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1ST SEMESTER BACHELOR OF SCIENCE IN NURSING TFN OUTLINE (MIDTERM) Module 1: Care Enhancement Qualities Including M1 LESSON 1: Course Introduction Core Values and Outcomes – based Education A registered nurse is a person...

1ST SEMESTER BACHELOR OF SCIENCE IN NURSING TFN OUTLINE (MIDTERM) Module 1: Care Enhancement Qualities Including M1 LESSON 1: Course Introduction Core Values and Outcomes – based Education A registered nurse is a person who: Module 2: Gearing Up For Self-Empowerment  Has successfully completed a recognized Module 3: Introduction to Nursing Theory and approved nursing education program Module 4: Client-Centered Theory by Dr. Sofia in the country where the qualification was Magdalena N. Robles & Mary Grace Gutierrez achieved;  Has acquired the necessary requirements to MODULE 1: CARE ENHANCEMENT QUALITIES be registered to practice nursing in this jurisdiction and use the title ‗registered INTRODUCTION nurse‘; Focuses on the care enhancement qualities of the  Demonstrates and maintains competency in Nurse. Qualities that are grounded on the the practice of nursing. theoretical underpinnings of the profession. The Nursing theories serve as the foundation or the The scope of nursing practice is the range of roles, backbone of the nursing practice since it brings into functions, responsibilities, and activities which a focus essential principles that can rationalize nursing registered nurse is educated, competent, and has actions and establishes a framework for making authority to perform. decisions and advancing into practice. Nursing practice is underpinned by values that The module then presents the importance of guide the way in which nursing care is provided. developing Core Values where Nurses' put a prime The following values should underpin nursing on the caring aspect of the profession and the practice and provide the basis for the formulation relative importance of developing attributes to of a philosophy of nursing: anchor the nursing practice. The topic on outcomes-based education highlights the need to 1. In making decisions about their individual adequately adjust to the established standards of scope of practice; nurses should keep to the nursing education which is essential to the holistic fore the rights, needs, and overall benefit to development of a nurse. the patient and the importance of promoting and maintaining the highest GRAPHIC ORGANIZER - 2 standards of quality in the health services. The care enhancement qualities of the nurse entails the development of relevant core values as 2. Nurses respect all people equally without founded on the outcomes based education. The discriminating on the grounds of age, contents of the module are: (1) Introduction, (2) gender, race, ethnicity, religion, civil status, Core Enhancement Qualities, (3) Core Values in the family status, sexual orientation, disability Nursing Profession, and (4) Outcomes Based (physical, mental or intellectual), or Education. membership of the Traveller community. 3. Fundamental to nursing practice is the therapeutic relationship between the nurse and the patient that is based on open communication, trust, understanding, compassion, and kindness, and serves to empower the patient to make life choices. 4. The nursing practice involves advocacy for the rights of the individual patient and for 1  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING their family. It also involves advocacy on On the other hand, Outcomes-Based Education behalf of nursing practice in organizational (OBE) is considered as a strategy or direction in and management structures within nursing. Nursing to meet the Philippine Education Quality 5. Nurses recognize their role in delegating Assurance Standards set by the government. care appropriately and providing supervision to junior colleagues and other THE THREE DOMAINS OF LEARNING ARE: health care workers, where required. 1. Cognitive 2. Psychomotor 6. Nursing care combines art and science. 3. Affective Nursing care is holistic in nature, grounded in an understanding of the social, emotional, MODULE 2: DIFFERENT VIEWS ON NON- cultural, spiritual, psychological, and NURSING THEORIES physical experiences of patients, and is based upon the best available research and experiential evidence. INTRODUCTION While caring for patient nurses often learns and uses 7. Nursing practice must always be based on nursing theory as a great resource. However, there the principles of professional conduct stated are other theories that are considered not specific in the latest edition of the Code of for nurses but are able to provide valuable and Professional Conduct and Ethics for useable information to contribute for the Registered Nurses. betterment of the Nursing profession. An individual nurse‘s scope of practice is dynamic – The different Non- Nursing Theories can serve as the that is, it will change and grow as they progress in backbone of the Nursing Theories. They serve the their career. purpose of providing information on how Nursing theories develop. The understanding of the non- The scope of practice of the individual nurse is nursing theories will aid in better understanding of influenced by a number of factors, including: the different nursing theories that will be discussed in this course.  