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TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) MODULE 7: NURSING CONCEPTUAL Implications of Rogers Theory Nursing Practice MODELS 1....

TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) MODULE 7: NURSING CONCEPTUAL Implications of Rogers Theory Nursing Practice MODELS 1. Evaluative and diagnostic phase includes determining the patients’ and their family’s well-being status at the time. Martha Rogers, Dorothea Orem, 2. Interventive how the nurse will go about implementing Imogene King nursing interventions for the patient. Education Martha Rogers: Science of Unitary Human Beings 1) That students have individual personalities and patterns to Background their work. ⮚ Martha E. Rogers was born in 1914 in Dallas, Texas. 2) They are all unitary human beings and should be interacted ⮚ She received her nursing diploma from the Knoxville with differently. General Hospital School of Nursing in 1936, then earned 3) Culture, family, and experiences affect their reasons and her Public Health Nursing degree from George Peabody motives to become a nurse. College in Tennessee in 1937. 4) Beings focuses on “the integrality of person and ⮚ Her Master’s degree was from Teachers College at environment, the individual’s active participation in Columbia University in 1945, and her Doctorate in change, and each person’s individual pattern. Nursing was earned at from Johns Hopkins University in Baltimore in 1954. Rogers died on March 13, 1994. Research ⮚ Rogers worked as a professor at New York University’s 1. It was found that the theory applies to any environment School of Nursing. that contains human beings. ⮚ She was also a Fellow for the American Academy of 2. Her theory focuses nursing interventions on the patient Nursing. well - being overall and not just their disease state. ⮚ Her publications include: 3. It encourages the use of guided imagery, relaxation, ✔ Theoretical Basis of Nursing (1970) therapeutic touch, and meditation. ✔ Nursing Science and Art: A Prospective (1988) ✔ Nursing: Science of Unitary, Irreducible, Human Beings Analysis of Theory Update (1990) a. Clarity - It is difficult-to-understand principles, lack of ✔ Vision of Space Based Nursing (1990). operational definitions, and inadequate tools for measurement model has passed the test of time for the Assumptions development of nursing science as nursing matured as a 1. Wholeness - Human being is considered as united whole. science 2. Openness - A person and his environment are b. Simplicity - when the model is examined in total continuously exchanging energy with each other. perspective, some still classify it as complex. With its 3. Unidirectionality - The life process of human being continued use in practice, research, and education, nurses evolves irreversibly and unidirectional i.e from birth to will come to appreciate the model’s elegant simplicity. death. c. Generality - Rogers’ conceptual model is abstract and 4. Pattern and Organization - Pattern identifies individuals therefore generalizable and powerful. It is broad in scope, and reflects their innovative wholeness. providing a framework for the development of nursing 5. Sentence and Thought - Humans are the only organisms knowledge through the generation of grand and able to think, imagine, have language and emotions. middle-range theories. d. Importance - Rogers’ science has the fundamental intent of understanding human evolution and its potential for human betterment. The science “coordinates a universe of open systems to identify the focus of a new paradigm and initiate nursing’s identity as a science”. Example of Application to Nursing: ⮚ Mary is a 53-year-old woman who is in end stage leukemia. She has had two failed bone marrow transplants and three rounds of chemotherapy. She is moving into Homodynamic Principles hospice home care, and the family and Mary become your 1) Resonance - is an arrangement for human and client. Mary is the mother of four children: 25, 23, 20, and environment that undergo transformation. 17. One child lives at home. Pattern appraisal includes: 2) Helicy - is the nature of change is unpredictable, Mary—frail, quiet, almost translucent in appearance, continuous and innovative. resting comfortably in hospital bed in living room, nasal 3) Integrality - is the energy fields of human and O2 in place Tom— husband, quiet, pacing Home—clean, environment in a continuous mutual process. orderly, many personal articles, large window facing north and looking into the yard. Noise level low. Dog sleeping on Nursing Metaparadigm floor. 1. Person 2. Environment ⮚ The life process of the ⮚ defines as irreducible Analysis: unitary human being is pan dimensional energy a. End of life is a process of merging of the past, present, and one of wholeness and field identified by future. continuity as well as pattern and manifesting b. Nursing care for Mary offers the opportunity to incorporate dynamic and creative characteristics different a variety of patterning. change. from those of the parts c. As Mary nears and prepares for the end of her life, many 3. Health 4. Nursing patterning concerns must be addressed for peaceful closure ⮚ symbolize wellness and ⮚ It is both art and science to her life and the change to another energy form. the absence of disease and the nurse is a factor d. The visible rhythmical pattern is a manifestation of peace and major illness. in healing environment. (Mary) and a human environmental manifestation of anxiety in husband. e. The unknown and preparation for loss is the focus. The pattern appraisal is ongoing. f. Harmony is noted in her relationship with her husband and family and with her sense of how she has progressed through this disease process. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Dorothea Orem: Self-Care Deficit Self Care Background: 1. Self Care Agent - provides the foundation for ⮚ Dorothea E. Orem (1914-2007), one of the prime US understanding the action requirements and action theorists born in Baltimore, Maryland. limitations of persons who may benefit from nursing. ⮚ Obtain her basic diploma in nursing at School of Nursing 2. Theory of Dependent Care - “explains how the self-care Washington, BSN (1939) and MSN in 1945 from system is modified when it is directed toward a person who Catholic University of America, and Doctorate degrees is socially dependent and needs assistance in meeting his or (honorary Doctorates awarded from different Universities). her self-care requisites”. ⮚ She began her nursing career at Providence Hospital 3. Therapeutic Self-Care Demand - is the totality of School of Nursing in Washington, DC, where she self-care actions to be performed for some duration in received a diploma of nursing in the early 1930s. order to meet self-care requisites by using valid methods ⮚ She published her theory in 1959 for the first time and and related sets of operations and actions. revised in 1971, 1983, 1987, and 2001. ⮚ Her contributions enabled her to achieve Excellency from Theory of Dependent Care prominent societies like Sigma Theta Tau International ⮚ Dependent care refers to the care that is provided to a Society, the National League for Nursing, and the person who, because of age or related factors, is unable to American Academy of Nursing. perform the self-care needed to maintain life, healthful functioning, continuing personal development, and Orem Philosophy well-being. ⮚ “Nursing is the ability to care for another human being, most importantly when they are unable to care for 1. Dependent-Care Demand themselves. The ultimate goal is achieving an optimal level ⮚ Summation of care measures at a specific point in time of health and wellness for our patients”. - Orem (1971) or over a duration of time for meeting the dependent’s therapeutic self-care demand when his or her self-care Concepts of Orem’s Model agency is not adequate or operational. 