meta-paradigm discipline, and involves caring. Goals of nursing include care of the NURSING PARADIGM well, care of the sick, assisting of Person or client self-care activities, helping recipient of nursing care including individuals attain their human individuals, families, groups, and potential, and discovering and using communities. nature daws of health. refers to a being composed of physical, intellectual, biochemical, FLORENCE NIGHTINGALE psychosocial needs; a human Environmental Theory energy field; a holistic being in the world; an open system, an Founder of Modern Nursing integrated whole an adaptive system, and a being who is greater Born on May 12, 1820. Affluent, than the sum aristocratic Victorian family of Environment Edward and Frances Nightingale the internal and external Was named after her birthplace, surroundings that affect the client Florence, Italy. including people in the physical Victorian Leaders environment, such as families, Nightingale was tutored in friends, and significant others. Mathematics, languages, religion, refers to the external elements that and philosophy. affect the person; internal and According to Sir Thomas Cook, she external conditions that influence the was a linguist, had a vast knowledge organism, significant others with  of science, mathematics, literature, Her belief that action for the benefit and arts of others is a primary way of serving Well read in philosophy, history, God served as the foundation for politics and economics. defining her nursing work as a Well informed about workings of the religious calling government and political.science In 1837 in her diary: "God spoke to ENVIRONMENTAL THEORY me and called me to his service." Nightingale did not subscribe to the She was a Unitarian who believe germ theory but she very clearly that action for the benefit of others is understood the concept of contagion a primary way of serving God. and contamination through organic In 1851, she completed her training materials from the patient or the at Kaiserworth, Germany as a nurse. environment, as observe in her In 1853, she became the work. superintendent of the Hospital for She believe that disease was a Invalid Gentlewomen in London. reparative process and that the 1854, During the Crimean War, manipulation of the patient's Nightingale received a request from surroundings - ventilation, warmth, Sidney Herbert (family friend and light, diet, cleanliness, and noise - Secretary of War) to go to Scutari, are necessary for proper nursing Turkey to provide trained nurses to care and health of the patient. care for wounded soldiers Nightingale did not used the term Major problems: lack of sanitation and "environment". She used the term presence of filth surroundings in her writings. - Few chamber pots -Contaminated water Nightingale Five Essential Components - Contaminated bed and linens 4 of Environment Health - Overflowing cesspools 1. Pure Air -Frostbite 2. Pure Water -Lice infestations 3. Efficient Drainage -Wound infections 4. Cleanliness 5. Light She was called The Lady of the Lamp, as immortalized in the poem "Santa Filomena" 1. Pure Air/ Proper ventilation (Longfellow, 1857) Greatest concern of Nightingale. "keep the air he breathes as pure as "THE LADY WITH THE LAMP" the external air, without chilling him" At night she carried a lamp while (Nigtingale, 1969 as cited by taking rounds from room to room to Alligood 2014). look after Recognizes this as a source of her patients. disease and recovery. This earned her the affectionate title 2. Light of "Lady with the Lamp." Direct sunlight is needed by patients  Nurses were instructed to move 4 She believe that patient with chronic and position patients to expose them illnesses could be starved to death. to sunlight Nurse should assess dietary intake 3. Water as well as meal schedule and its Lack of access to pure water leads effect on the patient. to disease Petty Management 4. Cleanliness Petty management was a term used Nightingale believe that dirty to denote that the nurse was in environment (floors, carpets, walls, control of the environment both and bed linens) was a source of physically and administratively. infection through the organic matter - Eg. Protecting the patient from it contained. receiving upsetting news, seeing She advocated bathing patient on a visitors who could negatively affect frequent, even daily, basis at a time recovery, and from experiencing when this practice was not the norm. sudden disruptions in sleep Required nurses to bathe call the Her work formed the foundation for daily, wear clean clothing, and wash professional nursing and distinguished hands frequently. nursing from the work of domestic servants 5. Efficient Drainage was an English social reformer, statistician Presence of organic material create and the founder of modern nursing a dirty area Founder of Modern Nursing Presence of organic material create a dirty area Metaparadigm Appropriate handling and disposal of PERSON bodily excretions and sewage was Nightingale referred to the person as required to prevent contamination of a patient. the environment Nurses performed tasks to and for Other Concepts: the patient and controlled the Warmth patient's environment to enhance Quiet recovery. Diet Passive patient HEALTH Warmth Defined as being well and using Manipulation of environment through every power that the person has to the use of good fire to produce the fullest extent in living life. warmth, opening windows, and She envisioned the maintenance of properly positioning the patient in the health through the prevention of room. disease via environmental control Noise and social responsibility Noise created by physical activities ENVIRONMENT in the environment (room) was to be To assist nature in healing the avoided by the nurse because it patient could harm the client. Diet  Environmental improvements would Hospital and King's College Hospital in affect the sick poor people both their London. bodies and mind Five components Florence Nightingale Work: Her admonition to nurses, both Her principles and rules serves the providing care in home and foundation of nursing practice hospitals, was to create and Should continue to be recognized as maintain a therapeutic environment the brilliant and creative founder of that would enhance comfort and modern nursing recovery of patients First Nursing Theorist NURSING Her reports describing health and Nursing is being responsible for sanitary condition in Crimea and someone else's life England identify her as an "What nursing has to do.. is to put outstanding scientist and empirical the patient in the best condition for researcher nature to act upon him' (Nightingale, her dependence on observable data 1859/1992). to support her position, it can be said GOAL OF NURSING that Nightingale was the FIRST To facilitate "the body's reparative NURSE RESEARCHER process" by manipulating the client's environment. Awards and Later Life FRAMEWORK Nightingale was the first woman to Manipulate the client's environment be granted the Order of Merit and to include appropriate noise, the Royal Red Cross by no less than nutrition, hygiene, light, comfort, the Queen Victoria of Great Britain. socialization, and hope Second most famous British person, after the Queen herself. Recipients She became a heroine in Great Britain as a of the award are entitled to use the result of her work in the Crimean War. Her post-nominal letters (OM, RRC) on depiction of the very poor sanitary their names. conditions in the hospital wards at Scutari is a manager and trainer of nurses overwhelming. She fought the bureaucracy during the Crimean War, in which for food, bandages, fresh bedding, and she organized care for wounded cleaning supplies for the soldier soldiers She spent the years after the Crimean war 1860, she laid the foundation of establishing schools of nursing and professional nursing with the influencing public policy by lobbying her establishment of her nursing school acquaintances about several of her at St Thomas' Hospital in London. It concerns. was the first secular nursing school After the war, She returned to England, She in the world, and is now part of was awarded funds in recognition of her King's College London. work, which she used to establish a She was able to work into her teaching institution for nurses at St. Thomas eighties and died in her sleep on August 13, 1910 at the age of 90.  