TFN (All Theorists) - Reviewer PDF

SYLLABUS 1. Definition of Concept, Theory and Principles 2. Characteristics of a Theory 3. Components of a Theory 4. Definition and Purposes of a Nursing Theory 5. Nursing Paradigm 6. Florence Nightingale- History and background 7. Nightingales’ Metaparadigm in nursing 8. Nightingale’s 12 Canons 9. Ernestine Wiedenbach 10. Virginia Henderson 11. Faye Glenn Abdellah - Biography Metaparadigm 12. 21 Nursing Problems 1. Jean Watson- Biography, Metaparadigm & 10 Carative Factors 2. Dorothea Orem- Biography, Metaparadigm, Universal Self-Care Requisites 3. Martha Rogers-Biography, Metaparadigm, Concepts that provide clarity to the basic precepts of the Rogerian Model 4. Dorothy Johnson- Biography, Metaparadigm, 7 Behavioral Subsystems 5. Sr. Callista Roy- Biography, Metaparadigm, 4 Adaptive Modes 6. Betty Neuman-Biography, Metaparadigm, Levels of Prevention 7. Imogene King- Biography, Metaparadigm, Conceptual framework 8. Hildegard Peplau 9. Ida Jean Orlando 10. Joyce Travelbee 11. Madeleine Leininger 12. Rosemarie Rizzo Parse 13. Joyce Fitzpatrick 14. Anne Boykin & Savina Schoenhofer 15. Margaret Newman 16. Josephine Paterson & Loreta Zderad 17. Lydia Hall 18. Myra Estrin Levine 19. Patricia Benner 13. Summary of all Theories 14. Different Views of Non-nursing Theories 15. General Systems Theory 16. Change Theory 17. Developmental Theory 18. Adaptation Theory 19. Health as a Multifactorial Phenomenon 20. Care Enhancement Qualities Including Core Values 21. Competency Standards NURSING is a practice-oriented discipline. CONCEPTUAL FRAMEWORK Nursing knowledge is derived from basic and § set of interrelated concepts that serve nursing sciences, experience, aesthetics, as building blocks of theories nurses’ attitudes, and standards of practice. § interrelated concepts or abstractions that are assembled together in some FACT is something that is seen happening or § relational scheme by virtue of their existing. It is an empirical observation. relevance to a common theme IDEA is a group of interrelated facts. Idea is an HYPOTHESIS image or formulation of something imagined § a statement of predicted relationships and visualized, of something vaguely between two or more variables, assumed, guessed or sensed out of related subjected to testing in empirical facts or observations. It is a person’s studies conception of what is the best example of § a temporary stand or prediction or something guess while the investigation goes on § educated guess PHENOMENON is an aspect of reality that can be consciously sensed or experienced. ASSUMPTION Examples of phenomena of nursing include § basic principles that are accepted as caring, self-care, and patient responses to being true on the basis of logic or stress. reason without proof or verification § statements that describe concepts CONCEPTS are ideas and mental images that definitions, purpose, relationships, and help to describe phenomena. Concept is a structure of a theory word or cluster of words describing an object, idea or event. It is an abstraction based on THEORY observation of certain behaviors or § A set of concepts, definitions, characteristics. It describes the essence of a relationships, and assumptions that thing. project a systematic view of a § Example: tower phenomena o It can be concrete or abstract. § a formal statement that is constructed Thus, each concept must be in order to organize ideas & explain specifically defined by the event theorist. § a group of related concepts that o The METAPARADIGM concepts propose actions that guide practice of person, environment, health, § a systematic way of looking at the and nursing serve as an world in order to describe, explain, umbrella for other concepts predict and control it that may be present in a nursing theory. THEORETICAL FRAMEWORK § Types of Concept § a set of interrelated theories that 1. Concrete/empirical concept organizes the direction of a research specific to time and endeavor/scientific inquiry place observable COMPONENTS OF A THEORY 2. Abstract concepts independent of time or 1. PURPOSE place § explains why the theory was indirectly formulated and specifies the context observable/not and situations in which it should be observable applied 2. CONCEPTS AND DEFINITIONS 6. Theories can be utilized by the § Concepts are logistic labels that are practitioner to guide & improve their assigned to objects or events. practice. § Definition defines the concept in 7. Theories must be consistent with other relation to other concepts and permits validated theories, laws & principles the description and classification of but will leave open unanswered phenomena. It convey the general questions that need to be meaning of the concepts. investigated. 3. THEORETICAL STATEMENTS § statements about the relationship PARADIGM between two or more concepts and § Model that explains the linkages of are used to connect concepts to science, philosophy, and theory devise the theory accepted and applied by the 4. STRUCTURE AND LINKAGES discipline. § The structure of a theory provides overall form to the theory § Theoretical linkages offer a reasoned explanation of why the variables in the theory may be connected in some manner 5. ASSUMPTIONS § The assumptions of a theory are based on what the theorist considers to be adequate empirical evidence to support propositions, on accepted knowledge, or on personal beliefs or The paradigm of nursing includes four links: values. the person, health, environment/situation, 6. MODELS and nursing. § schematic representation of some § NURSING PARADIGM patterns or aspect of reality models used to show a clear § Theoretical models represent the real relationship among the existing world through language or symbols theoretical works in nursing and directional arrows. § The elements of the nursing paradigm direct the activity of the nursing CHARACTERISTICS OF A THEORY profession, including knowledge 1. Theories can interrelate concepts in development, philosophy, theory, such a way to create a different way educational experience, research, of looking at a particular and practice phenomenon. 2. Theories must be logical in nature. METAPARADIGM 3. Theories should be relatively simple yet § It served as an organizing structure for generalizable. existing nursing frameworks and 4. Theories can be the bases for introduced a way of organizing hypothesis that can be tested. individual theoretical works in a 5. Theories contribute to and assist in meaningful structure. increasing general body of knowledge § A global perspective of a discipline within the discipline through the that identifies the primary research implemented to validate phenomena of interest to that them. discipline and explains how the discipline deals with those phenomena in a unique manner § Nursing metaparadigm: embodies o a tool that renders practice the knowledge base, theory, more efficient, more effective, philosophy, research, practice, and and goal directed educational experience and o Language of theory provides us literature identified with the with common grounds for profession. communication o and with labels and definitions DOMAIN for phenomena § The view or perspective of the o Professional autonomy and discipline or a profession. accountability are enhanced § It contains the: by theory use in practice. 1. Central concepts 2. Values & Beliefs DOMAIN AND NURSING THEORY RELATIONSHIP 3. Subject § Nursing has identified its domain in a 4. Central problems of the paradigm that includes four linkages: discipline 1. Person/client - is the recipient of 5. Phenomena of interest nursing care, including individual § The domain of nursing provides both a patients, groups, families, and practical and theoretical aspect of communities. The person is central the discipline. to the nursing care you provide. § It is the knowledge of nursing practice 2. Health – defined as what can be as well as the knowledge of nursing assessed, whereas well-being is the history, nursing theory, education, and human experience of health or research. wholeness. § The domain of nursing gives nurses a 3. Environment/situation – it includes comprehensive perspective that factors that affect individuals allows you to identify and treat internally and externally. It means patients’ health care needs at all not only in the everyday levels and in all health care settings. surroundings but all setting where nursing care is provided. NURSING THEORY is an organized framework 4. Nursing – described as a caring of concepts and purposes designed to guide relationship, an enabling condition the practice of nursing. of connection and concern. Caring is primary because caring PURPOSES OF NURSING THEORY sets up the possibility of giving and § In Education receiving help. It is central to all o Theory clarifies the central nursing theories. Definitions of meanings and improves the nursing describe what nursing is, status of the profession. what nurses do, and how nurses § In Research interact with clients. o Theory sets limits on what questions to ask and what NURSING AS A SCIENCE - owes much of its methods to use to pursue research-orientedness to the systematic answers to the questions. works of Florence Nightingale § In Clinical Practice o guides research TYPES OF NURSING THEORIES o provides the nurse with goals for 1. Grand theories – broad and complex. assessment, diagnosis, and It does not provide guidance for intervention. specific nursing interventions; but it provides the structural framework for broad, abstract ideas about nursing 2. Middle-range theories – address practice, thus supporting evidence- specific phenomena and reflect based practice. practice. It tends to focus on a specific field of nursing, such as uncertainty, So how do nurses use theory in everyday incontinence, social support, quality of practice? life, and caring, rather than reflect on § Organize patient data a wide variety of nursing care § Understand patient data situations § Analyze patient data 3. Descriptive theories – first level of § Make decisions about nursing theory development. It describes a interventions phenomenon, speculate on why they § Plan patient care occur, and describe their § Predict outcomes of care consequences such as grief or caring. § Evaluate patient outcomes 4. Predictive theories – identify conditions or factors that predict a phenomenon. 