Nursing Theories Review PDF

Recio, Alliah Francine M. REVIEWER TFN THEORIA means speculate THEORIES – interrelated concept that gives systematic review of phenomenon. THEORY – creative and rigorous structuring of ideas that projects tentative and systematic review of phenomen...

Recio, Alliah Francine M. REVIEWER TFN THEORIA means speculate THEORIES – interrelated concept that gives systematic review of phenomenon. THEORY – creative and rigorous structuring of ideas that projects tentative and systematic review of phenomena (Chinn&Kramer 1999) CONCEPTS – abstract ideas ABSTRACT – something or ideas that has no physical evidence; in our minds only PHENOMENON – observable facts/events RIGOROUS – accurate effort PROPOSITION – express judgement/opinions Theories are composed of concepts, definitions, models, propositions, and based assumptions. TWO PRINCIPAL METHODS: Deductive Reasoning – top-down; make inferences by going from general premises to specific conclusions; two true statements. A=B B=C A=C EXISTING THEORY – FORMULATIVE HYPOTHESIS – COLLECT DATA – ANALYZE DATA – DO/DON’T REJECT HYPOTHESIS Inductive Reasioning – bottom-up; takes you from specific to general. SPECIFIC – OBSERVATION – PATTERN RECOGNITION – GENERAL CONCLUSION Inductive Logic Observation A low cost airline flight is delayed Dog A&B have fleas Elephants depends on water to exist Observation Pattern Another 20 flights from low-cost airlines are delayed All observe dogs have fleas All observe animals depends on water to exist Developed Theory/General Preliminary Conclusion Low cost airlines always have delays All dogs have fleas All biological life depends on water to exist NURSING THEORY – defined as a belief, policy or procedure proposed or followed as the basis of action. It as an organized framework of concepts and proposes designed to guide the practice of nursing. NURSING THEORY: NURSING CARE Explains Describes Predicts Prescribes Theories – Characteristics 1. Theories can interrelated concepts in such way as to create a different way of looking at a particular phenomena. 2. Theories must be logical in nature – something rational. 3. Theories should be relatively simple yet generalizable. 4. Theories can be the basis for hypothesis that can be tested. 5. Contribute and assist in increasing the general body of knowledge within the discipline through the research implemented and validate them. 6. Can be used by the practitioners to guide and improve their practice. 7. Must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that needs to be investigated. THEORY IS A GUIDING PRINCIPLE MID 1800’S & 1960’S Nursing knowledge distinct from medical knowledge (Nightingale) Nursing practices was based in principle & traditions passed on through apparenticeship education & common sense wisdom. Nursing as a vocational heritage more than professional vision. 1960’s - debates regarding the proper directions and appropriate disciple for knowledge development. WHEN YOU ARE A MOTHER, YOU ARE ACTUALLY A NURSE. NURSING IS NOT JUST A PROFESSION BUT A VOCATION. CURRICULUM ERA – moving nursing education from hospital-based diploma programs into college & universities. RESEARCH ERA – path of knowledge; part of curricula developing graduate programs. GRADUATE ERA – 1950-1970 – Masters program in nursing emerged to meet the need of nurses with specialized education in nursing. THEORY ERA – 1980;s-1990’s – outgrowth of research era;research without theory produced isolated information; research and theory produced nursing science. THEORY UTILIZATION ERA – basis in education. MID 1970’S Evaluation of 25 years at nursing research revealed that nursing lacks conceptual/frameworks. MILESTONES 1: standardization of curricula for nursing master’s education; doctoral education for nurses should be in nursing. Transition of nursing Nursing practice is based on nursing science. 1980’s Pre paradigm period to paradigm period Introduced an organizational structure for nursing knowledgeable development to the nursing literature Utilization phase of theory era – emphasis shifts from the development to the use & application of what is known. CONCEPTS – words that describes objects, properties or events and basic components or theory. 3 TYPES OF CONCEPTS: Empirical Concepts Directly observable objects Limited by time and space In can be viewed or measured only in a specific period. Example: skin color, wounds Inferential Concepts Indirectly observable Example: pain, difficulty of breathing Abstract Concepts not clearly observed concepts both indirectly and directly non observable used in under settings and population Example: social support, self esteem  METAPRADIGM Specifies the main concepts that encompass the subject matter and scope of discipline. There is a general argument that nursing’s metaparadigm consist of central concepts of person, environment, health and nursing. PHILOSOPHY Specifies the definition of metaparadigm concepts in each of the conceptual models of nursing There are other theoretical that maybe considered philosohics, with specific philosophical approaches to nursing. MODELS Representation of interaction among and between the concepts showing patterns. In nursing models are often designed by theory authors and depict the beliefs in their theory. VERBAL – worded statement , a form of closely knowledge development SCHEMATIC – diagrams. Drawings, graphs and pictures that facilitate understanding PROPOSITION - statements that explain the relationship between the concepts PROCESS – senses of action, changes, or