The news of her death spread across the world, and she instantly became a celebrated and legendary person. CLEANLINESS Proper disposal of garbage Strict Implementation of RA 9003 Implementation of "Tapat Ko, Linis Ko" Program Regular Collection of Garbage Awareness of Environmental Sanitation Reduce/Reuse/Recycle Materials Frequent Handwashing EFFICIENT DRAINAGE Declogging of sewerage system as necessary Avoid throwing of garbage along the road or anywhere Maintenance of efficient drainage is a must Proper monitoring of factory and chemical wastes disposal PURE AIR Plant more trees Monitoring of vehicle smoke emission Monitoring of factory smoke emission Support clean air act Awareness on Global Warming Phenomenon Support bio-diesel fuel utilization Utilization of wind and solar energy Proper transport of garbage disposal PURE WATER Monitoring of potability of water Boil water when in doubt Use commercially prepared drinking water Monitoring of proper sewerage system, and proper waste disposal Assure pipeline consistency Conserve water MARGARET JEAN HARMAN WATSON "Caring is the essence of nursing Philosophy and Theory of Transpersonal and the most central and unifying Caring (Theory of Nursing Care) focus for nursing practice". - Jean Watson (June 10, Theory of Caring Development 1940-October 14, 2018) is an Watson developed the basic caring American nurse theorist and nursing nursing process, while writing a professor who is well known for her baccalaureate textbook. She "Philosophy and Theory of published Nursing: The Philosophy Transpersonal Caring." She has also and Science of Caring in Revised in written numerous texts, including (Fawcett & DeSanto-Madeya, 2013) Nursing: The Philosophy and This initial publication established Science of Caring. Watson's study the carative factors in nursing, and on caring has been integrated into were renamed in 2001 to Clinical education and patient care to Caritas Process (Wagner, 2010) various nursing schools and Another hallmark in Watson's healthcare facilities all over the exploration and development of the world. science and art of caring is her book, - Born and grew up in Welch, West Postmodern Nursing and Beyond Virginia (1999). Theory of Caring focuses on the CREDENTIALS interpersonal and transpersonal Master's degree in relationship between nurse and psychiatric-mental heath nursing other (self, patient, family, society, (1966) at University of Colorado. universe) Doctorate in educational psychology "Human caring is the moral ideal of and counseling (1973). nursing" (Fawcett & DeSanto- Faculty and administrative positions Madeya, 2013) PHILOSOPHY AND THEORY OF Published Books TRANSPERSONAL CARE (THEORY OF 1st- Nursing: The Philosophy and Science NURSING CARE) of Caring (1979) Emphasizes dignity and the person 2nd-Nursing: Human Science and Human as a whole, not an object or Care-A Theory of Nursing (1985) diagnosis. 3rd- Postmodern Nursing and Beyond Describes "Transpersonal Caring (1999) Relationship" as a foundational to her Theory; it is a "special kind of Latest Published Books human care relationship- a union Measuring Caring: International with another person-high regard for Research on Caritas as Healing the whole person and their (Nelson& Watch, 2011) being-in-the-world" (Watson, 1999) Human Caring Science: A theory of Nursing (Watson, 2012) Carative Factors 7. "The promotion of transpersonal 1. "The formation of a humanistic- teaching-learning" altruistic system of values" "Engaging in genuine teaching-learning "Practice of loving kindness and equanimity experience that attends to unity of being within the context of caring consciousness" and meaning, attempting to stay within others frame of reference" 2. The instillation of faith-hope" "Being authentically present and enabling 8. "The provision of supportive, and sustaining the deep belief system and protective, and (or) corrective mental, subjective life-world of self and one being physical, societal, and spiritual cared for" environment". "Creating healing environment at all levels 3. "The cultivation of sensitivity to one's (physical as well as nonphysical, subtle self and to others" environment of energy and consciousness, "Cultivation of one's own spiritual practices whereby wholeness. beauty, comfort, and transpersonal self going beyond the dignity, and peace are potentiated) ego self" 9.The assistance with gratification of 4. "Development of a helping-trust human needs relationship" became "development of a "Assisting with basic needs, with an helping-trusting, human caring relation" intentional caring consciousness, (in 2004 Watson website) administering human care essentials, which "Developing and sustaining a helping potentiate alignment of mind body spirit, trusting authentic caring relationship" wholeness, and unity of being in all aspects 5. "The promotion and acceptance of the of care. expression of positive and negative 10."The allowance for existential- feelings" phenomenological forces became "allowance for existential- "Being present to, and supportive of, the phenomenological spiritual forces" (in expression of positive and negative feelings 2004 Watson website) as a connection with deeper spirit and self "Opening and attending to spiritual- and the one-being-cared for" mysterious and existential dimensions of one's own life-death: soul care for self and 6. "The systematic use of the scientific problem solving method for decision Watson's ordering of needs making" became "systematic use of a - Lower order needs (biophysical creative problem solving caring process" needs) (in 2004 Watson website) The need for food and fluid "Creative use of self and all ways of The need for elimination knowing as part of the caring process: to The need for ventilation engage in the artistry of caring-healing - Lower order needs (psychophysical practices" needs) The need for activity-inactivity The need for sexuality  - Higher order needs (psychosocial needs) HEALTH The need for achievement She defined health as "unity and The need for affiliation harmony within the mind, body and - Higher order need soul" and is associated with the (intrapersonal-interpersonal need) "degree of congruence between the The need for self-actualization self as perceived and the self as Assumptions experienced", (Watson, 1988) (1) Caring can be effectively demonstrated Originally from WHO as, "The and practiced only interpersonally. positive state of physical, mental and (2) Caring consists of carative factors that social well-being with the inclusion of result in the satisfaction of certain human three elements: needs. Health as a high level-all physical, (3) Effective caring promotes health and mental and social functioning individual or family growth. Health as a general (4) Caring responses accept the patient as adaptive-maintenance level of daily he or she is now, as well as what he or she functioning and absence of illness may become. (5) A caring environment is one that offers Human Being the development of potential while allowing Human being is a valued person in the patient to choose the best action for him and of him to be cared for, or herself at a given point in time. respected, nurtured, understood, (6) A science of caring is complementary to and assisted. the science of