1. The Self-Care Deficit Theory developed as a result of 2. Self-Care Agency working toward her goal of improving the quality of ⮚ The self-care agency is a complex acquired ability of nursing in general hospitals in her state. mature and maturing persons to know and meet their 2. The model interrelates concepts in such a way as to create continuing requirements for deliberate, purposive action a different way of looking at a particular phenomenon. to regulate their own human functioning and 3. The theory is relatively simple, but generalizable to apply development. to a wide variety of patients. 3. Dependent-Care Agency 4. It can be used by nurses to guide and improve practice, but ⮚ Refers to the acquired ability of a person to know and it must be consistent with other validated theories, laws meet the therapeutic self-care demand of the dependent and principles. person and/or regulate the development and exercise of the dependent’s self-care agency. Concepts and Definition ⮚ The self-care deficit nursing theory is a general theory Theory of Self-Care Deficit composed of the following four related theories: 1) A self-care deficit occurs when an individual cannot carry ✔ Theory of Self-Care - which describes why and how out self-care requisites. people care for themselves. 2) Orem identifies method of helping: ✔ Theory of Dependent-Care - which explains how family ✔ Acting for and doing for others. members and/or friends provide dependent-care for a ✔ Guiding and directing. person who is socially dependent. ✔ Providing Physical and Psychological support. ✔ Theory of Self-Care Deficit - which describes and ✔ Environment of promoting personal development Teaching. explains why people can be helped through nursing. 3) Examples of self-care requisites are: ✔ Theory of Nursing Systems - which describes and ✔ Wound care explains relationships that must be brought about and ✔ Activities of Daily Living maintained for nursing to be produced. ✔ Bowel program ✔ Glucose monitoring Theory of Self-Care ⮚ “Self-care comprises the practice of activities that maturing Theory of Nursing Systems and mature persons initiate and perform, within time 1. Wholly compensatory support- patient is unable to frames, on their own behalf in the interest of maintaining complete any self-care independently; nursing compensates life, healthful functioning, continuing personal for patient’s inability to perform self-care. development and well-being through meeting known 2. Partial compensatory support- patient is able to perform requisites for functional and developmental regulations. self-care tasks with partial or no assistance from nursing. ⮚ The Theory of Self-Care has three components: 3. Supportive/educative compensatory– patient able to a. Universal Self-Care Needs perform tasks independently. Nursing provides ongoing b. Developmental Self-Care Needs education and support. c. Health Deviation. Four (4) Major Concepts of Orem Universal Self-Care Needs 1. Health 2. People ⮚ Air, food, water, elimination/excretion, activity & rest, ⮚ a state characterized by ⮚ is viewed biologically, solitude/social interaction, functioning/well being, soundness or wholeness symbolically and normalcy. of developed human socially but still as a ⮚ Developmental Self Care Requisites: more specific to the structures and of bodily whole person. This process of growth and development and are influenced by and mental functioning. person is considered to what is happening during the life cycle, it can be positive be able to provide or negative. self-care ⮚ Health Deviation Self Care Requisites: When a condition 3. Nursing 4. Environment permanently or temporarily alters structural, physiological ⮚ how a healthcare ⮚ the physical, chemical, or psychological function. professional develops a biologic and social plan of care to meet the factors that make up patient’s self-care needs. who a person is. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Significance of the Theory ⮚ Factors which affects the attainment of goal are: Nursing Practice ✔ Roles ⮚ has achieved a significant level of acceptance by the ✔ Stress international nursing community, as evidenced by the ✔ Space magnitude of published material and presentations at the ✔ Time International Orem Society World Congresses King Open System Framework Education 1. Nursing Focus is the care of human being. ⮚ The SCDNT was introduced as the basic structure for 2. Nursing Goal is the health of the individual and health care nursing management in German hospital DRG for the group. (diagnosis-related group) implementation. 3. Human Beings are open system in constant interaction with ⮚ The movement toward SCDNT-based nursing the environment. management. The influence of Orem’s SCDNT has continued at the international level through the translation Interacting Systems in Theory of Goal Attainment of Nursing Concepts of Practice into several languages. Personal System a. Perception Research b. Self ⮚ using the SCDNT or components, Biggs (2008) found c. Growth and Development more than 800 references. Berbiglia identified selected d. Body Image practice settings and SCDNT conceptual foci from a e. Time review of more than 3 decades of use of the SCDNT in f. Space practice and research and publicized selected international SCDNT practice models for the twenty-first century. Interpersonal System ⮚ How the nurse interrelates with a coworker or patient, Analysis of the Theory particularly in a nursepatient relationship. 1. Clarity - Orem defined the term and elaborated the a. Interaction substantive structure of the concept in a way that is unique b. Communication while also congruent with other interpretations. c. Transaction 2. Simplicity - Orem’s theory is expressed in a limited d. Role number of terms. These terms are defined and used e. Stress consistently in the expression of the theory. Orem’s general theory, the SCDNT, comprises the following four Social System constituent theories: self-care, dependent-care, selfcare ⮚ An organized system of social role, behavior and practices. deficit, and nursing systems. a. Organization 3. Generality - As a general theory, it serves nurses engaged b. Authority in nursing practice, in development and validation of c. Power nursing knowledge, and in teaching and learning nursing. d. Status 4. Accessibility - As a general theory, the SCDNT provides a e. Decision Making descriptive explanation of why persons require nursing and what processes are needed for the production of required nursing care The SCDNT differentiates the focus of nursing from other disciplines. Although other disciplines find the theory of self-care helpful and contribute to its development, the theory of nursing systems provides a unique focus for nursing. Application to Nursing ⮚ Mr. Shoaib is a 62 years old male patient admitted to a medical ward. He has right ischemic Cerebro Vascular Accident (CVA) and a resultant left sided body paralysis. He has no sensations or movement in the left side of the body. He has lost his gag reflux and is unable to swallow Assumptions food. A nasogastric (N/G) tube is placed for providing him 1. Basic Assumptions of Goal Attainment Theory is that nutrition. Mr. Shoaib is not able to change his position and the nurse and patient communicate information, set mutual is dependent on care givers for changing his position. He is goal act to achieve these goals it is the basic assumption of also not able to carry out his routine daily life activities. Nursing Process. His family is worried whether he would be able to regain 2. Each human being perceives the world as a total person in control of his life or not. They are also worried whether making transaction with individual and things in the they would be able to provide him the care he needs when environment. he is discharged from hospital. Nurse Patient Transaction Model Apply the case utilizing: 1) Action is a means of behavior or activities that are towards a. Universal Self-care requisite. the accomplishments of certain act. It is both physical and b. Health deviant self-care. mental. c. Development of self-care requisite. 