functions intended to bring about a desired result. CONCEPTUAL FRAMEWORK – the delivery of nursing come within the nursing process is directed by the way specific conceptual frameworks and theories define the person, environment, health and nursing. It outlines possible courses of action or to present a preferred approach to an idea or thought. FLORENCE NIGHTINGALE/ENVIRONMENTAL THEORY ▪ First nursing theorist ▪ Chief nurse for British in Crimean War in mid 1850’s ▪ Mother of modern nursing ▪ Created detailed report of both medical and nursing matters ▪ Nurse leader who revolutionalized nursing by collecting and using data ▪ Introduced hygiene practices which believes to reduce mortality rate and providing reports to government leaders about changes requires to improve military healthcare among British groups as well as Civilian Public. HER GREATEST CONTRIBUTION ▪ Aside from the fact that she helped to define nursing practice by suggesting that nurses did not need to know all about disease process like the medical field. ▪ Established the foundation of nursing practice across the world. ▪ With dilemination between legal practices of doctors and nurses independent and dependent nursing practices. DEPENDENT PRACTICES ARE CARRYING OUT ORDERS FROM DOCTORS. NUURSING THE PATIENTS, NOT ACTUALLY TREATING THEM. 5 ENVIRONMENTAL FACTORS 1. Fresh air 2. Pure and Clean water 3. Efficient drainage 4. Cleanliness and Sanitation 5. Light & Direct Sunlight GOAL OF NURSING: to give the most kind-hearted and highest quality of care ▪ Continuous progress and advancements of surgery and medical science is needed for us to be more effective in helping those in needs and injureds. ▪ Need to observe the negative and positive outcomes of modification in care; we need to know what produces positive effects and negative effects; we need BASIS. ▪ We need to provide quality of care for all, even those who cannot afford. Natural instinct and nursing mother Nursing is given evenly regardless of the socio-economic statics of person. METAPARADIGM – the most general statement of discipline and functions as framework; framework is a set of rules, ideas, beliefs and used dealing with problems; framework is the basis. ▪ PERSON – PATIENT, who is affected by environment; multidimensional/composed of biological, psychological, social and spiritual components; has a vital repairative power to deal with disease, recovery in safe environment.  ▪ HEALTH – not only to well but maintaining well-being by using person’s power to the fullest extent; maintain environmental factors to prevent disease.DISEASE – absence of comfort/DYS means difficulty. HEALTH & DISEASE are the focused of nurse who helps the person to the healing process. ▪ NURSING – activities that promotes health which occur in any care giving situation; can be done by anyone; nursing is different from medicine and the goal of nursing is to put patient in best possible condition for nature to act. ▪ ENVIRONMENT – reflects a community health model in which all that surrounds human beings is considered in relation to their state of health; an environment could be altered to improve condition so that the natural laws would allow healing to occur. FLORENCE NIGHTINGALE believes that a poor environment results in poor healthcare. TYPES OF ENVIRONMENT PSYCHOLOGICAL ENVIRONMENT – can be affected by negative physicsl environment, which leads to stress, requires activities to keep the mind active, involves communication about the person and others. SOCIAL ENVIRONMENT – society, physical enrionment such as clean air, water, proper drainage, and consist of person’s home or hospital home as well as the total community. CONCEPTS OF NIGHTINGALE THAT ARE STILL PERTINENT TODAY ▪ Infection control – cleaning hospital top-to-bottom, cleaning sheets and requiring proper hygiene. ▪ Self-care – encouraging patients to care for themselves to promote healing and independence. ▪ Assessment – assessing patients and their condition ▪ Therapeutic Communication – offer patients empathy and compassion during rounds; interacting with patients for the plan of care ▪ Spiritual Nursing – comfot patients who are getting ready to pass away. ▪ Public Health Advocacy – wrote report proposing reform for hospitals, therefore being an advocate for the public; health teachings on community NIGHTINGALES 12 CANONS Ventilations-Warming-Health of houses-Light-Noise-Bed-Bedding-Cleanliness of room-Cleanliness of walls-Personal cleanliness-Taking of good-Type of food Ventilation and Warming – pure air for patients, balanced, no chilling, room temperature Health of houses - environmental factors, vice versa cleanliness Light - direct sunlight is patient centered tangible effects, help the prognosis of patient Noise – assess and stop different kind of noise. Bed and Bedding – dirty bed and sheets can cause problem, infection Taking of food and type of food – proper food for patients nutritional intakes appropriate for the condition of patient HOW THEORY IS APPLIED TODAY ▪ Turning patients every 2 hours in bed – provides comfort ▪ Limiting the number of staff in rooms – not crowded, needs to be conducive for patientst ▪ Blinds are opened to help wake the patients – needs movement/activities ▪ Flowers encouraged from guests (if allowed) – caring, encourage healing ▪ Trips outside and activities created for residents in long term facilities ▪ Handwashing – must do DIAGNOSIS – impaired sleep pattern related to environmental light and wise separation from family PLANNING AND IMPLEMENTATION – nursing actions