curing. A person is greater than and different from the sum of its parts. (7) The practice of caring is central to Environment nursing. Society provides the values that determine how one should behave NURSING and what goals one should strive Nursing consists of knowledge, toward thought, values, philosophy, commitment, and action, with some Environment/Society degree of passion (Watson, 1988) - Watson states: Is interested in understanding "Caring (and nursing) has existed in every health, illness, and the human society. Every society has had some people experience who have cared for others. A caring attitude Is concerned with health promotion, is not transmitted from generation to restoration and illness prevention generation by genes. It is transmitted by the Nursing as a human science of culture of the profession as a unique way of people and human health-illness coping with its environment." experiences that are mediated by professional, personal scientific, Integration of Jean Watson's Theory of aesthetic, and ethical human care Caring into Nursing Practice transaction  Establish a caring relationship with patients. Treat patients as holistic beings. Display unconditional acceptance. Treat patients with positive regard. Promote health through knowledge and intervention. Spend uninterrupted time with patient Patricia Benner defined in the course of living a life. From Novice to Expert: Excellence and A person also has... an effortless Power in Clinical Nursing Practice and non-reflective understanding of the self in the world. The person is Biography & Career viewed as a participant in common - Born on August 31, 1942 in meanings." Hampton, Virginia Believed that there are significant - 1964, earned her Bachelor of Arts in aspects that make up a person. nursing from Pasadena College She had conceptualized the major - 1960, worked in nursing field aspects of understanding that the - 1970-1975, research associate at person must deal with as: the University of California at San 1. The role of the situation. Francisco School of Nursing 2. The role of the body. 3. The role of personal concerns. 4. The role of temporality Published books Goal: Overcome the Cartesian dualism, the 1. From Novice to Expert: Excellence and view that the mind and body are distinct, Power in Clinical Nursing Practice separate entities. 2. Nursing Pathways For Patient Safety 3. The Primacy of Caring Embodiment is the capacity of the body to respond to meaningful situations. Co-authored books 1. Expertise in Nursing Practice: Caring, 5 Dimensions of the body (Merleau, Clinical judgment, and Ethics Ponty & Dreyfus) 2. Clinical Wisdom in Critical Care: A 1. The unborn complex Thinking-in-Action Approach 2. The habitual skilled body 3. The projected body NURSING 4. The actual projected body Described as an "enabling condition 5. The phenomenal body of connection and concern" which shows a high level of emotional HEALTH involvement in the nurse-client Focused "on the lived experience of relationship. being healthy and ill." Viewed nursing practice as the care Defined health as what can be and study of the lived experience of assessed, while well-being is the health, illness, and disease and the human experience of health or relationships among these three wholeness. elements. Well-being and being ill are recognized as different ways of PERSON being in the world. Stated that "a self-interpreting being, Health is described as not just the that is, the person does not come absence of disease and illness. into the world predefined but gets Also, a person may have a disease  and not experience illness because meaningful components of a illness is the human experience of situation. loss or dysfunction, whereas disease The person has enough experience is what can be assessed at the to grasp aspects of the situation. physical level. Nurses functioning at this level are guided by rules and are oriented by ENVIRONMENT task completion. Used the term "situation" instead, They have difficulty grasping the because it suggests a social current patient situation in terms of environment with social definition the larger perspective. and meaning. However, clinical situations are Used the phenomenological terms of viewed by nurses at this level as a being situated and situated meaning, stage of their abilities. which are defined by the person's They feel highly responsible for engaged interaction, interpretation managing patient care, yet they still and understanding of the situation. rely on the help of those more experienced. 5 LEVELS OF SKILL ACQUISITION AND Most newly graduated nurses are SKILL DEVELOPMENT placed in this level. 1. NOVICE 3. COMPETENT The person has no background Through learning from actual experience of the situation in which practice situations and by following he or she is involved. the actions of others, advance Context-free rules and objective beginner moves to this level. attributes must be given to guide Typified by considerable conscious performance. and deliberate planning that There is difficulty discerning determines which aspects of the between relevant and irrelevant current and future situations are aspects of a situation. important and which can be ignored. Generally, this level applies to Consistency, predictability and time nursing students, but Benner management are important, and suggested that a nurse at higher gaining a sense of mastery through levels of skill in one area of practice planning and predictability is the could be classified at the novice accomplishment. level if placed in an unfamiliar area There is an increased level of or situation. efficiency but the focus is on time management and the nurse's 2. ADVANCED BEGINNER organization of the task world. The person can demonstrate The competent nurse may display marginally acceptable performance hyper-responsibility for the patient, having coped with enough real often more than is realistic, and may situations to note, or to have pointed exhibit an ever- present and critical out by a mentor, the recurring view of the self.  This stage is most pivotal in clinical 1. a clinical grasp and resource-based learning because the learner must practice begin to recognize patterns and 2. embodied know-how determine which elements of the 3. seeing the big picture situation warrant attention and which 4. seeing the unexpected can be ignored. The expert nurse has the ability of They devise new rules and pattern recognition on the basis of reasoning procedures for a plan deep experiential background. while applying learned rules for Meeting the patient's actual action on the basis of the relevant concerns and needs is of utmost facts of the situation. important, even if it means planning and negotiating for a change in the 4. PROFICIENT plan of care. The performer recognizes the most There is almost a transparent view salient aspects and has an intuitive of self grasp of the situation based on background understanding. MAJOR CONCEPTS AND DEFINITIONS Nurses at this level demonstrate a new ability to see changing ASPECTS OF A SITUATION relevance in a situation including the The recurring meaningful situational recognition and the implementation components recognized and of skilled responses to the situation understood in context because the as it evolves. nurse has previous experience. 