The nurse's educational preparation, professional practice, and competence. GRAPHIC ORGANIZER  Local, national, and international guidelines, policies, and evidence.  The practice setting.  Collaborative practice.  Other factors, such as patient safety, patient needs, and care outcomes. M1 LESSON 2: NURSING CORE VALUES AND OUTCOMES BASED EDUCATION Among the core values are: 1. Love of God and Country 2. Caring M2 LESSON 1: DEVELOPMENTAL THEORY 3. Quality and Excellence 4. Integrity THREE (3) THEORETICAL PERSPECTIVES 5. Collaboration A.) Environmentalism B.) Organismic C.) Psychoanalytic perspectives. 2  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING ENVIRONMENTALISM punishment. He also talked about  The human being is an empty organism at birth. the principle of reinforcement.  The view emphasizes that people grow to what According to Skinner, they are made to be by their environments. reinforcement or the perceived British  The idea that the origin of all consequences of behavior, Empiricism knowledge is sense experience. influences the frequency with The origin of modern which the behavior occurs. environmentalist perspectives can be traced to the ideas of John Howard and Tracey Lendler Locke (1632-1704) who believed (1950‘s-1960s) discovered that the human mind is a “Blank developmental differences in the Slate” at birth, and that all ways children and adults learn knowledge of the world comes to and solve problems in laboratory us through our senses. Children are settings. They repeat rewarded uncivilized creatures who need behaviors and delete behaviors adults to shape them into that are not rewarded. everything they will eventually Cultural The adult‘s role is to shape the come. Anthropology child according to socially Behaviorism  The human being is passive, accepted standards of behavior. and development is totally achieved by experiencing the Margaret Mead (1901-1978) environment. emphasized the experiential factors in development and John B. Watson (1878-1958) claimed that different patterns of believed that the only way to child rearing that reflect diverse understand the human organism is cultural values would result in a through objective observation considerable variety of adult behaviors. An environmental characteristics. experience imposes itself on the person through principles of Ruth Benedict (the other author of conditioning and reinforcement. this theory) The only behavior worth studying is learned. ORGANISMIC  The human being is active in determining its own Albert Bandura (1960) developed coarse of development. the perspective known as social  Stress the importance of factors within the learning and the key concept is organism itself. People grow to what they make of that development is guided by themselves to be rather that what the environment the initiation or avoidance of makes them. behavior that is modeled by other Naturalism  This theory emphasizes on people. By observing the spontaneous child activity consequences of someone else‘s as a part of educational action, people could learn how to process brush their teeth or how to ride a bicycle. Jean Jacques Rousseau’s (1712- 1778) philosophy stresses that B.F. Skinner defined operant children are innately good unless conditioning as a learning process corrupted by society‘s evils. that depends on reward and 3  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING Includes: basic conceptual thought  Animal feelings of pleasure stage & pain (0-5 yrs.) Concrete  Thinking is more socialized  Savage sensory awareness Operation and logical; with increased (5-12 yrs.) (7 – 11 years) intellectual and conceptual  Rational functioning and development; begins problem exploration (12-15 yrs.) solving by use of inductive  Emotional and Social reasoning and logical thought interests (15-20 yrs.) Formal Operation  LOGICALLY SOLVES all types  Spiritual maturity during (11 years – of problems; thinks adulthood. above) SCIENTIFICALLY; solves Maturationism  This theory represents a COMPLEX problems; unique approach to the COGNITIVE structures mature. study of human development Humanism  Focus on the dignity and Arnold Gesell G. Stanley Hall freedom of all individuals. believed that the individual development of a child repeats Abraham Maslow (1890-1970), the phases of human evolution Charlotte Buhler (1893-1974), and describes adolescence as a and Carl Rogers (1902-1988) period of ―storm & stress‖ rejected the view of human corresponding to a turbulent state nature that emphasizes of western civilization. environmental control and observable actions. Instead Gesell emphasized internal they stressed internal factors biological factors in development and self-perception. virtually ignoring the role of the environment. He advocated the ―Normal Tradition‖ of developmental analysis. Cognitive  Emphasizes internal mental Development processes and their interactions with the environment. Jean Piaget (1896-1980) attempt to explain how the individual thinks and how human processes vary. COGNITIVE DEVELOPMENT THEORY BY JEAN PIAGET Sensorimotor  Infant develops physically (0 – 2 years) with a gradually increase in the ability to think and use Description of Maslow’s Hierarchy of needs language; progresses from  Maslow‘s theory is based on the idea that simple reflex responses to some needs physical as well as repetitive behaviors to psychological take precedence over deliberate and imaginative others. activity.  