focus on changing the environment to support more normal sleep pattern that is being awake during day and sleeping at night EVALUATION – after two nights of uninterrupted sleep, normal sounds and parental encouragement, the patient will demonstrate increased orientation to place being able to identify that she is in the hospital. ERNESTINE WEIDENBACH/THE HELPING ART OF NURSING The need for help is defined as ‘any measure’ desire by the patient that has potential to restore or extend the ability to cope with varios life situations that affect health and wellness. ▪ GERMAN ; BORN IN 1900 in Germany, her family moved to New York in 1909 ▪ BACKGROUND; WELLESLY COLLEGE ON 1922, RN ON 1925, MASTERAL ON 1944, FACULTY AND ASSISTANT PROFESSOR ON 1952, MATERNAL NURSE ON 1954 She had her interest in nursing because of the private nurse who took care of her grandmother. ▪ Nursing is practice of identification of patient’s needs for help exploration of symptoms. ▪ Determine the discomfort and patients ability to resolve discomfort ▪ Individual patients perception of situation ▪ Nursing process – first apply by Orlando in 1961 The theory identifies four main elements in clinical nursing ▪ A Philosophy ▪ A Purpose ▪ A practice and; ▪ The Art Nursing is helping art it is goal directed deliberates of thoughts to understand patients needs. PHILOSOPHY – is his/her attitude and belief about life and how that affects reality. PURPOSE – is that which the nurse wants to accomplish through her actions. PRACTICE – of nursing consists of the observable nursing actions affected by beliefs and feelings about meeting the patients needs for help. ART – of nursing includes understanding the patients needs, developing goals and actions intended to enhance the patient’s ability and directing the activities related to medical plan to improve the patient’s condition. REVERANCE FOR LIFE – respect for dignity, work and anatomy and individuality of each human beings RESOLUTION – to act on personally and professionally beliefs. APPRECIATION of life and seen it as a gift of each human being. METAPARADIGM PERSON – any person who has entered the healthcare system and is receiving help of some kind such as care, teaching and advice. HEALTH – not defined (agreed to the definition given by WHO) NURSING – practice of identifying the needs of patient through observation of symptoms, assessing if the patient is able to resolve the discomfort and determining the need for help from the nurse or other healthcare team. ENVIRONMENT – composed of objects, policies, settings, atmosphere, time, human beings, happenings (past, current, anticipated) that are dynamic, unpredictable, exhalating, baffling and disruptive. NURSES NOT ONLT ACT BUT ALSO THINKS. IDENFICATION OF PATIENT NEEDS 1. Nurse uses powers of observation to look listen for actual consistencies and inconsistencies – assessment 2. The nurse explores the meaning of patients behavior with patient – confirmation 3. Nurse determines the causes of patients discomfort or incapability 4. The nurse verifies whether the patient can resolve his problem or if the patient has the need for help. TWO TYPES OF JUDGEMENT IN DEALING WITH PATIENTS Clinical Judgement – nurses likeliness to have sound decisions from differentiating fact from assumption and relating it to cause and effect Sound Judgement – result of disciplined functioning of mind and emotions and improves with expanded knowledge and increased clarity of professional purpose. BASIS OF THEORY ▪ Central Purpose – nurses recognize as essential to the particular discipline ▪ Prescription – fulfillment of central purpose ▪ Realities – immediate situation influence central purpose VIRGINIA AVENEL HENDERSON/NEED THEORY November 30, 1897 – March 19, 1996 Fisrt lady of nursing Emphasizes the importance of increasing patients independence and focusing on basic human needs so that progress after hospitalization would not be delayed ‘ I believe that the foundation of nurse performs is primarily an independent one that of acting for the patient when he lacks knowledge, physical strength, or the will to act for himself as he would ordinarily act in health or in complex and creative as offering unlimited opportunity to apply the physical, biological, and social sciences and the development of skills based on them. ‘ (Henderson, 1960) Assumptions of the NEED THEORY Virginia Henderson’s Need Theory assumptions are : 1. Nurses care for patients until they can care for themselves once again. 2. Patients desire to return to health. 3. Nurses are willing to serve and nurses will devote themselves to the patient day and night. 4. Henderson also believes that the mind and body are inseparable and are interrelated. MAJOR CONCEPTS OF NURSING NEED THEORY INDIVIDUAL – someone who needs nursing care but did not limit nursing to illness care. HEALTH – health was taken to mean balance in all realms of human life. ENVIRONMENT – maintaining a supportive environment conducive to health NURSING – the unique function of nurses is to assist the individuals, sick or well in the performance of those activities contributing to health or its recovery that he would perform unaided if he had necessary strength, will or knowledge, and to do this in such way as to help him gain independence as rapidly as possible. 