5. EXPERT ATTRIBUTE OF A SITUATION The expert performer no longer Measurable properties of a situation relies EXPERT analytical principle that can be explained without (rule, guide and maxim) to connect previous experience in the situation. her or his understanding of the situation to an appropriate action.t COMPETENCY The expert nurse as having an IIt is "an interpretively defined area intuitive grasp of the situation and as of skilled performance identified and being able to identify the region of described by its intent, functions, the problem without wasting and meanings." consideration on a range of alternative diagnoses and solutions. DOMAIN There is a qualitative change as the An area of practice having a number expert performer "knows the of competencies with similar intents, patient", meaning knowing typical functions, and meanings. patterns of responses and knowing the patient as a person. EXEMPLAR Key aspects of the expert nurse's An example of a clinical situation practice are: that conveys one or more intents, meanings, functions, or outcomes  easily translated to other clinical situation. EXPERIENCE An active process of refining and changing preconceived theories, notions, and ideas when confronted with actual situations; implies there is a dialogue between what is found in practice and what is expected. MAXIM cryptic description of skilled performance that requires a certain level of experience to recognize the implications of the instructions. PARADIGM CASE A clinical experience that stands out and alters the way the nurse perceives and understands future clinical situations. Paradigm cases create new clinical understanding and open new clinical perspectives and alternatives SALIENCE A perceptual stance or embodied knowledge whereby aspects of a situation stand out as more or less important. Martha Rogers Urinary Human Beings Pished Book ✓1961: Educational Revolution in Nursing Professional practice in nursing seeks to ✓1964: Reveille in Nursing promote symphonic interaction between ✓1970: An Introduction to the Theoretical man and environment, to strengthen the Basis of Nursing coherence and integrity of the human field, and to direct and redirect patterning of the Basic Assumptions human and environmental fields for ✓wholeness realization of maximum health potential." ✓ openness (Rogers, 1970, p. 122) ✓unidirectionality ✓ Pattern About the theorist ✓organization Martha Rogers was born on May 12, ✓ Sentience 1914 in Dallas, Texas. ✓ Thought In 1936, she received her nursing diploma from Knoxville General Postulation : Human Beings are dynamic Hospital School of Nursing. energy fields integral with environmental 1937, she obtained a bachelor of fields. science degree form George Peabody College in Nashville, FOUR BUILDING BLOCKS Tennessee 1.Energy field 1945, Muster's of arts degree in 2.universe of Open Systems public health nursing supervision 3.Pattern from Teachers College Columbia 4.Four Dimensionality university, New York 1952, Masters of public arts degree 1. ENERGY FIELD 1954, Doctor of science degree, ✓ Constitutes the fundamental unit of both John Hopkins University Baltimore the living and non-living In 1979, she became Professor ✓ Field is a unifying concept Emerita ✓ Energy signifies the dynamic nature of In 1988, colleagues and students the field joined her in forming the Society of Rogerian Scholars (SRS) TWO FIELDS Begun publishing Rogerian Nursing 1. Human Field Science News, a members' Defined as an irreducible, indivisible, newsletter to disseminate theory pandimensional energy field identified by developments and research studies. pattern and manifesting characteristics that 1993, The Journal of Rogerian are specific to the whole and that cannot be Nursing Science begun publishing predicted from knowledge of the parts journal annually. 2. Environmental Field Date of Death: March 13, 1994 Defined as an irreducible, pandimensional energy field identified by pattern and integral with the human field.  Both fields change continuously, creatively to direct and redirect patterning of and integrally the human and environmental fields for realization of maximum health potential". 2. A UNIVERSE OF OPEN SYSTEMS PERSON Holds that energy fields are infinite, As an open system in continuous open, and integral with one another process with the open system that is Human and the environmental field the environment are in contínuous process and are Man is a unified whole possessing open systems his own integrity and manifesting characteristics that are more than 3. PATTERN and different from the sum of its The distinguishing characteristic of parts an energy field and is perceived as a HEALTH single wave. Health and illness are manifestations The nature of the pattern changes of pattern and are considered to continuously, innovatively, and these denote behaviors that are of high changes give identity to the energy value and low value field passive health to symbolize wellness Manifestations of pattern have been and the absence of disease and described as unique and refer to major illness behaviors, qualities, and ENVIRONMENT characteristics of the field. An irreducible, pandimensional energy field identified by pattern and 4. PANDIMENSIONALITY manifesting characteristics different As a nonlinear domain without from those of the parts. spatial or temporal attributes environmental fields are infinite and Provides for an infinite domain change is continuously innovative, without límit unpredictable, and characterized by increasing diversity. NURSING is a learned profession FIVE ASSUMPTIONS (1970) Focuses on the people and the 1. "Man is a unified whole possessing world in which they live, as it his own integrity and manifesting encompasses people and their characteristics more than and environments. different from the sum of his parts" The art of nursing is the creative use (energy field) (p. 47). of the science of nursing for human 2. "Man and environment are betterment" continuously exchanging matter and Professional practice in nursing energy with one another" (openness) seeks to promote symphonic (p. 54). interaction between human and 3. "The life process evolves environmental fields, to strengthen irreversibly and unidirectionally the integrity of the human field, and  along the space-time continuum" Manipal Journal of Nursing and Health (helicy) (p. 59). Sciences, 4 (1), 50-56. 4. "Pattern and organization identify man and reflect hi innovative Mrs. Geetha, a 70 years old female, was wholeness" (pattern and diagnosed with Septicaemia. She was organization) (p. 65). admitted to the Intensive Care Unit of the 5. "Man is characterized by the hospital. She was known to have capacity for abstraction and imagery, hypertension and diabetes mellitus in the language and thought, sensation, past seven years. A year ago, she had and emotion" (sentient, thinking right-sided hemiplegia because of a stroke. being) (p. 73). She cannot express herself verbally when she is in the ICU. Theoretical Assertion She was fed through a Nasogastric tube; "The life process is homeodynamic... these Foley's catheter drained her urine, and her principles postulate the way the life process bowel pattern is regular. A Decubitus ulcer is and predict the nature of its evolving" (p. was present in the sacral region. Her 96) movements were restricted on the right side of her body. After regaining her Principles of Change consciousness and her condition is stable, Helicy - describes spiral she was transferred to the medical ward. development in continuous, She is more relaxed and comfortable in the nonrepeating, and innovative medical ward. Mrs. Geetha was able to patterning. tolerate the fluids in her body orally. After - describing the nature of three weeks at the hospital, she was change evolved from discharged. On her discharge, her catheter probabilistic to unpredictable, was removed, and she was able to tolerate while remaining continuous a soft diet. Her family members were taught and innovative about taking care of her. Social workers Resonancy-patterning changes with were also consulted to aid her. With the help the development from lower to of the social workers, Mrs. Geetha was able higher frequency, that is, with to sit with the support of the bed and move varying degrees of intensity. her limbs. Although she can do those Integrality- "reflects the unity or