Nursing Theories PDF

Grand theories (Based on Interactive Needs) Recap 1. Human needs refer to the fundamental requirements that must be met for individuals to achieve optimal health and well-being. It encompass a wide range of physical, psychological, social, and spiritual requirements that must be met for in...

Grand theories (Based on Interactive Needs) Recap 1. Human needs refer to the fundamental requirements that must be met for individuals to achieve optimal health and well-being. It encompass a wide range of physical, psychological, social, and spiritual requirements that must be met for individuals to achieve optimal health. 2. We got to know the famous nursing theorists, their biography, and their nursing metaparadigms (their concepts, assumptions, and definitions). Recap Human Needs theorists Grand theorists (Based on Interactive Needs) 1. Ida Jean Orlando-Pelletier – Nursing Process Discipline 2. Sister Callista Roy – Adaptation Model 3. Imogene King – Theory Goal Attainment 4. Hildegard Peplau – Interpersonal Relations 5. Jean Watson – Transpersonal Caring 6. Myra Levine – Conservation Theory Interactive Needs Theories based on interactive needs focus on the relationships and interactions between nurses, patients, and the environment. This concept emphasizes the importance of communication, collaboration, and mutual understanding in the nursing process. Theories that incorporate interactive needs recognize that health and well- being are influenced not only by individual factors but also by the dynamics of interpersonal relationships and the context in which care is provided.  “Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before concluding.” Ida Jean Orlando-Pelletier (August 12, 1926 – November 28, 2007) Ida Jean Orlando-Pelletier Ida Jean Orlando was a first-generation Irish American born in 1926. In 1961, she was married to Robert Pelletier and lived in the Boston area. She dedicated her life to studying nursing and graduated in 1947 and received a Bachelor of Science degree in public health nursing in 1951 from St. John’s University in Brooklyn, New York. In 1954, Orlando received her Master of Arts degree in mental health consultation from Teachers College, Columbia University. Ida Jean Orlando-Pelletier While studying, she also worked intermittently and sometimes concurrently as a staff nurse in OB, MS, ER, as a general hospital supervisor, and as an assistant director and a teacher of several courses. She was an internationally known psychiatric health nurse, theorist, and researcher who developed the “Deliberative Nursing Process Theory.” Her theory allows nurses to create an effective nursing care plan that can also be easily adapted when and if any complications arise with the patient. Ida Jean Orlando-Pelletier After receiving her master’s degree in 1954, Orlando went to the Yale University School of Nursing in New Haven, Connecticut as an associate professor of mental health and psychiatric nursing for eight years. She was awarded a federal grant and became a research associate and the principal project investigator of a National Institute of Mental health Institute of the United States Public Health Service’s grant entitled “Integration of Mental Health Concepts in a Basic Curriculum.” The project sought to identify those factors relevant to integrating psychiatric- mental health principles into the nursing curriculum. Ida Jean Orlando-Pelletier Orlando was an associate professor at Yale School of Nursing, and while there, served as the Director of the Graduate Program in Mental Health Psychiatric Nursing. It was also at Yale that she was project investigator of a National Institute of Mental Health grant. The research from this grant led to Orlando’s development of the Deliberative Nursing Process published in The Dynamic Nurse-Patient Relationship: Function, Process, and Principles (NLN Classics in Nursing Theory) in 1961. Ida Jean Orlando-Pelletier Ida Jean Orlando died on November 28, 2007, at the age of 81. Ida Jean Orlando- Pelletier’s Deliberative Nursing Process Deliberative Nursing Process According to the theory, all patient behavior can be a cry for help, both verbal and non-verbal, and it is up to the nurse to interpret the behavior and determine the needs of the patient. Through these, the nurse’s job is to determine the nature of the patient’s distress and provide the help he or she needs. The Deliberative Nursing Process has five stages: assessment, diagnosis, planning, implementation, and evaluation (ADPIE). Deliberative Nursing Process 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. According to her, persons become patients requiring nursing care when they have needs for help that cannot be met independently because of their physical limitations, negative reactions to an environment, or experience that prevents them from communicating their needs. The role of the nurse is to find out and meet the patient’s immediate needs for help. Deliberative Nursing Process Assumptions Deliberative Nursing Process Ida Jean Orlando’s model of nursing makes the following assumptions: 1. When patients cannot cope with their needs on their own, they become distressed by feelings of helplessness. 2. In its professional character, nursing adds to the distress of the patient. 3. Patients are unique and individual in how they respond. 4. Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child. 5. The practice of nursing deals with people, the environment, and health. Deliberative Nursing Process 6. Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs. 7. People can be secretive or explicit about their needs, perceptions, thoughts, and feelings. 8. The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient. 9. People attach meanings to situations and actions that aren’t apparent to others. 10. Patients enter into nursing care through medicine. Deliberative Nursing Process 11. The patient cannot state the nature and meaning of his or her distress without the nurse’s help or him or her first having established a helpful relationship with the patient. 12. Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or her need or finding out that he or she is not in need at that time. 13. Nurses are concerned with the needs the patient is unable to meet on his or her own. Deliberative Nursing Process Major Concepts Deliberative Nursing Process The nursing metaparadigm consists of four concepts: person, environment, health, and nursing. Of the four concepts, Ida Jean Orlando only included three in her theory of Nursing Process Discipline: person, health, and nursing Deliberative Nursing Process Human Being 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. 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 require help. Deliberative Nursing Process Environment Orlando completely disregarded the environment in her theory, only focusing on the patient’s immediate need, 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. Deliberative Nursing Process 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. Deliberative Nursing Process STRENGTHS WEAKNESSES The guarantee that patients will be treated The lack of operational definitions of society as individuals is very much applied in or environment was evident, limiting the Orlando’s theory of the Deliberative Nursing development of the research hypothesis. Process. Each patient will have an active Orlando’s work focuses on short-term care, and constant input into their own care. particularly aware and conscious The assertion of nursing’s independence as individuals, and the virtual absence of a profession and her belief that this reference groups or family members. independence must be based on a sound theoretical framework. The model also guides the nurse to evaluate her care in terms of objectively observable patient outcomes. Question How does Ida Jean Orlando's Deliberative Nursing Process theory emphasize the role of nurse-patient interaction in identifying and addressing patient needs? Question How does the nursing process facilitate the delivery of patient-centered care? “Though there are hard and fast answers in the healthcare field, it is also adaptive and nurses need to be flexible in order to provide the best care for their patients. After all, each patient is different and should be cared for based on the individual needs of that particular patient.” Sister Callista Roy October 14, 1939 - present Sister Callista Roy Bon October 14, 1939, is a nursing theorist, professor, and author. She is known for her groundbreaking work in creating the Adaptation Model of Nursing. She received her Bachelor of Arts Major in Nursing from Mount Saint Mary’s College in Los Angeles in 1963 and her master’s degree in nursing from the University of California in 1966. After earning her nursing degrees, Roy began her sociology education, receiving both a master’s degree in sociology in 1973 and a doctorate in sociology in 1977 from California. Sister Callista Roy Sister Callista Roy is a member of the Sisters of Saint Joseph of Carondelet. Her work is known internationally; she has presented at conferences in at least 36 countries and throughout the United States. In 2007, she was awarded the American Academy of Nursing’s Living Legend award. She is currently professor and nurse theorist at Boston College’s Connell School of Nursing (Connell School of Nursing, 2016). Sister Callista Roy She developed the model’s basic concepts while she was a graduate student at the University of California from 1964 to 1966. In 1968, she began operationalizing her model when Mount Saint Mary’s College adopted the adaptation framework as the nursing curriculum’s philosophical foundation. Roy was an associate professor and chairperson of the Department of Nursing at Mount Saint Mary’s College until 1982 and was promoted to the professor’s rank in 1983 at both Mount Saint Mary’s College and the University of Portland. Sister Callista Roy From 1987 to the present, Roy began the newly created resident nurse theorist position at Boston College School of Nursing, where she teaches doctoral, master’s, and undergraduate students. In 1991, she founded the Boston Based Adaptation Research in Nursing Society (BBARNS), which would later be renamed the Roy Adaptation Association. Sister Callista Roy Sr. Callista Roy has numerous publications, including books and journal articles, on nursing theory and other professional topics. Her works have been translated into many languages all over the world. Roy and her colleagues at Roy Adaptation Association have critiqued and synthesized the first 350 research projects published in English based on her adaptation model. Sister Callista Roy’s Adaptation Model of Nursing Adaptation Model of Nursing Developed by Roy in 1976, the Adaptation Model of Nursing asks three central questions: 1. Who is the focus of nursing care? 2. What is the target of nursing care? and 3. When is nursing care