14 COMPONENTS OF VIRGINIA NURSING NEED THEORY 1. Breathe normally 2. Eat and Drink adequately 3. Eliminate body waste 4. More and maintain desirable posture 5. Sleep and rest 6. Select suitable clothes; dress and undress 7. Maintain body temperature within a normal range by adjusting clothing and modifying the environment 8. Keep body clean and well groomed and protect integument 9. Avoid dangers in environment and avoid injuring other 10. Communicate with others in expressing emotions, needs, opinions, fears 11. Worship according to one’s faith 12. Work in such way that there is a serve of accomplishment 13. Play/participate in various forms of recreation 14. Learn, discover, satisfy the curiosity that leads to normal development and health and use the available health facilities CONCEPTS USED BY HENDERSON HUMAN BEING – patients as an indivual who requires assistance to achieve health and independence or peaceful death. The mind and the body are inseparable. Family and patient viewed as unit HEALTH – she says the quality of the health rather than life itself, that margins of mental physical rigor that allows persons to work most effectively to reach his highest potential of satisfaction ENVIRONMENT – the aggregate of all external conditions and inferences affecting the life and development of organism NURSING – used the function of nursing as definitions METAPARADIGM INDIVIDUAL Have basic needs that are component of health Requiring assistance to achieve health and independence or peaceful death Mind and body are inseparable and interrelated Considers the biological, physiological, sociological and spiritual components ENVIRONMENT Settings in which an individuals learns unique pattern for living Relation to families Providing conditions HEALTH Good health is challenged affected by age, cultural background Need to stress promotionof health and prevention and care Based on individuals ability to function independently METAPARADIGM Assisting and supporting indivudals in life activities and attainment of independence HENDERSON’S THEORY AND NURSING PROCESS 1. Nursing assessment: Assess needs of human being based on 14 components of basic nursing care 2. Nursing Diagnosis: Identify patients ability to meet own needs 3. Nursing Plan: Document on how nurse can assist individual sick/well APLLICATION PRACTICE Assessment – 14 Needs Planning – Fit prescribed plan Implementation – Aligned with 14 basic needs Evaluation – Identify goals or not  FAYE GLENN ABDELLAH/NEEDS THEORY/21 NURSING PROBLEMS March 13, 1919 February 24, 2017 Important contribution – disease centered to patient centered First nurse and woman to serve as Deputy Surgeon General (2 stars) of US Theory 21-Typology of 21 nursing problems To promote professional status and autonomy of nursing She used a problem-solving approach for the basis of typology Her typology of nursing published in 1960 1973 defined some beliefs in nursing Major Typology of Abdellah Divided in basic to all patient sustenance care needs remedial care needs Restorative care needs Basic to all patients 1. Maintain good hygiene 2. To promote optimal activity exercise rest sleep - it’s the nurse responsibility 3. To promote safety through prevention of accident injury or other trauma and through prevent of spread of infection. 4. To maintain good body mechanics and prevent and correct deformity Sustenance Care Needs 5. Facilitate the maintenance of a supply of oxygen to all body cells as to order by Dr. 6. To facilitate maintenance of nutrition of body cells 7. The facility maintenance of elimination 8. To facilitate maintenance of fluid and electrolyte balance 9. To recognize the Fishel logical responses of bad to disease conditions - we need to know what a logical and physiological and more compensatory 10. To facilitate the maintenance of regulatory mechanisms and functions 11. To facilitate the maintenance of sensory function Remedial Care Needs 12. To identify and accept positive and negative the reactions - Talk to the patients for relief of anxiety during procedures, allow them to ask questions 13. To identify and accept interrelatedness of motions and organic illness – Verbalize the feelings release of heavy emotions 14. To facilitate the maintenance of effective verbal and nonverbal communication’s 15. To promote development and productive interpersonal relationship 16. To facilitate progress toward achievement Personal spiritual goals - Allow to practice Spiritual, provide privacy for the patience time and for practice their faith 17. To create and maintain a therapeutic environment - Proper of everything quiet environment 18. To facilitate awareness of self as individuals with varying physical emotional and developmental needs. Restorative Care Needs 19. To accept the optimum possible goals in light of limitation’s physical and emotional - Depends of capability more of limitations 20. To Use community resources as an aid in resolving problems arriving from illness - Maximize the availability of resources help them in health center. 21. To understand the role of social problems is influencing factors in the cause of illness - Advise what to do in community environment needs to be Observed. Metaparadigm people - As having physical Emotional and social logical needs emphasis should be placed upon prevention and rehabilitation Overt means covered and covert means covered Convert are the problems we may or we may not see. nursing service - It needs up individual Health- Emphasis should be placed upon prevention and Rehabilitation - We need to Holistic approach by nurse to achieve state of health. Environment - The home or community from which patient corners - We need an optimum health focus of nursing services in the individual. nursing - There would mean a comprehensive nursing source - nurses do not just think but also acts. Nursing comprehensive services 1. Recognizing the nursing problems of the patient 2. Deciding the appropriate actions to take interns of relevant nursing problems - Identifying the problem alone Won’t solve the problem identify the actions you need to Take. 3. Providing continuous care of the individual Health needs - Providing continuous care for patient care for individuals most answer the individual Total care Needs.  