Nursing Theories Week 9-11 PDF

Nursing Theories Week 9-11 Hildegard Peplau’s Theory of Interpersonal Relationship About the Theory  Stresses the importance of the nurse’s ability to understand their own behaviors to help others identify perceived difficulties.  Emphasize the focus on the interpersonal processes and t...

Nursing Theories Week 9-11 Hildegard Peplau’s Theory of Interpersonal Relationship About the Theory  Stresses the importance of the nurse’s ability to understand their own behaviors to help others identify perceived difficulties.  Emphasize the focus on the interpersonal processes and therapeutic relationship that develops between the nurse and client. Major Concepts of Peplau’s Theory  Nurses should apply principles of human relations to the problems that arise at all levels of experience.  The theory explains the phases on interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process.  Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of healthcare. Major Concepts of Peplau’s Theory  Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.  The attainment of goal is achieved through the use of a series of steps following a series of pattern.  The nurse and patient work together so that both become mature and knowledgeable in the process.  Roles of Nurses Primary Secondary Stranger Technical Expert Teacher Mediator Resource Person Safety Agent Counselor Researcher Surrogate Tutor Leader Manager of Environment Different Nursing Roles Assumed During the Various Phases of Nurse- Patient Relationship Stranger Receives the client in the same way one meets a stranger in other life situations. Provides an accepting climate that builds trust. Teacher Who imparts knowledge in reference to a need or interest. Resource Person One who provides a specific needed information that aids in the understanding of a problem or new situation. Counselors Help understand and integrate the meaning of current life circumstances. Provide guidance and encouragement to make changes. Surrogate Helps to clarify domains of dependence, interdependence and independence and acts on client’s behalf as an advocate. Leader Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.  Elements Involved in Nurse-Patient Relationship This time, place and purpose of meetings as well as conditions for Contract termination are established between. Boundaries Roles of participants are clearly defined, the nurse is defined as a professional helper, the client’s needs and problems focus on the interaction. Confidentiality The nurse should share information only with professional staff who need to know. The nurse should obtain client’s written permission to share information with others outside the treatment team. Therapeutic Nurse Behaviors  Self- awareness  Genuineness  Warmth and respectful  Empathy  Cultural sensitivity  Responsibility  Ethical practice 4 Phases of Nurse- Patient Relationship  Orientation- client seeking assistance, meeting of nurse patient, identifying the problem and services needed (interview process), and guidance.  Identification- identifying who is best to support needs, patient addresses personal feelings about the experience and is encouraged to participate in care to promote personal acceptance and satisfaction.  Exploitation- patient attempts to explore, understand and deal with the problem, and gains independence of achieving the goal.  Resolution- termination of the therapeutic relationship to encourage emotional balance for nurse and patient. (difficult for both patient and nurse as psychological dependence persists). Limitations Cannot be used who does not have a felt need. Examples are patients who are withdrawn and unconscious patients. Application of the Theory  The theory urges nurses to use nursing situation as source of observation from which unique concepts could be derived.  By applying this theory in clinical areas, nurse acts as a participant observer and thus upgrades her previously acquired theoretical knowledge.  Interpersonal relations in nursing are used as manuals for instruction to nursing students.  Foundation of psychiatric nursing education. Questions? Next Topic Ida Jean Orlando’s Theory of Deliberative Nursing Process  The role of the nurse is to find out and meet the patient’s immediate need for help.  The patient’s representing behavior may be an appeal for help; however, the help needed may not be what it appears to be.  Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with patients in the meaning of their behavior.  This process helps the nurse find out the nature of distress and what help the patient needs. Assumptions  When patient cannot cope with their needs without help, they become distressed with feelings of helplessness.  Patients are unique individual in their responses.  Nursing deals with people, environment and health.  Patients need help in communicating needs, they are uncomfortable and undecided about dependency needs.  Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and feelings.  