things, she still needs someone who can wholeness of humans and their accompany her to the activities of daily environment" (Jarrin, 2012, p. 14). living. Her pattern in the hospital had changed Title: Application of Rogers' system model in because of the decision of her family and nursing care of a client with cerebrovascular health care professionals. During her days accident in the hospital, the primary concern of the Author: Priya Reshma Aranha staff was to help her achieve good health. Source: Aranha, P.R. (2018). Application of When the time came that she was Roger system model in nursing care of a discharged, family support and rehabilitation client with cerebrovascular Accident. were provided to have a better life. Mrs. Geetha uses all of the resources from her family, society, and the hospital to have a better future. The nursing care was provided Integrality to Mrs. Geetha using the nursing process. As Mrs Geetha is hemiplegic and ready for discharge, her family has to do some NURSING ASSESSMENT modifications at home. She has to get treatment for her HTN and DM also. Her Pattern son stated, "I do not know how to take care Mrs Geetha is a right sided hemiplegic. She of her at home and prevent any forth said, "I cannot do anything of my own. I am coming problems." dependent on others for everything." She tolerates only fluid and soft diet and her intake is reduced. She has a deep bedsore over sacral region. Her pattern is decided by others in the hospital. She said, "I am not able to mix up with others due to my condition, I feel lonely." Mrs Geetha's son stated, "She is very religious and bold enough to face the problems of life, but now she has lost the confidence. She feels lonely and isolated." Mrs Geetha strives hard to achieve the fullest health within her limits. Resonancy Mrs Geetha is on treatment. She complies with it. She states, "If I do not take these medicines my condition may deteriorate further. She further states, "My illness has laid burden on my son." But her son is very supportive. It is observed that sometimes she is pleasant, sometimes dull and withdrawn. When she was dull she said, "I feel depressed and guilty of my illness. I, do not know what will happen in the future? Helicy In Mrs Geetha's present condition she is unidirectional in moving towards achieving health within her limits. She said, "I accept my illness; I may be recovering by using all the resources available. I do not fear death." Her son stated, "We will support and care for our mother throughout her remaining life." Dorothea Orem's SELF-CARE is a human regulatory Self-Care Nursing Theory function that individuals must, with deliberation, perform themselves or Let's talk about the Theorist must have performed for them too Was born in July 15, 1914 in maintain life, health, development, Baltimore, Maryland and well being (Alligood, 2014). Earned her nursing diploma from the SCDNT's Philosophical Emphasis is Providence Hospital School of that all patients want to care for Nursing in Washington, D.C in themselves, and they are able to 1930s. She went on to complete her recover more quickly and holistically Bachelor of Science in Nursing in by performing their own self-care as 1939 and her Master's of Science in much as they're able. Nursing in 1945, both from the This theory is mainly used in Catholic University of America in rehabilitation and primary care or Washington, D.C. other settings in which patients are ,One of the America's foremost encouraged to be INDEPENDENT. nursing theorist She was involved in nursing Composed of the following interrelated practice, nursing service and nursing theory: education Theory of Self-Care She worked as a staff nurse, private Theory of Self-Care Deficit duty nurse, nurse educator, nurse Theory of Nursing Systems administrator and nurse consultant Orem's Self-Care Deficit Theory Classified as: focuses on each "individual's ability Wholly compensatory to perform self-care, defined as 'the Partially compensatory practice of activities that individuals Supportive-educative initiate and perform on their own behalf in maintaining life, health, and "Caring in nursing conveys physical acts, well-being." embraces the mind-body-spirit as it reclaims died on June 22, 2007, at her the embodied spirit as its focus of attention." residence on Skidaway Island, Georgia. Bedridden Meta-paradigm in Nursing 1st Book: Orem's theory addresses client's Nursing: Concepts of Practice self-care needs. It is defined as (1971) goal-oriented activities that are set Subsequent editions of the same towards generating interest in the book were published in 1980, 1985, part of the client to maintain life and 1991, 1995 and 2001. health development. Received honorary Doctor of The theory is aimed towards making Science Degree in 1976 the clients perform self-care activities in order to live Dorothea Orem's Self-Care Nursing independently. Theory Person  Human being who functions inabilities to maintain continuous biologically, psychologically, provision of healthcare. symbolically, and socially. An art through which the practitioner are very much different from other of nursing gives specialized living things in terms of their assistance to persons with capacity. disabilities of such a character that can reflect upon events, themselves, greater than ordinary assistance is and their environment. necessary to meet daily needs for have the potential for learning and self care and to intelligently development participate in the medical care they Capable for self- knowledge are receiving from the physician. Can engage in deliberate actions, interpret experiences, and perform Major Concepts and Definition beneficial actions Self-Care Able to meet self-care needs Self-Care is an activity that promotes (requisites) a person's well- being. It is as an individual, patient, multiperson performed by persons who are unit, self-care agent, dependent-care aware of the time frames on behalf agent. of maintaining life, continuing personal development and a healthy Environment functional living. Has two dimensions: Environmental: Physical, Self-Care Requisites Chemical and biologic features Self-Care Requisites are insights of atmosphere, pollutants, weather actions or requirements that a conditions, pets, infectious person must be able to meet and organism, etc. perform in order to achieve well-being. The two elements of Development: socioeconomic features self-care requisites are: family & community 1. The factor to be controlled or Gender and age roles, cultural roles, managed to keep as aspects of and cultural prescriptions of authority human functioning and development within the norms compatible with life, Nursing health and personal well-being and; According to Orem, Nursing is 2. The nature of the required action. helping clients to establish or identify ways to perform self- care activities. Universal Self-Care Requisite Nursing actions are geared towards Eight (8) self-care requisites common to the independence of the client. men, women and children (Alligood, 2014) Orem defines nursing as a human are as follows: service and it is based on values. It 1. Maintenance of a sufficient intake of is a distinguished human service air. since its focus is on persons with 2. Maintenance of sufficient intake of food.  3. Maintenance of sufficient intake of prevention, and provision) water. (Orem, 2001, p.523) 4. Provision of care associated with elimination processes and Self-Care Agency excrements. The complex acquired ability of 5. Maintenance of balance between mature and maturing persons to activity and rest. know and meet their continuing 6. Maintenance of balance between requirements for deliberate, solitude and social interaction. purposive action to regulate their 7. Prevention of hazards to human life, own human functioning and human functioning, and