Florence Nightingale's Environmental Theory PDF

THEORISTS ON NURSING THEORY 1. Florence Nightingale Nightingale’s Nursing Education: ENVIRONMENTAL THEORY ▪ At age of 31, she studied in Kaiserswerth,...

THEORISTS ON NURSING THEORY 1. Florence Nightingale Nightingale’s Nursing Education: ENVIRONMENTAL THEORY ▪ At age of 31, she studied in Kaiserswerth, Germany at the Institution of Deaconesses / ▪ The manipulation of the physical environment as Order of Deaconesses. Studied there for 3 a major component of nursing care. months. ▪ Began her nursing training in 1851 in Germany. ▪ She was given the title of ▪ “Founder of Modern Nursing” ▪ “The Lady with the Lamp” Nightingale’s Environmental Theory Model ▪ “Ministering Angel” ▪ Viewed the manipulation of the physical ▪ Born on May 12, 1820, in Florence, Italy environment as a major component for nursing. ▪ Raised in England in an atmosphere of culture ▪ Defined the following aspects as major areas of and affluence. the physical, social, and psychological ▪ At the age of 24, Florence Nightingale decided to environment that the nurse could control: help the suffering masses and desired to work in a hospital. In which greatly opposed by her 1. Health of Houses family. ▪ Asses the surrounding environment for ▪ Her experience in treating sick/injured soldiers in essence pure air, pure water, efficient the Crimean War strongly influenced her drainage, cleanliness, and light. philosophy of nursing. ▪ Advocated that “nursing knowledge is distinct 2. Ventilation and Warming from medical knowledge” ▪ Assess the client's body temperature, room ▪ Her philosophy in nursing is environment- temperature, and room for fresh air (or oriented. adequate ventilation) and foul odors. ▪ Nursing is a spiritual calling. ▪ Develop a plan to keep the room airy free of ▪ She defined a calling as doing work in such a order while maintaining the client's body way as to do what is right and best. temperature. ▪ Nursing work is to be done with enthusiasm and is so important it should be thought of as 3. Light a religious vow. ▪ Access the room for adequate light. Sunlight ▪ She focused on the physical aspects of the works best. Develop and implement adequate environment. light in the client’s room without placing the ▪ She believed that "Healthy surroundings were client in direct sunlight. necessary for proper nursing care." ▪ She stated that “Nursing is an act of utilizing the 4. Noise environment of the patient to assist him in his ▪ Assess the noise level in the client's room and recovery” the surrounding area. Attempt to keep noise ▪ Established the Nightingale School for Nurses level to a minimum, and refrain from at St. Thomas’ Hospital in London whispering outside the door. ▪ She compiled notes of her visits to hospitals and ▪ Can cause harm and stress to the patient. her observations of the sanitary facilities, social problems of the places she visited 5. Variety ▪ Put down her ideas in 2 published books. ▪ Attempt to stimulate variety in the room and 1. Notes on Nursing, What It Is and What It Is with the client. This is accomplished with Not cards, flowers, pictures, books, or puzzles. 2. Notes on Hospitals. Encourage friends and relatives to engage the clients in some sort of stimulating conversation. ▪ Activities to relieve boredom; Entertainment 6. Bed and Bedding 12. Social Considerations/ Petty Management ▪ Assess the bed and bedding for dampness, ▪ Petty management ensures continuity of care. wrinkles, and soiling, and check the bed for Documentation of the plan of care and all. height. Keep the bed dry, wrinkle free, and at Evaluation will ensure others give the same a lower height to ensure the client’s comfort. care to client in your absence. ▪ Care giver should never lean against, sit ▪ proposed the avoidance of psychological upon, or unnecessarily shake the bed of a harm, no upsetting news. Strictly war issues patient. and concerns should not be discussed inside ▪ Bed should be placed in the lightest part of the hospital. She includes the use of small the room and placed so the patient could see pets f psychological therapy. out a window. Nightingale’s 3 Types of Environments 7. Cleanliness of Rooms and Walls ▪ Assess the room for dampness, darkness, and 1. Physical Environment dust or mildew. Keep the room free from ▪ Consists of physical elements where the dust, dirt, mildew, and darkness. patient is being treated ▪ Cleanliness of environment relates directly to 8. Personal Cleanliness disease prevention and patient mortality ▪ Attempt to keep the client dry and clean at all ▪ Aspects of the physical environment times. Frequent assessment of the client's influence the social and psychological skin is needed to maintain adequate skin environments of the person moisture ▪ Personal (patient, nurse) 2. Psychological Environment ▪ Can be affected by a negative physical 9. Nutrition and Taking Food environment which then causes STRESS ▪ Assess the diet of the client. Take note of the ▪ Requires various activities to keep the mind amount of food and drink ingested by the active (e.g., manual work, appealing food, a client at every meal or snack. pleasing environment) ▪ Dietary intake ▪ Involves communication with the person, ▪ No distraction while eating about the person, and about other people: ▪ Right food brought at the right time communication should be therapeutic, soothing, and unhurried. 10. Chattering Hopes and Advices ▪ Avoid talking without reason or giving 3. Social Environment advice that is without fact continue to talk to ▪ Involves collecting data about illness and the clients in person and to continue to disease prevention stimulate the client's mind and avoid percent ▪ Includes components of the physical talk. environment - clean air, clean water, proper ▪ False hope can be depressing. drainage ▪ Heed what is being said, sick persons should ▪ Consists of a person’s home or hospital room, hear good news. as well as the total community that affects the patient’s specific environment 11. Observation of the Sick ▪ Observe everything about your client. Record all observations. Observations should be factual and not really opinions. Continue to observe the client surrounding environment and make alterations in the plan of care when needed. Essential Components of a Healthy Environment ▪ Nightingale envisioned the person as comprising physical, intellectual, emotional, social and 1. Pure Fresh Air spiritual components. ▪ "To keep the air, he breathes as pure as the external air without chilling him.” ENVIRONMENT 2. Pure Water ▪ The foundational component of Nightingale’s ▪ "Well water of a very impure kind is used for theory. domestic purposes. And when epidemic disease ▪ Anything that can be manipulated to place a shows itself, persons using such water are almost patient in the best possible condition for nature to sure to suffer.” act. ▪ The external conditions and forces that affect 3. Effective Drainage one’s life and development ▪ "All the while the sewer maybe nothing but a ▪ Poor or difficult environments led to poor health laboratory from which epidemic disease and ill and disease. health is being installed into the house." ▪ Includes everything from a person’s physical and psychological components. 4. Cleanliness ▪ “The greater part of nursing consists in preserving cleanliness.” HEALTH ▪ Nightingale defined health as being well and 5. Light (especially direct sunlight) fully using every resource in living life. ▪ "The usefulness of light in treating disease is very ▪ Maintained by using a person’s healing powers to important.” their fullest extent Any deficiency in one or more of these factors could ▪ Maintained by controlling the environmental lead to impaired functioning of life processes or factors to prevent disease diminished health status. ▪ Illness and disease are viewed as a reparative process instituted by nature ▪ Nurses help patients through their healing Major Components of a Healthful / Healing process Environment ▪ She believed in the prevention and health 1. Proper Ventilation promotion in addition to nursing patient from 2. Adequate Light illness and disease. 