5. Prescriptive theories – address nursing interventions and predict their consequences School of thoughts in Nursing Theories (1950- 1970) Need Interaction Outcome theorists Theorists theorists King Wiedenbach Johnson Abdellah Paplau Levine Orem Travelbee Roy Henderson Orlando Rogers Peterson & Zderad REASONS TO STUDY NURSING THEORY § Everyday practice enriches theory § Both practice and theory are guided by values and beliefs § Theory helps to reframe our thinking about nursing § Theory guides use of ideas and techniques § Theory can close the gap between theory and research § To envision potentialities § The overall goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. Theory generates nursing knowledge for use in THEORISTS ON NURSING THEORY 1. Florence Nightingale (1860) § Environmental Theory § also known as The Lady with the Lamp § Born in May 12, 1820 in Florence, Italy § Nursing Education: trained in Kaiserwerth, Germany at a Protestant religious community with a hospital and after 3 months she was declared trained as a nurse (1851). § One day she visited a hospital and that CHANGED HER LIFE. § Defined nursing as: “the act of utilizing the environment of the patient to assist him in his recovery”, that involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development. § Hospitals in 1830’s o Often people who went into hospital died o They were Dirty o Badly run o Nurses didn’t know what to do § Turned down several offers of marriage to pursue her career. o Harry Nicholson o Richard Monckton Milnes o Harry Verney § Crimean War o Broke out when Florence was 34 years old o War Russia vs Turkey (Britain and France) o Reports were coming through about terrible conditions in hospitals o Florence left London with 38 nurses o Scutari Barrack Hospital § Mortality rate at the hospital was 42.7% of those treated § Mortality rate dropped to 2.2% § She got to work Scrubbed the floors Cleaned the wards Washed the bedclothes Made the men comfortable § In the night she carried a lamp, so she was called “The Lady with the Lamp” § Soldiers kissed her shadow § They began to get better Sitting up, cheerful and happier. § Letter from Queen Victoria o Thanking “Miss Nightingale and her ladies” for all their hard work. § Notes on Nursing: What it is and What it is Not was a book first published by Florence Nightingale in 1859. o On the purpose of nursing.” …the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet- all at the least expense of vital power to the patient” o On the empowering partnership with clients in the community.” “We must not talk to them or at them but with them” § Origins of Nightingale’s Theory for Nursing Practice o Prolific writer. o Her ideas, values, and beliefs on a wide range of topics can be identified in her documents. o In 1859, she was the first to conceptualize nursing work into a theoretical framework. § Assumptions of Florence Nightingale’s Theory: 1. Law – “thoughts of God” Ø This is reflective of Nightingale’s profound belief in God. She defined a law as “the thought of God” and discussed the predictability of nature. 2. Natural laws Ø Natural Laws are universal natural laws that govern the ways in which the world works. 3. Mankind can achieve perfection Ø Mankind can achieve perfection relates to her strongly held beliefs in self- determination, in self-realization, and that ultimately, mankind does seek self- perfection, which means perfect health. The route to perfection is through strict adherence to the natural laws. Ø The role of the nurse was to alter the environment in such a way as to obey the natural laws, and thus provide the environment in which perfection might be achieved. 4. Nursing is a calling Ø She defined a calling as doing work in such a way as to do what is right and best. Ø Nursing work is to be done with enthusiasm and is so important it should be thought of as a religious vow. 5. Nursing is an art and a science Ø By identifying nursing as having components of art and science, she provides the profession with the expectation that nursing will be practiced by educated individuals using current research and methods as well as compassion and common logic. 6. Nursing is achieved through environmental alteration Ø Environmental alteration-see canons (which are laws or rules). Nightingale’s Canons Major Concepts Ventilation and Warming Light, noise Cleanliness of rooms/wall Physical Environment Health of houses Bed and bedding Personal cleanliness Chattering hopes and advices Psychological Environment Taking food Nutritional Status Petty management/observation Nursing Care Plan & Management 7. Nursing requires a specific educational base Ø Nursing cannot be taught by books alone. Nurses need a combination of clinical and theoretical training. 8. Nursing is distinct and separate from medicine Ø Although the physician and nurse my deal with the same population, nursing is not to be viewed as subservient to medicine, as the purposes of the two are distinctly different. Ø Nursing’s focus is on caring through environmental alteration, whereas medicine’s focus is cure of the disease. Ø Nursing and medicine are most effective when working in a collaborative manner. § ENVIRONMENTAL THEORY: Major Concepts and Definitions § Environment - concepts of ventilation, warmth, light, diet, cleanliness and noise. o She focused on the physical aspects of the environment. o She believed that "Healthy surroundings were necessary for proper nursing care." o She stated that “Nursing is an act of utilizing the environment of the patient to assist him in his recovery” § 5 Essential Components of a Healthy Environment: 1. Pure fresh air - "to keep the air he breathes as pure as the external air without chilling him. “ 2. Pure water - "well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer. “ 3. Effective drainage - "all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house." 4. Cleanliness - "the greater part of nursing consists in preserving cleanliness. “ 5. Light (especially direct sunlight) - "the usefulness of light in treating disease is very important. “ § Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. § The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. § How are the issues public hospitals now? o Pure Water? o Pure fresh air? o Effective drainage o Light? o Control of noise? § FIVE MAJOR COMPONENTS OF A HEALING ENVIRONMENT 1. Ventilation 2. Light 3. Warmth 4. Control noise 5. Control odor § Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient. § Nightingale's theory was shown to be applicable during the Crimean War when she, along with other nurses she had trained, took care of injured soldiers by attending to their immediate needs, when communicable diseases and rapid spread of infections were rampant in this early period in the development of disease-capable medicines. § The practice of environment configuration according to patient's health or disease condition is still applied today, in such cases as patients infected with Clostridium tetani (suffering from tetanus), who need minimal noise to calm them and a quiet environment to prevent seizure-causing stimulus. § Concerns of Environmental Theory o Proper ventilation focuses on the architectural aspect of the hospital. o Light has quite as real and tangible effects to the body. Her nursing intervention includes direct exposure to sunlight. o Cleanliness and sanitation. She assumes that dirty environment was the source of infection and rejected the "germ theory". Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage, frequent bathing for patients and nurses, clean clothing and handwashing. o Warmth, diet and quiet environment. She introduced the manipulation of the environment for patient's adaptation such as fire, opening the windows and repositioning the room seasonally, etc. o Unnecessary noise is not healthy for recuperating patients. o Dietary intake. o Petty management proposed the avoidance of psychological harm, no upsetting news. Strictly war issues and concerns should not be discussed inside the hospital. She includes the use of small pets of psychological therapy. NITHANGLE’S NURSING METAPARADIGM o Nursing § Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act. § Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation. They can be done by anyone." § Major component of nursing: manipulation of physical environment § Nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” o Person § People are multidimensional, composed of biological, psychological, social and spiritual components. § The patient is the focus of the environmental theory. The nurse should perform the task for the patient and control the environment for easy recovery. She practices nurse-patient passive relationship. o Health § Health is “not only to be well, but to be able to use well every power we have”. § A healthy body can recuperate and undergo reparative process. Environmental control uplifts maintenance of health. § Disease is considered as dysease or the absence of comfort. § Six D’s of Dys-ease: - Dirt - Drink - Diet - Damp - Draughts - Drains § balance between human and his/her environment § being well and using every power (resource) to the fullest extent in living life § disease and illness – reparative process that nature instituted when a person did not attend to health concerns § health maintenance through prevention of disease via environmental control and social responsibility o Environment § Poor or difficult environments led to poor health and disease. § Environment could be altered to improve conditions so that the natural laws would allow healing to occur. § F. N. synthesized immediate knowledge of disease with the existing sanitary conditions in the environment. Major areas of environment that can be controlled by the nurse: health of houses § presence of pure air § pure water § efficient drainage light § light § direct sunlight § purifying effect of direct sunlight upon room air ventilation and warming § breathe air that is as pure as external air; without chilling § source of the air in the patient’s room § proper room temperature § patient’s body temperature noise § can harm the patient bed and bedding § Bed should be placed in the lightest part of the room and placed so the patient could see out a window. § Care giver should never lean against, sit upon, or unnecessarily shake the bed of a patient. § clean, neat, and dry § positioning the patient for maximum comfort variety § need for changing color and form § reading, needlework, writing and cleaning as activities to relieve boredom cleanliness § personal (patient, nurse) § physical environment o dirty environment as source of infection nutrition § dietary intake § variety of food § no distraction while eating § right food brought at the right time chattering hopes and advices § False hope can be depressing. § Heed what is being said; sick persons should hear good news. Logical Form o She used inductive reasoning from her experiences and observation which is addressed with logical thinking and philosophy. § Importance of Environmental Theory 1. Practice Ø Disease control Ø Sanitation and water treatment Ø Utilized modern architecture in the prevention of "sick building syndrome" applying the principles of ventilation and good lighting. Ø Waste disposal Ø Control of room temperature. Ø Noise management. 2. Education Ø Principles of nursing training. Better practice result from better education. Ø Skills measurement through licensing by the use of testing methods, the case studies. 3. Research Ø Use of graphical representations like the polar diagrams. Ø Notes on nursing. 4. Critique Ø Simplicity – simple and logical; tends toward description and explanation rather than prediction Ø Generality – provides general guidelines for all nurses Ø Empirical Precision – Little or no provision is made for empirical examination; individual observation rather than systematic research Ø Derivable Consequences – to extraordinary degree, direct the nurse to action on behalf of patient and herself; These directives encompass the areas of practice, research and education 2. Ernestine Wiedenbach (1964) § The Perspective Theory of Nursing § Helping Art of Clinical Nursing § "My thesis is that nursing art is not comprised of rational nor reactionary actions but rather of deliberative action." § Wiedenbach conceptualizes nursing as the practice identification of a patient’s need for help through observation of presenting behaviors and symptoms, exploration of the meaning of those symptoms with the patient, determining the cause(s) of discomfort, and determining the patient’s ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. § Nursing primarily consists of identifying a patient’s need for help. If the need for help requires intervention, the nurse facilitates the medical plan of care and also creates and implements a nursing plan of care based on needs and desires of the patient. § In providing care, a nurse exercises sound judgment through deliberative, practiced, and educated recognition of symptoms. The patient’s perception of the situation is an important consideration to the nurse when providing competent care. § According to Wiedenbach there are four elements to clinical nursing: (1) philosophy, (2) purpose, (3) practice, and (4) art. § The nurses’ philosophy was their attitude and belief about life and how that effected reality for them. Philosophy is what motivates the nurse to act in a certain way. § Wiedenbach also believed that there were 3 essential components associated with a nursing philosophy: o Reverence for life o Respect for the dignity, worth, autonomy and individuality of each human being o Resolution to act on personally and professionally held beliefs § Nurses’ purpose is that which the nurse wants to accomplish through what she does. It is all of the activities directed towards the overall good of the patient. § Practices are those observable nursing actions that are affected by beliefs and feelings about meeting the patient’s need for help. § The Art of nursing includes understanding patient’s needs and concerns, developing goals and actions intended to enhance patient’s ability and directing the activities related to the medical plan to improve the patient’s condition. § The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns. § WIEDENBACH METAPARADIGM o PERSON: Any individual who is receiving help from a member of the health profession or from a worker in the field of health. o ENVIRONMENT: Not specifically addressed o HEALTH: Concepts of nursing, client, and need for help and their relationships imply health-related concerns in the nurse— client relationship. o NURSING: the nurse is a functional human being who acts, thinks, and feels. All actions, thoughts, and feelings underlie what the nurse does. 3. Virginia Henderson (1897-1996) § “The Nightingale of Modern Nursing” § "The 20th century Florence Nightingale." § Awards, Honorary Doctorates & Lectureships o Christianne Reimann Prize o Yale University, Catholic U. of America, Pace U., Emory U., Boston College, Rush U., Old Dominion U., U. Rochester, U. Western Ontario, Thomas Jefferson U., etc. o Royal College of Nursing o Sorbonne o Japanese Nursing Assoc. § The first lady of nursing § Popular for her definition of nursing § Focus of nursing research "from studying nurses to studying the differences that nurses can make in people's lives." § Like Nightingale, Henderson described nursing in relation to the client and the client’s environment. § Unlike Nightingale, she was concerned with both healthy and ill individuals § Teaching and advocacy roles of the nurse § Definition of Nursing: “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.” § “It is my contention that the nurse is, and should be legally, an independent practitioner [as long as she is not performing the doctor’s duties.] But the nurse is the authority on basic nursing care. Perhaps I should explain that by basic nursing care I mean helping the patient with the following activities…” § “I believe that the FUNCTION the 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 carrying out prescribed therapy.” § Importance of increasing the patient’s independence § Progress after hospitalization would not be delayed (Henderson,1991) § Assisting individuals to gain independence § She described the nurse's role as: o SUBSTITUTIVE (doing for the person) o SUPPLEMENTARY (helping the person) o COMPLEMENTARY (working with the person) - with the goal of helping the person become as independent as possible § FOUR METAPARADIGMS: HENDERSON’S PHILOSOPHY IS NURSING § 14 BASIC NEEDS OF MAN 1. Eating and drinking 2. Incontinence 3. Body posture 4. Mobility 5. Day and night pattern 6. Getting dressed and undressed 7. Body temperature 8. Hygiene 9. Avoidance of danger 10. Communication 11. Contact with others 12. Sense of rule and values 13. Daily activities 14. Recreational activities 15. Learning ability § HENDERSON’S 14 COMPONENTS AS APPLIED TO MASLOW’S HEIRARCHY OF NEEDS o ESTEEEM 1. Work at something providing a sense of accomplishment 2. Play or participate in various forms of recreation 3. Learn, discover, or satisfy the curiosity. o LOVE AND BELONGINGNESS 1. Communicate with others in expressing emotions, needs, fears or opinions. 2. Worship according to one’s faith. o SAFETY NEEDS 1. Avoid dangers in the environment and avoid injuring others. o PHYSIOLOGICAL NEEDS 1. Breathe normally. 