The needs are placed in a pyramid with the most important making the base. Pre-operation  Child begins to understand (2 – 7 years) relationships and develops 4  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING  If the basic needs are not met, the base of that human as well as the pyramid is not formed and the rest of lower animal behavior may the needs are not achieved. have biological origins.  The first levels of needs are the deficiency Moral  Describes human morality needs, those that if not met cause a Development development across lifespan. deficiency, or lack that motivates a person This represents that individuals to strive to achieve the need. made progress by mastering  The fifth level, the actualization level, is a each stage, one at a time. growth level.  Few people ever reach the growth level Lawrence Kohlberg suggested and spend their lives going up and down that some people reach a the pyramid meeting the lower level needs. post-conventional level of moral thinking where they think Maslow‘s Hierarchy of needs is easily applied to in terms of universal ethical nursing practice principles which take priority  The theory focuses on human potential, over society‘s laws and values. “gives hope a chance”.  The theory allows the nurse to highlight the KOHLBERG’S MORAL DEVELOPMENT Level 1 Preconventional Level person‘s strengths instead of focusing on (TODDLER) one‘s deficits (McEwen & Wills, 2007) Stage 1 Punishment and Obedience Orientation  Basic needs such as air, food, drink, and “I must follow the rules otherwise I will be punished.” warmth, are the basic needs of human Stage 2 Instrumental Relativist Orientation survival and health. “I must follow the rules for the reward and favor it gives.”  Safety, be it with ambulation or in taking Level 2 Conventional Level medication, is very important in nursing. (PRE-SCHOOL)  Social needs are met with visiting hours and Stage 3 Good-Boy-Nice-Girl Orientation “I must follow the rulesso I will be accepted.” through the nurse-patient (care giver) Stage 4 Society-Maintaining Orientation relationship. “I must follow the rules so there is order in the society.”  Esteem and self-actualization may or may Level 3 Post Conventional Level not be met in the hospital setting. Stage 5 Social Contract Reorientation  The theory provides the blueprint for “I must follow the rules as there are reasonable laws for it.” prioritizing client care according to a Stage 6 Instrumental Relativist Orientation hierarchy of needs. “I must follow the rules because my conscience tells me.” Ethology  Describe human behavior/development in real PSYCHOANALYTIC PERSPECTIVE life settings.  Focus on the underlying forces that motivate  Recognize the importance behavior. of human being‘s living in  Sigmund Freud described a series of harmony with their psychosexual stages in which gratification shifts environment. from one body zone to another and the child‘s  Primary concern is the role of maturational level determines when the shifts will human behavior in the survival occur. of human species.  The human being is not rational but ;is governed by emotion or appetite. The contribution of ethology to the study of PSYCHOSEXUAL DEVELOPMENTAL THEORY human development Id -Sexual and aggressive drive centers on the suggestion -Inborn (Infant) 5  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING -I want what I want; and I want it now (occurs among male) / -Pleasure principle Electra Complex (occurs -Operates on pleasure principle among female) -Primary thinking process: Imagery Phallic 3 – 5 years Genital is the focus. -Irrational and not based on reality Penis envy & Electra Ego -Chief executive officer complex (girls) (1 - 3 -Operates on reality principle Castration fear & Oedipus years) -I can wait for what I want Complex (boys) -Secondary thinking process: logical Latency 5 – 11 extended to Complexes are resolved. 