4. Providing continuous care to relieve pain and discomfort - No gap, continuity some is a must. 5. Adjusting total care plan to meet patients Individual needs 11 nursing skills 1. Observation of health status - Identify the problems using clinical eye 2. Skills of communication 3. Application of knowledge - You need to have basic knowledge 4. Teaching of patients and families 5. Planning and organization of work - work smartly and use it effectively 6. Use of resource materials - Creativity is much needed 7. Use of personal resource - teach patients maximize the benefits of using what is available 8. Problem-solving – Identify the existing problem 9. Direction of Work for others - We need to help people lend proper management of care. 10. Therapeutic Use of the Self - Use ourselves to identify the problems and help patients comply to their identity 11. Nursing procedures - Implement Other contributions Improvement of nursing in Education Transform the focus Profession from being this is centered patient centered Guide the researchers to force on the body of nursing knowledge itself. The identification of patient problems the organization of nursing interventions the improvement of nursing education in the structure of curriculum. Patient centered care that focusing on complex medical intervention Nursing education and then slowly deviated its concentration and it’s complex medial intervention to concepts into exercising attention to the client as primary Concern. The extensive research done regarding the patient needs to serve and foundation of development of nursing diagnosis JEAN WATSON/THOERY OF HUMAN CARING Philosophy of caring attempt to define outcome in regard of humanistic aspects of life. Her theory and philosophy of. Based on the value of kindness concern love of self and others respect for spiritual dimension person. The foundation of Nursing Theory of Watson’s Published in 1979 The philosophy and science of nursing Basis of Theory and philosophy Values of kindness Concern Love of self and others and Respect for the spiritual dimension of persons Caring in nursing Watson’s Defined human caring in nursing as “an act and Science in which Leaving is human to human process demonstrated through therapeutic interpersonal interactions. Major elements Carative Factors Transportation and caring relationship Caring Movements 10 Carative factors 1. Formation of humanistic altruistic system of values - Values shared with parents altruistic behavior 2. The installation of Faith and hope - Provide sense of well-being Through Beliefs 3. The cultivation sensitivity to oneself to others 4. The development of helping past relationship - Communication support, caring needs to be congruent 5. The promotion and acceptance of the positive and negative expression 6. The systematic use of the scientific problem solution for Decision making 7. The promotion of interpersonal teaching and learning - Learning process instead of teaching Process 8. The provision for A supportive protective and corrective mental physical and social cultural and spiritual environment - Provide comfort, safety and privacy 9. Assistance with The gratification of Human need 10. The allowance for existential Phenomenological forces Trans Personal caring relationship Intersubjective human to human relationship nurse to patient/ shows Concerns and Naturality Protects and Hanses and preserve human dignity humanity wholness and inner harmony - Human relationship nurse commitment nurses caring and nursing goals Caring Occasion or movement The movement in the nurse and another person come together both person come together and human to human transaction 4 Major concepts 1. Human being - Valued person to be respected nurtured understand and assisted - fully functioning integrated self 2. Health - High level of over all physical mental social, General Adaptative - Maintenance of daily function, absence of illness presence of Effort. 3. Environment - caring is transmitted by the culture of profession as unique way of coping 4. Nursing - nursing is concerned with promoting health and preventing illness caring for sick and restoring health WATSON’S Theory and nursing process Assessment - observation, identification and review a problem - Use of knowledge and conceptualization Plan determine how valuable would Measure - Data Collected Intervention - Direct action and implementation Evaluation - Analyses and examination of implementation - Interpretation of data collected DOROTHEA OREM/SELF CARE THEORY-GRAND THEORY 3 RELATED PARTS OF GENERAL THEORY 1. THEORY OF SELF CARE 2. THEORY OF SELF CARE DEFICIT 1. 