3. Sufficient Warmth 4. Control of Noise NURSING 5. Control of Effluvia (Noxious Odors) ▪ Nursing is different from medicine and the goal of nursing is to place the patient in the best NITHANGALE’S NURSING METAPARADIGM possible condition for nature to act. PERSON ▪ Manipulate the physical environment to affect health; provides fresh air, light, warmth, ▪ Referred to by Nightingale as the “patient”, the cleanliness, quiet, and a proper diet. one who is receiving the care; a dynamic and ▪ Facilitates a patient’s reparative process by complex being. ensuring the best possible environment ▪ A human being acted upon by a nurse, or affected ▪ Nursing is a discipline distinct from medicine by the environment focusing on the patient’s reparative process ▪ Has reparative powers to deal with disease rather than on their disease. ▪ Recovery is in the patient’s power as long as a ▪ Nurses were to use common sense, observation, safe environment exists. and ingenuity to allow nature to effectively repair ▪ Nightingale had respect for persons of various the patient. backgrounds and was not judgmental about social worth. 2. MARGARET JEAN WATSON Watson’s Education: PHILOSOPHY AND SCIENCE OF CARING / ▪ BSN in University of Colorado, 1964 THEORY OF HUMAN CARING ▪ MS in Psychiatric Nursing in University of Colorado, 1966 ▪ How nurses care for their patients. And how that ▪ PhD in Educational Psychology and Counseling caring translates into better health plans to help in University of Colorado, 1973 patient get healthy. ▪ Watson’s defined human caring in nursing as “an ▪ 6 Honorary Doctoral Degrees; Including 3 act in a science in which caring is a human-to- International Honorary Doctorates (Sweden, UK, human process demonstrated through its Canada) therapeutic interpersonal interactions” ▪ TLC (Tender Loving Care): When you give “Nursing is an Art and a Science” someone extra compassionate and thoughtful Science: “Application of nurses knowledges” attention. Art: “Decision- making and Critical thinking skills” 1. Caring can be effectively demonstrated and practiced only interpersonally. MAJOR ELEMENTS OF THE CARING 2. Caring consists of carative factors that result in THEORY the satisfaction of certain human needs. 1. Carative Factors 3. Effective caring promotes health and individual 2. Transpersonal Caring Relationships or family growth. 3. Caring Occasion / Caring Moment 4. Caring responses accept person not what he or she is now but as what he or she may become CARATIVE FACTORS 5. A caring environment is one that offers the development of potential while allowing the ▪ A guide for the core of nursing. person to choose the best action for himself or ▪ Contrasts the curative factors of medicine herself as a given point in time. (Curative means to cure a disease) 6. Caring is more “healthogenic” than curing. The ▪ The term “Carative” means caring with love; science of caring is complementary to the science originates from the Latin word “Caritas” which of curing. means to cherish, appreciate, and give special 7. The practice of caring is central to nursing attention. ▪ Carative factors attempt to “honor the human ▪ Born on June 10, 1940, and grew up in Welch, dimensions of nursing’s work and the inner life West Virginia, and currently living in Colorado world and subjective experiences of the people ▪ Founder of the original Center for Human we serve” Caring in Colorado. ▪ Watson’s philosophy of caring attempts to define WATSON’S TEN CARATIVE FACTORS the outcome of nursing activity regarding the humanistic aspects of life. Her theory and 1. Formation of Humanistic-Altruistic System of philosophy of caring is based on the values of Values (Embrace) kindness, concern, love of self and others and ▪ Begins at an early age with the values shared by respect for the spiritual dimension of the person. parents. ▪ Watson’s defined nursing as a human science of ▪ The system of values is mediated by the nurse’s persons and humans’ health- Illness experiences life experiences, learning gained, and exposure to that are mediated by professional, personal, the humanities. It is perceived as necessary to the scientific, esthetic and ethical human care and nurse’s maturation which in turn promotes transaction. altruistic (selfless) behavior towards others. ▪ The foundation of Watson's theory of nursing was published in 1979: “Nursing: The 2. Installation of Faith-Hope (Inspire) Philosophy and Science of Caring” ▪ Essential to both carative and curative processes. ▪ When modern science has nothing else to offer to a patient, a nurse can continue to use faith-hope to provide a sense of well-being through a belief system meaningful to the individual. 3. Cultivation of Sensitivity to One’s Self and to 8. Provisions for a Supportive, Protective and / Others (Trust) or Corrective Mental, Physical, Sociocultural ▪ There is a need for the nurse to develop and and Spiritual Environment (Co-create) examine one's own feelings. ▪ An interdependence exists between internal and ▪ Increased sensitivity to others is developed. The external factors since the person perceives the nurse becomes authentic and promotes self- situation in the environment as either threatening growth and self-actualization. or non-threatening. ▪ Nurses promote "health and higher-level ▪ Which Watson’s divides into interdependent functioning only when they form person-to- internal and external variables: person relationships” ▪ External Variables which include physical, safety and environmental factors; and 4. Development of a Helping-Trust Relationship ▪ Internal variables which refer to mental, (Nurture) spiritual or cultural activities ▪ Communication, both verbal and non-verbal, is a ▪ The nurse's intervention is aimed at helping, the mode of accomplishing a helping-trust person develops a more accurate perception to relationship to establish rapport and caring. help strengthen coping capabilities. Provision of ▪ Includes congruence, empathy, warmth and comfort, safety and privacy are major aspects of honesty. this carative factor. ▪ Listening that connotes empathetic understanding. 9. Assistance with the Gratification of Human ▪ e.g. Addressing the patient with their last name Needs (Minister) ▪ The hierarchy of human needs is the essence of 5. Promotion and Acceptance of the Expression this carative factor. of Positive and Negative Feelings (Forgive) ▪ Watsons has created a hierarchy which she ▪ It is important to facilitate awareness of both believes is relevant to the science of caring in negative and positive feelings to improve on nursing. According to her, each need is equally one's level of awareness. important for quality nursing care and the ▪ Need to be considered and allowed for in a caring promotion of optimal health. All the needs relationship because of how feelings alter deserve to be attended to and valued. thoughts and behavior. ▪ The awareness of the feelings helped the nurse, 10. Allowance for Existential-Phenomenological- and the patient understand the behavior it causes. Spiritual Forces (Open) ▪ Phenomenology is a way of understanding 6. Systematic Use of the Scientific Problem- people from the way things appear to them, from Solving Method for Decision Making (Deepen) their frame of reference. ▪ Which allows for control and prediction, and ▪ Existential Psychology is the study of human permit self-correction. The science of caring existence using phenomenological analysis. should not always be neutral and objective. ▪ This factor helps the nurse to reconcile and ▪ Utilizing research-based findings to improve mediate the incongruity of viewing the person nursing practice and provide holistic care. holistically while at the same time attending to the hierarchical ordering of needs. Thus, the 7. Promotion of Interpersonal Teaching- nurse assists the person to find the strength or Learning (Balance) courage to confront life or death. ▪ Since the nurse should focus on the learning process as much as the teaching process. Understanding the person's perception of the situation assists the nurse to prepare a cognitive plan. ▪ Persons (patients) gain control over their own health because it provides them with both information and alternatives. Learning offers opportunities to individualize information dissemination. WATSON’S NURSING METAPARADIGM / FOUR MAJOR CONCEPTS 1. HUMAN BEING ▪ She adopts a view of the human being as a valued person in and of him or herself to be cared for respected, nurtured, understood, and assisted. In general, a philosophical view of a person as fully functional integrated self. ▪ Human as greater than and different from, the sum of his parts. 