Carative Factors in Nursing PDF

Transpersonal that foundation. The ten primary carative factors with their The transpersonal concept is an intersubjective human-to- corresponding translation into clinical caritas processes are human relationship in which the nurse...

Transpersonal that foundation. The ten primary carative factors with their The transpersonal concept is an intersubjective human-to- corresponding translation into clinical caritas processes are human relationship in which the nurse affects and is affected by listed in the table below. the person of the other. Both are fully present in the moment Carative Factors and Caritas Processes and feel a union with the other, they share a phenomenal fuel Carative Factors Caritas Process that becomes part of the life story of both. 1. "The formation of a humanistic-altruistic system of values "Practice of loving-kindness and equanimity within the context Subconcepts of caring consciousness" Phenomenal field 2. The instillation of faith-hope" The totality of human experience of one's being in the world. Being authentically present and enabling and sustaining the This refers to the individual's frame of reference that can only be deep belief system and subjective life-world of self and one known to that person. being cared for" Self -The organized conceptual gestalt composed of 3. "The cultivation of sensitivity to one's self and to others" perceptions of the characteristics of the I or "ME and the "Cultivation of one's own spiritual practices and transpersonal perceptions of the relationship of the " and "ME to others and to self-going beyond the ego self" various aspects of life. 4. "Development of a helping-trust relationship" became Time - The present is more subjectively real and the past is "development of a helping-trusting, human caring relation" (in more objectively real. The past is prior to, or in a different mode 2004 Watson website) of being than the present, but it is not clearly distinguishable. Past, present, and future incidents merge and fuse. "Developing and sustaining helping trusting authentic caring relationship" 10 Carative Factors 5. "The promotion and acceptance of the expression of positive Watson devised 10 caring needs specific carative factors critical to the caring human experience that need to be and negative feelings" addressed by nurses with their patients when in a caring role. "Being present to, and supportive of, the expression of positive As carative factors evolved within an expanding perspective, and negative feelings as a connection with deeper spirit and self and as per ideas and values evolved. Watson offered a and the one-being-cared for" translation of the original carative factors into clinical caritas 6. "The systematic use of the scientific problem-solving method processes that suggested open ways in which they could be for decision making" became "systematic use of creative considered. problem-solving caring process" (in 2004 Watson website) The first three carative factors are the "philosophical foundation" for the science of caring, while the remaining seven derive from  "Creative use of self and all ways of knowing as part of the  Skill-refers to Nursing interventions and Clinical judgment caring process; to engage in the artistry of caring-healing skills in actual clinical situations. practices"  As the N gains experience, Clinical knowledge becomes 7. "The promotion of transpersonal teaching-learning" a GOOD MIX of PRACTICAL & THEORETICAL "Engaging in genuine teaching-learning experience that KNOWLEDGE attends to unity of being and meaning, attempting to stay within LEVELS OF SKILL ACQUISITION: others' frame of reference" Benner's Stages of Clinical Competence 8. "The provision of supportive, protective, and (or) corrective Stage 1 Novice: This would be a nursing student in his or her mental, physical, societal, and spiritual environment" first year of clinical education; behavior in the clinical setting is "Creating healing environment at all levels (physical as well as very limited and inflexible. Novices have a very limited ability to nonphysical, subtle environment of energy and consciousness, predict what might happen in a particular patient situation. Signs whereby wholeness, beauty, comfort, dignity, and peace are and symptoms, such as change in mental status, can only be potentiated)" recognized after a novice nurse has had experience with 9. "The assistance with gratification of human needs" patients with similar symptoms. "Assisting with basic needs, with an intentional caring Stage 2 Advanced Beginner: Those are the new grads in their consciousness, administering 'human care essentials,' which first jobs; nurses have had more experiences that enable them potentiate alignment of mind body spirit, wholeness, and unity of to recognize recurrent, meaningful components of a situation. being in all aspects of care" They have the knowledge and the know-how but not enough in- depth experience. 