2) Reaction is a form of reacting or a response to a certain stimuli. Imogene King: Goal Attainment Theory 3) Interaction is any situation wherein the nurse relates and Background: deals with a clientele or patient. ⮚ Theorist : Imogene King - born in 1923. 4) Transaction is a unique observable in which human being ⮚ Bachelor in science of nursing from St. Louis University communicate with the environment. in 1948. ⮚ Master of science in nursing from St. Louis University in 1957. ⮚ Doctorate from Teacher’s college, Columbia University. ⮚ Theory describes a dynamic, interpersonal relationship in which a person grows and develops to attain certain life goals. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Metaparadigm Levine’s Theory: Conservation Model 1. Person 2. Health Myra Estrine Levine ⮚ existing in an open ⮚ as continuous ⮚ Finished her Master of Science in nursing at Wayne State system who makes adjustment to stress in University in 1962. choices and select the internal and external ⮚ She authored 77 published artciles which included “An alternative action. environment. Introduction to Clinical Nursing” with multiple piblication 3. Environment 4. Nursing years on 1969, 1973, and 1989. ⮚ as the process of balance ⮚ is an observable ⮚ She also received an hononary doctorate from Loyola involving internal ad behavior found in the University in 1992. external interactions health care systems in ⮚ She died on 1996. inside the social system. society”. ⮚ The goal of nursing “is Conservation Model to help individuals ⮚ The core of the Conservation Model is to improve a maintain their health so person’s physical and emotional well-being by considering they can function in the four domains of Conservation she set out. their roles” ⮚ Nursing’s role in Conservation is to help the person with the process of “keeping together” the total person through Significance the least amount of effort. Nursing Practice ⮚ Individualized the plans of care while encouraging active Major Concepts of Conservation Model participation from clients. 1. Adaptation ⮚ The profession of nursing function through individuals and 2. Wholeness groups within the environment. 3. Conservation Education Adaptation ⮚ It is used in curriculum design in nursing programs. ⮚ The process of the change, and conservation is the outcome ⮚ It provides a systematic means of viewing nursing as of adaptation. profession, an organize body of knowledge and clarifying ⮚ Adaptation is the process whereby the patient maintains nursing as discipline. integrity within the realities of the environment. ⮚ Some adaptations are successful and some of them are not. Research ⮚ It is design and conducted to implement this system in Three Characteristic of Adaptation hospital, ambulatory, community and home care nursing. a. Historicity b. Specificity Analysis of the Theory c. Redundancy 1. Clarity - Theory of Goal Attainment is the ease with which it can be understood by nurses. Concepts are Historicity concretely defined and illustrated. ⮚ Adaptation is a historical process. 2. Simplicity - King’s definitions are clear and are ⮚ Responses are based on past experiences both personal and conceptually derived from research literature. genetic term. 3. Generality - It has been criticized for having limited application in areas of nursing in which patients are unable Specificity to interact competently with the nurse. ⮚ Adaptation is also specific. 4. Accessibility - A descriptive study was conducted to ⮚ It refers to the individual responses and their adaptive identify the characteristics of transaction and whether pattern, which varies on the basis of specific genetic nurses made transactions with patients structure. 5. Importance - middle-range Theory of Goal Attainment ✔ Each system has particular responses. The physiologic focused on all aspects of the nursing process: assessment, responses that “defend oxygen supply to the brain are planning, implementation, and evaluation. The body of distinct from those that maintain the appropriate blood literature clearly establishes King’s work as important for glucose levels.” knowledge building in the discipline of nursing. Redundancy Application to Nursing ⮚ Represents the fail-safe options available to the patient to 1) Communication between nurse and patient is the ensure continued adaptation. cornerstone of the interpersonal system and the most important prerequisite for transaction to occur. It can be Wholeness established both verbally and non-verbally. ⮚ Levine stated that “the unceasing interaction of the 2) A middle-aged female patient referred to the emergency individual organism with its environment does represent an room with weakness and feebleness. The attending open and fluid system, and a condition of health, physician gave the diagnosis of acute pulmonary edema. wholeness, exists when the interaction or constant Emergency staffs needed to start invasive interventions to adaptations to the environment, permit ease - the assurance manage her acute condition. However, they failed to of integrity in all the dimensions of life.” understand her conditions and did not provide her with adequate treatment-related information. She did not give Conservation consent for treatments and treatments were not ⮚ The product of adaptation. administered. This example shows that nurses and ⮚ Conservation is from the Latin word “conservation”, physicians need to give high priority to the establishment meaning “to keep together”. of effective communication with patients to help them ⮚ Conservation describes the way complex systems are able make wiser decisions to retain their own health as their to continue to function even when severely challenged. main goal. Moreover, they need to allow patients articulate ⮚ Through conservation, individuals are able to confront their perceptions of their illnesses, personal illness-related obstacles, adapt accordingly, and maintain their experiences, and the level of their stress. It is only in this uniqueness. way that nurse and patient can help each other and create a ⮚ “The goal of conservation is health and the strength to favorable environment for decision-making.. Consequently, confront disability” as “the rules of conservation and the goal of health is attained when both sides of integrity hold” in all situation in which nursing is requires. relationship properly interact with each other and collaboratively work together to attain their goals. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Levine’s Nursing Metaparadigm Nursing 1. Person ⮚ Nursing involves engaging in “human interactions.” 2. Environment ⮚ “The nurse enters into a partnership of human experience 3. Health where sharing moments in time, some trivial, some 4. Nursing dramatic leaves its mark forever on each patient.” 5. Person and Environment ⮚ The goal of nursing is to promote adaptation and maintain wholeness (health). Person ⮚ a holistic being who constantly strives to preserve Person and Environment wholeness and integrity and one “who is sentient, thinking, ⮚ Person and Environment become congruent over time. future-oriented, and past-aware.” ⮚ It is the fit of the person with his/her predicament of time ⮚ The wholeness (integrity) of the individual demands that and space. the “individual life has meaning only in the context of ⮚ The specific adaptive responses make conservation social life”. possible occur on many levels; molecular, physiologic, ⮚ The person is also describes as a unique individual in unity emotional, psychological, and social. and integrity, feeling, believing, thinking, and whole system of system. Conservation of Energy ⮚ Refers to balancing energy input and output to avoid Environment excessive fatigue. ⮚ Completes the wholeness of the individual. ⮚ It includes adequate rest, nutrition, and exercsie. ⮚ The individual has both an internal and external ⮚ Examples: Availability of adequate rest; Maintenance of environment. adequate nutrition. Conservation of Structural Integrity ⮚ Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing. ⮚ Examples: Assist patient in ROM exercise; Maintenance of patient’s personal hygiene. Conservation of Personal