2. HEALTH ▪ Refers to unity and harmony within mind ▪ Combination of body, mind, and soul. ▪ Watson believes that there are other factors that are needed to be included in the world health organization (WHO) definition of health. She adds the following 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) 3. ENVIRONMENT / SOCIETY ▪ 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. ▪ Provides the values that determine how one should behave and what goals one should strive toward. 4. NURSING ▪ “Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health” ▪ It focuses on health promotion and treatment of disease. She believes that holistic care is central to the practice of caring in nursing. ▪ Watson’s defined nursing as- a human science of persons and human health- illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transaction. 3. PATRICIA BENNER ▪ Benner’s research and theory work provides the profession of nursing with what we know as the FROM NOVICE TO EXPERT (Stages of Novice to Expert model, also known as Nursing Expertise Nursing Philosophies) Benner’s Stages of Clinical Competence. ▪ Benner’s work as applied to the nursing ▪ Born on August 1942, in Hampton, Virginia; profession is adapted from the Dreyfus Model American of Skill Acquisition. ▪ Benner has a wide range of clinical experience, including positions in acute medical-surgical, critical care, and home health care. DREYFUS MODEL OF SKILL ACQUISITION ▪ Dr. Benner categorized nursing into 5 levels of ▪ An influential framework that outlines the capabilities: Novice, Advanced Beginner, progression of skill development through distinct Competent, Proficient, and Expert. stages. This five-stage model provides a ▪ She believed experience in the clinical setting is comprehensive understanding of the learning key to nursing because it allows a nurse to process, offering valuable insights into how continuously expand their knowledge base and to individuals acquire, refine, and master new skills. provide holistic, competent care to the patient. ▪ Her research was aimed at discovering if there were distinguishable, characteristic differences BENNER’S STAGES OF CLINICAL in the novice’s and expert’s description of the COMPETENCE same clinical incident. STAGE 1: NOVICE ▪ A beginner with no experience. They are taught Benner’s Nursing Education: general rules to help perform task, and their rule- ▪ She obtained a baccalaureate of arts degree from governed behavior is limited and inflexible. In Pasadena College in 1964. other words, they are told what to do and ▪ In 1970, she earned a master’s degree in nursing, simply follow instructions. e.g., Nursing student with major emphasis in medical- surgical ▪ Novices have very limited ability to predict what nursing, from the University of California, San might happen in a particular patient situation. Francisco (UCSF) School of Nursing. ▪ There is difficulty discerning between relevant ▪ Her PhD in stress, coping, and health was and irrelevant aspect of the situation. conferred in 1982 at the University of California, ▪ Beginner to profession or nurse changing area of Berkeley practice Benner as An Author STAGE 2: ADVANCED BEGINNER Dr. Benner is the author of books including: ▪ Demonstrates marginally acceptable performance. Nurses have had more 1. From Novice to Expert experiences that enable them to recognize 2. The Primacy of Caring recurrent, meaningful components of a 3. Interpretive phenomenology: embodiment, situation. caring and ethics in health and illness ▪ Has experienced enough real situations to make 4. The Crisis of Care judgments about them. 5. Expertise in Nursing Practice: Caring, ▪ Nurses functioning at this level are guided by Clinical Judgment, and Ethics rules and oriented by task completion 6. Caregiving ▪ Still requires mentor or experienced nurses to 7. Clinical Wisdom and Interventions in Critical assist with defining situation, to set priorities, and Care: A Thinking-in-action Approach to integrate practical knowledge. ▪ e.g. Fresh graduates in their first jobs STAGE 3: COMPETENT HEALTH ▪ Has 2 or 3 years of experience. Demonstrates ▪ Dr. Benner focuses on the lived experience of being advance organizational and planning abilities. healthy and being ill. ▪ Health is defined as what can be assessed whereas ▪ Differentiates important factors from less well-being is the human experience of health or important aspects of care. wholeness. ▪ Devices new rules and reasoning procedures for ▪ Well-being and being ill are understood as distinct a plan while applying learned rules for action ways of being in the world. based on the relevant facts of the situation. ▪ Coordinates multiple complex care demands. ENVIRONMENT / SITUATION STAGE 4: PROFICIENT ▪ Benner uses situation rather than environment because situation conveys a social environment with ▪ Has 3 to 5 years of experience. The performer social definition. perceived the situation as a whole (total ▪ “To be situated implies that one has a past, present, picture) rather than in terms of aspects. and future and that all of these aspects… influence the ▪ Uses maxims as guides for what to consider in a current situation” situation. ▪ Has holistic understanding of the client, which NURSING improves decision making. ▪ Focuses on long-term goals. ▪ Nursing is described as a caring relationship, an ▪ Nurses at this level demonstrate a new ability to “enabling condition of connection and concern” ▪ “Caring is primary because caring sets up the see changing relevance in a situation including possibility of giving and receiving help” the recognition and the implementation of skilled ▪ Nursing is viewed as a caring practice whose responses to the situation as it evolves. science is guided by the moral art and ethics of care and responsibility. ▪ Dr. Benner understands that nursing practice as STAGE 5: EXPERT the care and study of the lived experience of health, illness, and disease and the relationship ▪ 5 years or greater of experience. Performance among the three elements. is fluid, flexible, and highly proficient; They have an intuitive grasp of the situation based on their deep knowledge and experience. ▪ Able to identify the origin of the problem without wasting time considering the range of alternative diagnosis and solutions. ▪ The expert performer no longer relies on the analytical principles (i.e. rules, guidelines, maxims) to connect an understanding of the situation to appropriate action. ▪ The expert operates from a deep understanding of the total situation. BENNER’S NURSING METAPARADIGM CLIENT / PERSON ▪ "The person is self-interpreting being, that is the person does not come into the world predefined but gets defined in the course of living a life.” ▪ How the person defined its own life 4. KATIE ERIKSSON THE ACT OF CARING ▪ Contains the caring elements (faith, hope, love THEORY OF CARITATIVE CARING tending, playing and learning), involves the BIOGRAPHY AND CAREER categories of infinity and eternity, and invites to deep communion. ▪ Born on November 18, 1943, in Jakobstad, ▪ The act of caring is the art of making something Finland. very special out of something less special. ▪ Katie Eriksson is a Finland-Swedish nurse. ▪ One of the pioneers of caring science in the THEORY OF CARITATIVE CARING Nordic countries, forerunner of basic research in caring science. CARITATIVE CARING ETHICS ▪ After taking nursing in 1965 in Helsinki Swedish ▪ Comprises the ethics of caring, the core of which School for Nursing, she became a nursing is determined by Caritas motive. instructor at Helsinki Swedish Medical ▪ An approach that is based on the ethics in care Institute. means that we, without prejudice, see that human ▪ Her main area of work was teaching and being with respect, and that we confirm their research. absolute dignity. It also means that we are willing ▪ In 1986, she