10. The allowance for existential-phenomenological forces became "allowance for existential-phenomenological spiritual Stage 3 Competent: These nurses lack the speed and flexibility forces' (n 2004 Watson website) of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent "Opening and attending to spiritual-mysterious and existential nurses recognize patterns and nature of clinical situations more dimensions of one's own life-death; soul care for self and the quickly and accurately than advanced beginners. one-being-cared for" Stage 4 Proficient: At this level, nurses are capable to see situations as "wholes" rather than parts. Proficient nurses learn PATRICIA BENNER: NURSING EXPERTISE MODEL from experience what events typically occur and are able to Her concern is: modify plans in response to different events. "How do Nurses learn to do Nursing" Stage 5 Expert: Nurses who are able to recognize demands > Experience-based skill acquisition - is safer & quicker when it and resources in situations and attain their goals. These nurses is founded on a sound educational base know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep have a smooth recovery and can get back to the best health knowledge and experience. Focus is on the most relevant possible. problems and not irrelevant ones. Analytical tools are used only There are eight concepts in Rogers' nursing theory: energy when they have no experience with an event, or when events field, openness, pattern, pan-dimensionality, don't occur as expected. homeodynamic principles, resonance, helicy. and APPLICATION integrality. Instrumental in differentiating knowledge development & career The belief of the coexistence of the human and the environment progression in Nursing. has greatly influenced the process of change toward better It is important for Nursing students and professional nurses alike health. In short, a patient can't be separated from his or her to learn through Experience or by Experiential Learning. environment when addressing health and treatment. This view Learning by experience will allow you to gain Mastery of a given lead and opened Martha E. Rogers' theory, known as the skill. "Science of Unitary Human Beings," which allowed nursing to be considered one of the scientific disciplines. Rogers' theory defined Nursing as "an art and science that is humanistic and VI. OTHER NURSING THEORIES humanitarian. It is directed forward the unitary human and is MARTHA ROGERS: SCIENCE OF UNITARY HUMAN concerned with the nature and direction of human development. BEINGS The goal of nurses is to participate in the process of change." Martha Rogers' theory is known as the Science of Unitary According to Rogers, the Science of Unitary Human Beings Human Beings (SUHB). The theory views nursing as both a contains two dimensions: the science of nursing, which is the science and an art as it provides a way to view the unitary knowledge specific to the field of nursing that comes from human being, who is integral with the universe. The unitary scientific research; and the art of nursing, which involves human being and his or her environment are one. Nursing using the science of nursing creatively to help better the focuses on people and the manifestations that emerge from the life of the patient. mutual human-environmental field process. Assumptions SUHB contains two dimensions: the science of nursing, which is The assumptions of Rogers' Theory of Unitary Human Beings the knowledge specific to the field of nursing that comes from are as follows: (1) Man is a unified whole possessing his own scientific research; and the art of nursing, which involves using integrity and manifesting characteristics that are more than and the science of nursing creatively to help belter the life of the different from the sum of his parts. (2) Man, and environment patient. are continuously exchanging matter and energy with one Her model addresses the importance of the environment as an another. (3) The life process evolves irreversibly and integral part of the patient, and uses that knowledge to help unidirectionally along the space-time continuum. (4) Pattern and nurses blend the science and art of nursing to ensure patients organization identify the man and reflect his innovative wholeness. And lastly, (5) Man is characterized by the capacity Nursing aims to assist people in achieving their maximum health for abstraction and imagery, language and thought sensation potential. Maintenance and promotion of health, prevention of and emotion. disease, nursing diagnosis, intervention, and rehabilitation Major Concepts encompass the scope of nursing's goals. The following are the major concepts and metaparadigm of Nursing is concerned with people-al people-well and sick, rich Martha Rogers' nursing theory: and poor, young and old. The arenas of nursing's services extend into all areas where there are people: at home, at school, Human-unitary human beings at work, at play; in hospital, nursing home, and clinic; on this A person is defined as an indivisible. pan-dimensional energy planet and now moving into outer space. field identified by a pattern, and manifesting characteristics Environmental Field specific to the whole, and that can't be predicted from knowledge of the parts. A person is also a unified whole, having "An irreducible, indivisible, pan dimensional energy field its own distinct characteristics that can't be viewed by looking at, identified by pattern and integral with the human field." describing, or summarizing the parts. Energy Field Health The energy field is the fundamental unit of both the living and Rogers defines health as an expression of the life process. It is the non-living. It provides a way to view people and the the characteristics and behavior coming from the mutual, environment as irreducible wholes. The energy fields simultaneous interaction of the human and environmental fields, continuously vary in intensity, density, and extent. and health and illness are part of the same continuum. The Subconcepts multiple events occurring during the life process show the extent Openness to which a person is achieving his or her maximum health There are no boundaries that stop energy flow between the potential. The events vary in their expressions from greatest human and environmental fields, which is the openness in health to those conditions that are incompatible with the Rogers' theory. It refers to qualities exhibited by open systems; maintaining life process. human beings and their environment