Integrity Internal Environment ⮚ Recognizes the individual as one who strives for Homeostasis recognition, respect, self-awareness, self-hood, and self ⮚ Stable state normal alterations in physiologic parameters determination. respond to environmental changes; an energy sparing state, ⮚ Example: Recognize and protect patient’s space needs. a state of conservation. Conservation of Social Integrity Homeorrhesis ⮚ An individual is recognized as some one who resides ⮚ Is the orchestrated or coordinated control in metabolism of within a family, a community, a religious group, a political body tissues necessary to support a physiological state. system, and a nation. ⮚ Example: Help the individual to preserve his/her place in a Three Aspects of External Environmental upon Bate’s family, community, and society. (1967) Perceptual Assumptions About Individuals ⮚ The perceptual environment consists of information that is 1. Each individual “is an active participant in interactions recorded by the sensory organs. with the environment, constantly seeking information from ⮚ This is the perceptual level includes aspect of the world it (Levine, 1969).” that individuals are able to intercept and interpret with their 2. The individual “is a sentient being, and the ability to sense organs (eyes, ears, nose, tongue, and skin) interact with the environment seems ineluctably ties to his sensory organs.” Operational 3. “Change is the essence of life, and it is unceasing as long ⮚ The Operational Environment consists of the undetected as life goes on. Change is characteristics of life (Levine, natural forces and that impinge on the individual. 1973). “ ⮚ It contains things that affect individuals physically although they cannot directly perceive them things such as Assumptions About Nursing microorganism. 1) “Ultimately, the decisions for nursing intervention must be based on the unique behavior of the individual patients.” Conceptual 2) “Patient-centered nursing care means individualized ⮚ The Conceptual Environment is influenced by language, nursing care. It is predicated on the reality of common culture, ideas, and cognition. experience: every man is a unique individual, and as much ⮚ The environment is constructed from cultural patterns he requires a unique constellation of skills, techniques, and characterized by a spiritual existence and meditate by the ideas designed specifically for him.” symbols of language, thoughts, and history; this is the ability of an individual to think and experience emotion Module 8: Johnson, Roy, Neuman and the patterns that come from life experiences. Dorothy Johnson: Behavioral System Model Health Background: ⮚ Levine (1991) clarified what she meant by health as: “the ⮚ Dorothy Johnson was born on August 21, 1919, in avenue of return to the daily activities compromised by ill Savannah, Georgia. health. It is mot only the insult or the injury that is repaired ⮚ She was the youngest of seven children. Her father was the but the person himself or herself. It is not merely the superintendent of a shrimp and oyster factory, and her healing of an afflicted part. It is rather a return to self-hoof, mother was very involved and enjoyed reading. where the encroachment of the disability can be set aside ⮚ In 1938, she finished her associate’s degree at Armstrong entirely, and the individual is free to pursue once more Junior College in Savannah, Georgia. Due to the Great his/her own interests without constraint.” Depression, she took a year off from school to be a ⮚ Disease - it is the “unregulated and undisicplined change governess, or teacher, for two children in Miami, Florida. and must be stopped or death will ensue.” ⮚ This was when she began to realize her love for children, nursing, and education. ⮚ Dorothy Johnson’s professional nursing career began in 1942 when she graduated from Vanderbilt University School of Nursing in Nashville, Tennessee. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) ⮚ She was the top student in her class and received the Dorothy Johnson’s Behavioral System Model prestigious Vanderbilt Founder’s Medal. ⮚ In 1948, she received her master’s in public health from Harvard University in Boston, Massachusetts. Introduction ⮚ Johnson’s theory and her related writings reflect her knowledge about both development and general systems theories. ⮚ The combination of nursing, development, and general systems introduces some of the specifics into the rhetoric about nursing theory development that make it possible to test hypotheses and conduct critical experiments. Subsystem Four (4) Structural Components Four (4) Goals of Nursing a. The goal of a subsystem is defined as the desired result or 1. To assist the patient whose behavior is proportional to consequence of the behavior. social demands. b. The behavioral set is a predisposition to act in a certain 2. To assist the patient who is able to modify his behavior in way in a given situation. ways that it supports biological imperatives. c. Choice refers to the individual’s repertoire of alternative 3. To assist the patient who is able to benefit to the fullest behaviors in a situation that will best meet the goal and extent during illness from the physician’s knowledge and attain the desired outcome. skill. d. The concern is with the efficiency and effectiveness of the 4. To assist the patient whose behavior does not give evidence behavior in goal attainment. Actions are any observable of unnecessary trauma as a consequence of illness. responses to stimuli. Concepts and Definition Functional Subsystem a. Behavior a) Protection from noxious stimuli influences with which the ⮚ as expressed by the behavioral and biological scientists; system cannot cope. that is, the output of intraorganismic structures and b) Nurturance through the input of appropriate supplies form processes as they are coordinated and articulated by and environment. responsive to changes in sensory stimulation. c) Stimulation to enhance growth and prevent stagnation. b. System Metaparadigm Concepts ⮚ is a whole that functions as a whole by virtue of the 1. Human Being - as having two major systems, the interdependence of its parts, that there is “organization, biological system and the behavioral system. It is role of interaction, interdependency, and integration of the parts the medicine to focus on biological system where as and elements. Nursling's focus is the behavioral system. 2. Environment - is any factor influencing the behavioral c. Behavioral System subsystem manipulated by the nurse to achieve health. ⮚ is a patterned, repetitive, and purposeful ways of behaving. 3. Health - is the lack of balance in the structural or These ways of behaving form an organized and integrated functional requirements of the subsystems leads to poor functional unit that determines and limits the interaction health. between the person and his or her environment and 4. Nursing - is an external regulatory force which acts to establishes the relationship of the person to the objects, preserve the organization and integration of the patient’s events, and situations within his or her environment. behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or d. Subsystem social health, or in which illness is found. ⮚ is “a mini system with its own particular goal and function that can be maintained as long as its relationship to the Application to Nursing other subsystems or the environment is not disturbed.” NOTE: By elderly people, those from the age of 65 and above, most of which have retired. These people are normally seen as a e. Stressor bother to their loved ones as their needs increase from the ⮚ Internal or external stimuli that produce tension and result normal. They thus need more care which cannot be provided at in a degree of instability. home so they are often taken to nursing homes where they can get the proper care. Because of old age and stress from Subsystem of Behaviors retirement. These people have difficulty coping with the changes ⮚ Subsystem are parts of the behavioral system. around them and their behavior