human development (Orem, 2001). well-being. Agent 8. Promotion of human functioning and Agent is the individual who is development within social groups in engage in meeting the needs of a accordance with human potential, person or a person who has the known human limitations, and the power to engage in a course of human desire to be normal. action. Health Deviation Self-Care Requisites Self-Care Deficit These self-care requisites exist for A relationship between the human persons who are ill or injured, who properties of therapeutic self-care have specific forms of pathological demand and self-care agency in conditions or disorders, including which constituent developed self- defects and disabilities, and who are care capabilities within self-care undergoing medical diagnosis and agency are not operable or treatment. inadequate for knowing and meeting some or all components of the Therapeutic Self-Care Demand existent or projected therapeutic These are the summation of all self-care demand. activities needed to alleviate the existing disease or illness by Nursing Agency methods appropriate for the Nursing Agency is a set of following: established capabilities of a nurse - Controlling or managing the who can legitimately perform factors identified in the activities of care for a client. It helps requisites, the values of a person achieve their health care which are regulatory of demand. human functioning (sufficiency of air, water, and Nursing Systems food) These are series and sequences of - Fulfilling the activity element deliberate practical actions of nurses of the requisites performed at times in coordination (maintenance, promotion, with actions of their patients. Helping Methods 3. Supportive-educativo From a nursing perspective, it is a sequential series on actions, which, Evaluation if performed, will overcome or Formative - Has the client been able to compensate for the re-establish self- caro? health-associated limitations of Summative-How effective is Orem's persons to engage in actions to Self-Care Model in organizing the delivery regulate their own functioning and of self-care in a particular nursing specialty? development or that of their dependents. Implementation 1. Acting for or doing for another intervention may be: 2. Guiding and directing 1. Doing for or acting for another 3. Providing physical or psychological 2. Guiding or directing support 3. Providing physical support 4. Providing and maintaining an 4. Providing psychological support environment that supports personal 5. Providing an environment that supports development development 5. Teaching 6. Teaching another 3 Classification of Nursing Systems Collect Data in Six Areas Wholly Compensatory- The nurse 1. The health goals within the context of life or caregiver does all care for the history, lifestyle, and health status. patient. Patients are unable to care 2. The person's requirements for self- care for themselves. 3. The person's health status Partly Compensatory- Patient can 4. The physician's perspective of the do some care for themself but still person's health status relies on the nurse or caregiver for 5. The person's perspective of his or Health assistance. 6. The person's capacity to perform Supportive Educative - Patient self-care learns to provide care for themself on their own without any assistance INTEGRATION OF OREM'S THEORY from the nurse or caregiver. INTO PRACTICE Nursing Diagnosis & Care Plans Assessment - Is there a deficit between the The nurse designs a system that is wholly client's self-care abilities and the demands or partly compensatory or for self-care? is the deficit due to: lack of supportive-educative. The two actions are: knowledge; lack of skill lack of motivation; or 1. Bringing out a good organization of the limited range of available behavior? components of patients' therapeutic self- care demands. Planning 2. Selection of a combination of ways of Set goals to achieve or maintain self-come helping that will be effective and efficient in Plan interventions to be compensating for/overcoming a patient's 1. Wholly compensatory self-care deficits. 2. Partly compensatory Implementation & Evaluation Activity/rest- Frequent rest is required due Nurse assists the patient or family in to pain. Pain not completely relieved, self-care matters to achieve Activity level has come down. Deformity of identified and described health and the joint secondary to the disease process health-related results. and use of the joints. Collecting evidence in evaluating Social interaction - Communicates well results achieved against results with neighbors and calls the daughter by specified in the nursing system phone Need for medical care is design. communicated to the daughter. Actions are directed by etiology Prevention of hazards- Need instruction component of nursing diagnosis. on care of joints and prevention of falls. Need instruction on improvement of OREM'S SELF CARE MOBEL nutritional status. Prefer to walk barefoot. Promotion of normalcy - Has good SELF CARE relation with daughter. Dietary Precautions Physical Activities DEVELOPMENTAL SELF-CARE Regular Checkups REQUISITES Maintenance of developmental SELF CARE AGENCY environment - Able to feed self, Difficult to Lack of family support perform the dressing, toileting etc Lack of awareness Prevention/management of the Unhealthy diet conditions threatening the normal development - Feels that the problems are SELF CARE REQUISITE due to her own behaviors and discusses the Management and prevention of problems with husband and daughter. HTN, Stress and Obesity HEALTH DEVIATION SELF CARE NURSING AGENCY REQUISITES Health education Adherence to medical regimen- Report Music therapy the problems to the physician the hospital. Mind diversion therapy Cooperates with the medication, Not much Volunteers training aware about the use and side effects of medicines UNIVERSAL SELF-CARE REQUISITE Awareness of potential problem Air- Breaths without difficulty, no pallor associated with the regimen - Not aware cyanosis about the actual disease process. Not Water - Fluid intake is sufficient. Edema compliant with the diet and prevention of present over ankles. Turgor normal for the hazards. Not aware about the side effects of age the medications Food- Hb 9.6gm%, BMI 14. Food intake is Modification of self image to not adequate or the diet is not nutritious. incorporates changes in health status - Elimination- Voids and eliminates bowel Has adapted to limitation in mobility. The without difficulty. adoption of new ways for activities leads to She listed the foods that are rich in deformities and progression of the disease. iron and that are locally available. Adjustment of lifestyle to accommodate The self care deficit in terms of food changes in the health status and medical is decreased with the initiation of the regimen. - Adjusted with the deformities. nutritional intake. Pain tolerance not achieved The supportive educative system was useful for Mrs. X. NURSING CARE PLAN Therapeutic self care demand: Deficient area: food Adequacy of self care agency: Inadequate OUTCOMES AND PLAN Outcome: - improved nutrition - Maintenance of a balanced diet with adequate iron supplementation. Nursing Goals and objectives Goal: to achieve optimal levels of nutrition. Objectives: Mrs. X will state the importance of maintaining a balanced diet. List the food items rich in iron, that are available in the locality. Design of the nursing system: - supportive educative Method of helping: - guidance - Support - - Teaching - Providing developmental environment IMPLEMENTATION - Mutually planned and identified the objectives and the patient were made to understand about the required changes in the behavior to have the requisites met. EVALUATION Mrs. X understood the importance of maintaining optimum nutrition. She verbalized that she