founded the Department of Caring to sacrifice something of ourselves. Science at Abo Akademi University in Vaasa, ▪ This model of nursing distinguishes between where she is currently working there as a caring ethics and nursing ethics. professor of health sciences. Where she built a Caring Ethics master's degree program in health sciences, and a ▪ The practical or basic relationship between four-year postgraduate studies program leading the patient and the nurse -the way in which the to a doctoral degree in health sciences. nurse meets the patient in an ethical sense. ▪ The core of nursing ethics. Nursing Ethics ▪ The ethical principles and rules that guide a nurse's work and decision-making abilities. ▪ Standards and the responsibilities of a nurses towards the patients ▪ e.g., Nurse boundaries and scope. Caritative Caring ▪ Consist of Caritas, which means love and charity, respect and reverence for human CARITAS holiness and dignity. ▪ Means Love and Charity, Eros and Agape are ▪ Suffering that occurs because of a lack of united caritative care is a violation of human ▪ By nature: Unconditional Love dignity. ▪ Fundamental motive of caring science; Motive for all caring. DIGNITY ▪ Caring is an endeavor to mediate faith, hope, and ▪ Constitutes one of the basic concepts of love through tending, playing, and learning caritative caring ethics. CARING COMMUNION Absolute Dignity ▪ Constitutes the context of the meaning of caring ▪ Granted through creation. and is the structure that determines caring reality. Relative Dignity ▪ It is a form of intimate connections that ▪ Influence and form to culture and external characterizes caring. context. ▪ Requires meeting in time and space, an absolute, lasting presence. ▪ Dignity as Human Being ▪ Characterized by intensity and vitality, and by ▪ Partly absolute and relative dignity. warmth, closeness, rest, respect, honesty and ▪ A human being’s absolute dignity involves the tolerance. right to be confirmed as a unique human being. ▪ Caring communion is seen as source of strength and meaning in caring. ▪ Dignity as Nurses ▪ It is one of the deepest forms of communication ▪ Patients look up to nurses ▪ Caring communication is what unites and ties ▪ Nurses should not have any vices together and gives caring a significance. ▪ Partly absolute and relative dignity ▪ Communion starts with communication. 5. MARTHA ELIZABETH ROGERS SCIENCE OF UNITARY MAN SCIENCE OF UNITARY HUMAN BEINGS ▪ Nursing is an art and science that is humanistic and humanitarian. It is directed toward the BIOGRAPHY AND CAREER unitary human and is concerned with the nature ▪ Born on May 12, 1914, in Dallas Texas. and direction of human development. ▪ Died on March 13, 1994, at age if 79 years of ▪ The goal of nurses is to participate in the process age of Nursing interventions seek to promote ▪ One of the most original thinkers of nursing, harmonious interaction between persons and for the way she synthesized and resynthesized their environment, strengthen the wholeness of knowledge into “an entirely new system of the individual and redirect human and thought” environmental patterns or organization to ▪ Today she is thought of as “ahead of her time, achieve maximum health. in and out of this world” ▪ e.g., How you treat the patient ▪ Nursing Practice: Rural public health, Michigan FIVE ASSUMPTIONS OF THE SCIENCE OF ▪ Visiting nurse supervision, education, and UNITARY HUMAN BEINGS practice in Connecticut 1. WHOLENESS ▪ Established Visiting Nurse Service of Phoenix, ▪ Human being is considered as united whole. Arizona ▪ Possessing individual integrity and ▪ For 21 years, she was a professor and head of the manifesting characteristics that are more than Nursing Division, New York University. and different from the sum of parts. ▪ In 1979, she become a Professor Emerita, held this until her death. 2. OPENNESS ▪ The individual and the environment are ▪ Published 3 books, with more than 200 articles continuously exchanging matter and energy 1. An introduction to the Theoretical Basis of with each other Nursing (1970) ▪ e.g., Gardens and entertaining painting for ▪ Described as conceptual model for nursing children and adults in hospitals 2. Nursing Science and an Art: A Prospective 3. UNIDIRECTIONALITY (1988) ▪ The life process of human being evolves 3. Nursing Science of Unitary Irreducible irreversibly and unidirectionally along a space- Unitary Human Beings (1990) time continuum. ▪ All humans undergo in just one process ▪ i.e. from birth to death INTRODUCTION OF THEORY ▪ The belief of the coexistence of the human and the 4. PATTERN AND ORGANIZATION environment has greatly influenced the process of ▪ Pattern identifies individuals and reflects their change toward better health. innovative wholeness. ▪ A patient can't be separated from their 5. SENTENCE AND THOUGHT environment when addressing health and ▪ Humans are the only organisms able to think, treatment. imagine, have language and emotions. ▪ This view lead and opened Rogers' theory, known ▪ The individual is characterized by the capacity as the "Science of Unitary Human Beings," for abstraction and imagery, language and which allowed nursing to be considered one of the thought, sensation and emotion. scientific disciplines ▪ Rogers repeatedly stated that she did not create a FOUR MAJOR CONCEPTS OF THE SCIENCE "theory" but rather an abstract system, a science, OF UNITARY HUMAN BEINGS from which many theories may be derived. ▪ All the human beings are viewed as an integral part of universe. ▪ Human beings and the environment have energy field, nursing action is directed towards patterning and maintaining these energy fields. 1. ENERGY FIELD THREE MAJOR PRINCIPLES / ▪ It is inevitable part of life. HOMEODYNAMIC PRINCIPLES OF THE ▪ Human and environment both have energy SCIENCE OF UNITARY HUMAN BEINGS field which is open ▪ Homeodynamics refers to the balance between ▪ i.e. energy can freely flow between human and the dynamic life process and environment. environment ▪ These principles help to view human as unitary ▪ Energy is the “potential for process, human being. movement, and change” ▪ The principles of homeodynamics postulate the ▪ The energy field is the conceptual boundary of way of perceiving unitary human needs. all that is. ▪ The fundamental unit of the living system is an ▪ Fundamental unit of both living and the energy field nonliving. ▪ Major principles include: Resonancy, Helicy and ▪ Provides a way to perceive people and their Integrity. environment as irreducible wholes ▪ These principles describe the nature of the person ▪ Continuously varies in intensity density, and and environment process involving change and extent. growth. 2. OPENNESS 1. RESONANCY ▪ The human field and environment field are ▪ The intensity of change embraces the constantly exchanging energy. continuous variability of the human energy ▪ There is no boundary or barrier that can field as it evolves inhibit the flow of energy between human and ▪ An ordered arrangement of three teams environment which leads to the continuous characterizing both humans’ field and the movement or matter of energy. environmental fields that undergoes ▪ “The human beings openly participate in continuous dynamic metamorphosis in the energy transformation with the environment human environment process creating mutual change” 2. HELICY 3. PATTERN ▪ The unpredictable but continuous, nonlinear ▪ Pattern is defined as the distinguishing evolution of energy fields as evidenced by characteristic of an energy field perceived as nonrepeating rhythmicities. a single wave. ▪ The life process involves sequential stages ▪ Rogers calls it "pattern is an abstraction that along a curve that has the same general gives identity to the field" shape. ▪ Patterning “is the dynamic or active process of ▪ The principle of helicy postulates is an the life of the human being” that is “accessible ordering of the human’s evolutionary to the senses”. emergence ▪ Pattern manifestations include “a person’s experiences, expression, perceptions, and 3. INTEGRITY physical, mental, social and spiritual data”. ▪ Encompasses the mutual, continuous relationship of the human energy field and 4. PANDIMENSIONALITY the