are open systems. Nursing Pandimensional It is the study of unitary, irreducible, indivisible human and Pan-dimensionality is defined as "non-linear domain without environmental fields: people and their world. Rogers claims that spatial or temporal attributes." The parameters that humans use nursing exists to serve people, and the sate practice of nursing in language to describe events are arbitrary, and the present is depends on the nature and amount of scientific nursing relative; there is no temporal ordering of lives. knowledge the nurse brings to his or her practice Synergy is defined as the unique behavior of whole systems, Scope of Nursing unpredicted by any behaviors of their component functions taken separately. Human behavior is synergistic. Principle of Resonancy Pattern It speaks to the nature of the change occurring between human Rogers defined the pattern as the distinguishing characteristic of and environmental fields. The life process in human beings is a an energy field seen as a single wave. It is an abstraction and symphony of rhythmical vibrations oscillating at various gives identity to the field. frequencies. Principles of Homeodynamics It is the identification of the human field and the environmental field by wave patterns manifesting continuous change from Homeodynamics should be understood as a dynamic version of longer waves of lower frequency to shorter waves of higher homeostasis (a relatively steady state of internal operation in frequency. the living system). Principle of Helicy Homeodynamic principles postulate a way of viewing unitary human beings. The three principles of homeodynamics are The human-environment field is a dynamic, open system in resonance, helicy, and integrality. which change is continuous due to the constant interchange Principle of Reciprocy between the human and environment. Postulates the inseparability of man and environment and This change is also innovative. Because of constant interchange, predicts that sequential changes in life process are continuous, an open system is never exactly the same at any two moments; probabilistic revisions occurring out of the interactions between rather, the system is continually new or different man and environment. Mutual patterning of the human and environmental field includes: Principle of Synchrony  Sharing knowledge This principle predicts that change in human behavior will be  Offering choices determined by the simultaneous interaction of the actual state of  Empowering the patient the human field and the actual state of the environmental field at any given point in space-time.  Fostering patterning Principle of Integrality (Synchrony + Reciprocy)  Evaluation Because of the inseparability of human beings and their  Repeat pattern appraisal, which includes nutrition, environment. sequential changes in the life processes are work/leisure activities, wake/sleep cycles, relationships, continuous revisions occurring from the interactions between pain, and fear/hopes human beings and their environment.  Identify dissonance and harmony Between the two entities, there is a constant mutual interaction  Validate appraisal with the patient and mutual change whereby simultaneous molding is taking  Self-reflection for the patient place in both at the same time. IDA JEAN ORLANDO: DELIBERATIVE NURSING PROCESS  The practice of nursing deals with people, environment, THEORY and health. lda Jean Orlando's nursing theory stresses the reciprocal  Patients need help communicating their needs; they are relationship between patient and nurse. it emphasizes the uncomfortable and ambivalent about their dependency critical importance of the patient's participation in the needs. nursing process. Orlando also considered nursing as a  People are able to be secretive or explicit about their distinct profession and separated it from medicine where needs, perceptions, thoughts, and feelings. nurses as determining nursing action rather than being  The nurse-patient situation is dynamic; actions and prompted by physician's orders, organizational needs and reactions are influenced by both the nurse and the past personal experiences. She believed that the physician's patient. orders are for patients and not for nurses. She proposed that  People attach meanings to situations and actions that "patients have their own meanings and interpretations of aren't apparent to others. situations and therefore nurses must validate their inferences  Patients enter into nursing care through medicine. and analyses with patients before drawing conclusions."  The patient is unable to state the nature and meaning of Goal his or her distress without the help of the nurse, or without him or her first having established a helpful lda Jean Orlando's goal is to develop a theory of effective relationship with the patient. nursing practice. The theory explains that the role of the nurse is to find out and meet the patient's immediate needs for help.  Any observation shared and observed with the patient is According to the theory, all patient behavior can be a cry for immediately helpful in ascertaining and meeting his or help. Through these, the nurse's job is to find out the nature of her need, or finding out that he or she is not in need at the patient's distress and provide the help he or she needs. that time.  Nurses are concerned with the needs the patient is Assumptions unable to meet on his or her own. Ida Jean Orlando's model of nursing makes the following assumptions: Major Concepts  When patients are unable to cope with their needs on their own, they become distressed by feelings of The nursing metaparadigm consists of four concepts: person, helplessness environment, health, and nursing. Of the four concepts, lda Jean Orlando only included three in her theory of Nursing Process  In its professional character, nursing adds to the distress Discipline: person, health, and nursing. of the patient.  