The nurse- patient situation is dynamic, actions and reactions are influenced by both nurse and patient.  Nurses are concerned with needs that patients cannot meet on their own. 2 Nursing Actions Identified in the Theory Deliberative: the nurse initiates believing that she will help ascertain or meet client’s immediate need for help. Automatic: actions which are not focused on the client’s need but other need such as nurses or physician. Application of the Theory Mrs. Camille Dela Concha, a 26 year old nullipara came to the infertility OPD with history of 6 years of non- consanguineous marriage and no history of contraceptives for the treatment of primary infertility. Objectives of the Nursing Management  Assess the patient condition by the use of the theory.  State perception of the client.  Find the client’s immediate need for help.  Validate immediate need for help. Reactions:  Verbal: Manganganak pa ba ako? Sobrang pressured na ako sa pamilya ko… sinisisi nila ako.  Non Verbal: Anxious, worried, depressed, no eye contact while answering, only nodding of head is observed in questions. Need for Help  Anxiety related to chances of conception  Knowledge deficit regarding assisted reproductive techniques and treatment of infertility. Nursing Action  Identify positive coping behavior and reinforce them.  Give positive reinforcement.  Reassure the patient.  Clarify doubts of the patient.  Provide simple instruction.  Involve the couple for counselling.  Arrange special meeting with patients who had positive results from infertility treatment.  Provide psychological support to the patient.  Give realistic opinion.  Encourage patient to take her decision independently. Evaluation  Evaluate the patient level of anxiety and stress after clarifying the doubts.  Re- evaluate the patient in the next visit. Effects of the Theory  It stresses the reciprocal relationship between the patient and the nurse in finding out and meeting the patient’s immediate need for help.  The deliberative process helps nurses achieve more successful patient outcomes. The theory remains a most effective practice especially to new nurses who begin their practice. Questions? Next Topic Joyce Travelbee’s Human to Human Relationship Model Central Theme of the Theory A sick person finding meaning in illness and suffering and human to human relationship. Basic Concepts Suffering an experience that varies in intensity, duration and depth, a feeling of unease, ranging from mild, transient mental, physical or mental discomfort to extreme pain and extreme torture. Meaning Meaning is the reason as oneself attributes. Hope It is the nurse’s job to help the patient to maintain hope and avoid hopelessness. Hope is the faith that can and will be changed that would bring something better with it. Hope’s core lies in a fundamental trust the outside world, and a belief that others will help someone when you need it. Characteristics of Hope: It is strongly associated with dependence on other people. It is future oriented. It is linked to elections from several alternatives or escape routes out if its situation. The desire to possess any object or condition, to complete a task or have an experience. Confidence that others will be there for one when you need them. The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward towards its goals. Communication A strict necessity for good nursing care. Therapeutic use of Self The ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions. Refers to the nurse’s presence, a physical being there and psychological being with a patient for the purpose of meeting the patient’s health care needs. Stages of Human to Human Relationship  Original Encounter- first impression y the nurse with the ill person.  Emerging Identities- nurse and patient perceive each other as a unique person. Bonds begin to form  Empathy- the ability to share in the other person’s experience.  Sympathy- the nurse has the desire to alleviate the cause of the patient’s illness or suffering  Rapport- nursing actions are done to relieve the patient’s distress. Stages of Human to Human Relationship Application to Nursing Practice  Teaches the nurses on the meaning of illness and suffering.  Applicable to hospice care, helping terminally ill individuals and their families find meaning in suffering.  Psychiatric nursing deals more on the feeling of the patient and as well as the relationship between the nurse and the patient.  