Module 5: Orlando, Pender, Levine, & Hall Theories PDF

NCM 100 - THEORETICAL FOUNDATIONS ON NURSING FINAL TERM MODULE 5 IDA JEAN ORLANDO DELIBERATIVE NURSING PROCESS DELIBERATIVE NURSING PROCESS THEORY  It allows nurses to formulate an eff...

NCM 100 - THEORETICAL FOUNDATIONS ON NURSING FINAL TERM MODULE 5 IDA JEAN ORLANDO DELIBERATIVE NURSING PROCESS DELIBERATIVE NURSING PROCESS THEORY  It allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient.  It stresses the reciprocal relationship between patient and nurse.  It emphasizes the critical importance of the patient’s participation in the nursing process.  Orlando also considered nursing as a distinct profession and separated it from medicine where nurses as determining nursing action rather than being prompted by physician’s orders, organizational needs and past personal experiences.  She believed that the physician’s orders are for patients and not for nurses.  She proposed that “patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.” METAPARADIGM PERSON  Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient relationship.  For her, humans in need are the focus of nursing practice. METAPARADIGM HEALTH  In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for nursing.  She stated that nursing deals with individuals who need help. METAPARADIGM ENVIRONMENT  Orlando completely disregarded environment in her theory, only focusing on the immediate need of the patient, chiefly the relationship and actions between the nurse and the patient (only an individual in her theory; no families or groups were mentioned).  The effect that the environment could have on the patient was never mentioned in Orlando’s theory. METAPARADIGM NURSING  Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation.  The efforts to meet the individual’s need for help are carried out in an interactive situation and in a disciplined manner that requires proper training. Sub-concepts of the Deliberative Nursing Process Theory  Orlando described her model as revolving around the following five major interrelated concepts: 1. the function of professional nursing, 2. presenting behavior, 3. immediate reaction, 4. nursing process discipline, 5. and improvement. FUNCTION OF PROFESSIONAL NURSING - organizing principle  This means finding out and meeting the patient’s immediate needs for help.  According to Orlando, nursing is responsive to individuals who suffer, or who anticipate a sense of helplessness.  It is focused on the process of care in an immediate experience and is concerned with providing direct assistance to a patient in whatever setting they are found in for the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the patient. PRESENTING BEHAVIOR - problematic situation  The nurse finds the patient’s immediate need for help.  To do this, the nurse must first recognize the situation as problematic.  Regardless of how the presenting behavior appears, it may represent a cry for help from the patient.  The presenting behavior of the patient, which is considered the stimulus, causes an automatic internal response in the nurse, which in turn causes a response in the patient. IMMEDIATE REACTION - internal response  The patient perceives objects with his or her five senses.  These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act.  These three items are the patient’s immediate response.  The immediate response reflects how the nurse experiences his or her participation in the nurse-patient relationship. NURSING PROCESS DISCIPLINE – investigation  Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time  The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate until she checks the validity of it in exploration with the patient  The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does.  When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops IMPROVEMENT - resolution  It is not the nurse’s activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met.  In each contact the nurse repeats a process of learning how to help the individual patient \ LYDIA HALL CARE, CORE, CURE THEORY CORE, CARE, CURE MODEL  Hall postulated that individuals could be conceptualized in three separate domains: CARE (hands on bodily care), CORE (using the self in relationship to the patient), and CURE (applying medical knowledge)  HALL believed that patients should receive care only from professional nurses.  Nursing involves interacting with a patient in a complex process of teaching & learning.  Hall believed that professional nursing hastened the recovery of patients and that more professional nursing care & health teaching was needed in the light of decreasing medical care rendered to the patient. CORE, CARE, CURE MODEL  Hall emphasized the autonomy inherent in professional nursing.  Her model encompasses adult patients who have passed the acute stage of disease and who are now in the rehabilitation phase of healthcare.  