indicated? This model looks at the patient from a holistic perspective. Adaptation Model of Nursing The Adaptation Model of Nursing is a prominent nursing theory aiming to explain or define the provision of nursing science. In her theory, Sister Callista Roy’s model sees the individual as a set of interrelated systems that maintain a balance between various stimuli. Roy defined nursing as a “health care profession that focuses on human life processes and patterns and emphasizes the promotion of health for individuals, families, groups, and society as a whole.” Adaptation Model of Nursing Views the individual as a set of interrelated systems that strives to maintain a balance between various stimuli. Inspired the development of many middle-range nursing theories and adaptation instruments. Adaptation Model of Nursing The three concepts of her model are the 1. human being, 2. adaptation, and 3. nursing. Under the concept of adaptation are four modes: 1. physiological, 2. self-concept, 3. role function, and 4. interdependence. Adaptation Model of Nursing The physiological mode deals with the maintenance of the physical body. This includes basic human needs such as air, water, food, and temperature regulation. The function of the mode of self-concept is the need for the maintenance of the mind. The person’s perceptions of his or her physical and personal self are included in this mode. Social integrity is emphasized in the role function mode. This addresses people’s adaptations to different role changes that occur throughout a lifetime. The interdependence mode also addresses social integrity. This mode deals with the balance between independence and interdependence in a person’s relationships with other people. Adaptation Model of Nursing Assumptions  Scientific Assumptions Philosophical Assumptions Systems of matter and energy progress to Persons have mutual relationships with the higher levels of complex self-organization. world and God. Consciousness and meaning are constructive Human meaning is rooted in the omega point of person and environment integration. convergence of the universe. Awareness of self and environment is rooted in God is intimately revealed in the diversity of thinking and feeling. creation and is the common destiny of creation. Humans, by their decisions, are accountable Persons use human creative abilities of for the integration of creative processes. awareness, enlightenment, and faith. Thinking and feeling mediate human action. Persons are accountable for the processes of System relationships include acceptance, deriving, sustaining, and transforming the protection, and fostering of interdependence. universe. Persons and the earth have common patterns and integral relationships. Persons and environment transformations are created in human consciousness. Integration of human and environmental meanings results in adaptation. Adaptation Model of Nursing Major Concepts Major Concepts of the Adaptation Model The following are Callista Roy’s Adaptation Model’s major concepts, including the definition of the nursing metaparadigm as defined by the theory. 1. Person 2. Environment 3. Health 4. Nursing Major Concepts of the Adaptation Model Person “Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which they adjust effectively to changes in the environment and, in turn, affect the environment.” Based on Roy, humans are holistic beings that are in constant interaction with their environment. Humans use a system of adaptation, both innate and acquired, to respond to the environmental stimuli they experience. Human systems can be individuals or groups, such as families, organizations, and the whole global community. Major Concepts of the Adaptation Model Environment “The conditions, circumstances and influences surrounding and affecting the development and behavior of persons or groups, with particular consideration of the mutuality of person and health resources that includes focal, contextual and residual stimuli.” The environment is defined as conditions, circumstances, and influences that affect humans’ development and behavior as an adaptive system. The environment is a stimulus or input that requires a person to adapt. These stimuli can be positive or negative. Major Concepts of the Adaptation Model Environment Roy categorized these stimuli as focal, contextual, and residual. Focal stimuli are that confront the human system and require the most attention. Contextual stimuli are characterized as the rest of the stimuli present with the focal stimuli and contribute to its effect. Residual stimuli are the additional environmental factors present within the situation but whose effect is unclear. This can include previous experience with certain stimuli. Major Concepts of the Adaptation Model Example: A 45-year-old patient is admitted to the hospital with a diagnosis of acute myocardial infarction (heart attack). Focal stimuli The acute myocardial infarction itself is the focal stimulus. It is the primary issue that the patient is dealing with and requires immediate medical intervention and adaptation. Contextual stimuli The patient's history of hypertension, diabetes, and smoking are contextual stimuli. These factors contribute to the patient's overall health status and influence how they respond to the heart attack. Major Concepts of the Adaptation Model Example: A 45-year-old patient is admitted to the hospital with a diagnosis of acute myocardial infarction (heart attack). Residual