13 years and reality-oriented Genital focus is turned to -Major Functions: adaptation to reality, social activities. modulation of anxiety, problem Formation of superego. solving, control and regulates instinctual dives. Use Reality Testing Focuses on the physical & and Defense Mechanisms. intellectual activities. Superego -CONSCIENCE, punishes one for Genital 11 -13 over lapping Development of biologic with previous (4 – 6 something wrong that was done. EGO- capacity for orgasm. years) Ideal, rewards one for something good Starts to appreciate that was done. Residue of internalized capacity for true values and moral training of early intimacy. childhood. PSYCHOSOCIAL THEORY Phases Age Ranges Developmental Focus  Erik Erikson described eight stages of Oral Birth – 18 months Mouth is the major site of psychosocial development between infancy and tension and gratification old age. Each stage involves the resolution of a including biting and particular crisis, achieving balance between sucking activities. Id is extremes and crisis emerges according to present at birth. maturationally based time table. When their needs are Virtue Developmental Developmental Task met, they feel secured. Stage Greatest need: SECURITY Drive and Trust vs Viewing the world as hope Mistrust safe and reliable; Birth – 18 months relationships as *sucking of a baby is for hunger & pleasure.* nurturing, stable, and dependable. NPO – Nothing per Orem Self - Autonomy vs Achieving a sense of (mouth) control & Shame/Doubt control and free will. 1 ½ - 3 years will power 18 months – 3 yrs Anal Anus and surrounding old area are major source of Direction & Initiative/Guilt Beginning interest. Voluntary Purpose Pre-school stage development of a sphincter control is the 3 – 6 yrs. old conscience; learning goal. Ego develops to manage conflict gradually. and anxiety. Methods & Industry/ Emerging Genital Region: Primary Competen Inferiority confidence in own Source of Pleasure ce 6 – 11 yrs. old abilities; taking pleasure in Major Conflict: Oedipus accomplishments 6  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING b. A system is more than the APPLICATION TO NURSING PRACTICE sum of its parts.  The GST is a universal theory. Ex. c. A system is everchanging Multidisciplinary approach in healthcare. and any change in one part affects the whole. (such as the organ system of a  The GST views human beings as holistic and person) goal-directed. Ex. Roy Adaptation Theory d. Boundaries are implicit and human systems are open and  The GST views persons as open systems who dynamic. strive to maintain harmony and balance between their internal and external TWO (2) TYPES OF SYSTEMS environment. Ex. Neuman‘s Health care Systems differ from each other related to degree of self-sufficiency, complexity, and adaptability systems model and Johnson‘s Behavioral systems model. 1. Closed systems have fixed relationships among system components and no  The GST also holds that individuals at the interaction with the environment. subsystem carry out networking with their environment in hierarchically arranged 2. Open systems interact with their systems of increasing complexity. Ex. environment, have dynamic interaction of components, and can be self- Imogene King‘s interpersonal system regulating.  The GST emphasizes relationships as well as components of the system. Ex. Hildegard Human organizations are open systems (since they Peplau‘s Model interact); boundaries are permeable, continually engage in importing, transforming, and exporting matter, energy, information, and people; Human M2 LESSON 2: THEORIES OF CHANGE organizations are at the high end of the complexity THE CHANGE THEORY scale due to these characteristics. People grow and change throughout their lives. This TWO (2) IMPORTANT ASPECTS OF SYSTEM growth and change are evident in the dynamic 1. Structure nature of basic human needs and how they are 2. Function or Process met. A system should be able to perform three essential Change happens daily. It is subtle (not obvious), processes. continuous, and manifested in both everyday  Adaptation to the environment occurrences and more disruptive life events.  Decision-making about allocation of resources  Integration of system parts Kurt Lewin (1962) Developed the change theory and identified the 3 In order to carry out the systems processes the stages of change. system must decide whether or not to exchange matter, energy, or information depending on SIX (6) COMPONENTS specific premises. This is referred to as Transactional 1. Recognition of the area where the change Modes. is needed. 8  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING 2. Analysis of a situation to determine what The goal of the movement phase is to achieve the forces exist to maintain the situation and desire change. This is when the change is what forces are working to change it. implemented. 3. Identification of methods by which change can occur. The goal of the refreezing phase is stabilization of 4. Recognition of the influence of the group the change. Change must continuously be mores or customs on change. practiced until it becomes familiar. 