Encourages nurses to take a step closer to their patients. Questions? Next Topic Lydia Hall’s Core Care Cure Model  Hall believed that patient outcomes are improved by direct care as given by the nurse. She saw nursing as interacting with the person- called the core; the body- called the care; and the disease- called the cure. The Care Circle Motherly care and comfort of patient. Provides teaching and learning activities. Patient may explore and share feelings with the nurse. When functioning in a care circle, the nurses apply knowledge of the natural and biological sciences. The patient views the nurse as potential comforter, one who provides care and comfort. Nurses provide bodily care for the patient The Core Circle Patient care is based on social sciences. Involves therapeutic use of self and is shared with other team members. By developing interpersonal relationship with the patient, the nurse is able to help the patient verbally express feelings regarding the disease process and its effects. Patient is able to gain self- identity and further develop maturity. Patient is able to make conscious decisions. The Cure Circle Cure based on pathological and therapeutic sciences. Application of medical knowledge by nurses. Nurse assisting the doctors in performing different procedures. Nurse is patient advocate in this circle. The cure aspect is different from the care circle because many of nurse’s actions changes from a negative quality of avoidance of pain rather than a positive quality of comfort. Nurse’s role changes to positive quality to negative quality. Nursing Application of the Theory Geriatric Nursing Operating Room Critical Care Unit Dialysis Unit Questions? Next Topic Faye Abdellah’s 21 Nursing Problems Description of the Theory  Abdellahs’ typology of 21 nursing problems is a conceptual model mainly concerned with patient’s needs and nurses’ role in problem identification using a problem analysis approach. The 21 Nursing Problems fall into 3 categories: 1. Physical sociological and emotional needs of clients. 2. Types of interpersonal relationships between the nurse and patient. 3. Common elements of client care.  She used Henderson’s 14 human needs and nursing research to establish the classification of nursing problems. Problem Solving  Is a process involves identifying the problem, selecting pertinent data, formulating hypothesis, testing through the collection of data and revising hypothesis where necessary on the basis of conclusions obtained from the data. Classification of the 21 Nursing Problems  Basic to all patients  Sustenal care needs  Remedial care needs  Restorative care needs Basic to All Patients 1. To maintain good hygiene and physical comfort. 2. To promote optimal activity; exercise, rest, sleep. 3. To promote safety through prevention of the spread of infection. 4. To maintain good body mechanics and prevent and correct deformity. Sustenal Care Needs 5. To facilitate the maintenance of a supply of oxygen to all body cells. 6. To facilitate the maintenance of nutrition for all body cells. 7. To facilitate the maintenance of elimination. 8. To facilitate the maintenance of fluid and electrolyte balance. 9. To recognize the physiological responses of the body to disease conditions- pathological, physiology and 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 expressions, feelings and reactions. 13. To identify and accept interrelatedness of emotions and organic illness. 14. To facilitate the maintenance of effective verbal and nonverbal communication. 15. To promote the development of productive interpersonal relationships. 16. To facilitate progress toward achievement and personal spiritual relationships. 17. To create or maintain a therapeutic environment. 18. To facilitate awareness of self as an individual with varying physical, emotional and developmental needs. Restorative Care Needs 19. To accept the optimum possible goals in the light if limitations, physical and emotional. 20. To use community resources as an aid in resolving problems that arise from illness. 21. To understand the role of social problems as influencing factors in the cause of illness. Application Nursing Practice  Improvement in the nursing education.  It transforms the focus of the profession from being disease- centered to patient- centered.  The guide care is not just for hospital setting but also applied to community nursing. Questions? Next Topic Virginia Henderson’s Need Theory About the Theory She described the nurse’s role as that of a substitute for the patient, a helper to the patient, or a partner with the patient. The theory emphasizes to help the patient become as independent as possible so that progress after hospitalization would not be delayed. To take care of the patient as a whole to ensure they will have fewer setbacks once released from the hospital. Nurses need to make themselves valuable to their patients and doctors. She categorized nursing activities into 14 components based on human needs. 14 components of Henderson’s Theory Assumptions of the Theory  Nurses care for the patients until patient can care for themselves once again. Patients desire to return to health, but this assumption is not explicitly stated.  Nurses are willingly to serve and that nurses will devote themselves to the patient day and night.  Nurses should be educated at university level in both arts and sciences.  It is the responsibility of the nurse to access the needs of the patient and educate them on health promotion. Characteristics of the Theory  There is interrelation of concepts.  Concepts of fundamental human needs, biophysiology, culture and interaction, communication are borrowed from other discipline. Example is Maslow’s Theory.  