2. Eat and drink adequately 3. Eliminate body wastes 4. Move and maintain desirable postures 5. Sleep and rest 6. Select suitable clothes – dress and undress 7. Maintain body temperature within normal range by adjusting clothing and modifying environment 8. Keep the body temperature within normal range by adjusting clothing and modifying environment § NURSE’S ROLE o Substitutive: acting for a person o Supplementary: assisting a person o Complementary: working with the person § “…with the goal of helping the person become as independent as possible.” § NURSING METAPARADIGM o PERSON § Biological, psychological, sociological, and spiritual components. § A complete and independent being with biological, sociological and spiritual components § Henderson considered the person to be of primary importance and that is the reason why we categorize her theory as client-centered. § To her, the individual person or client is a whole, complete and independent being with biological, sociological, and spiritual components. § To be whole, the person must maintain physiological and emotional balance; the mind and body are inseparable. § These components are operationalized in the 14 fundamental or basic human needs. § Henderson also stated that under conditions of positive health and well-being, people are likely to have little difficulty in satisfying these needs by themselves. However, in times of illness and at certain life cycle or during terminal illness, an individual may be unable to satisfy these requirements without the assistance of others. This is where the nurse can come in. In other words, the patient as an individual will require assistance to achieve health and independence or peaceful death. She also emphasized the importance of the family as she mentioned that the patient and his family are viewed as a unit. o PATIENT: as someone who needs nursing care § Not limited to illness care. o ENVIRONMENT § It encompasses all external conditions and influences that affect life and development. § There are seven essentials that must be present in the environment which include light, temperature, air movement, atmospheric pressure, appropriate disposal of waste, minimal quantities of injurious chemicals, and cleanliness of any surfaces coming in contact with individual. § The effects of 7 components (light, temperature, air movement, atmospheric pressure, proper waste disposal, absence of injurious chemicals, cleanliness of surroundings) on the life and development of a person. § Although Henderson did not give her own definition of environment, she used Webster's New Collegiate Dictionary (1961), which defines environment as “the aggregate of an the external conditions and influences affecting the life and development of an organism.” § Henderson's point of view regarding the environment can also be inferred from her writings. She listed seven essentials in the environment: light, temperature, air movement, atmospheric pressure, appropriate disposal of waste, minimal quantities of injurious chemicals, and cleanliness of surfaces and furnishings coming in contact with the individual. She recognized the effects of these factors on man when she stated that the environment can act either positively or negatively upon the patient. Therefore, the nurse's function is to alter the environment in such a way as to support the patient § She described what the nurse can do to help or assist the individual to be in control of the environment. Healthy individuals may be able to control their environment, but illness may interfere with that ability. Thus, nurses should have safety education. Nurses must know about social customs and religious practices to assess dangers. She should protect the patient from mechanical injury. She can minimize the chances of injury through recommendations regarding construction of buildings, purchase of equipment and maintenance. Doctors use nurses' observations and judgments upon which to base prescriptions for protective devices. o HEALTH § It is equated with independence or ability to perform activities without any aid in the 14 fundamental or basic human needs. § Nurses need to stress promotion of health, prevention of illness and its cure. § Health is basic to human functioning. § Although Henderson did not state her own definition of health, she equated health with - independence. She further stated that individuals will achieve or maintain health if they have the necessary strength, will or knowledge. She viewed health in terms of the patient's ability to independently perform the 14 basic needs which comprise the components of nursing care. § She also stated that it is the “quality of health rather than life itself, that margin of mental physical vigor that allows a person to work most effectively and to reach his highest potential level of satisfaction in life.” (Henderson and Nite, 1978). § She described health as basic to human functioning and that promotion of health is more important than care of the sick. o NURSING § “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.” § Henderson defined nursing in functional terms. To her, the unique function of the nurse is“to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death), that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.” In other words, the goal of nursing is independence in the satisfaction of the human being's 14 fundamental or basic needs. § There are also special developmental situations where the nurse is needed, such as when the very young and the very old cannot meet their basic human needs because of physical, psychological or social factors. § She also mentioned the nurse's function as a member of the medical team and emphasized the nurse's independence. § "She/he functions independently of the physician, but promotes his or her plan, if there is a physician in attendance. The nurse can function independently and must, if she or he is the best prepared health worker in the situation. The nurse can and must diagnose and treat if the situation demands it " (Henderson emphasized this in the sixth edition of Principles and Practice of Nursing). § To be able to do her functions effectively, the nurse should be knowledgeable in both biological and social sciences. The 14 basic needs of the patient comprise the components of nursing care. § DEATH o March 19, 1996 (98 years old) o Connecticut Hospices o Interred in her family's plot of the churchyard of St. Stephens Church, Forest, Bedford Country, Virginia § How to apply Henderson’s Theory into Practice? o Stroke or paralyzed patient o ADL o Comatose o Body temp o Eating and drinking o Hygiene o Incontinence o Avoidance of danger o Body posture o Contact with others o Mobility § KEY CONCEPTS § Henderson’s theory revolves around her concept of nursing. She defined nursing in a functional manner. To her, the nurse plans the care appropriate to assisting the individual in activities contributing to his/her health. She further stated that individuals will achieve or maintain health if they have the necessary strength, will or knowledge. She considered the 14 fundamental or basic needs as the basis for the nurses' basic functions. § Henderson's theory placed the person in a primary position. She considered the person as a whole being having biological, psychosocial, and spiritual components, which are operationalized in the 14 fundamental or basic human needs. A second major component is nursing function, and the third is the interaction of the two components in the process called nursing care. Take note that the nurse's importance is based on her ability to define the needs of the client and to assist him/her rationally in meeting these needs. 4. Faye Glen Abdellah (1960) § Patient-Centered Approaches § 21 nursing problems § Background o Born -March13.1919 o Nursing Diploma from Fitkin Memorial Hospital o Columbia University o Bachelor’s Degree in Nursing 1945 o Master’s Degree in Physiology 1947 o Doctorate in Education 1955 o May 6, 1937 § German hydrogen-fueled airship Hindenburg exploded in Lakehurst, New Jersey § "I could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would learn nursing." § Faye was 18 years old where she and her brother witness the explosion of this airship in Lakehurst where her family resided. So together with her brother, they ran to help the injured people. § Accomplishments o U.S. Public Health Service (Branch of Military) o Chief Nurse Officer o First Deputy U.S. Surgeon General o Uniformed Services University of Health Sciences o Founder and First Dean, Graduate School of Nursing o Yale University School of Nursing o Nursing Instructor o Nursing researcher and theorist § “First woman to become a surgeon general as a nurse” § Originated from nursing practice and desire to promote patient-centered comprehensive care § Faye G. Abdellah’s Theory o Abdellah’s theory, “Nursing is based on an art and science that moulds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs.” § ABDELLAH’S NURSING METAPARADIGM o PERSON § Having physical, emotional, and sociological needs. § Needs may be OVERTè largely physical needs § COVERT è emotional, sociological and interpersonal needs- which are often missed and perceived incorrectly. § Nursing Responsibilities § Effective communication between patient and caregiver. Information is accurate, timely and appropriate. § Do everything possible to alleviate patients’ pain and make them feel comfortable. § We provide emotional support and alleviate fears and anxiety. § We involve family and friends in every phase of our patients’ care. § Patient is described as the only justification for the existence of nursing. o HEALTH § Does not give a definition of health § “Total health needs” and “a healthy state of mind and body” in her description of nursing as a comprehensive service. o ENVIRONMENT § Home or community from which patient comes. § Society is included in “planning for optimum health on local, state, national and international levels.” o NURSING § “Nursing is based on an art and science that mold the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs” § Comprehensive nursing service § Service to individuals, to families and therefore to society. § Goal of nursing is the fullest physical, emotional, intellectual, social and spiritual functioning of the client which pertains to holistic care. § 11 Nursing Skills o Observation of health status o Skills of communication o Application of knowledge o Teaching of patients and families o Planning and organization of work o Use of resource materials o Use of personnel resources o Problem-solving o