The goal is to make sure that the patient achieves success in self-actualization and self-love after the disease. CONCEPTS AND DEFINITIONS CORE – refers to the person or the recipient of care and includes the use of therapeutic self to relate with the patient. CURE – refers to medical interventions that are performed on the patient. It includes nursing activities that are dependent upon the orders of the physician. CARE – the exclusive domain of nursing METAPARADIGM PERSON  Hall emphasizes the importance of the individual as unique, capable of growth and learning, & requiring a total person approach.  The source of energy & motivation for healing is the individual care recipient NOT the health care provider. METAPARADIGM HEALTH  Health can be inferred to be a state of self-awareness with a conscious selection of behaviors that are optimal for that individual.  Hall stresses the need to help the person explore the meaning of his or her behavior to identify and overcome problems through developing self-identity & maturity. METAPARADIGM ENVIRONMENT  The concept of environment is dealt with in relation to the individual.  the hospital environment during treatment of acute illness creates a difficult psychological experience for the ill individual.  In such a setting, the focus of the action of the nurses is the individual, so that any actions taken in relation to society or environment are for the purpose of assisting the individual in attaining a personal goal. METAPARADIGM NURSING  Nursing is identified as consisting of participation in the care, core, and cure aspects of patient care MYRA ESTRIN LEVINE THE CONSERVATION MODEL CONCEPTS AND DEFINITIONS  Levine’s Conservation model is based on three (3) major concepts and assumptions namely: Conservation Adaptation Wholeness  That is promoting adaptation and maintaining wholeness using the principles of conservation.  She further advocated that individuals continuously defend their wholeness through ongoing process of change or adaptation. And the outcome or product of adaptation is conservation. A. CONVERSATION  Keeping together of the life system. It is to maintain a proper balance between active nursing interventions coupled with patient participation and on the other hand, the safe limits of the patient’s ability to participate.  The goal of conservation is health and the strength to confront disability.  The nurse accomplishes the goals of the model through the FOUR CONSERVATION PRINCIPLES.  Individuals choose the most economical, frugal, energy-sparing options available to safeguard their integrity. B. ADAPTATION  Is achieved through the “frugal, economic, contained & controlled use of environmental resources by the individual in his or her best interest”.  It is the bridge that allows ready movement from one environmental reality to another.  It is the process by which individuals ‘fit’ the environments in which they live. (Levine, 1996)  The goal of adaptive change is the conservation of wholeness (health) and integrity.  It has three (3) characteristics: 1. Historicity – patterned responses passes on through genetics. 2. Specificity – unique adaptive responses to specific environmental challenges. 3. Redundancy – availability of multiple adaptive responses. C. WHOLENESS  It exists when the interactions or constant adaptations to the environment permit the assurance of integrity. (Levine, 1991) METAPARADIGM PERSON  Is a holistic being who constantly strives to preserve wholeness and integrity and one who is sentient, thinking, future-oriented, and past-aware.  The wholeness (integrity) of the individual demands that the “individual life has meaning only in the context of social life”.  The person is also described as a unique individual in unity and integrity, feeling, believing, thinking and whole system of system. METAPARADIGM ENVIRONMENT  Completes the wholeness of the individual. It is both internal & external.  Internal Environment – combines the physiological & pathophysiological aspects of the individual & is constantly challenged by the external environment.  External Environment is divided into: 1. Perceptual – a portion of the external environment which individuals respond to with their sense organs. 2. Operational – that portion of the external environment which interacts with the living tissue even though the individual does not possess sensory organs that can record the presence of these factors. 3. Conceptual – that portion of the external environment that consists of language, ideas, symbols & concepts & inventions & encompasses the exchange of language, the ability to think & experience emotion, value systems, religious beliefs, ethnic & cultural traditions & individual psychological patterns that come from life experiences.  ORGANISMIC RESPONSE Is a change in the behavior of a patient during an attempt to adapt to the environment. These responses help the patient protect and maintain his or her integrity. These 4 types of responses are: 1. Fight or flight: An instantaneous response to real or imagined threat. It is the most primitive response. 2. Inflammatory: A response intended to provide for structural integrity & the promotion of healing. 