will select the iron rich diet for her food. Sister Callista Roy The process and outcome whereby ADAPTATION MODEL thinking and feeling person as Sisters of Saint Joseph of individuals or in groups, use Carondelet conscious awareness and choice to Mount St. Mary's College in L.A., create human and environmental California (BSN-1963) integration. UNIVERSITY OF CALIFORNIA, L.A - 1966-MAN ADAPTATION LEVEL - 1973- MA in Sociology Represents the condition of the life - 1977 - Ph.D in Sociology processes described on three levels STIMULUS as integrated, compensatory and Is any factor that provokes a response compromised. A constantly changing point, made Three Classes of Stimulus: up of focal, contextual, and residual, 1. Focal Stimuli which represent the person's own Immediately confront the person standard of the range of stimuli to The internal or external stimulus which one can respond with ordinary most immediately confronting the adaptive responses. human system ADAPTATION PROBLEMS 2. Contextual Stimuli Broad areas of concern related to All other stimuli present that adaptation contribute to the effect of the focal Describe the difficulties related to stimulus the indicators of positive adaptation Are all environmental factors that Areas of concern for the nurse present to the person from within or related to adapting person or group without but which are not the center of the person's attention and/or COPING PROCESSES energy Are innate or acquired ways of interacting with the changing 3. Residual Stimuli environment. Environmental factors whose effects are unclear in a given situation ACQUIRED COPING MECHANISMS Are developed through strategies SYSTEM such as learning A set of parts connected to function The experiences encountered as a whole for some purpose and throughout life contribute to that does so by virtue of the customary responses to particular interdependence of its parts. stimuli. Also have inputs, outputs, and control and feedback processes. REGULATOR SUBSYSTEM A major coping process involving the ADAPTATION neural chemical, and endocrine systems.  formed from internal perceptions and COGNATOR SUBSYSTEM perceptions of others' reaction A major coping process involving four cognitive-emotive channels Components 1. Perceptual and information 1. Physical self-involves sensation processing and body image 2. Learning 2. Personal self-made up of 3. Judgment self-consistent self-ideal or 4. Emotion expectancy and the moral-ethical-spiritual self ADAPTIVE RESPONSES The basic need underlying the individual That promote integrity in terms of the self-concept mode has been identified as goals of human systems psychic and spiritual integrity INEFFECTIVE RESPONSES Group identity That do not contribute to integrity in Reflects how people in groups terms of the goals of the human perceive themselves based on system environmental feedback Composed of the following: INTEGRATED LIFE PROCESS 1. Interpersonal relationships Adaptation level at which the 2. Group self-image structures and functions of a life 3. Social milieu process are working as a whole to 4. Culture meet human needs The basic need of the group identity PHYSIOLOGICAL PHYSICAL MODE mode is identity integrity The physiological mode is associated with the physical and ROLE FUNCTION MODE chemical processes involved in the It focuses on the roles the person function and activities of living occupies in society organisms. Defined as a set of expectations about how a person occupying one FIVE NEEDS OF PHYSIOLOGICAL position behaves toward a person INTEGRITY occupying another position 1. Oxygenation - Instrumental behavior - 2. Nutrition actual physical performance 3. Elimination of a behavior 4. Activity and rest - Expressive behavior - the 5. Protection feelings, attitudes, likes or dislikes that a person has SELF-CONCEPT-GROUP IDENTITY about a role or about the MODE performance of a role Self-concept is defined as the Basic need is social integrity - the composite of beliefs and feelings need to know who one is in relation about oneself at a given time and is to others so that one can act.  PERCEPTION ROLE FUNCTION MODE Is the interpretation of a stimulus 1. Primary role and the conscious appreciation of it. - Determines the majority of behavior Links the regulator with the engaged in by the person during a cognator and connects the adaptive particular period of life, determined modes by age, sex and developmental stage SCIENTIFIC ASSUMPTION 2. Secondary role Systems of matter and energy - Are those that a person assumes to progress to higher levels of complex complete the task associated with self-organization. the developmental stage and Consciousness and meaning are primary stage constructive of person and 3. Tertiary role environment integration. - Are normally temporary in nature, Awareness of self and environment freely chosen by the individual, and is rooted in thinking and feeling. may include activities such as clubs Humans, by their decisions, are or hobbies accountable for the integration of creative processes INTERDEPENDENCE MODE Thinking and feeling mediate human It focuses on close relationships of action. people and their purpose, structure, System relationships include and development acceptance, protection, and Two relationships: fostering of interdependence. 1. With the significant others, persons Persons and the earth have who are the most important to the common patterns and integral individual. relationships. 2. With support systems, others Persons and environment contributing to meeting transformations are created in interdependence needs. human consciousness. Integration of human and Two major areas of interdependence environmental meanings results in behavior adaptation. 1. Receptive behavior 2. Contributive behavior PHILOSOPHICAL ASSUMPTION - Apply respectively to the Persons have mutual relationships receiving and giving love, with the world and God. respect and value in Human meaning is rooted in the interdependent relationships. omega point convergence of the - The basic need of universe. interdependence mode is God is intimately revealed in the relational integrity diversity of creation and is the common destiny of creation.  Persons use human creative abilities of awareness, enlightenment, and TWO INTERRELATED SUBSYSTEM faith. 1. Primary, functional or control Persons are accountable for the subsystem processes of deriving, sustaining, - Regulator and transforming the universe. - Cognator NURSING 2. Secondary, effector subsystem Health care profession that focuses Consists of four adaptive modes: on human life processes and a. Physiological needs patterns and emphasizes promotion b. Self-concept of health for individuals, families, c. Role Function groups, and society as a whole. d. Interdependence Nursing science is a developing system of knowledge about persons SIX STEPS NURSING PROCESS that observes, clarifies, and relates A nurse's role in the Adaptation the processes by which persons Model is to manipulate stimuli by positively affect their health status. removing, decreasing, increasing, or Goal: promotion of adaptation for altering stimuli so that the patient. indials and groups in each of the 1. Assess the behaviors manifested four adaptive modes thus from the four adaptive modes. contributing to health, quality of life, 2. Assess the stimuli, categorize them and dying with dignity. as focal, contextual residual. 