changes. Some become ⮚ It carry out specialized task/function needed to maintain aggressive while others develop mental problems making the integrity of the whole system. long-term nursing homes the best to take proper care of these ⮚ It has a set of behavioral responses that re developed individuals. through motivation, experience and learning. a. Nurses have to pay keen attention to such aggressive behavior and identify which of the seven subsystems is not functioning properly thus help these patients restore balance in their systems. b. It could be dependence, the attachment, or the aggressive causing a change in behavior. The dependence in the sense that the patient who was used to taking care of himself now finds it frustrating when he has to rely on others for all his needs. c. The attachment comes in when the patient struggles to form new relationships at the care facilities and being kept away from the existing relationships. d. Normally the patient plays a role in the behavioral system model of treatment but in dealing with mental complications, especially the ones accompanied by aggressive behavior. Most of the effort is required from the part of the nurse who has to be patient with the patient. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Sister Callista Roy: Adaptation Model Subsystem Background: a. Regulator subsystem is a major coping mechanism which ⮚ Sister Callista L. Roy (born October 14, 1939) is a responds automatically through physiological adaptive nursing theorist, professor, and author. mode, responds automatically through neural, chemical, ⮚ She is known for her groundbreaking work in creating the and endocrine coping processes. Adaptation Model of Nursing. b. The cognator is a major coping subsystem responds to ⮚ She received her Bachelor of Arts Major in Nursing from complex processes of perception and information Mount Saint Mary’s College in Los Angeles in 1963 and processing, judgement and emotions. her master’s degree in nursing from the University of California in 1966. Implication to Nursing Practice, Education, and Research ⮚ After earning her nursing degrees, she began her sociology Nursing Practice education, receiving both a master’s degree in sociology in ⮚ Features of the discipline provides direction for practice. 1973 and a doctorate in sociology in 1977 from ⮚ It considers goals, values, the client and practitioner California. intervention. ⮚ She developed the model’s basic concepts while she was a ⮚ Uses the steps in Nursing Process of used: Assessment, graduate student at the University of California from 1964 Nursing Diagnosis, The goal is set, Intervention and to 1966. Evaluation. ⮚ She was an associate professor and chairperson of the Department of Nursing at Mount Saint Mary’s College Education until 1982 and was promoted to the professor’s rank in ⮚ The model is a valuable to analyze distinctions between 1983 at both Mount Saint Mary’s College and the nursing and medicine. University of Portland. ⮚ The model has been implemented as basis of curriculum ⮚ The RAM focuses on the inter relatedness of four adaptive development in Associate degree program, baccalaureate systems. and higher degree program. ⮚ It focuses on persons coping(adaptative)abilities in response to constantly to changing environment ( Lopes, Research Pagliuca, Araujo,2006). ⮚ The model generates many testable hypothesis tested to ⮚ Nursing can promote effective coping by asking” How can practice and theory. I modify this patient’s environment to facilitate his adaptation (Chitty & Black, 2011). Metaparadigm 1. People - both individually and in groups, as holistic Major Concepts and Definition adaptive systems, complete with coping processes acting to a. A system is “a set of parts connected to function as a whole maintain adaptation and to promote person and for some purpose and that does so by virtue of the environment transformations. interdependence of its part. 2. Health - is the reflection of personal and environmental b. “Adaptation level represents the condition of the life interactions that are adaptive. processes described on three levels as integrated, 3. Environment - are conditions, circumstances, and compensatory, and compromised” influences surrounding and affecting the development and behavior of individuals and groups. Types of Stimuli 4. The Goal of Nursing - was the first major concept of her i. Focal Stimulus - is the degree of change or stimulus more nursing model to be described. She identifies the unique immediately confronting the person and the one to which function of nursing in promoting health. the person must make adaptive response. ii. Contextual Stimuli - are present to contribute to the Application to Nursing behavior caused or precipitated by the focal stimuli. NOTE: A 23-year-old male patient is admitted with a fracture iii. Residual Stimuli - are factors that may be affecting of C6 and C7 that has resulted in quadriplegia. He was injured behavior but whose efforts are not validated. during a football game at the university where he is currently a senior. His career as a quarterback had been very promising. At Coping Processes the time of the injury, contract negotiations were in progress ⮚ “are innate or acquired ways of interacting with the with a leading professional football team. changing environment” 1. Use Roy’s criteria to identify focal and contextual stimuli for each of the four adaptive modes. Innate Coping Mechanisms 2. Consider what adaptations would be necessary in each of ⮚ “are genetically determined or common to the species and the following four adaptive modes: (1) physiological, (2) are generally viewed as automatic processes; humans do self- concept, (3) interdependence, and (4) role function. not have to think about them” Betty Neuman: System Model Acquired Coping Mechanisms Background: ⮚ “are developed through strategies such as learning. The ⮚ Betty Neuman was born in 1924 near Lowell, Ohio. experiences encountered throughout life contribute to ⮚ She grew up on a farm which later encouraged her to help customary responses to particular stimuli”. people who are in need. ⮚ Her father was a farmer who became sick and died at the age of 36. ⮚ Her mother was a self-educated midwife that led the young Neuman to be always influenced by the commitment that took her away from home from time to time. ⮚ In 1957, she received a baccalaureate degree in public health and psychology with honors. ⮚ She also earned a master’s degree in mental health, public health consultation in 1966 from the University of California, Los Angeles (UCLA). ⮚ After her graduation, she was hired as a department chair in the UCLA School of Nursing graduate program. ⮚ In 1985, Betty Neuman concluded a doctoral degree in clinical psychology at Pacific Western University. She was a pioneer of nursing involvement in mental health. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) ⮚ Neuman System Model as “a unique, open-system-based perspective that provides a unifying focus for approaching a wide range of concerns. ⮚ A system acts as a boundary for a single client, a group, or even several groups; ⮚ it can also be defined as a social issue. ⮚ A client system in interaction with the environment delineates the domain of nursing concerns.” Betty Neuman’s Systems Model ⮚ Neuman System Model focuses on the different stressors patients have and ways to relieve the stress from the different stressors. ⮚ The model also focus on how the patient may react to the stress. ⮚ Internal and external affects the patient are stressors. ⮚ The role of the nurse is the to keep the system stable through out the three level of prevention; ✔ Primary Prevention - is used before a reaction to stressors occurs. ✔ Secondary Prevention - involves the treatment of symptoms following a reaction to stressors. ✔ Tertiary Prevention - involves the maintenance of optimal wellness following treatment. Concepts and Definitions Wholistic Approach Major Assumptions ⮚ Clients are viewed as wholes whose parts are in dynamic 1. Nursing - is concerned with the whole person. She views interaction. nursing as a “unique profession in that it is concerned with ⮚ The model considers all variables simultaneously affecting all of the variables affecting an individual’s response to the client system: physiological, psychological, stress. sociocultural, developmental, and spiritual. 