The 14 components are a guide for the individual and nurse in reaching the chosen goal.  Simple yet generalized.  Applicable to all ages.  The ideas of nursing practice are accepted.  Can be utilized by practitioners to guide and improve their practice. Application to Nursing  The nurse reinforces the patient when he lacks the will, knowledge, or strength. The nurse will make an effort to understand him.  The nurses are taught to care for the needs of the patients.  Everytime we change bandages, administer medications, comfort, bathe, ambulate, promote wellness, advocate, and educate our patients we are following Henderson’s Need Theory. Questions? Next Topic Nola Pender’s Health Promotion Model  Health Promotion Model specifies that human are complex, multifaceted beings that are influenced by a variety of factors (external and internal) that modify their health behavior.  The model is used to recognize, assess, modify, and evaluate these factors in an individual in order to encourage behaviors that promote health and well-being.  The model notes that each person has unique personal characteristics and experiences that affect subsequent actions.  The set of variables for behavioral specific knowledge and affect have importance motivational significance. These variables can be modified thru nursing actions.  Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development.  The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail and intended health promoting actions. Propositions of the Model  Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health promoting behavior.  Persons commit to engaging in behaviors from which they anticipate deriving valued benefits.  Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior.  Perceived competence or self efficacy to execute ma given behavior increases the likelihood of commitment to action and actual performance of the behavior.  when positive emotions or affect are associated with a behavior, the probability of commitment and action is increased. Propositions of the Model  Persons are more likely to commit to and engage in health promoting behaviors when significant others model the behavior, expect the behavior to occur and provide assistance and support to enable the behavior.  Families, peers and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health promoting behavior.  Situational influences in the external environment can increase or decrease commitment to or participation in health promoting behavior.  The greater the commitment to a specific plan of action, the more likely health promoting behaviors are to be maintained over time.  Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions. Three Area Focus of the Model  Individual characteristics and experiences  Behavior- specific cognitions and affect  Behavioral outcomes Individual Characteristics and Experiences Prior Related Behavior- the prevalence of the same or similar behavior in the past. Influences the possibility of participating in health promoting behaviors. Personal Factors- involves biological, psychological, and sociocultural domains. Characteristics from these domains, such as gender, age, and race affect health promoting behavior. Behavior Specific Cognitions and Affect Perceived Benefits of Action- perceptions of positive results from engaging in a health promoting behavior. Perceived Barriers to Action- perceptions of obstacles from engaging a health promoting behavior. Perceived Self Efficacy- perceptions of one’s ability to competently engage in a health promoting behavior. Behavior Specific Cognitions and Affect Activity Related Affect- emotions and feelings felt prior, during and after engaging in a health promoting behavior. Interpersonal Influences- how the individual believes others will perceive a health promoting behavior. Includes societal and cultural norms, social support and role models. Situational Influences- perceptions of the compatibility of the one’s personal situation and the environment in either facilitating or impending a health promoting behavior. Behavior Specific Cognitions and Affect Commitment to a Plan of Action- selecting prepared strategies and having the intention to be successful in performing a health promoting behavior. Immediate Competing Demands and Preferences- competing alternative behaviors that can diverge the individual away from engaging in the planned health promoting behavior. Behavior Outcome- Health Promoting Behavior Health Promoting Behavior- the behavior that promotes the desired health outcome. Eating healthy food, exercising consistently, getting adequate sleep are some of the examples. Difference of Preventive Model to Promotion Model Preventive Model- mainly deals with specific risk factors on the individual. (Smoking Cessation) Promotion Model- primarily supports health development by increasing resources which allow better maintenance and enhancement of positive health. Application of the Model  Build on past experiences.  