3. Make a statement or nursing PERSON diagnosis of the person's adaptive As an adaptive system, the human state. system is described as a whole with 4. Set a goal to promote adaptation. parts that function as unity for some 5. Implement interventions aimed at purpose managing the stimuli. Human systems have thinking and 6. Evaluate whether the adaptive goal feeling capacities, rooted in has been met. consciousness and meaning, by which they adjust effectively to changes in the environment and, in turn, affect the environment. ENVIRONMENT All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons or groups with particular consideration of the mutuality of persons and earth resources that includes focal, contextual, and residual stimuli. BETTY NEUMAN Honorary Member of the Fellowship The System Model Theory of the American Academy of Nursing (1993) Background of the theorist Honorary Doctorate of Science, She was born in 1924 near Lowell, Grand Valley State Ohio University, Michigan (1998) Her father was a farmer who became sick and later died at the Betty Neuman took inspiration in developing age of 36. Her mother was a her theory from the following theories/ self-educated midwife, that led the philosophers: young Neuman to be always 1. Pierre Tielhard de Chardin a influenced by the commitment that philosopher-priest that believed took her away from home from time human beings are continually to time. evolving towards a state of Her love for nursing started when perfection-an Omega Point she took the responsibility of taking 2. Gestalt Theory: A theory of German care of her father which later created origin which proposes that the her compassion in her chosen dynamic interaction of the individual career path. and the situation determines In 1947, She received her RN experience and behavior. diploma from Peoples Hospital 3. General Adaptation Syndrome School of Nursing in Akron, Ohio. mainly talks about an individual In 1957, she received a reaction to stress on the some baccalaureate degree in public mainly talks about an individual's b) health and psychology with honors. resistance c) exhaustion In 1985, Betty Neuman concluded a 4. Hans Selye's definition of stress, doctoral degree in clinical which is the nonspecific response of psychology at Pacific Western the body to any demand made on it. University. She was a pioneer of 5. General Systems Theory postulates nursing involvement in mental that the world is made up systems health. that are interconnected and are influenced by each other. Published books: 6. Caplan's Levels of Prevention 1st - Consultation and Community Organization in Community Mental Wholistic Client Approach Health Nursing It is a dynamic, open, systems 2nd - The Neuman Systems Model: approach to client care originally Application to Nursing Education developed to provide a unifying and Practice focus for nursing problem definition and for best understanding the client Awards: in interaction with the environment. Honorary Doctorate of Letters, The client as a system may be Neumann College, Aston, PA (1992) defined as a person, family, group, community, or issue. Wholistic Concept - Physiological Client are viewed as wholes whose - Psychological parts are in dynamic interaction. It - Sociocultural considers all variables - Spiritual simultaneously affecting the client - Developmental system: physiological, psychological, Basic Structure Energy Resources socio-cultural, developmental and This is otherwise known as the spiritual. central core, which is made up of the Holistic to wholistic - to enhance basic survival factors common to all understanding of the term as organisms. These include the referring to the whole person following: Open system Normal temperature range - body its elements are exchanging temperature regulation ability information energy within its Genetic structure - Hair color and complex organization. bodily features Stress and reaction to stress are Response pattern-functioning of basic components of an open body systems homeostatically system. Organ strength or weakness Environment Ego structure Internal and external forces affecting Knowns or commonalities-value and being affected by the client at system any time. The person's system is an open 1. Internal (intrapersonal) system - dynamic and constantly 2. External (interpersonal and changing and evolving extrapersonal) Stability, or homeostasis, occurs Created Environment when the amount of energy that is Client's unconscious mobilization of available exceeds that being used all system variables toward system by the system. integration, stability and integrity A homeostatic body system is Content constantly in a dynamic process of Physiological, psychological, input, output, feedback, and socio-cultural, developmental and compensation, which leads to a spiritual variables of man in state of balance. interaction with the environment Input and Output Basic Structure Matter, energy and information that Viewed the client as an open system are exchanged between the client consisting of a basic structure or system central core of energy resources Feedback which represent concentric circles System output in the form of matter, Each concentric circle or layer is energy and information for future made up of the five variable areas input, for corrective action to which are considered and occur change, enhance or stabilize the simultaneously in each client system concentric circles. These are: Negentropy  A process of energy utilization that Disharmony among the parts of the assists system progression toward system is considered illness, which stability or wellness is the result of unmet needs in Entropy varying degree A process of energy depletion and Normal line of Defense disorganization that moves the It represents a stability state for the system toward illness or possible individual or system death Maintained over time and serves as Stability a standard to assess deviations from The client successfully cope with the client's usual wellness stressors; it is able to maintain an Includes system variables and adequate level of health. behaviors such as the individual's Stressors usual coping patterns, lifestyle, and Are tension-producing stimuli developmental stage occurring within the boundaries of Flexible line of Defense the client system It is dynamic and can be rapidly Are capable of producing either a altered over a short time positive or negative effect on the Perceived as a protective buffer for client system. preventing stressors from breaking Is any environmental force which through the usual wellness state as can potentially affect the stability of represented by the normal line of the system defense Intrapersonal- occur within person, Relationship of the variables can example is infection, thoughts and affect the degree of individual are feelings able to use their flexible line of Interpersonal - occur between defense against possible reaction to individuals, e.g. role expectations stressor/s (loss of sleep) Extrapersonal- occur outside the Lines of Resistance individual, e.g. job or finance Represent resource factors that help concerns the client defend against a stressor A person's reaction to stressors (immune response system) depends on the strength of the lines The last boundary that protects the of defense. basic structure When the lines of defense fails, the Protect the basic structure and resulting reaction depends on the become activated when strength of the lines of resistance. environmental stressors invade the As part of the reaction, a person's normal line of defense. An example system can adapt to a stressor, an would is that when a certain bacteria effect known as reconstitution enters our system, there is an Wellness increase in leukocyte count to It exists when the parts of the client combat infection. system interact in harmony. System Degree of Reaction needs are met Is the amount of energy required for Illness the client to adjust to the stressor Reconstitution resistance factors in order to prevent Is the state of adaptation to damage to the central core. This stressors in the internal and external occurs after the system reacts to a environment. It can begin at any stressor. This includes appropriate degree or level of reaction and may treatment of symp