Patients are unique and individua! in how they respond.  Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child. Human Being needs for help. According to Orlando, nursing is responsive to Orlando uses the concept of human as she emphasizes individuals who suffer, or who anticipate a sense of individuality and the dynamic nature of the nurse-patient helplessness. It is focused on the process of care in an relationship. For her, humans in need are the focus of nursing immediate experience, and is concerned with providing direct practice. assistance to a patient in whatever setting they are found in for the purpose of avoiding, relieving, diminishing, or curing the Health sense of helplessness in the patient. The Nursing Process In Orlando's theory, health is replaced by a sense of Discipline Theory labels the purpose of nursing to supply the helplessness as the initiator of a necessity for nursing. She help a patient needs for his or her needs to be met. That is, if stated that nursing deals with individuals who are in need of the patient has an immediate need for help, and the nurse help. discovers and meets that need, the purpose of nursing has Environment been achieved. Orlando completely disregarded environment in her theory, only Presenting Behavior focusing on the immediate need of the patient, chiefly the Presenting behavior is the patient's problematic situation. relationship and actions between the nurse and the patient (only Through the presenting behavior, the nurse finds the patient's an individual in her theory, no families or groups were immediate need for help. To do this, the nurse must first mentioned). The effect that the environment could have on the recognize the situation as problematic. Regardless of how the patient was never mentioned in Orlando's theory. presenting behavior appears, it may represent a cry for help Nursing from the patient. The presenting behavior of the patient, which is Orlando speaks of nursing as unique and independent in its considered the stimulus, causes an automatic internal response concerns for an individual's need for help in an immediate in the nurse, which in turn causes a response in the patient. situation. The efforts to meet the individual's need for help are Distress carried out in an interactive situation and in a disciplined manner The patient's behavior reflects distress when the patient that requires proper training. experiences a need that he cannot resolve. a sense of Subconcepts helplessness occurs. lda Jean Orlando described her model as reviving around the Immediate Reaction following five major interrelated concepts: the function of The immediate reaction is the internal response. The patient professional nursing, presenting behavior, immediate reaction, perceives objects with his or her five senses. These perceptions nursing process discipline, and improvement. stimulate automatic thought, and each thought stimulates an Function of Professional Nursing automatic feeling. causing the patient to act. These three items The function of professional nursing is the organizing principle. are the patient’s immediate response. The immediate response This means finding out and meeting the patient's immediate reflects how the nurse experiences his or her participation in the and each goal or outcome is given nursing interventions to help nurse-patient relationship. achieve the goal. By the end of this stage. the nurse will have a Nurse Reaction nursing care plan. The patient behavior stimulated a nurse reaction, which marks Implementation the beginning of the nursing process discipline. In the implementation stage, the nurse begins using the nursing Nurse's Action care plan. When the nurse acts, an action process transpires. This action Evaluation process by the nurse in a nurse-patient contact is called nursing Finally, in the evaluation stage, the nurse looks at the progress process. The nurse's action may be automatic or deliberative. of the patient toward the goals set in the nursing care plan.  Automatic Nursing Actions are nursing actions decided Changes can be made to the nursing care plan based on how upon for reasons other than the patient's immediate need. well (or poorly) the patient is progressing toward the goals. If any new problems are identified in the evaluation stage, they  Deliberative Nursing Actions are actions decided upon can be addressed, and the process starts over again for those after ascertaining a need and then meeting this need specific problems. 5 Stages of the Deliberative Nursing Process NOLA PENDER: HEALTH PROMOTION MODEL The Deliberative Nursing Process has five stages: assessment, Focuses on 10 Categories of determinants of health-Promoting diagnosis, planning, implementation, and evaluation. Behaviors. Assessment Views a person's health-promoting behavior in the light of his In the assessment stage, the nurse completes a holistic individual characteristics & experiences assessment of the patient's needs. This is done without taking The 10 Determinants are: the reason for the encounter into consideration. The nurse uses a nursing framework to collect both subjective and objective 1. Prior related behavior data about the patient. 