3. Stress: A response developed over time and influenced by each stressful experience the patient encounters. 4. Perceptual: Involves gathering information from the environment and converting it into meaningful experiences. METAPARADIGM HEALTH  Are patterns of adaptive change.  It is implied to mean unity and integrity and is wholeness and successful adaptation.  The goal of nursing is to promote health. METAPARADIGM NURSING  Involves engaging in “human interactions”. (Levine 1973)  The nurse enters into a partnership of human experience where sharing moments in time leaves its mark forever on each patient.  The goal of nursing is to promote adaptation & maintain wholeness (health). MAJOR ASSUMPTIONS OF THE CONSERVATION MODEL Assumptions About Individuals  Each individual “is an active participant in interactions with the environment… constantly seeking information from it.” (Levine, 1969)  The individual “is a sentient being, and the ability to interact with the environment seems ineluctably tied to his sensory organs.”  “Change is the essence of life, and it is unceasing as long as life goes on. Change is characteristic of life.” (Levine, 1973) Assumptions About Nursing  “Ultimately, the decisions for nursing intervention must be based on the unique behavior of the individual patient.”  “Patient-centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques, and ideas designed specifically for him.” (Levine, 1973) NOLA J. PENDER HEALTH PROMOTIONAL MODEL HEALTH PROMOTIONAL MODEL  It encourages scholars to look integratively at variables that have been shown to impact health behavior.  It synthesizes research findings from nursing, psychology and public health into an explanatory model of health behavior that still must undergo further testing.  It focuses on ten categories of determinants of health-promoting behaviors.  It views person’s health-promoting behavior in the light of his individual characteristics and experiences.  The person’s level of cognitive abilities and affect also play a major role in the development of these health- promoting behaviors. METAPARADIGM PERSON  Man seeks to create conditions of living through which they can express their unique human health potential  Man also has the capacity for reflective self-awareness, including the assessment of his own competencies.  Man values growth in positive directions and attempts to achieve a personally acceptable balance between change & stability.  Man also seek to actively regulate their own behavior. METAPARADIGM HEALTH  Defines health as “a positive dynamic state not merely the absence of disease”.  Health promotion is directed at increasing a client’s level of well-being.  It describes the multi-dimensional nature of persons as they interact within the environment to pursue health. METAPARADIGM ENVIRONMENT  Persons always interact with the environment, transform the environment progressively, and become transformed themselves over time. METAPARADIGM NURSING  Nursing is a helping profession that empowers patients towards self-attribution, self-evaluation, and self-efficacy TEN DETERMINANTS OF HEALTH-PROMOTING BEHAVIORS 1. Prior related Behavior 2. Perceived benefits of action (health-promoting behaviors) 3. Perceived barriers to action (health-promoting behaviors) 4. Perceived self-efficacy 5. Activity-related affect 6. Interpersonal influences (family, friends, providers), norms, support, and models 7. Situational influences (options, demand characteristics, aesthetics) 8. Immediate competing demands (low control) and preferences (high control) 9. Commitment to a plan of action 10. Personal factors (biological, psychological, sociocultural) CONCEPTS AND DEFINITIONS 1. PERCEIVED BENEFITS OF ACTION – anticipated positive outcomes that will occur from health behavior. 2. PERCEIVED BARRIERS TO ACTION – anticipated, imagined or real blocks and personal costs of understanding a given behavior. 3. PERCEIVED SELF-EFFICACY – judgment of personal capability to organize and execute a health-promoting behavior. It influences perceived barriers to action so higher efficacy results in lowered perceptions of barriers to the performance of the behavior. CONCEPTS AND DEFINITIONS (cont.) SITUATIONAL INFLUENCES  personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior.  Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place  It may have direct or indirect influences on health behavior.  IMMEDIATE COMPETING DEMANDS & PREFERENCES 1. COMPETING DEMANDS – are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. 2. COMPETING PREFERENCES – are alternative behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack. CONCEPTS AND DEFINITIONS (cont.)  COMMITMENT TO PLAN OF ACTION - The concept of intention and identification of a planned strategy leads to the implementation of health behavior.  HEALTH – PROMOTING BEHAVIOR – an endpoint or action outcome that is directed toward attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and productive living.