2. Health - as a continuum of wellness to illness that is dynamic in nature and is constantly changing. Open System 3. The Client System - is a dynamic composite of ⮚ A system is open when there is a continuous flow of input interrelationships among physiological, psychological, and processes, output, and feedback. sociocultural, developmental, and spiritual factors. ⮚ Stress and reaction to stress are basic components of an 4. Environment - as all the internal and external factors that open system. surround and influence the client system. Stressors (intrapersonal, interpersonal, and extrapersonal). Function/Process ⮚ The client as a system exchanges energy, information, and Madeleine Leininger: Transcultural matter with the environment as well as other parts and subparts of the system as it uses available energy resources Nursing: Essential Knowledge to move toward stability and wholeness. Dimension Input and Output Introduction to Transcultural Nursing ⮚ For the client as a system, input and output are the matter, Transcultural Nursing (TCN) energy, and information that are exchanged between the ⮚ Describes the blending of nursing and anthropology into an client and the environment. area of specialization within the discipline of nursing. ⮚ Using the concepts of culture and care, Leininger Feedback established TCN as a theory and evidence-based formal ⮚ System output in the form of matter, energy, and area of study and practice within nursing that focuses on information serves as feedback for future input for people’s culturally based beliefs, attitudes, values, corrective action to change, enhance, or stabilize the behaviors, and practices related to health, illness, healing, system. and human caring. ⮚ The goal of TCN is to develop a scientific and humanistic Client System body of knowledge in order to provide culture-specific and ⮚ The Client System is a composite of five variables culture-universal nursing care practices for individuals, (physiological, psychological, sociocultural, families, groups, communities, and institutions of similar developmental, and spiritual) in interaction with the and diverse cultures. environment. Culture-specific Five (5) Types of Stressor ⮚ Refers to particular values, beliefs, and patterns of i. Physiological Stressors behavior that tend to be special or unique to a group and ii. Psychological Stressor that do not tend to be shared with members of other iii. Socio-cultural Stressors cultures. iv. Developmental Stressors v. Spiritual Stressors Culture-universal ⮚ Refers to the commonly shared values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Definition of Terms Cultural Awareness Culture ⮚ It is an in-depth self-examination of one’s own ⮚ Set of values, beliefs, and traditions, that are held by a background, recognizing biases and prejudices and specific group of people and handed down from generation assumptions about other people. to generation. ⮚ It is the learned, shared, and transmitted values, beliefs, Culturally Congruent Care norms, and life what practices of a group that guide ⮚ Care that fits the people’s valued life patterns and set of thinking, decisions, and action in patterned ways. meanings which is generated from the people themselves rather that based of predetermined criteria. Religion ⮚ A set of belief in a divine or superhuman. Culturally Competent Care ⮚ Power/powers to be obeyed and worshipped as the creator ⮚ The ability of the practitioner to bridge the cultural gaps in or rule of the universe. caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring. Ethnic Group ⮚ Refers to a group of people who share common distinctive Madeleine Leininger culture and who are members of a specific group. ⮚ A nursing theorist who developed the Transcultural ⮚ Share a common social and cultural heritage that is passed Nursing Theory or Culture Care Nursing Theory. on to successive generations ⮚ She was born on July 13, 1925 and died on August 10, 2012.) Ethnicity ⮚ She was an internationally known educator, author theorist, ⮚ A consciousness of belonging to a group. administrator, researcher, consultant, public speaker, and the developer of the concept of Transcultural Nursing that Culture Identity has a great impact on how to deal with patients of different ⮚ The sense of being part of an ethnic group or culture. culture and cultural background. Types of Culture: Transcultural Nursing Theory a. Material Culture ⮚ Through her observations, while working as a nurse, ⮚ Physical objects resources, and spaces. Madeleine Leininger identified a lack of cultural and care ⮚ Examples: Home, Church, Tools, and Goods. knowledge as the missing component to a nurse’s understanding of the many variations required inpatient Non-Material Culture care to support compliance, healing, and wellness, which ⮚ Non-physical ideas that people have about their culture. led her to develop the theory of Transcultural Nursing ⮚ Examples: Values, Rules, Norm, Beliefs. also known as Culture Care Theory. ⮚ Leininger’s theory’s main focus is for nursing care to fit with or have beneficial meaning and health outcomes for Subculture people of different or similar cultural backgrounds. With ⮚ Composed of people who have a district identity but are these, she has developed the Sunrise Model in a logical related to a larger cultural group. order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity and Universality. Diversity ⮚ The Transcultural Nursing Theory or Culture Care ⮚ The sense of being part of an ethnic group or culture. Theory by Madeleine Leininger involves knowing and ⮚ May occur between cultures and within a cultural group. understanding different cultures concerning nursing and health-illness caring practices, beliefs, and values to Biocultural provide meaningful and efficacious nursing care services to ⮚ A person who crosses two cultures, lifestyles, and set of people’s cultural values health-ilness context. values. Major Concepts of the Transcultural Nursing Theory Aculturation Transcultural Nursing ⮚ People of minority group tends to assume the attitudes, ⮚ Transcultural Nursing is defined as a learned subfield or values, beliefs, find practices of the dominant society branch of nursing that focuses upon the comparative study resulting in a blended cultural pattern. and analysis of cultures concerning nursing and health-illness caring practices, beliefs, and values to Culture Shock provide meaningful and efficacious nursing care services to ⮚ The state of being disoriented or unable to respond to a their cultural values and health-illness context. different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to the Ethnonursing stranger’s perceptions and expectations that is ⮚ This is the study of nursing care beliefs, values, and differentiated from others by symbolic markers. practices as cognitively perceived and known by a designated culture through their direct experience, beliefs, Phases of Culture Shock and value system. 1. Honeymoon Phase - the culture is new and exciting. Their dreams and expectations about the future seem to be Nursing coming true. ⮚ Nursing is defined as a learned humanistic and scientific 2. Rejection Phase - The realities of life (housing, profession and discipline which is focused on human care employment, and family) can become overwhelming. phenomena and activities to assist, support, facilitate, or Many things do not go according to plan, and refugees may enable individuals or groups to maintain or regain their feel misunderstood. well-being (or health) in culturally meaningful and 3. Regression Phase - In order to deal with the stressful beneficial ways, or to help people face handicaps or death. changes, a refugee may only try to surround himself with people of their own culture. Professional Nursing Care (Caring) 4. Recovery Phase - If a person can work through the ⮚ Professional Nursing Care (Caring) is defined as formal regression phase, they may be able to accept and feel and cognitively learned professional care knowledge and accepted. practice skills obtained through educational institutions 5. Reverse Culture Shock - A person may become so that are used to provide assistive, supportive, enabling, or accustomed to their new culture that they would exhibit facilitative acts to or for another individual or group to culture shock of they returned to the home country. improve a human health condition (or well-being), disability, lifeway, or to work with dying clients. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Cultural Congruent (Nursing) Care Subconcepts of the Transcultural Nursing Theory ⮚ Cultural Congruent (Nursing) Care is defined as those Generic (Folk/Lay) Care Systems cognitively based assistive, supportive, facilitative, or ⮚ Generic (folk or lay) Care Systems are culturally learned enabling acts or decisions that are tailor-made to fit with and transmitted, indigenous (or traditional), folk the individual, group, or institutional, cultural values, (home-based) knowledge and skills used to provide beliefs, and lifeways to provide or support meaningful, assistive, supportive, enabling, or facilitative acts toward or beneficial, and satisfying health care, orn well-being for another individual, group, or institution with evident or services. anticipated needs to ameliorate or improve a human life way, health condition (or well-being), or to deal with Health handicaps and death situations. ⮚ It is a state of well-being that is culturally defined, valued, and practiced. Emic ⮚ It reflects individuals’ (or groups) ability to perform their ⮚ Knowledge gained from direct experience or directly from daily role activities in culturally expressed, beneficial, and those who have experienced it. It is generic or folk patterned lifeways. knowledge. Human Beings Professional Care Systems ⮚ Such are believed to be caring and capable of being ⮚ Professional Care Systems are defined as formally taught, concerned about others' needs, well-being, and survival. learned, and transmitted professional care, health, illness, Leininger also indicates that nursing as a caring science wellness, and related knowledge and practice skills that should focus beyond traditional nurse-patient interactions prevail in professional institutions, usually with and dyads to include families, groups, communities, total multidisciplinary personnel to serve consumers. cultures, and institutions. Etic Worldview ⮚ The knowledge that describes the professional perspective. ⮚ Worldview is how people look at the world, or the ⮚ It is professional care knowledge. universe, and form a "picture or value stance" about the world and their lives. Ethnohistory ⮚ Ethnohistory includes those past facts, events, instances, Cultural and Social Structure Dimensions experiences of individuals, groups, cultures, and ⮚ Cultural and Social Structure Dimensions are defined as instructions that are primarily people-centered (ethno) and involving the dynamic patterns and features of interrelated describe, explain, and interpret human lifeways within structural and organizational factors of a particular culture particular cultural contexts over short or long periods of (subculture or society) which includes religious, kinship time. (social), political (and legal), economic, educational, technological, and cultural values, ethnohistorical factors, Care and how these factors may be interrelated and function to ⮚ Care as a noun is defined as those abstract and concrete influence human behavior in different environmental phenomena related to assisting, supporting, or enabling contexts. experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human Environmental Context condition or lifeway. ⮚ Environmental Context is the totality of an event, ⮚ Care as a verb is defined as actions and activities directed situation, or particular experience that gives meaning to toward assisting, supporting. or enabling another individual human expressions, interpretations, and social interactions or group with evident or anticipated needs to ameliorate or in particular physical, ecological, sociopolitical, and/or improve a human condition or lifeway or face death. cultural settings. Culture Shock Culture ⮚ Culture Shock may result when an outsider attempts to ⮚ Culture is learned, shared, and transmitted values, beliefs, comprehend or adapt effectively to a different cultural norms, and lifeways of a particular group that guides their group. The outsider is likely to experience feelings of thinking, decisions, and actions in patterned ways. discomfort and helplessness and some degree of disorientation because of the differences in cultural values, Culture Care beliefs, and practices. Culture shock may lead to anger and ⮚ Culture Care is defined as the subjectively and objectively can be reduced by seeking knowledge of the culture before learned and transmitted values, beliefs, and patterned encountering that culture. lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, Cultural Imposition improve their human condition lifeway, or deal with ⮚ Cultural Imposition refers to the outsider's efforts, both illness, handicaps or death. subtle and not so subtle, to impose their own cultural values, beliefs, behaviors upon an individual, family, or Culture Care Diversity group from another culture. (Leininger, 1978) ⮚ Culture Care Diversity indicates the variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of care within or between collectives related to assistive, supportive, or enabling human care expressions. Culture Care Universality ⮚ Culture Care Universality indicates the common, similar, or dominant uniform care meanings, patterns, values, lifeways, or symbols manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people. (Leininger, 1991) TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Sunrise Model of Madeleine Leininger’s Theory 3. Culture Care Repatterning/Restructuring ⮚ The Sunrise Model is relevant because it enables nurses to ⮚ Includes those assistive, facilitative, or enabling develop critical and complex thoughts about nursing professional actions and decisions that help clients reorder, practice. These thoughts should consider and integrate change, or greatly modify their lifeways for new, different, cultural and social structure dimensions in each specific and beneficial health care pattern while respecting the context, besides nursing care's biological and clients cultural values and beliefs and still providing a psychological aspects. beneficial or healthier lifeway than before the changes were established with the clients. The Assumptions of Madeleine Leiniger’s Theory 1. Different cultures perceive, know, and practice care differently, yet there are some commonalities about care among all world cultures. 2. Values, beliefs, and practices for culturally related care are shaped by, and often embedded in, "the worldview, language, religious (or spiritual), kinship (social), political (or legal), educational, economic, technological, ethnohistorical, and environmental context of the culture. 3. While human care is universal across cultures, caring may be demonstrated through diverse expressions, actions, patterns, lifestyles, and meanings. 4. Cultural care is the broadest holistic means to know, explain, interpret, and predict nursing care phenomena to guide nursing care practices. 5. All cultures have generic or folk health care practices, that professional practices vary across cultures, and that there will be cultural similarities and differences between the care-receivers (generic) and the professional caregivers in any culture. 6. Care is the distinct, dominant, unifying, and central focus of nursing, and while curing and healing cannot occur effectively without care, care may occur without a cure. 7. Care and caring are essential for humans' survival and their growth, health, well-being, healing, and ability to deal with handicaps and death. 