2. Perceived benefits of action Diagnosis 3. Perceived barriers of action The diagnosis stage uses the nurse's clinical judgment about 4. Perceived self-efficacy health problems. The diagnosis can then be confirmed using 5. Activity related effect links to defining characteristics, related factors, and risk factors 6. Interpersonal Influences (family, friends, found in the patient's assessment. providers) norms, support & models Planning 7. Situational Influences options, demand The planning stage addresses each of the problems identified in the diagnosis. Each problem is given a specific goal or outcome, characteristics, aesthetics) 8. Immediate competing demands (low control) and preferences The Health Promotion Model notes that each person has (high demand) unique personal characteristics and experiences that affect 9. Commitment to a plan of action subsequent actions. The set of variables for behavioral specific 10. Personal Factors (biological, Psychological, Sociocultural) knowledge and effect have important motivational significance. Application: These variables can be modified through nursing actions. Health-promoting behavior is the desired behavioral outcome Health Promotion Activities are the major Focus of Hx Care and is the endpoint in the Health Promotion Model. Organizations. In order for patients to take on the behavior we, Health care professionals, advise them to take. we should Major Concepts of the Health Promotion Model carefully look into a host of factors that can influence his Health promotion is defined as behavior motivated by the decision to really adopt the behavior it is important for nurses to desire to increase well-being and actualize human health be ROLE MODELS for the patients potential. It is an approach to wellness. MYRA LEVINE: FOUR CONSERVATION PRINCIPLES OF Health protection or illness prevention is described as NURSING behavior motivated desire to actively avoid illness, detect it early, 1. Conservation of Energy or maintain functioning within illness constraints. Example: complete bed rest without bathroom privileges Individual characteristics and experiences (prior related behavior and personal factors). 2. Conservation of Structural Integrity Behavior-specific cognitions and affect (perceived benefits of Example: turn patient from side to side every two hours to action, perceived barriers to action, perceived self-efficacy. avoid bed sores activity-related affect, interpersonal influences, and situational Conservation of Personal Integrity influences). Example: maintain patient's privacy > Behavioral outcomes (commitment to a plan of action, 4. Conservation of Social Integrity immediate competing demands and preferences, and health- promoting behavior). Example: maintenance of patient's relationships Subconcepts of the Health Promotion Model APPLICATION Personal Factors Nurses should be able to identify the many Nurse-Patient activities which are implied in the 4 Conservation Models. It can Personal factors are categorized as biological, psychological, be applied to geriatric nursing where majority of the elderly pts and socio-cultural. These factors are predictive of a given will have some problems in at least 2 of the conservation behavior and shaped by the target behavior's nature being models. considered. NOLA J. PENDER'S HEALTH PROMOTION MODEL Personal biological factors. include variables such as age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, or balance. Personal psychological factors. sources of interpersonal influences are families, peers, and Include variables such as self-esteem, self-motivation, personal healthcare providers. Competence, perceived health status, and definition of personal Situational Influences socio-cultural factors. Include variables health such as race, Personal perceptions and cognitions of any given situation or ethnicity, acculturation, education, and Socioeconomic status. context can facilitate or impede behavior. Include perceptions of Perceived Benefits of Action options available, demand characteristics, and aesthetic Anticipated positive outcomes that will occur from health features of the environment in which given health-promoting is behavior. proposed to take place. Situational influences may have direct Perceived Barriers to Action or indirect influences on health behavior. Anticipated, imagined, or real blocks and personal costs of Commitment to Plan of Action understanding a given behavior. The concept of intention and identification of a planned strategy Perceived Self-Efficacy leads to the implementation of health behavior. The judgment of personal capability to organize and execute a Immediate Competing Demands and Preferences health-promoting behavior. Perceived self-efficacy influences Competing demands are those alternative behaviors over which perceived barriers to action, so higher efficacy results in lowered individuals have low control because of environmental perceptions of barriers to the behavior's performance. contingencies such as work or family care responsibilities. Activity-Related Affect Competing preferences are alternative behaviors over which individuals exert relatively high control, such as choice of ice Subjective positive or negative feeling occurs before, during, cream or apple for a snack. and following behavior based on the stimulus properties of the behavior itself. Health-Promoting Behavior Activity-related affect influences perceived self-efficacy, which A health-promoting behavior is an endpoint or action-outcome means the more positive the subjective feeling. the greater its directed toward attaining positive health outcomes such efficacy. In tum, increased feelings of efficacy can generate a suboptimal wellbeing, personal fulfillment, and productive living. further positive affect. Interpersonal Influences Cognition concerning behaviors, beliefs, or attitudes of others. interpersonal influences include norms (expectations of significant others) social support instrumental and emotional encouragement). and modeling (vicarious learning through observing others engaged in a particular behavior). Primary