5. Identification of the methods that the reference group uses to bring about M2 LESSON 3: LEARNING THEORIES AND OTHER change. RELATED THEORIES 6. The actual process of change. BEHAVIORIST LEARNING 1. Classical Conditioning PLAN CHANGE - Is learned based on pairing of conditioned and 1. Unfreezing unconditioned stimuli resulting in a conditioned Involves finding a method of making it response. possible for people to let go of an old pattern that was counterproductive in some 2. Operant Conditioning way. Is learning based on consequences meaning, behavior that is rewarded is most likely to be 2. Movement repeated. Involves a process of change in thoughts, feelings, behaviors, or all three, which is in BASIS OF BEHAVIORISM some way more liberating or more  Operant Conditioning by B.F. Skinner productive. focuses on the behavior of the organism and the reinforcement that occurs after the 3. Refreezing response. Is establishing the change as a new habit, so that it now becomes the ―standard  Positive reinforcement or reward greatly operating procedure.‖ Without this stage of enhances the likelihood that a response refreezing, it is easy to backslide into the old may be repeated in similar circumstances. ways.  Negative reinforcement or punishment- PLANNED CHANGE happens after a response is made. This Freezing theory states that change occurs involves the removal of an unpleasant whenever the forces in a given field are unequal. stimulus through either escape conditioning or avoidance conditioning. The difference During unfreezing, conditions are viewed as stable between the two is timing or ―frozen‖. Change begins with a felt need, a plan that maximizes driving forces and minimizes Basis of Behaviorism restraining forces.  The gestalt perspective of cognitive learning emphasizes the importance of perception in learning. Perception is selective. Individuals orient 9  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING themselves to the Outcome Expectation experience while screening out or About the consequences of one‘s actions or habituating to other features. opinions about how individual behavior is likely to influence outcomes Cognitive learning  Cognitive and information processing Efficacy expectation or self-efficacy perspectives emphasizes About one‘s own competence to perform thinking processes: thought, reasoning, the the behavior needed to influence way information is outcomes encountered and stored, and memory functioning. d. Incentive (or reinforcement) is defined as the value of a particular object or outcome. SOCIAL LEARNING THEORY a. SLT is the offshoots of Cognitive Learning. e. When reinforcements or consequences of behavior are believed to operate by influencing b. Cognitive learning theories assume the individual expectations regarding the situation, such must have direct Experiences in order to learn. formulations are generally termed as ―value- expectancy‖ theories. c. Contends that much learning occurs by observation-watching other people and seeing HEALTH BELIEF MODEL what happens to them. The model was originally proposed by Godfrey M. Hochbaum in 1958 as a theoretical model of d. Role modeling is a central concept. preventive health behavior, later developed by Rosenstock in 1966 who coined the term ―Health  Albert Bandura developed SLT. Belief Model‖ and further modified by Becker in 1974.  The SLT states that there is a continuous and reciprocal relationship between these It suggests that the decision whether or not to factors: (1) a person‘s behavior; (2) the change behavior will be influenced by an environmental consequences of that evaluation of its feasibility and its benefits weighed behavior; and (3) the cognitive processes against its costs. going on inside the person This model hypothesizes that health related action SOCIAL COGNITIVE THEORY depends upon the simultaneous occurrence of a. SLT was later called Social Cognitive Theory three (3) classes of factors. b. According to Bandura, behavior is determined 1. Perceived susceptibility or perceived threat. by expectancies and incentives 2. Perceived severity c. Expectancies may include: 3. Perceived benefits or effectiveness of treatment 4. Perceived cost or barriers Environmental cues 5. Cue to action Environmental cues beliefs about how events are connected. 10  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING Theory of Reasoned Action of interest and the education factors The theory is developed by Fishbein and Ajzen in affecting the behavior of interest 1975 argues that perceived social norms also play a role in determining motivation. THE SEVEN (7) PHASES OF PRECEDE 1. SOCIAL DIAGNOSIS Motivation to act is seen as a product of perceived - quality of life in a community group norms and one‘s private beliefs about the action 2. EPIDEMIOLOGICAL DIAGNOSIS - identify specific health problems The PRECEDE-PROCEED Framework This was developed by Lawrence W. Green in 1980 3. BEHAVIORAL DIAGNOSIS as a comprehensive model for planning and - Identify specific health related behaviors evaluating health education and health promotion programs. 