stimuli The patient's past experiences with healthcare, such as previous hospitalizations or surgeries, and their underlying anxiety about health issues are residual stimuli. These factors might not be immediately obvious but can affect the patient's overall adaptation to the current health crisis. Major Concepts of the Adaptation Model Health “Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way.” Health is defined as the state where humans can continually adapt to stimuli. Because illness is a part of life, health results from a process where health and illness can coexist. If a human can continue to adapt holistically, they will maintain health to reach completeness and unity within themselves. If they cannot adapt accordingly, the integrity of the person can be affected negatively. Major Concepts of the Adaptation Model Nursing “The goal of nursing is] the promotion of adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality of life, and dying with dignity.” In Adaptation Model, nurses are facilitators of adaptation. They assess the patient’s behaviors for adaptation, promote positive adaptation by enhancing environment interactions and helping patients react positively to stimuli. Nurses eliminate ineffective coping mechanisms and eventually lead to better outcomes. Major Concepts of the Adaptation Model Adaptation Adaptation is the “process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration.” Person as an Adaptive System: - The individual is viewed as a holistic adaptive system that interacts with the environment. This system includes biological, psychological, and social aspects. Major Concepts of the Adaptation Model Internal Processes Regulator The regulator subsystem is a person’s physiological coping mechanism. The body attempts to adapt via regulation of our bodily processes, including neurochemical and endocrine systems. Cognator The cognator subsystem is a person’s mental coping mechanism. A person uses his brain to cope via self-concept, interdependence, and role function adaptive modes. Major Concepts of the Adaptation Model Adaptive Responses: Physiological Mode: Involves the physical responses of the body to stimuli (e.g., heart rate, blood pressure). Self-Concept Mode: Relates to the individual’s perception of themselves, including self- esteem and body image. Role Function Mode: Concerns the roles the individual occupies in society and how these roles affect their adaptation. Interdependence Mode: Focuses on relationships and the support systems that influence adaptation. Major Concepts of the Adaptation Model Levels of Adaptation Integrated Process: The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful relationship). Compensatory Process: The cognator and regulator are challenged by the environment’s needs but are working to meet the needs (e.g., grief, starting with a new job, compensatory breathing). Compromised Process: The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships). Six-Step Nursing Process A nurse’s role in the Adaptation Model is to manipulate stimuli by removing, decreasing, increasing, or altering stimuli so that the patient. 1. Assess the behaviors manifested from the four adaptive modes. 2. Assess the stimuli, categorize them as focal, contextual, or residual. 3. Make a statement or nursing diagnosis of the person’s adaptive state. 4. Set a goal to promote adaptation. 5. Implement interventions aimed at managing the stimuli. 6. Evaluate whether the adaptive goal has been met. Question How does Sister Callista Roy's Adaptation Model guide nurses in assessing and promoting patient adaptation in the four adaptive modes, and what specific interventions might be used in each mode to enhance patient outcomes? Answers: Four Adaptive Modes Interventions 1. Physiological Mode: - Administering medications to manage symptoms or treat conditions. This mode involves the physical and - Providing nutritional support and dietary biological aspects of the patient’s adaptation. counseling. Nurses assess vital signs, physical symptoms, - Implementing exercise and physical therapy and overall health status. programs to improve physical function. 2. Self-Concept Mode: - Offering counseling and psychological support to address issues of self-esteem and This mode relates to the patient’s body image. psychological and spiritual well-being, - Encouraging participation in activities that including self-esteem, body image, and promote a positive self-concept, such as personal beliefs. hobbies or social groups. - Providing spiritual care and support, including access to chaplaincy services or meditation practices.  Four Adaptive Modes Interventions 3. Role Function Mode: - Assisting the patient in adapting to changes in their roles, such as returning to work or This mode concerns the roles the patient adjusting to new family dynamics. occupies in society, such as family roles, work - Providing education and resources to help roles, and social roles. the patient fulfill their roles effectively. - Facilitating communication and problem- solving skills to manage role-related stress. 4. Interdependence Mode: - Encouraging the development and maintenance of supportive relationships. This mode focuses on the patient’s - Connecting the patient with community relationships and support systems, including resources and support groups. family, friends, and community resources. - Providing family education and counseling to enhance the support system. THE END...