Identify benefits and ways to alleviate barriers.  Develop strong efficacy to experience success.  Make the experiences before, during and after health promoting activities enjoyable.  Encourage support from significant others.  Allow the individual to interact in the health promoting activities.  Collaborate with the patient in developing feasible plans that reduces competing demands and preferences. Questions? Next Topic Madeleine Leininger’s Theory of Culture Care Diversity and Universality What is Transcultural Nursing? An area of study and practice focused on the comparative cultural care values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture- specific and universal nursing care practice in promoting health and well-being or to help people face unfavorable conditions, illness or death in culturally meaningful ways. What is Cross Cultural Nursing? Refers to nurses who use applied or medical anthropological concepts. International nursing occurs when nurses travel to or have nursing practice or service learning experiences in other nations or countries. The construct of care has been Care knowledge is important critical to human growth and to promote the healing and development. well-being of clients. Reasons for Studying Culture Care Theory To understand cultural The nursing profession needs knowledge and the roles of to systematically study care caregivers and care recipients from a broad and holistic in different culture. cultural perspective. Assumption of Theory  Similarities and differences of culture care.  Awareness of folk remedies.  Influence of practices by cultural beliefs, practices, worldview, religions and among others. Reason for the Theory  Increase migration.  Patient of different cultures have different needs.  Culture shock among children. Goal of the Theory  To provide cultural congruent care or care that fits the culture.  Comprehensive approach in patient care.  Consideration of cultural dynamics.  Patient involvement in his or her care- culturally congruent care.  Should focus on patient values, beliefs and practices. Culturally Competent Care  Incorporate client beliefs and practices into the plan of care.  Provides wholistic cultural based care.  Integrate appropriate cultural practices into patient care.  Knowledgeable about culture differences. Emic Knowledge  Local, indigenous or other insider’s views and values about a phenomenon.  Stems from the concept of immersion in a specific culture but does not necessarily mean the participant is a member or part of the culture or society. Ethno Nursing  Research method for describing, documenting and explaining nursing care phenomena by the study of the beliefs, values and practices concerning nursing care that belong to a specific culture, as reflected by the language, beliefs and values of the members of that culture. Generic Care Professional Care Learned and transmitted by Formal and explicit cognitively indigenous, traditional or local folk learned professional are and knowledge and practices. knowledge and practices obtained through educational institutions taught to nurses. Culturally Congruent Care Culturally based care knowledge, acts and decisions Used in sensitive, creative and meaningful ways to appropriately fit the cultural values, beliefs and lifeways of clients for their health and well-being or to prevent illness, disability or death. Major goal of the culture care theory. Sunrise Enabler Method to assess culture and healthcare determinants Level 1- worldview Level 2- individual’s view Level 3- health (beliefs and practices) Level 4-how patient should be cared Application of the Theory  Culture affects nurse- patient interactions.  Nurses should ask about each client’s cultural practices and preferences when providing care.  Integrate the client’s cultural need/beliefs, practices, into the plan of care when necessary.  Respect and recognize cultural diversity.  Be more knowledgeable and sensitive with cultural diversity.  Failure to be congruent with client can lead to cultural conflict, stress, noncompliance, ethical and moral concern. Questions? Next Topic Margaret Newman’s Theory of Health as Expanding Consciousness Overview of Newman’s Theory  Movement is the reflection of consciousness that indicates inner organization or disorganization of persons; it communicates harmony or person’s pattern with the environment.  Time is considered and index of consciousness.  Dimensions of space- time- movement are complementary and linked to one another. Explicit Assumptions of the health as Expanding Consciousness Theory  The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes.  Removal of the pathology in itself will not change the pattern of the individual.  If becoming ill is the only way an individual’s pattern can manifest itself, then that is health for that person. Implicit Assumptions of the Health as Expanding Consciousness Theory  Humans are intuitive as well as cognitive and affective beings.  Humans are capable of abstract thinking and sensation.  