3, THEORY OF NURSING SYSTEM 1. Self-care activities that that individuals initiatives Self care agency - ability of engaging in self care Therapeutic self-care demand - Totality of self-care actions to be performed for some duration in order to meet self-care requisites be using valid methods and related set of actions Self-care requisites - action directed towards Provision of self-care Three categories of self-care requisites 1. Universal self Requisites - associated with life processes and maintenance - Common intake of food prevention of hazard 2. Developmental Self-care requisites - Derive from condition/adjusting 3. Health Deviation of self-care Requisites - Seeking for appropriate medical assistance Theory of Self-care deficits - Nursing is required an adult or in case of the pendant is in capable are you limited in the provision of continuous affective self-care 5 Methods of helping Acting for and doing for other Guiding others Supporting another Providing an environmental promoting personal development in relation to meet future demands Teaching another Different systems Wholly compensatory systems - nurse should be compensating patient total inability. Partly compensatory system - Both nurse and patient perform care Supportive educative system therapeutic self-care But cannot do so without assistance. Major assumptions people should be self-reliant responsible Nursing is form of action Successfully meeting Universal in the event of mental sulfuric receipts is an important component of primary care prevention and ill Heath Definitions of the Domain concepts Nursing - art helping service and technology Goal of nursing - Rendered the patient Member of the family capable of meeting patient’s healthcare needs - maintain State of health - To regain normal/ State of health in event of Disease or injury - To stabilize, Control minimize effects of chronic poor health/Disability Health and healthy - Terms used to describe living things Environment - components are enthronement Factors, elements condition, Develop Environment Human beings - has the capacity to symbolize’s and use symbols Nursing client - Human being is health related health deny been elation not render him in capable of continuous Self-care dependent care orientation that result in ineffective or incomplete Care Nursing problem - Deficit in universal developmental and the health derive and health related conditions Nursing Process A system to determine 1. Why person is Under care 2. plan of care 3. implementation of care C. Nursing systems Describes how patient self-care needs will be Meet by the nurse patient or both - Wholly system - Partly System - Supportive education system MRYA ESTRIN LEVINE/THE CONSERVATION MODEL She was born in Chicago in 1920, the first child of three siblings. Her involvement throughout her father’s persistent gastrointestinal illness contributed to her interest in and devotedness to nursing. THE CONSERVATION MODEL - Believes nursing intervention is a conservation activity with energy conservation as a fundamental concern for conservation principles of nursing where conceptualize, it guides nurses to concentrates to importance and responses at the level of person/patient. Nurses fulfill the theory purpose by conserving energy, structure, personal and social integrity. - She believes that every patients has a different array od adaptive responses – each individual has a unique way of adjusting or adapting to every situations which vary based on personal factors. FACTORS: AGE GENDER PRESENCE AND ABSENCE OF ILLNESS If the individual is in the face of conservation it means that the person can adapt challenges with the slightest amount of effort. The core of her conservation model is to improve physical and emotional well-being by considering the four domains of conservation, by proposing to address the conservation of energy, structure, personal and social integrity. This Nursing theory helps guide us/nurses in providing care that will help maintain and promote health of the patient. NOTES FROM LEVINE ‘ The conservation principles do not, of course, operate singly and in isolation from each other. They are joined within the individual as a cascade of life events, churning and changing as the environmental challenge is confronted and resolved in each individual’s unique way. The nurse as a caregiver becomes part of that environment, bringing to every nursing opportunity his or her own cascading repertoire of skill, knowledge and compassion. It is a shared enterprise and each participant is rewarded. ‘ (Levine, 1989) - CHURNING AND CHANGING – Change the form of a thing to another form CONSERVATION OF ENERGY - refers to balancing energy input and output to avoid excessive fatigue. - E.G. availability of adequateness, sustenance of adequate nutrition CONSERVATION OF STRUCTURAL INTEGRITY – refers to maintaining or restoring the body’s structure, preventing physical breakdown, and promoting healing. - E.G. arrange of motion exercise, preservation of patient’s personal hygiene  - Recognizes the individual as one who strives for recognition, respect, self-awareness. selfhood, and self-determination - E.G. acknowledge and preserve patient’s space needs, providing privacy CONSERVATION OF SOCIAL INTEGRITY – exists when patient is recognized as someone who resides within a family, a community, a religious group, an ethnic group, a political system, and a nation. - E.G. senior citizen patient, - During this conservation of social integrity, we can help the patient to preserve his/her place in a family, community, and society. - E.G. if the patient is already retired or not working he/she can serve the community as a leader of aging population, committee leader, any program under the community enhancement. MAJOR CONCEPTS ENVIRONMENT – includes both internal and external environment - 3 aspects: drawn from conceptualization in 1967 - OPERATIONAL ENVIRONMENT – consist of undetected natural forces that impinge on the individual. - IMPINGE – impact/effect especially a negative one - PERCEPTUAL ENVIRONMENT – consist of information that is recorded by the sensory organs - PERCEPTUAL – we are relating to the ability to interpret or become aware of something through our senses. - CONCEPTUAL ENVIRONMENT - influenced by language, culture, ideas, and condition PERSON – is a unique individual, in unity, integrity, feeling, belief, thinking and whole. HEALTH – is the pattern of adaptive change of whole being NURSING – is the human interaction relying on communication, rooted in the individual human being’s organic dependency in his relationships with other human beings. OTHER CONCEPTS ADAPTATION – process of change and integration of oranism in which the individual retains integrity or wholeness, possible decrease of adaptation CONSERVATION – joining together and a product of adaptation included here is the nursing intervention, and the patient participation to retain a safe balance PERSONAL INTEGRITY – sense of identity and self definition STRUCTURAL INTEGRITY – healing is the process of restoring structural integrity through nursing intervention that promotes healing and contains structural integrity ENERGY CONSERVATION – nursing intervention is based on the conservation of patient’s energy, minimize energy to promotion rest and needed comfort HOLISM – singular yet integrated response of an individual to forces in environment  E.G. an obese patient who has reduced weight, the reduction on weight gave result for an integrated effort of choosing the correct diets, exercise, rest and sleep HOMEOSTASIS – stable state of normal alterations in combination of physiologic response to environmental changes, state of conservation MODES OF COMMUNICATION – many ways to gather informations, needs and feelings are transimitted to families, nurses and healthcare workers through modes of communication THERAPEUTIC INTERVENTIONS – interventions that influenced adaptation favorably, enhancing the adaptive responses available to person. SUB-CONCEPTS HISTORICITY – adaptation is a historical process, responses are based on past experiences, both personal and genetic SPECIFICITY – adaptation is also specific, each system has particular responses REDUNDANCY – although the changes that occur are sequential they should not be viewed as linear, incascades, there is interacting and evolving effect which there are incidents which one sequence is not yet completed when the next begins ASSUMPTIONS OF LEVINE’S MODEL INDIVIDUAL – each individual ‘is an active participant in interactions with the environment, constantly seeking information from it‘ (LEVINE, 19679) - Sentient or able to feel or perceived things, ability to interact with the environment seems unavoidable to his/her sensory organs - Change is the essence of life NURSING – ‘ultimately, the decision for nursing intervention must be based on the unique behavior of the individual patient’ - Patient centered nursing care means individual as nursing care, it is predicated on the reality of common experience, guided by the principle that every man is a unique individual and as such he requires a unique constellation of skills, techniques and ideas designed specifically for patient RELATIONSHIPS – conservation of energy, structural integrity, personal integrity, social integrity - Balance activity in the person’s available energy - Limit the amount of tissue involvement - Permits individuals to make decision for themselves - Preserve client’s interaction with family and the social system they belong to ALL NURSING INTERVENTIONS ARE BASED ON CAREFUL AND CONTINUED OF CONSERVATION MARTHA ROGERS/SCIENCE OF UNITARY HUMAN BEINGS Born on May 12, 1914, Dallas, Texas, USA – Diploma: Knoxville General Hospital School of Nursing (1936) Graduation in Public Health Nursing: George Peabody College (1937) MA: Teachers College, Columbia University Doctorate in Nursing: John Hopkins University, Baltimore (1954) Position: Professor at Division of Nursing, New York University and Consultant, Speaker Died: March 13, 1994 Coexsistence of the human and the environment has greatly influenced the process of change toward better health - The patient cannot be separated from his or her environment when addressing the health and treatment concerns ROGER’S THEORY SCIENCE OF UNITARY HUMAN BEINGS ALSO KNOWN AS HOMEO DYNAMIC PRINCIPLES The science of unitary human beings comprises of five assumption, four major concepts and three major principles. - Allowed nursing to be considered as one of the scientific disciplines - She repeatedly stated that she did not create a theory but rather just an abstract system, a science from which many viewers derived Major concepts are Energy Field, Openness, Pattern and Pan Dimensionality Major principles include resonancy, helicy and integrity ASSUMPTIONS WHOLENESS – human being considered as united whole OPENNESS – a person and his/her environment are continuously exchanging energy with each other UNIDIRECTIONALITY – the life process of human being evolves irreversibly and unidirectional – birth of death PATTERN AND ORGANIZATION – pattern identifies individuals and reflects their innovative wholeness SENTENCE AND THOUGHT – human are the only organisms able to think, imagine, have language and emotions MAJOR CONCEPTS ENERGY FIELD – inevitable part of life, human and environment both have energy field which is open OPENNESS – no boundary or barrier that can inhibit the flow of energy between human and environment which leads to the continuous matter or energy PATTERN – distinguishing