Direction of work of others o Therapeutic use of the self o Nursing procedures § Abdellah’s Theory and Nursing Influence § Four categories of patient needs o Basic to all patients o Substernal care needs o Remedial care needs o Restorative care needs. § Twenty-One Nursing Problems: Serve as a knowledge base for nursing (Categorized according to needs) ABDELLAH’S THEORY § States that nursing is the use of the problem-solving approach with key nursing problems related to the health needs of people. NURSING PROBLEMS: The patient’s health needs can be viewed as problems, which may be overt as an apparent condition, or covert as a hidden or concealed one. § Nursing problem presented by a patient is a condition faced by the patient or patient’s family that the nurse, through the performance of professional functions, can assist them to meet. § Abdellah’s use of the term nursing problems can be interpreted as more consistent with “nursing functions” or “nursing goals” than with patient-centered problems; this viewpoint could lead to an orientation that is more nursing- centered than patient-centered. § In her typology of basic nursing problems presented by patients, she includes three columns: basic nursing problems presented by the patient, specific problem of patient, and common conditions THE TWENTY-ONE NURSING PROBLEMS: The crucial element within Abdellah’s theory is the correct identification of nursing problems. These 21 nursing problems focus on the physical, biological, and socio- psychological needs of the patient and attempt to provide a more meaningful basis for organization than the categories of the systems of the body ABDELLAH'S TYPOLOGY OF 21 NURSING PROBLEMS BASIC TO ALL PATIENTS 1. To maintain good hygiene and physical comfort – After colonoscopy, patients are usually soiled from the procedure. It is therefore important to clean them properly. Physical comfort through proper positioning in bed. 2. To promote optimal activity: exercise, rest, and sleep – Patients who were sedated during the procedure stay in the unit until the effect of the sedation has decreased to a safe level. As a nurse, make sure the patients are able to rest and sleep well by providing a conducive environment for rest, such as decreasing environmental noise and dimming the light if necessary. 3. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection – one way we prevent the spread of infection is through proper disinfection of the equipment. Bed alarm, call light at all times 4. To maintain good body mechanics and prevent and correct deformity – Positioning the patient properly, allowing for the normal anatomical position of body parts. SUSTENAL CARE NEEDS 5. Facilitate the maintenance of a supply of oxygen to all body cells – when patients manifest breathing problems, oxygen is attached to them. Sedated patients are attached to cardiac monitor and pulse oximeter while having the oxygen delivered. When the oxygen saturation falls below the normal levels, the rate of oxygen is increased accordingly, as per physician's order. 6. To facilitate the maintenance of nutrition of all body cells – patients undergoing endoscopic procedures are on NPO. For this reason, it is important to monitor the blood glucose level. When the patient's blood glucose falls from the normal value, we inject D50W to the patient or we change the patient's IVF to a dextrose containing fluid. 7. To facilitate the maintenance of elimination – Providing bedpans or urinals to patients and at times, insertion of Foley catheter when the patient is not able to void 8. To facilitate the maintenance of fluid and electrolyte balance – Proper regulation of the intravenous solutions. 9. To recognize the physiological responses of the body to disease conditions — pathological, physiological, and compensatory ex. Pt. with DENGUE-it is important to check the patients for signs of bleeding by monitoring the BP, capillary refill 10. To facilitate the maintenance of regulatory mechanisms and functions – When a patient has a difficulty in breathing and is showing an increase respiratory rate, elevating the head part of the bed is done to facilitate the respiratory function. 11. To facilitate the maintenance of sensory function – When a patient is admitted who is already deaf and mute, we communicate to them by body language to maintain their basic need despite of inadequacy to the sensory function. Communicate to comatose patient. REMEDIAL CARE NEEDS 12. To identify and accept interrelatedness of emotions and organic illness – Encourage patients to verbalize their feelings and allow them to cry when they have the need to do so will help them emotionally. Some patients are diagnosed with malignancy after the procedure and during this time the emotional needs of the patient is a priority. 13. To identify and accept positive and negative expressions, feelings, and reactions – most patients feel anxious before undergoing the procedures. It is necessary to listen to the patients' expressions and allow them to ask questions. to decrease their anxiety. 14. To facilitate the maintenance of effective verbal and nonverbal communication – when patients are not able to express themselves verbally, it is important to assess for nonverbal cues. For instance, when patients are in pain, assessing for facial grimacing. 15. To promote the development of productive interpersonal relationships – allow the patient's significant others to stay with the patient before and after the procedure. This allows for bonding and promotes interpersonal relationship. 16. To facilitate progress toward achievement of personal spiritual goals – nurse usually visits the patients in the unit. Patients may benefit from this, allowing them time to practice their faith. 17. To create and/or maintain a therapeutic environment - providing proper lighting, proper room temperature, a quiet environment is done to patients staying in the unit. 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs – care to patients vary according to their developmental needs. Allowing the parents to stay during the procedure help the pediatric patients in their emotional and developmental needs. RESTORATIVE CARE NEEDS 19. To accept the optimum possible goals in the light of limitations, physical, and emotional – The goals for each patient vary depending on the capability of the patient. The nutritional goal for a patient with a PEG tube for instance will be different, knowing that the patient has limited feeding options 20. To use community resources as an aid in resolving problems arising from illness – Some patients live far from the city and thus referral to health centers is sometimes done. Support groups for depressed patients. Shelter homes for victims of abuse 21. To understand the role of social problems as influencing factors in the cause of illness – Some patients who are diagnosed with amoebic colitis for instance are advised to avoid buying street foods to which the preparation they are not sure of, and also avoid drinking water that are not safe. § 10 Ways to Identify a Client’s Problem o Learn to know the patient o Sort out relevant and significant data o Analyze and make generalizations about available data o Identify the therapeutic plan o Test generalizations with the patient and make additional generalizations o Validate the patient’s conclusion about his nursing problems o Continue to observe and evaluate the patient over time to identify any attitudes and clues affecting his behavior o Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan o Identify how the nurse feels about the patient’s nursing problems o Discuss and develop a comprehensive nursing care plan § CHARACTERISTICS o Abdellah’s theory has interrelated the concepts of health, nursing problems and problem solving as she attempts to create a different way of viewing nursing phenomenon. § LIMITATIONS o The major limitation of Abdellah theory and the twenty-one nursing problems is their very strong nursing centered orientation. With the orientation appropriate use might be the organization of teaching content for nursing students, the evaluation of a students, performance in the clinical area or both. But in terms of client care there is little emphasis on what the client is to achieve. o Using Abdellah’s concepts of health, nursing problems, and problem solving, the theoretical statement of nursing that can be derived is the use of the problem- solving approach with key nursing problems related to health needs of people. From this framework, 21 nursing problems were developed. o Abdellah’s theory provides a basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies. 5. Margaret Jean Watson (1979) § Theory of Human Caring § Education o Dr. Watson was born and raised in a small town in the Appalachian Mountains of West Virginia in the 1940’s o 1958-61 § R.N. Diploma in Nursing § Lewis-Gale School of Nursing o 1962-64 § B.S. in Nursing § University of Colorado o 1964-66 § M.S. in Psychiatric Mental-Health Nursing; Minor Psychology § University of Colorado o 1969-70 § Graduate Work: Social and Clinical Psychology § University of Colorado o 1969-73 § Ph.D. in Educational Psychology and Counseling § University of Colorado § Jean Watson, as many of you know, is a living legend and theorist. She was born in West Virginia in the 1940’s and received most of her higher education in Colorado. § As shown here, she received her RN designation in her home town of Virginia in 1961, while her Bachelor of Science in Nursing, Master of Science in in Mental-Health Nursing and PhD in Educational Psychology and Counseling at the