environment energy field. ▪ "A non-linear domain without spatial or ▪ Change of course by continuous returning temporal attributes" of the human and environmental health by ▪ Human being is pan-dimensional being and resonance wave. have more than three dimensions. ▪ The parameters in language that humans use to describe events are arbitrary. ▪ The present is relative, there is no temporal ordering of lives. ROGER’S NURSING METAPARADIGM NURSING PERSON / UNITARY HUMAN BEING ▪ A learned profession that is both science and art. Independent science of nursing ▪ Open system in continuous process with the open ▪ An organized body of knowledge which is system that is the environment (Integrality) specific to nursing is arrived at by scientific ▪ Unitary human being is an irreducible, research and logical analysis. indivisible, four-dimensional (pan dimensional) energy field identified by patterns and Art of nursing practice manifesting characteristics that are specific to the ▪ The creative use of science for the whole and which cannot be predicted from betterment of humans. knowledge of the parts. ▪ The creative use of its knowledge is the art ▪ A unified whole having its own distinctive of its practice characteristics which cannot be perceived by ▪ The art of nursing involves the imaginative and looking at, describing, or summarizing the parts. creative use of nursing knowledge. ▪ The person has the capacity to participate ▪ Nursing is the study of unitary, irreducible, knowingly in the process of change indivisible human and environment energy fields. ENVIRONMENT ▪ The purpose of nurses is to promote health and well-being for all persons and groups wherever ▪ Encompasses all that is outside any given human they are using the art and science of nursing. field. A person exchanging matter and energy. ▪ The health services should be community-based ▪ The environment is an “irreducible pan- dimensional energy field identified by patterns and integral with the human field. ▪ The fields coexist and are integral. Manifestation emerges from this field and is perceived. ▪ Each environment field is specific to its given human field. Both changes continuously and creatively. ▪ Environmental and human fields are identified by wave patterns manifesting continuous mutual change. HEALTH ▪ Not specifically addressed, but emerges out of interaction between human and environment, moves forward, and maximizes human potential. ▪ Roger’s defined health as an expression of the life process: “characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environment fields. ▪ Health and illness are parts of the same continuum (moves forward). ▪ Multiple events taking place along life’s axis denote the extent to which man is achieving his maximum health potential and vary in their expressions form greatest health to those conditions which are incomparable with the maintaining life presence. 6. DOROTHEA ELIZABETH OREM Self-Care Requisites ▪ Actions directed towards provision of self- SELF-CARE DEFICIT NURSING THEORY care. (SCDNT) ▪ Three categories of self-care requisites are: ▪ Nursing’s concern – “man’s need for self-care 1. Universal Self-Care Requisites action and the provision and management of it on ▪ Associated with life processes and the a continuous basis in order to sustain life and maintenance of the integrity of human health recover from disease or injury, and cope structure and functioning. with their effects” ▪ Common to all activities of daily living ▪ Nursing goal – “overcoming human limitations” (ADL) BIOGRAPHY AND EDUCATION 2. Developmental Self-Care Requisites ▪ Born on 1914 in Baltimore, Maryland, US. ▪ Associated with developmental processes, ▪ Died on June 22, 2007, at the age of 92. derived from a condition, or associated ▪ One of America’s foremost nursing theorists with an event ▪ Earned her diploma at Providence Hospital at 3. Health Deviation Self-Care Requisites Washington, DC ▪ Required in conditions of illness, injury, or ▪ In 1939, she earned her Bachelor of Science in disease Nursing Education at University of America. THEORY OF SELF-CARE DEFICIT ▪ In 1945, she earned her Master of Science in Nursing at University of America. Self-Care Deficit ▪ A term used to define the relationship between THEORY OF SELF-CARE the actions that are capable by an individual and their demands for care. Self -Care ▪ An abstract concept, when expressed in the ▪ The performance or practice of activities that terms of action limitation. individuals initiate and perform or their own behalf to maintain life, health and well-being. ▪ It provides guides in helping and ▪ An action system that must be learned and must understanding patient role in self-care. be performed deliberately and continuously in ▪ The nursing action of self-care deficit focuses on time and in conformity with the regulatory the identification of limitations and implements. requirements of individuals. appropriate interventions to meet the needs of the person. ▪ When self-care is effectively performed, it helps to maintain structural integrity and human functioning and contributes to human development. Self Care Agency ▪ Self-care agency is the human's acquired power and capabilities to engage in self-care. ▪ The ability to engage in self-care is affected by basic conditioning factors. ▪ The basic conditioning factors are age, gender, developmental state, health state, sociocultural orientations, health care system factors, pattern of living, life experience, and available THEORY OF NURSING SYSTEMS resources. Nursing system Therapeutic Self-Care Demand ▪ Series and consequences of deliberate practical ▪ Total of care activities needed, either at an actions of nurses performed at times in identified moment or over a period, to meet a coordination with the actions of their patients person's known requirements for self-care. to know and meet components of patient’s ▪ Totality of self-care actions to be performed for therapeutic self-care demands and to protect some duration in order to meet self-care requisites by using valid methods and related and regulate the exercise of development of sets of operations and actions. patients’ self-care agency. ▪ This theory describes how the patient's self-care HEALTH needs will be met by the nurse, the patient, or both. ▪ Structural and functional soundness and ▪ If there is a self-care deficit- that is, if there is a wholeness of the individual (Orem 1991). difference between what the individual can do (self- ▪ When human beings are structurally and care agency) and what needs to be done to maintain functionally whole or sound. optimum functioning (therapeutic self- care demand)- nursing is required. ▪ Wholeness or integrity includes that which makes a person human operating in conjunction CLASSIFICATION OF NURSING SYSTEM with psychological and psychophysiological mechanisms and a material structure and in ▪ It identifies 3 classifications of nursing system to relation to and interacting with other human meet the self-care requisites of the patient: beings. 1. WHOLLY COMPENSATORY SYSTEM ▪ A patient's self-care agency is so limited that NURSING they depend on others for well-being. ▪ The acts of a specially trained and able individual ▪ The patient is dependent. to help a person or multiple people deal with their ▪ The nurse is expected to accomplish all the actual or potential self-care deficits. patient’s therapeutic self-care or to compensate ▪ Is an art, a helping service, and a technology. for the patient’s inability to engage in self-care or when the patient needs continuous guidance in self-care. ▪ e.g., The patient is unconscious because he had a stroke. 2.PARTLY COMPENSATORY SYSTEM ▪ The patient can meet some needs ▪ needs nursing assistance ▪ Both the nurse and the patient engaged in meeting self-care needs. ▪ e.g., Fractured, lower extremities are gone or damaged 3. SUPPORTIVE - EDUCATIVE SYSTEM ▪ Patients can meet self-care requisites. ▪ Needs assistance with decision making or knowledge and skills to learn self-care ▪ e.g., Diabetic patients, Pregnant, and Vaccine OREM’S NURSING METAPARADIGM PERSON / HUMAN BEING / NURSING CLIENT ▪ An individual with physical and emotional requirements for development of self and maintenance of their well-being. ▪ A total being with universal, developmental needs and capable of continuous self-care. ENVIRONMENT ▪ Client's surroundings which may affect their ability to perform their self-care activities. ▪ Components are environmental factors, environmental elements, conditions, and developmental environment. 