4-5. EDUCATIONAL DIAGNOSIS - Identified 3 classes of factors that affect health The framework recognized the integration of health behaviors promotion as an extension of health education. a. PREDISPOSING FACTOR Green (1980) defined Health Education as ―any includes a person‘s attitudes, beliefs, values combination of learning experiences designed to and perceptions facilitate voluntary adaptations of behavior conducive to health‖. b. ENABLING FACTOR are barriers created mainly by societal Green (1991) defined health promotion as ―the forces or systems such as limited facilities & combination of educational and inadequate resources environmental supports for actions and conditions of living conducive to c. REINFORCING FACTOR health‖. are those related to the feedback the learner receives from others THE PRECEDE a. PRECEDE is an acronym for Predisposing, 6. ADMINISTRATIVE DIAGNOSIS Reinforcing, and Enabling causes in Educational - Actual development and implementation of a Diagnosis and Evaluation health education program. b. It is a model intended for the planning 7. EVALUATION and evaluation of health education - Is an integral and continuous part of working with and addresses the acknowledged the entire framework. problem of disjointed planning (Green, 1980). Evaluation proceeds from process evaluation of the program, to impact evaluation in terms of c. The PRECEDE component of the changing the predisposing, enabling, reinforcing model begins ideally with an appraisal factors as well as the behavior itself; lastly to of the quality-of-life in the population 11  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING outcome evaluation dealing with Adults learn best when learning is problem- changes in health status and quality of life. centered, meaningful and experiential PRECEED TO PROCEED MODEL Psychodynamic Learning PRECEDE – PROCEED Model for health promotion, - A theory of motivation stressing emotions rather planning and evaluation in 1991 with a more than cognition and responses, the psychodynamic comprehensive field of health promotion perspective emphasizes the importance of conscious and unconscious forces in guiding  PROCEED is an acronym for Policy, behavior, personality conflicts, and the enduring Regulatory and Organization Constructs in impact of childhood experiences. Educational and Environmental Developments Humanistic Learning - Underlying the humanistic perspective on learning  This phase reviews and reconciles existing is the assumption that each individual is unique and and required resources such as personnel, that all individuals have a desire to grow in a time and finances positive way.  Green (1991) ―Behavior is seen increasingly M2 LESSON 4: THEORIES/MODELS OF not as isolated acts under the autonomous COMMUNICATION control of the individual, but rather as THEORIES OF COMMUNICATION socially conditioned, culturally embedded, 1. An (interpersonal) source: economically constrained patterns of Some person with ideas, needs, intentions, living‖. information and reason for communicating.  Heath promotion emerged out of health 2. A message education and is aimed at encouraging Coded, systematic set of symbols complementary social and political actions representing ideas, purpose, intentions and that will facilitate the necessary feelings organizational, economic and environmental supports for the conversion of 3. An encoder individual actions into health enhancements The mechanism for expressing or translating and quality of life gains. the purpose of the communication into the message. ADULT LEARNING THEORY Malcolm Knowles (1967) recognized the need 4. A channel for a unifying theory for adult education. The medium for carrying the message. Andragogical theory is based on 4 main assumptions: 5. A decoder The mechanism for translating the message 1. Changes in self-concept into a form that the recipient can use. 2. The role of experience 3. Readiness to learn 6. A receiver 4. Orientation to learning The target or recipient of the message. 12  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING MODEL OF COMMUNICATION INFORMATION THEORY  Communication is diverse, ranging from  Communication includes all of the mass media, popular culture and language procedures by which one mind may affect to individual and social behavior the other.  ―Communicare‖ meaning ―to make  The process begins with a source selecting a common‖ message out of all messages which would be possible to communicate. The transmitter The are two main schools of thought is the voice mechanism producing the explaining communication signal (spoken words or the varying pressure passing from the vocal system of one person 1. PROCESS school to the ear of another) transmitted through Sees communication as the transmission air (the channel). The receiver (the ear) of messages. Includes theories of decodes the message and reconstructs the Shannon and Weavers (1949) and message from the signals transmitted. This is Newcombs (1953). passed on to a destination. 2. SEMIOTIC School 1. Noise Uses semiotics or the science of signs Is anything which is added to the signal and meanings as its main methods of which is not intended by the information study. It is concerned with text and source. culture. 