Humans are more than the sum of their parts. Major Concepts Health  Health is an expansion of consciousness defined as the informational capacity of the system and seen as the ability of the person to interact with the environment. Consciousness  Includes not only the cognitive and affective awareness normally associated with consciousness, but also the interconnectedness of the entire living system, which includes physiochemical maintenance and growth processes as well as the immune system. This pattern of information, which is the consciousness of the system, is part of a larger, undivided pattern of an expanding universe. Pattern  Is characterized by movement, diversity and rhythm and is described as a design or framework as is seen in person- environment interactions.  Pattern recognition is the insight or recognition of a principle, realization of a truth, or reconciliation of a duality and is key to the process of evolving to a higher level of consciousness. Parallel between Newman’s Theory and Young’s Stages of Human Evolution Application of the Theory to Practice  Engagement with the patient  Development of the narrative  Follow-up meetings  Application of the theory  Family and community patterns Next Topic Rosemarie Parse’s The Human Becoming Theory Goal The goal is to be present with people as they enhance the quality of life. Parse refers to it as an art of nursing by developing dignity, leading and following; teaching, learning and mentoring with the end goal being to enhance the quality of your patient’s life. Assumptions of the Theory  The human is structuring meaning, freely choosing the situation, bearing responsibility for decisions.  The human is coexisting while constituting rhythmic human universe patterns.  The human unitary, continuously constituting patterns of relating.  Human becoming is transcending multidimensionally with the possibles.  Becoming is an open process, experienced by the humans.  Becoming is the human’s patterns of relating value priorities.  Becoming is an intersubjective process of transcending with he possibles.  Becoming is human evolving. Postulates in the Human Becoming Theory Illimitability- an indivisible unbounded knowing extended to infinity, the all-at- once remembering prospecting with the merging now. Paradox- an intricate rhythm expressed as a pattern preference. Freedom- is contextually construed liberation. Mystery- the unexplainable, that which cannot be completely known unequivocally. Principle of Human Becoming Theory Principle I Principle II Principle III Meaning Rhythmicity Transcendence First Principle: Meaning Structuring meaning multidimesionally is cocreating reality through the languaging of valuing and imaging. Human becoming is freely choosing personal meaning in situation in the intersubjective process of prioritizing one’s living values. Concepts of Meaning Imaging- how a person views the world. Valuing- how person makes choices, act, feel, or think Languaging- how we express Second Principle: Rhythmicity Cocreating rhythmical patterns of relating is living the paradoxical unity of revealing- concealing, enabling- limiting while connecting- separating. Human becoming is co-creating rhythmical patterns of relating in mutual process with the universe. It involves the configuration of apparent opposite experiences in the universe that co exist in rhythmical patterns. Revealing- Concealing Enabling- Limiting Connecting- Separating Third Principle: Transcendence Contranscending with the possibles is powering unique ways of originating in the process of transforming. Human becoming is co-transcending multidimensionally with emerging possibilities. Powering Originating Transforming Treating Patient by Meaning  Illuminating meaning and true presence Acknowledging, empathizing, and respecting. Backgrounds, cultures, ethnicities, beliefs, and political allegiance. Boundaries, moral, preferences, threshold, and values. Nurses should be free of judgment. Treating Patient by Rhythmicity  Synchronizing Rhythmicity Understanding the patient’s life patterns, relate to the patient. Modify interactions and surroundings to fit patient’s pattern. Customizing patient care to address physical, psychological, emotional needs. Always remain patient-centered. Treating Patient by Transcendence  Inspiring and mobilizing transcendence Guide patient and families, facilitate towards their desired health outcome and quality of life. Empower the patient to be involved in their care. Explore possibilities, what they hope to achieve. Significance in Nursing Application  Guides nurses in their practice to focus on helping patients achieve their quality of life as they describe and choose to live it.  The theory gives nurses the ability to see the patient’s perspective, which allows the nurse to be with the patient, and guide the patient towards health goals.  It does not focus on fixing the patient’s problem.  It focuses on considering the patient’s perspectives and values.  Cocreation of changing health patterns through a nurse-patient relationship. End Of Week 9-11