8. Nursing, as a transcultural care discipline and profession, has a central purpose of serving human beings in all areas of the world; that when culturally based nursing care is beneficial and healthy, it contributes to the well-being of the clients) - whether individuals, groups, families, communities, or institutions - as they function within the ⮚ The cultural care worldview flows into knowledge about context of their environments. individuals, families, groups, communities, and institutions 9. Nursing care will be culturally congruent or beneficial only in diverse health care systems. when the nurse knows the clients. The clients' patterns, ⮚ This knowledge provides culturally specific meanings and expressions, and cultural values are used in appropriate and expressions concerning care and health. The next focus is meaningful ways by the nurse with the clients. on the generic or folk system, professional care systems, 10. If clients receive nursing care that is not at least reasonably and nursing care. culturally congruent (that is, compatible with and ⮚ Information about these systems includes the respectful of the clients' lifeways, beliefs, and values), the characteristics and the specific care features of each. client will demonstrate signs of stress, noncompliance, ⮚ This information allows for the identification of similarities cultural conflicts, and/or ethical or moral concerns. and differences or cultural care universality and cultural care diversity. Module 9: Anne Boykin and Savina Three (3) Modes of Nursing Care Decisions and Actions Schoenhofer - The Theory of Nursing as 1. Cultural Care Preservation/Maintenance ⮚ It includes those assistive, supporting, facilitative, or Caring enabling professional actions and decisions that help ⮚ Anne Boykin and Savina Schoenhofer developed the people of a particular culture to retain and/or preserve Theory of Nursing as Caring which emphasizes relevant acre values so that they can maintain their compassion and empathy in nursing practice. well-being, recover from illness, or face handicaps and/or death. Anne Boykin: Background and Contributions Education and Contributions to Influence on the 2. Cultural Care Accomodation/Negotiation Experience Nursing Theory ⮚ It includes those assistive, supportive, facilitative, or ⮚ Anne Boykin ⮚ Boykin’s ⮚ Boykin’s enabling creative professional actions and decisions that holds a Ph.D. research insights into help people of a designated culture to adapt to or negotiate in Nursing and focuses on the the role of has extensive existential and human with others for a beneficial or satisfying health outcome experience in spiritual connection and with professional care providers. clinical aspects of caring formed practice and nursing care, the foundation academia. highlighting of the Theory the importance of Nursing as of Caring. individualized care. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Nursing Response Savina Schoenhofer: Background and Contributions ⮚ The nursing response is co-created in the immediacy of Professional Research and Co-Creator of the what truly matters and is a specific expression of caring Journey Scholarship Theory nurturance to sustain and enhance the other living and ⮚ Savina ⮚ Schoenhofer’s ⮚ Schoenhofer growing in caring. Schoenhofer is work focuses collaborated an experienced on expanding with Anne Story as Method for Knowing Nursing nurse with a the Boykin in ⮚ Story is a method for knowing nursing and a medium for background in understanding developing the all forms of nursing inquiry. critical care of nursing as Theory of ⮚ Nursing stories embody the lived experience of nursing and education. caring and its Nursing as ⮚ She was impact on Caring, situations involving the nurse and the nursed. assigned in the patient’s bringing her intensive care well-being. practical Major Assumptions unit. expertise on Assumption Definition the framework. Nursing is Both a Discipline 1. Nursing and a Profession. Understanding the Theory of Nursing as Caring Persons are Caring by Virtue 1. Definition of their Humanness Persons ⮚ The Theory of Nursing as Caring posits that nursing 2. Person are Whole and Complete in practice, rooted in genuine care and compassion, enhances the Moment. the overall health and well-being of patients. Personhood is Enhanced through Participating in 2. Holistic Approach 3. Environment Nurturing Relationships with ⮚ The theory emphasizes understanding patients as unique Caring Others. individuals, considering their physical, emotional, and Personhood is Living Life spiritual dimensions in the care process. 4. Health Grounded in Caring. 3. Interpersonal Connection Application of the Theory in Nursing Practice ⮚ Nursing as Caring emphasizes the importance of 1. Assessing Patient Needs establishing meaningful and therapeutic relationships ⮚ Nurses use the theory to assess patients' physical, between nurses and patients. emotional, and spiritual needs, providing individualized care. Major Concepts and Definitions Focus and Intention of Nursing 2. Creating Therapeutic Environments ⮚ The focus of nursing from the perspective of the Theory of ⮚ Applying the theory, nurses create healing environments Nursing as Caring is that the discipline of knowledge and that promote comfort, trust, and a sense of security. professional practice is nurturing persons living and growing in caring. 3. Facilitating Healing Relationships ⮚ The general intention of nursing is to know persons as ⮚ The theory guides nurses in establishing caring caring and to support and sustain them as they live caring. relationships to support patients' well-being and enhance the healing process. Perspective of Persons as Caring ⮚ Person therefore is recognized as constantly unfolding in Evidence and Examples Supporting the Theory caring. From the perspective of the theory, “fundamentally, 1. Research Findings potentially, and actually each person is caring” even though ⮚ Studies have shown that nursing interventions focused on every act of the person might not be understood as caring. caring improve patient satisfaction, adherence to treatment, and overall health outcomes. Nursing Situation ⮚ The nursing situation is what is present in the mind of the 2. Patient Testimonials nurse whenever the intent of the nurse is “to nurse”. ⮚ Patients often express gratitude for the caring approach of nurses, highlighting the positive impact on their healing Personhood journey. ⮚ Personhood is a process of living that is grounded in caring. 3. Case Studies ⮚ Personhood implies being who we are as authentic caring ⮚ Real-life examples showcase how integrating the Theory of persons and being open to unfolding possibilities for Nursing as Caring improves patient experiences and caring. overall quality of care. Direct Invitation Implications and Future Directions ⮚ The direct invitation opens the relationship to true caring 1. Enhancing Nursing Education between the nurse and the one nursed. ⮚ Integrating the Theory of Nursing as Caring into nursing ⮚ The direct invitation of the nurse offers the opportunity to curricula can help develop compassionate and empathetic the one nursed to share what truly matters in the moment. nurses. Call for Nursing 2. Promoting Research ⮚ Calls for nursing are calls for nurturance perceived in the ⮚ Further research can explore the impact of caring mind of the nurse. interventions on different patient populations and enhance evidence-based practice. Caring Between ⮚ When the nurse enters the world of the other person with 3. Advocating for Policy Changes the intention of knowing the other as a caring person, the ⮚ Recognizing the significance of caring in nursing can lead encountering of the nurse and the one nursed gives rise to to policy changes that prioritize patient-centered care and the phenomenon of caring between, within which nurse well-being. personhood is nurtured. TFN-MIDTERMS (JOSHUA D. DIZON, RN, USRN) Afaf Ibrahim Meleis: Transition Theory