7. IMOGENE KING 1. PERSONAL / INDIVIDUAL SYSTEM ▪ Personal systems are individuals, who are THEORY OF GOAL-ATTAINMRENT / regarded as rational, sentient, and social beings. GOAL ATTAINMENT THEORY ▪ The concepts for the personal system are perception, self, growth and development, BIOGRAPHY AND CAREER body image, learning, time, and personal ▪ Born on January 30, 1923, in West Point, Iowa space. These are fundamentals in understanding ▪ Died on December 24, 2007, at the age of 84 human being because this refers to how the nurse ▪ Earned a diploma in nursing from St. John's views and integrates self-based from personal Hospital of Nursing in St Louis in 1945. goals and beliefs. ▪ Worked as office nurse, staff nurse, school nurse, ▪ Among all these concepts, the most important is and private duty nurse to support herself while perception, because it influences behavior. studying for a baccalaureate degree. ▪ Concepts related to the personal system are: ▪ Bachelor of Science in Nursing from St. Louis University in 1948 PERCEPTION ▪ Master of Science in Nursing from St. Louis ▪ A process of organizing, interpreting, and University in 1957 transforming information from sense data and ▪ Doctorate from Teacher's college, Columbia memory that gives meaning to one's experience. University, New York in 1961. ▪ Represents one's image of reality and influences one's behavior. THEORY OF GOAL ATTAINMENT ▪ Describes the importance of the participation of SELF all individuals in decision making as well as ▪ A composite of thoughts and feelings that constitute choices, alternatives, and outcomes of nursing a person's awareness of individual existence, of care. who and what he or she is. ▪ It pertains to the importance of interaction, perception, communication, transaction, self, GROWTH AND DEVELOPMENT role, stress, growth and development, time, and personal space. ▪ Cellular, molecular and behavioral changes in ▪ Reflects King's belief that the practice of nursing human beings that are a function of genetic is differentiated from other healthcare endowment, meaningful and satisfying professions by what nurses do with and what they experiences, and an environment of conducive to do for individual. helping individuals move toward maturity. ▪ The nurse and patient/client communicates ▪ The processes that take place in an individual's life information in order to set goals mutually and that help the individual move from potential then acts to attain those gools. capacity for achievement to self-actualization. ▪ It was developed by Imogene king in the early 1960’s. BODY IMAGE ▪ A person’s perception of his or her body. 3 INTERACTING SYSTEM ▪ Other reaction to his or her appearance which ▪ King developed a general systems framework results from others’ reaction to self and a theory of goal attainment where the framework refers to the three interacting systems: LEARNING ▪ Gaining knowledge by experience 1. PERSONAL / INDIVIDUAL SYSTEM ▪ Teaching-Learning process, a nurse learns from 2. INTERPERSONAL / GROUP SYSTEM their patients, and the patients learn from the nurses. 3. SOCIAL / SOCIETY SYSTEM TIME TRANSACTION ▪ The duration between the occurrence of one event ▪ A process of interaction in which human beings and the occurrence of another event. communicate with the environment to achieve ▪ Nurses should use their time wisely. goals that are valued; goal-directed human ▪ One at a time behaviors. ▪ We cannot turn back the time. ▪ Observable behaviors of human beings interacting with their environment. SPACE / PERSONAL SPACE ROLE ▪ The physical area called territory that exists in all direction and is the same everywhere. ▪ A set of behaviors expected of a person occupying ▪ Boundaries and limitations. a position in a social system. 2. INTERPERSONAL / GROUP SYSTEM STRESS ▪ Two or more individuals in interaction form ▪ A dynamic state whereby a human being interacts interpersonal system. with the environment to maintain balance for ▪ As the number of individuals increases, so does growth, development, and performance which the complexity of the interaction. involves an exchange of energy and information ▪ Dyads – Two individuals between the person and the environment for ▪ Triads – Three individuals regulation and control of stressors. ▪ Small Group or Large Group – Four or more individuals STRESSORS ▪ This shows how the nurse interrelates with a co- worker or patient, particularly in a nurse-patient ▪ Events that produce stress. relationship. ▪ Communication between the nurse and the client COPING can be verbal or nonverbal. Collaboration between the Dyads (nurse-patient) is very ▪ A way of dealing with stress. important for the attainment of the goal. ▪ The constantly changing cognitive and behavioral ▪ The concepts associated for the interpersonal efforts to manage specific external and internal system are: demands that are appraised as taxing or exceeding the resources. INTERACTIONS 3. SOCIAL / SOCIETY SYSTEM ▪ The acts of two or more persons in mutual ▪ The final interacting system is the social system. presence. ▪ Compose of large groups with common interests ▪ A sequence of verbal and nonverbal behaviors that or goals. are goal directed. ▪ Social systems are organized boundary systems of social roles, behaviors, and practices COMMUNICATION developed to maintain values and the ▪ The vehicle by which human relations are mechanisms to regulate the practices and rules. developed and maintained ▪ This shows how the nurse interacts with ▪ Encompasses intrapersonal, interpersonal, verbal, coworkers, superiors, subordinates and the client and nonverbal communication. environment in general. ▪ Information processing, a change of information ▪ These are groups of people within the community from one state to another. or society that share a common goals, values and ▪ Communication is a way to know the patient; interests. should be therapeutic communication. ▪ It provides a framework for social interaction and relationships and establishes rules of behavior and courses of action. ▪ Interactions with social systems influence individuals throughout their lifespan. ▪ Concepts that are useful to understand ENVIRONMENT interactions within social systems and between ▪ King defined Environment as the process of social and personal systems are as follows: balance involving internal and external AUTHORITY interactions inside the social system. ▪ Reactions from the interaction between the ▪ A transactional process characterized by active, internal and external environment can be reciprocal relations in which members' values, biological, psychological, physical, social or backgrounds, and perceptions play a role in spiritual. defining, validating, and accepting the authority of ▪ It has a direct exchange of information between individuals within an organization. the internal and external. POWER HEALTH ▪ The processes whereby one or more persons ▪ A dynamic state in the life cycle; illness influence other persons in a situation. interferences with that process. ▪ The capacity or ability of a group to achieve goals. ▪ Health implies continuous adjustment to stress in the internal and external environment through STATUS optimum use of one's resources to achieve ▪ The position of an individual in a group or a group maximum potential for daily living. in relation to other groups in an organization. NURSING DECISION MAKING ▪ Nursing is a process of action, reaction, and ▪ A dynamic and systematic process by which goal- interaction whereby nurse and client share directed choice of perceived alternatives is made, information about their perceptions in the and acted upon, by individuals or groups to answer nursing situation. a question and attain a goal. ▪ The nurse and client share specific goals, problems, and concerns and explore means to CONTROL achieve a goal. ▪ Being in charge ▪ Be accountable and responsible