characteristic of an energy field perceived in a single way / gives identity to the field PAN-DEMENSIONALITY – not comparable, across dimension and composed of too many areas, elements and factors HOMEO DYNAMIC PRINCIPLES Homeo-dynamic refers to the balance between the dynamic life process and environment These principles help to view human as unitary human being Three Principles of Homeo-dynamics: Resonancy, Helicy and Integrality HELICY – continuous, innovative, unpredictable increasing diversity and human and environmental field pattern, nature of change RESONANCY – hearing, wave patterns that continuously changing in an environment and human energy field INTEGRITY – energy fields of human and environment are in a continuous mutual process METAPARADIGM OF ROGERS PERSON – is open systems which continuously interact with environment o A person cannot be viewed as a part it sould be considered as a whole ENVIRONMENT – includes the entire energy field other than a person o Irreducible, not limited by space and time, identified by its pattern and organization HEALTH – not clearly defined o Determine by the interaction between energy fields like human and environment o Bad interaction or misplacing of energy leads to illness NURSING – exists to serve people o Both science and art, direct responsibility to the society APPLICATION OF ROGER’S THEORY IN NURSING CLINICAL PRACTICE – nursing action is always focus in the unitary being and change the energy field between human and environment, nursing action includes all non-invasive action, management of pain and supportive theraphy and rehabilitation are the focus NURSING EDUCATION – emphasis should be given on the understanding of the patient and self, energy field and environment, teach patients RESEARCH – ROGERIAN THEORY has used in many research works and it needs to be testable and applicable in research o E.G. study to assess the effectiveness of music theraphy on stress reduction… DOROTHY JOHNSON’S/BEHAVIORAL SYSTEMS MODEL Born on August 21, 1919 in Georgia USA 1942 – Graduated BSC-Nursing 1948 – MA in Public Health in Harvard 1940 – Creation of Theory 1978 – retirement 1999 – death BSM 1968 – first proposed It advocates the fostering of the patient and effective behavioral functioning Patient is defined as a behavior system composed of seven behavioral subsystems 1980 – published DEFINITION OF NURSING - An external regulatory force which acts to preserve the organizations and integration of the patients behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health or in which illness is found - External regulatory force GOALS OF NURSING ACCORDING TO BSM To assist the patient whose behavior is proportional to social demands To assist the patient who is able to modify his behavior in wasy that it supports biological imperatives To assist the patient who is able to benefit to the fullest extent during illness from physician knowledge and skills To assist patient whose behavior does not give evidence of unnecessary trauma as a consequence of illness PURPOSES OF BSM Nurses creates a balance between client and environment Protection from noxious stimuli that threaten the survival of the behavioral system Nurturance which provides adequate to sustain behavior Stimulation of continue growth of the behavior ASSUMPTIONS OF BSM 1. There is organization interaction, interdependency and integration of the parts and elements of the behaviors that go to makeup the system  2. A system tends to achieve a balance among the various forces which operates within and upon it 3. A behavioral system, which both require and results in some degree of regularity and constancy in behavior is essential to man, functionally significance 4. System balance reflects adjustments and adoptions that are successful in some way and to some degree SUB SYSTEMS 1. ATTACHMENT OR AFFILLIATIVE SUBSYSTEM a. Social inclusion intimacy and the formation and attachment of a strong social bond b. It provides survival and security 2. DEPENDANCY SUBSYSTEM a. Approval attention or recognition and physical assistance b. Promote helping behavior calls for nurturing responses c. Developmentally dependency behavior evolves from almost total dependence on others to greater degree of dependence on self 3. INGESTIVE SUBSYSTEM a. Meaning and structures of the social events b. When, how, what, how much and under what condition we eat c. Serves the board function of appetite satisfaction 4. ELIMINATIVE SUBSYSTEM a. the existence of such a pattern remains different from cultures to cultures b. When and how and under which conditions 5. SEXUAL SUBSYSTEM a. Both biological and social factor affect the behavior in the sexual subsystem 6. AGGRESSIVE SUBSYSTEM a. Relates to the behavior concerned with the protection and self preservation b. Viewed aggressive subsystem as one that generates defensive response from the indivudal when life or territory is being threatened 7. ACHIEVEMENT SUBSYSTEM a. provokes behavior that attempts to control the environment, intellectual, physical, creative, mechanical and social skills achievement are some of the areas recognized by Johnson APPLICATION PROCESS OF JOHNSON THEORY ASSESSMENT – questions related to specific subsystems must be developed DIAGNOSIS – focus on insufficiency/system that is not functioning properly PLANNING AND IMPLEMENTATION – nurses action to modify client’s behavior/bring homeostasis in the subsystem/includes protections, nursery and more EVALUATION – base on the attainment of the goal of balance in the identified subsytems