University of Colorado. § Accomplishments o International Kellogg Fellowship in Australia o Fulbright Research Award in Sweden o Six Honorary Doctoral Degrees o Including 3 International Honorary Doctorates (Sweden, UK, Canada) o 1993 National League for Nursing Martha E. Rogers Award § Listed here are many of her accomplishments of distinction, most of which were given for recognition of her work in making significant contributions to nursing knowledge and the science of care. § Some notable mentions include her six honorary doctoral degrees, three of which are internationally recognized from Sweden, the UK and Canada. o Her recent undertaking involves the Centre for Human Caring in Colorado, in which she is the founder. Here, programs have been established to promote human caring activities of nursing as a way to branch off from reductionist models of the biomedical approach. o Dr. Watson founded and directs the non- profit Watson Caring Science Institute, dedicated to furthering the work of caring, science, and heart-centered Carita‘s Nursing, restoring caring and love for nurses’ and health-care clinicians’ healing practices for self and others. o Distinguished Nurse Scholar, recognized by New York University o Norman Cousins Award in 1999 o Recognition for her commitment to developing; maintaining and exemplifying relationship-centered care practices o Founder of the Centre for Human Caring in Colorado o Is a Fellow at the American Academy of Nursing o Influences o Her theories are influenced by the Eastern Philosophy viewpoint, seeing the body as a whole unit, not a sum of parts. This idea links to previous theories to her time, including those of Nightingale, Leininger and Paterson & Zderad. Because of her background in psychology, theorists like Carl Rogers and Richard Lazarus also show some influence. § Theory of Human Caring o It is the Blueprint for nurses to restore the art of nursing practice and better care for their patients and themselves o Nursing has changed dramatically as science and medicine have adapted to meet the growing demands of our population. It’s increasingly a skilled –based profession with paper works to accomplish. However, it is important to remember the roots of nursing which are based on caring and healing principles. § Watson’s Motivation for Developing Her Model: o Education o Life Experiences o Exploration of Self § Major Elements of the Caring Theory o Carative factors, evolving into Clinical Caritas Processes o Transpersonal Caring Relationships o Caring occasion/Caring moment § Carative Factors o Guides the core of nursing o Carative factors attempt to “honor the human dimensions of nursing’s work and the inner life world and subjective experiences of the people we serve” (Watson, 1997, p. 50). o Contrasts the curative factors of medicine (curative means to cure a disease) o Carative factors evolve into Caritas factors o Watson now makes connections between human caring, healing, and even peace in our world, with nurses as caritas peacemakers when they are practicing human caring for self and others. Caritas comes from the Latin word meaning “to cherish and appreciate, giving special attention to, or loving § Ten Carative Factors 1. FORMATION OF A HUMANISTIC-ALTRUISTIC VALUE SYSTEM. The value of altruism (regard for others as a personal action) is learned at an early age. It is a value shared with parents. One's own life experiences are learning opportunities to gain insights about dealing with others. Caring based on humanistic values and altruistic behavior "can be developed through examination of one's own views, beliefs, interactions with various cultures and personal growth experiences." This development is perceived necessary for the nurse's own maturation. 2. INSTALLATION OF FAITH-HOPE. This factor is deemed essential to both carative and curative processes. To nurses, this provides a basis for looking into the healing power of belief, or the spiritual dimension, when curing is not possible. The use of Faith-Hope as a nursing intervention allows nurses to explore alternative methods of healing, like meditation. It seems that the goal for this activity is the provision of a sense of wellbeing through belief systems that are meaningful to the client. 3. CULTIVATION OF SENSITIVITY TO SELF AND OTHERS. Nurses promote "health and higher level functioning only when they perform person-to-person relationships as opposed to manipulative relationships." There is a need for the nurse to develop and examine one's own feelings. Through this process, increased sensitivity to others is developed. The nurse becomes honest and promotes self-growth and self-actualization. Watson's premise further states "that at the highest level of nursing, the nurse's human care responses, human care transactions, and presence in the relationship transcend the physical material world." The explanation makes it clear that interactions between the nurse and the client deal with the person's emotional and subjective world as a means to learn the inner self 4. DEVELOPMENT OF A HELPING-TRUST RELATIONSHIP. Communication, both verbal and non- verbal, is a mode of accomplishing a helping-trust relationship to establish rapport and caring. Characteristics common to this carative factor are congruence, empathy, warmth and honesty. Positive acceptance of another is most often expressed by body language, touch and tone of voice. I'm sure that given your clinical experiences, you can think of many situations to relate to this fourth carative factor. 5. PROMOTION AND ACCEPTANCE OF THE EXPRESSION OF POSITIVE AND NEGATIVE FEELINGS. According to Watson, it is important to facilitate awareness of both negative and positive feelings to improve on one's level of awareness. Feelings need to be considered in a caring environment. Being aware of both positive and negative feelings leads to better understanding of behavior. 6. SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD FOR DECISION MAKING. This factor gives notice to the limitations nurses have in assessing the issue of developing a scientific base because most of our time is dedicated to the performance of nursing tasks such as procedures and treatments. Thus, recognition is given to the use of the systematic problem-solving method in building nursing knowledge. In the same way, the argument extends to other methods of knowing like utilizing research-based findings in order to improve nursing practice and provide holistic care. 7. PROMOTION OF INTERPERSONAL TEACHING-LEARNING. Through this factor, persons (clients) gain control over their own health because it provides them with both information and alternatives. Learning offers opportunities to individualize information dissemination. The caring nurse focuses on the learning and teaching process, as well as in understanding the client's perception of the situation. This provides for a cognitive plan workable within the client's frame of reference. 8. PROVISIONS FOR A SUPPORTIVE, PROTECTIVE AND (OR) CORRECTIVE MENTAL, PHYSICAL, SOCIOCULTURAL AND SPIRITUAL ENVIRONMENT. There are two divisions or categorizations relative to this factor: external variables which include physical, safety and environmental factors; and internal variables which refer to mental, spiritual or cultural activities which the nurse may manipulate for the person's well-being. An interdependence exists between internal and external factors since the person perceives the situation in the environment as either threatening or non-threatening. There are events in a person's life that can arouse a sense of threat. The person appraises the situation and copes to the best of his ability. The nurse's assessment capabilities can be valuable in helping the person appraise the situation and cope with it. The nurse's intervention is aimed at helping, the person develop a more accurate perception to help strengthen coping capabilities. Provision of comfort, safety and privacy are major aspects of this carative factor. A clean and esthetic environment is considered a basic element. Esthetics is deemed essential in the promotion of increased self-worth and dignity. 9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN NEEDS. The hierarchy of human needs is the essence of this carative factor. It is grounded in a hierarchy of need similar to that of the Maslow’s. Watsons has created a hierarchy which she believes is relevant to the science of caring in nursing. According to her, each need is equally important for quality nursing care and the promotion of optimal health. All the needs deserve to be attended to and valued. 10. ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL-SPIRITUAL FORCES. Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. Existential psychology is the study of human existence using phenomenological analysis. This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. Thus the nurse assists the person to find the strength or courage to confront life or death. § The Carative Factors Evolve into Caritas Factors o Carative § Faith and hope § Helping-trusting, human care relationship § Creative problem-solving caring process § Expressing positive and negative feelings § Transpersonal teaching- learning o Caritas § Being authentically present and enabling the beliefs of the one being cared for and the one giving care § Developing and maintaining a trusting, authentic, caring relationship § Creative use of self § Being present to and supporting the positive and negative feelings with a connection of a deeper spirit § Engaging in genuine teaching-learning experience § Transpersonal Caring Relationship o Transpersonal means to go beyond one’s own ego and reach a deeper spiritual connection while comforting a patient. o The transpersonal relationship depends on: § A commitment from the nurse to enhance and protect human dignity § An awareness from the nurse that they have the ability to heal § The nurse must go beyond the objective role § To preserve and protect a person’s humanity, and dignity § Preserve a patient’s spirit to ensure the patient does not become an object o The nurse’s caring and connection have potential to heal since experience, intention, and perception are taking place. o Nursing goes beyond an objective assessment and shows concern for the patient’s own healthcare o Goal of transpersonal caring relationship protects, enhances, and preserves human dignity, humanity, wholeness, and inner harmony § Caring Occasion/Caring Moment o Caring occasion is the moment when the nurse and another person come together in such a way that an occasion for human caring is created. Both persons come together in a human-human transaction. The one caring for and the one being cared for are influenced by the choices and actions decided within the relationship o Watson (1998, 1999) stated that when human caring is created the nurse and patient come together to create a moment, this is known as the caring occasion/caring moment o Watson (1999) feels as though the nurse and the patient must be aware of the caring moment so as to make appropriate choices and actions, thereby the nurse without knowing becomes a part of the patients “life history” § NURSING METAPARADIGM o Human Being § The person is to be valued, cared for, respected and viewed in a holistic way, as body, mind and spirit o Environment § The person’s environment should be conducive to healing and that the person and their environment are connected. § The person’s frame of reference is also something that should be considered, and the nurse should strive to stay within the person’s frame of reference § According to Watson, caring (and nursing) has existed in every society. A caring attitude is not transmitted from generation to generation. It is transmitted by the culture of the profession as a unique way of coping with its environment. o Health § Health is viewed as overall functioning and distress and disharmony can be caused by more than just disease processes § Watson believes that there are other factors that are needed to be included in the WHO definition of health. She adds the following three elements: A high level of overall physical, mental and social functioning A general adaptive-maintenance level of daily functioning The absence of illness (or the presence of efforts that leads its absence) o Nursing § Watson argues that caring is central to the profession of nursing and that nursing care should also focus on promoting health and preventing illness. § The nurse should focus their care on healing and wholeness as opposed to tasks, illness and disease § How does the theory apply to our nursing practice? o We agree with Watson and feel that the contact and the bond between two individuals is the foundation of nursing. We provide this caring and z approach to promote holistic health and prevent illness. o A “good” nurse cannot be defined solely by her ability and skills but also by how well she interacts with the client and family while providing that care. § CARING AS THE ESSENCE OF NURSING (JEAN WATSON, 1979) o Watson viewed caring as the essence of nursing. Caring connotes responsiveness between the nurse and the person. The nurse co-participates with the person. The purpose of caring is to assist the person in gaining control and becoming knowledgeable, and in the process promote health changes. If we have thought of the concept of empowerment while reading this, yes, we can say that it is similar to that. By allowing the client to be knowledgeable, the nurse provides an environment for better decision-making, better self-control and, better self-respect. The concept is common to Filipino culture: “kakayahan" or "patibayin ang kakayahan," meaning assisting the person in gaining control. o While it is true that caring as an attribute in nursing has been described and clarified by many others, there is uniqueness in Watson's science of caring. Basic assumptions for the science of caring are supported by ten carative factors that provide structure to the concept of caring. According to Watson, the first three carative factors provide the philosophical foundation for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three. § Theory of Caring Applied § Carative factors used with postpartum women experiencing multiple emotions o Never pass judgments, provide all patients with the same respect and level of care. o Instill hope in the mothers that they will be able to care for their babies and return to their “normal” state of health. o Discuss the patient’s perceptions and feelings towards their birthing/parenting experiences. o Provide a trusting relationship where the patient feels that you are committed to helping them. Advocate for the patient. o Enable the patient to discuss positive and negative feelings concerning her current healthcare/home situation. o Use creativity during teaching opportunities and holistic treatments involving pain management. o Ensure that their environment is comfortable and enables them to get rest. Ensure that the patient’s home environment is safe for mother and baby upon return. o Help patients reach harmony (mind, body, spirit) through holistic and caring modalities. Promote mother-infant bonding. Assess patient’s support system. § “Caring in the nursing profession takes place every time a nurse-to-patient contact is made... That caring makes a difference to the patient’s sense of well-being. Caring may occur without curing but curing cannot occur without caring” § Strengths & Weakness o S - Can be applied in any area of nursing o S - Addresses all aspects of the health and illness continuum, and the concepts are abstract and open to interpretation o W- Lack of concrete guidelines è do not have specific steps 6. Dorothea Orem (1971) § Self-Care Deficit Theory of Nursing § Born in Baltimore, Maryland in 1914 § Orem’s parents o Father was a construction worker o Mother was a homemaker § EDUCATION o 1930- graduated from Providence Hospital School of Nursing, Washington, DC o 1935- BSN from Catholic University of America o 1945- MSN from Catholic University of America o Orem’s World of Academia o 1959- Dean of the School of Nursing at Catholic University of America o 1976 - Doctor of Science from Georgetown University o 1988 - Doctor of Humane Letters from Illinois Wesleyan University o 1998- Doctor of Nursing Honoris Causae from University of Missouri § Orem’s nursing experience o Operating room nurse o Staff nurse o Private duty nurse o Nurse educator o Nurse administrator o Nurse consultant § The Historical Evolution of Orem’s Model o 1949-1957 § Orem worked on developing nursing curriculum and nursing practice o 1958-1960 § Worked for the Office of Education, in the U.S. Dept. of Health, Education and Welfare as a curriculum consultant o 1958-1960 cont’d § Guidelines for Developing Curricula for the Education of Practical Nurses was developed (Tomey and Alligood, 2006). o 1960-1970 § Eventually served as the acting dean of the School of Nursing at the Catholic University of America o 1971 § Published Nursing: Concepts of Practice § Nursing Concepts of Practice o Development of the self-care deficit nursing theory and illustrates its relevance to nursing practice with a common sense approach. § TERMS o Self-care agency § Human’s ability or power to engage in self-care and is affected by basic conditioning factors. o Basic conditioning factors § Age, gender, developmental state, health state, sociocultural orientation, health care system factors § Family system factors, patterns of living, environmental factors, and resource adequacy and availability. o Nursing Agency § Complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self- care demands o By exercising or developing their own self-care agency. § METAPARADIGMS OF OREM’S MODEL o PERSON § distinguished from other living things by their capacity to: Reflect upon themselves and their environment Symbolize what they experience Use symbolic creations (ideas, words) in thinking, in communicating, and in guiding efforts to do and to make things that are beneficial for themselves or others” § Integrated human functioning includes physical, psychological, interpersonal, and social aspects. § Orem believes that individuals have the potential for learning and developing. o ENVIRONMENT § 4 realms of state are encompassed in environment: § Physical Shelter Security- internal and external Climate Amenities (eg. Heat, electricity, indoor plumbing, sanitation) § Chemical Pollutants: o Air o Water § Biological Molds Pollens Allergens Mites Animal waste and its by-products § Socioeconomical Family income Education level Occupation o Social status o Resources o HEALTH § Promotes function and development within social groups in accordance with human potential, known human limitation, and the human desire to return to normal § Orem supports the WHO’s definition of health as “a state of physical, mental, and social well-being and not merely the absence of disease or infirmity.” She states that “the physical, psychological, interpersonal and social aspects of health are inseparable in the individual”. § Orem also presents health based on the concept of preventive health care. o NURSING § Skilled