KING’S NURSING METAPARADIGM PERSON ▪ King described a person existing in an open system as a spiritual being and rational thinker who makes choices, selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals. 8. BETTY NEUMAN LINES OF RESISTANCE NEUMAN SYSTEMS MODEL ▪ A series of broken rings surrounding the basic core structure. HISTORY AND BACKGROUND ▪ Act when the normal line of defense is invaded by too much stressor, producing alterations in the ▪ Born in 1924, in Lowel, Ohio, United States client's health. ▪ Died on May 12, 2022, at the age of 97 ▪ It acts to facilitate coping to overcome the stressors ▪ In 1947, she received RN Diploma from Peoples that are present within the individual. Hospital School of Nursing, Akron, Ohio. ▪ These rings represent resource factors that help ▪ Completed B.Sc. nursing in 1957, and MS in defend against a stressor. Mental Health Public health consultation, from ▪ “Lines of resistance serve as protection factors that University of California at Los Angeles (UCLA) are activated by stressors penetrating the normal in 1966. line of defense.” ▪ A pioneer in the community mental health movement in the late 1960s. NORMAL LINE OF DEFENSE HISTORY OF THE NEUMAN'S SYSTEMS ▪ To achieve the stability of the system, the normal MODEL line of defense must act in coordination with the normal wellness state. It must reflect the actual ▪ Developed in 1970 as a teaching tool to range of responses to any stressors. integrate four variables of man. ▪ The normal line of defense in the model's outer ▪ 1974 - published and classified as a systems solid circle. model called "The Betty Neuman Health-Care Systems Model: A Total Approach to Patient FLEXIBLE LINE OF DEFENSE Problems" ▪ Published first book detailing NSM in 1982. ▪ Serves as boundary for the normal line of defense Notable change: "patient" now referred to as to adjust to situations that threaten the imbalance "client" within the client's stability ▪ The Neuman Systems Model, 2nd ed., 1989. ▪ It expanded the range of normal defense from Spiritual variable added to diagram as fifth becoming invaded by the stressors thus increasing variable. its protection. ▪ 3rd, 4th & 5th editions of The Neuman Systems ▪ The models outer broken rings. Model published in 1995, 2002 and 2010. ▪ Protective buffer for preventing stressors form breaking through the usual wellness state as CLIENT SYSTEM represented by the normal line of defense. ▪ A composite of five variables (physiological, WELLNESS psychological, sociocultural, developmental and spiritual) in interaction with the environment. ▪ "Wellness exists when all system subparts 1. Physiological Variable interact in harmony with the whole system and all ▪ Refers to the body structure and function. system needs are being met." ▪ Absence of Illness. 2. Psychological Variable ▪ Refers to mental process in interaction with the ILLNESS environment. ▪ "Illness exists at the opposite end of the continuum 3. Sociocultural Variable from wellness and represents state of instability ▪ Refers to the effects and influences of social and energy depletion” and cultural conditions. 4. Developmental Variable STRESSOR ▪ Refers age-related processes and activities. ▪ Are forces that produce tensions, alterations or potential problems causing instability within the 5. Spiritual Variable client's system it could be positive or negative ▪ Refers to spiritual beliefs and influences. outcome. ▪ Stressors may arise from the following: 2. SECONDARY PREVENTION a. Intrapersonal Forces ▪ Focuses on strengthening internal lines of ▪ Occurring forces within the individual, such as resistance, reducing the reaction of the stressor, “conditioned responses" and increasing resistance factors in order to ▪ e.g., emotions and feeling, hypertension, low prevent damage to the central core. This occurs blood glucose) after the system reacts to a stressor. ▪ “Involves interventions or treatment initiated b. Interpersonal Forces after symptoms from stress have occurred” ▪ Occurring forces between one or more ▪ The client’s internal and external resources are individuals, such as “role expectations" used to strengthen internal lines of resistance, ▪ e.g., role expectations, perceptions of reduced reaction, and increase resistance caregiver, friends’ relationship factors. 3. TERTIARY PREVENTION c. Extrapersonal Forces ▪ Focuses on readaptation and stability, and ▪ Occurring forces outside the individual, such protects reconstitution or return to wellness as “financial circumstance" after treatment. ▪ e.g., Job or finance pressures ▪ Occurs after the active treatment or secondary prevention stage. DEGREE OF REACTIONS ▪ The goal is to maintain optimal wellness by ▪ "The degree of reaction represents system preventing recurrence of reaction or instability that occurs when stressors invade the regression. normal line of defense." ▪ Tertiary prevention leads back in a circular fashion towards primary prevention. PREVENTION AS INTERVENTION RECONSTITUTION/ RECONSTRUCTION ▪ Interventions are purposeful actions to help the ▪ After treatment for stressor reactions. " It represents client retain, attain, or maintain system stability. system return of the system to stability" which may ▪ They can occur before or after protective lines of be at a higher or lower level of wellness than before defense and systems are penetrated. stressor invasion. ▪ Neuman defines prevention as the primary nursing ▪ It is the increase in energy that occurs in relation to intervention. the degree of reaction to the stressor ▪ Prevention focusses on keeping stressors and the ▪ It begins at any point following in initiation of stress response from having a detrimental effect on treatment for invasion of stressor. the body ▪ May expand the normal line of defense beyond its ▪ Depending upon man's reactions to stressors, previous level, stabilize the system at a lower level, primary, secondary and tertiary preventions may be or return it to the level that existed before the needed. illness. ▪ Neuman identifies three levels of intervention: NEUMAN’S NURSING METAPARADIGM 1. PRIMARY PREVENTION ▪ Focuses on protecting the normal line of PERSON defense and strengthening the flexible line of defense. ▪ Neuman's definition of a person was originally as ▪ This occurs before the system reacts to a physiological, psychological, socio-cultural, stressor and strengthens the person to enable spiritual and developmental being. them to better deal with stressor. ▪ The concept of person in the Neuman is called ▪ Used when a stressor is suspected or identified. client or client system. ▪ The client whether an individual, group, ▪ The purpose is to reduce the possibility of community or social system, is a dynamic encounter with stressor or to decrease the composite of interrelationships between possibility of a reaction. Physiological, Socio-cultural, Developmental and Spiritual variables, and basic structure variables. ▪ Clients are composed of a basic structure of survival factors inclusive of the five client system variables and surrounded by various lines of defense and resistance. ENVIRONMENT ▪ The environment is seen to be the totality of the Internal and External forces which surround a person and with which they Interact at any given time. ▪ These forces include the Intrapersonal, interpersonal and extrapersonal stressors which can affect the person's normal line of defense and so can affect the stability of the system ▪ The created environment is another example of Neuman's effort to delineate the holistic concept approach of the model in addition to spirituality HEALTH ▪ Is viewed as a continuum running from greatest Negentropic State (wellness) to greatest Entropic State (illness). ▪ It is a condition determine by the degree of harmonious arrangement of the five client variables and the basic structure factors and is reflected in the client's level of wellness. ▪ Neuman sees health as being equated with wellness. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client". NURSING ▪ Neuman sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor. ▪ Neuman defines nursing as actions which assist individuals, families, and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors. 9. SISTER CALLISTA ROY SYSTEM ROY’S ADAPTATION MODEL ▪ A set of parts connected to function as a whole for some purpose and that does by virtue of the HISTORY AND BACKGROUND interdependence of its parts. ▪ Systems also have inputs, outputs, and control and ▪ Born at Los Angeles on October 14, 1939. feedback processes. ▪ Nurse theorist, writer, lecturer, researcher and teacher. ADAPTATION LEVEL ▪ Professor and Nurse Theorist at the Baston College of Nursing in Chestnut Нill ▪ Represents the condition of the life processes ▪ Bachelor of Arts with a Major in Nursing from described on three levels as integrated, Mount St. Mary's College, Los Angeles in 1963. compensatory, and compromised. ▪ Master's Degree program in Pediatric Nursing ▪ A person's adaptation level is a constantly changing from the University of California, Los Angeles in point, made up of focal, contextual, and residual 1966. stimuli, which represent the person's own standard ▪ She entered the Sisters of St. Joseph of the range of stimuli to which one can respond Carondelet. with ordinary adopted responses. ▪ Roy had the significant opportunity of working FOCAL STIMULI with Dorothy E. Johnson ▪ Internal or external stimuli that most immediately confront the human system. WHY WAS THE ROY ADAPTATION MODEL CONTEXTUAL STIMULI CREATED? ▪ All other stimuli present in the situation that contribute to the effect of the focal stimulus. ▪ Promotes proper care for a patient by taking a ▪ All the environmental factors that present to holistic approach. the persons from within or without but which ▪ Makes a nurse take a step back and look at all are not the center of the person's attention parts of a patient's life that affect their health and and/or energy. wellness. ▪ Promotes positive adaptation. RESIDUAL STIMULI ▪ Defines the goals and expectations of nursing in ▪ Environmental stimuli within or without the their practice by providing a structured 6 step human system with effects in the current process to follow. situation that are unclear. ▪ Improves nursing and patient care. ADAPTATION PROBLEMS ROY ADAPTATION MODEL ▪ The occurrences of situations of inadequate ▪ The model "outlines the purpose of nursing as response to need deficits or excesses. promoting a person's adaptation, the process ▪ Seen not as nursing diagnosis, but areas of concern and outcome by which thinking and feeling for the nurse related to adapting person or group persons use conscious awareness and choice to (Within each adaptive mode). create human and environmental integration" ▪ Broad areas of concern related to adaptation. These (Hood, 2006). describes the difficulties related to the indicators of ▪ The model consists of four metaparadigm positive adaptation. concepts. These include person, environment, nursing and health. COPING PROCESS ▪ There are four modes of functioning. These ▪ Coping processes – Are innate or acquired ways include physiologic-physical mode, self- of interacting with the changing environment. concept, role function and interdependence. Innate Coping Mechanism ▪ Are genetically determined or common to the species and are generally viewed as an automatic process. ▪ Humans do not have to think about them  Acquired Coping Mechanism 2. SELF-CONCEPT MODE ▪ Develop through strategies such as learning. ▪ The composite of beliefs and feelings that one ▪ The experience encountered throughout life holds about oneself at a given time. contributes to customary responses to ▪ A psychological and spiritual characteristic of particular stimuli. the person. ▪ It is formed from perceptions, particularly of other's reactions, and directs one's behavior. 1. Regulator Subsystem ▪ The self-concept incorporates two components ▪ A major coping process involving the neural, these are: chemical, and endocrine systems. Physical Self ▪ e.g., Body adjusting to the weather ▪ Incorporates body sensation and body 2. Cognator Subsystem image. ▪ A major coping process involving four Personal Self cognitive-emotive channels: perceptual and ▪ Made up of self-consistency, self-ideal or information processing, learning, expectancy, and the moral-ethical-spiritual judgment, and emotion" self. RESPONSES ▪ The underlying need for the self-concept mode is the need to know who one is so that they can Adaptive Responses exist with a sense of unity. ▪ Responses that promote integrity of the person in terms of goals of survival, growth, 3. ROLE PERFORMANCE MODE reproduction, and mastery. ▪ Role function is the performance of duties based on given positions in society. Ineffective Responses ▪ The role function mode focuses on a person's ▪ Responses that do not contribute to integrity or role in society and in a group setting. adaptive goals, that is, survival, growth, ▪ A role, as the functioning unit of society is a set reproduction, and mastery. of expectations about how a person occupying one position behaves towards a person ROY ADAPTATION MODEL FOUR MODES occupying another position. OF FUNCTIONING ▪ Social Integrity – The goal of the role function. 1. PHYSIOLOGICAL MODE ▪ Physical mode involves the activities of all 4. INTERDEPENDENCE MODE cells, tissues, organs and systems that make up ▪ Involves one's relations with significant the body. others and support systems. In this mode one ▪ Involve the body's basic needs and ways of maintains psychic integrity by meeting needs dealing with adaptation in regard to fluid and for nurturance and affection. electrolytes; exercise and rest; elimination; ▪ Interdependence mode focuses on nutrition; circulation and oxygen; and interactions related to giving and receiving regulation, which includes the senses, love, respect and value in interdependent temperature and endocrine regulation relationships ▪ Refers to the way a person responds as a physical being to stimuli from the environment. ▪ The 5 physiological needs of this mode are: 1. Oxygenation 2. Nutrition 3. Elimination 4. Activity and Rest 5. Protection FOUR METAPARADIGM OF ROY ADAPTATION MODEL HUMAN BEING ▪ The Person viewed as an adaptive system, their health, and their environment. ▪ Interchanging with the environment ▪ Person also refers to families, groups, communities and the whole society HEALTH ▪ It is a process where he or she is striving to achieve their maximum potential. ▪ Health is a state and process of being and becoming integrated and a whole person ▪ It is a reflection of adaptation, that is, the interaction of the person and the environment. ENVIRONMENT ▪ All conditions, circumstances and influences that surround and affect the development and behavior of the person or groups ▪ A change acts as a stimulating and causes adaptive responses. NURSING ▪ Nursing acts to enhance the interaction of the person with the environment to promote adaptation. ▪ Healthcare profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole. 10. DOROTHY JOHNSON NURSING THE BEHAVIORAL SYSTEM MODEL ▪ "An external regulatory force which acts to preserve the organization and integration of the HISTORY AND BACKGROUND patient's behaviors at an optimum level....” ▪ Born on August 21, 1919, in Savannah Georgia ▪ Died in February 1999 at 80 years of age SEVEN SUBSYSTEMS ▪ 1938 AA Armstrong Jr. College ▪ Each has structural and functional components. ▪ BSN from Vanderbilt University School of ▪ A Subsystem is “a mini system with its own Nursing, 1942 particular goal and function that can be maintained ▪ MPH Harvard University in Boston, 1948 as long as its relationship to other subsystem or the ▪ Professional Experience; Mostly involved environment is not disturbed” teaching ▪ Identified by Johnson are open, linked, and ▪ In 1943 to 1944 she is a nurse at Chatham- interrelated. Input and output are components of all Savannah Health Council seven subsystem ▪ In 1949 to 1978 she is an instructor and assistant professor in pediatric nursing at Vanderbilt ▪ Johnson proposed that the client is a behavioral University School of Nursing system, organized into seven subsystem of behavior ▪ Professor of nursing at University of California which are as follows: in LA 1. ATTACHMENT-AFFILIATIVE SUBSYSTEM ▪ In 1980 she published the Behavioral System ▪ Development and maintenance of interpersonal Model