professional who evaluates and acknowledges a patient’s health deficit. § Nursing plans and implements care based: actual and potential self-care deficits Task Performance Self-Care Promotion Demographics Supportive Coordinated § Helping clients to establish or identify ways to perform self-care activities § Nursing actions are geared towards independence of the client. If the client is highly dependent, there is a need for the nurse to assist and address the needs of the client. § Nursing is a distinguished human service since its focus is on persons with inabilities to maintain continuous provision of health care. § Nursing is based on values. Concepts Unique to Orem’s Model § SELF-CARE DEFICIT THEORY OF NURSING: Dorothea Orem’s theory is based on the belief that the individual has a need for self-care actions and that nursing can assist the person in meeting that need to maintain life, health, and well-being. This is a general theory composed of 3 related theories: (1) THE THEORY OF SELF-CARE (2) THE THEORY OF SELF-CARE DEFICIT (3) THE THEORY OF NURSING SYSTEMS Theory of Self Care o “Self –care comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development and well-being through meeting known requisites for functional and developmental regulations” § To understand the theory of self-care one must first understand the concepts of: § SELF-CARE o consists of activities that individuals carry out on their own behalf. o These actions are deliberate, have pattern and sequence, and are developed from day-to-day living. § SELF-CARE AGENCY o The human’s acquired ability or power to engage in self-care. o This ability to engage in self-care is affected by basic conditioning factors (age, gender, developmental state, health state, socio- cultural, health care system, family system, patterns of living, environmental and resource adequacy and availability). For instance, infants and children, as well as aged, ill, and disabled people, require help with self-care activities. § Data Collection BASIC CONDITIONING FACTORS Age 56 years old Gender Female Health state Disability due to health condition, therapeutic self-care demand Developmental state Ego integrity vs. despair Socio-cultural orientation No formal education, Indian, Hindu Health care system Institutional health care Family system Married, husband working Patterns of living At home with partner Environment Rural area, items for ADL not easy to reach, no special precautions to prevent injury Resources Husband, daughter, sister’s son § SELF-CARE REQUISITES o Can be defined as “the reasons for which self-care is undertaken; o they express the intended or desired results”. o The Theory of Self-Care has three components: § Universal self-care needs § Developmental self-care needs § Health deviation. Universal Self-Care Requisites § Universally set goals that must be undertaken in order for an individual to function in scope of healthy living § Common to all human beings during all stages of the life cycle and should be viewed as interrelated factors, each affecting the others. § Orem identifies universal self-requisites as follows: 1. The maintenance of a sufficient intake of air 2. The maintenance of a sufficient intake of water 3. The maintenance of a sufficient intake of food 4. The provision of care associated with elimination 5. The maintenance of balance between activity and rest 6. The maintenance of a balance solitude and social interaction 7. The prevention of hazards to human life, human functioning, and human well-being 8. The promotion of human functioning and development UNIVERSAL SELF-CARE REQUISITES Air Breaths without difficulty, no pallor cyanosis Water Fluid intake is sufficient, edema present over ankles. Turgor normal for the age Food Hb – 9.6%, BMI = 14. Food intake is not adequate or the diet is not nutritious Elimination Voids and eliminates bowel movement bowel without difficulty Activity/rest Frequent rest is required due to pain. Pain not completely relieved. Activity level has come down. Social interaction Communicates well with neighbors and calls the daughter by phone. Need for medical care is communicated to the daughter. Prevention of hazards Need instruction on care of joints and prevention of falls. Need instruction on improvement of nutritional status. Prefer to walk bare foot. Promotion of normalcy Has good relation with daughter Developmental Self-Care Requisites § Promote development § Engage in self-development § Preventing or overcoming adverse human conditions and life situations DEVELOPMENTAL SELF-CARE REQUISITES Maintenance of developmental environment Able to feed self, difficult to perform dressing, toileting, etc. Prevention/management of the conditions Feels that the problems are due to her own threatening the normal development behaviors and discuss the problems with husband and daughter. Health Deviation Self-Care Requisites § Required in illness or injury or as a result of medical tests or treatments to correct a condition (e.g. right upper quadrant abdominal pain when foods with a high fat content are eaten, or learning to walk using crutches following a casting of a fractured leg) § When a condition permanently or temporarily alters structural, physiological or psychological function. § Comatose states § Autism § Mental Retardation HEALTH DEVIATION SELF-CARE REQUISITE Adherence to medical regimen Reports the problems to the physician when in the hospital. Cooperate with the medication, not much aware about the use and side and effects of medicines Awareness of potential problem Not aware about the actual disease process. Not associated with the regimen complaint with the diet and prevention of hazards. Not aware about the side effects of medications Modification of self-image to Has adapted to limitation in mobility. The adoption of incorporate changes in health status new ways for activities leads to deformities and progression of the disease Adjustment of lifestyle to Adjusted with the deformities. Pain tolerance not accommodate changes in the achieved. health Theory of Self-Care Deficit § Occurs when an individual cannot carry out self-care requisites § Examples of self-care requisites are: o Wound care o Activities of Daily Living § Bowel program § Glucose monitoring § the basic element of Orem’s (2001) general theory of nursing because it delineates when nursing is needed § Nursing is required when adults (or in the case of a dependent, the parent or guardian) are incapable of or limited in their ability to provide continuous effective self-care. § Orem (2001) identifies the following five methods of helping that nurses may use: 1. Acting for or doing for another 2. Guiding and directing 3. Providing physical or psychological support 4. Providing and maintaining an environment that supports personal development 5. Teaching NURSING CARE PLAN TO OREM’S THEORY OF SELF CARE DEFICIT Nursing Outcome Implementation Evaluation (regulatory operations) diagnosis and plan (control operations) (diagnostic (prescriptive operations) operations) Based on self- Outcome Nurse-patient Effectiveness of the nurse patient care deficits Nursing goal actions to action to promote patient as self-care and Promote patient as agent, meet self-care needs, decrease objectives self-care agent the self-care deficit Design of Meet self-care nursing needs Effectiveness of the selected nursing system Decrease the self- system to meet the needs Appropriate care deficit method of helping Theory of Nursing Systems § Designed by the nurse, is based on the assessment of an individual’s self- care needs and on the assessment of the abilities of the patient to perform self-care activities. § ongoing education and support. § describes how the patient’s self care needs will be met by the nurse , the patient, or both § Nursing agency o Is a complex property or attribute of people educated and trained as nurses that enable them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency. o Is similar to self-care agency in that both symbolize characteristics and abilities for specific types of deliberate action. § Nursing agency vs. Self-care agency o Nursing agency – carried out for the benefit and well-being of others o Self-care agency – is employed for one’s own benefit § Orem (2001) has identified three classifications of nursing systems to meet the self-care requisites of the patient: 9. Wholly compensatory § The nurse gives total care to meet all needs since the patient is unable to complete any self-care independently. 10. Partly compensatory § Both nurse and patient perform care measures or other actions. The patient is able to perform self-care tasks with partial or no assistance from nursing. 11. Supportive-Educative § The person can carry out self- care activities but requires assistance. § This is also known as supportive-developmental system § The “patient’s requirements for help are confined to decision making, behavior control, and acquiring knowledge and skills”. § The nurse’s role, then, is to promote the patient as a self-care agent. § Orem’s Theory Applied to Nursing Education o Conceptualize patients’ current and potential self-care deficits. o Supports the nursing process in all 3 nursing theories. § Research Status of Orem’s Model o Current research using Orem’s theory would include: § Chinese Medicine § Battered woman counseling § Orem’s Strengths o Self-Care Deficit Theory is specific to nursing. o Can be used in multiple nursing specialties. o Creates a coordinated nursing care plan that adjusts to the patient’s needs througho

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