2. Entropy THE SEMIOTIC SCHOOL Is the uncertainty or disorganization of  A radically different approach that puts communication, associated with the emphasis on communication as the amount of freedom of choice one has in generation of meaning constructing a message.  Semiotics or semiology is the study of signs and the way they work. The 3. Entropy Redundancy  American logician and philosopher C.S. Is that portion of the message which is not Pierce and swiss linguist Ferdinand de determined by the free choice of the  Saussure were the founders of semiotics sender. (Fiske, 1990) NON-VERBAL COMMUNICATION  In semiotics, the receiver, also called the  It functions to convey information about the reader, is seen as playing a more active speaker and his or her identity,  role. emotions, attitudes, intentions or social  Meanings are determined by the cultural position. experience of the reader, who in turn  The second function of non-verbal helps create the meaning of the text by communication is to manage the kind of bringing to it his or her experience, relationship that one person wants with attributes and emotions. another. By using a certain tone of voice, posture, facial expression, gesture, the nurse can attempt to dominate a patient, 13  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING reassure, or intimidate.  Intermittent, emphatic and forceful up-and- down gestures often indicate strong There are several non-verbal modes of emotional states, whereas more fluid, communication. continuous, circular gestures indicate a desire to explain or to persuade. 1. Physical Appearance  Refers to body characteristics 5. Body Stance that are under voluntary control---  Include posture, configuration of arms or hair, clothes, body paint and legs, distribution of body weight and over-all adornment---and those less quality of movement. controllable—height and weight.  Our ways of standing, sitting and lying can  This can indicate physical health, communicate interpersonal attitudes personal grooming habits or (friendliness, hostility, superiority, inferiority) eating habits. It can send and emotional state (tension and messages about personality, relaxation) social status and emotional state. NON-VERBAL MODE OF COMMUNICATION 2. Body Movement  Kinesics is the study of body PARALANGUAGE movement in communication.  Includes voice qualities such as speaking rate, pitch range, pitch variety, rhythm and  It has 3 categories: Facial tempo of speaking, raspness and tone. expression, Gestures and Body  Also includes giggling and whimpering and Stance vocalized pauses (um, er, eh or throat clearing), which are used to fill in spaces 3. Facial Expression between words and phrases. Involves the This can convey emotional messages such use of SILENCE. This can convey interest in as happiness, sadness, fear, concern and what the other is saying, sympathy or others. respect.  Silence accompanied by head nods or * EYE CONTACT interrupted by ‗uh-hum‘ encourages the is a special type of facial expression. speaker to go on and convey the message *Maintaining eye contact coupled with a ―I am listening‖. smile usually effects rapport with a patient TOUCHING Hapics 4. Gestures  Is the study of touch in communication.  This involves the hands, arms, feet and  Nurses need to be aware that they send head. powerful messages through the use of  Gestures may indicate either general touch. emotional arousal or specific emotional states. 14  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING  The amount and quality of touch people personal contact, or people wanting to receive can significantly affect their have some private moments emotional and physical health.  Thoughts somehow project through touch.  Personal Zones - 18-36 inches) This distance is comfortable between and among family TIME members and friends who are talking. Chronemics  Is the study of how people use time in  Social Zones - (4-12 feet) This distance is communication. acceptable for communication in social,  The way a nurse goes about her work, and business setting. activities in a patient‘s room (as if she can‘t wait to leave, how early  Public Zones - (12-25 feet) This distance is or late we arrive for a meeting, acceptable between a speaker and an how long we keep a patient audience, small groups, and other informal waiting before answering functions. inquiries, and the length of time we spend before responding to a  Functional-Professional Touch - Used in call) all convey non verbal examinations or procedures such as when messages. the nurse touches a client to assess skin turgor or a masseur performs a massage. SPACE AND TERRITORY Proxemics  Social-Polite Touch - Used in greeting, such  Is the study of the distances people as a handshake and the ―air kiss‖ some maintain between themselves and others women use to greet acquaintances, or and how they defend their territories to when a gentle hand guides someone in maintain preferred distances. the correct Direction.  People need space to feel comfortable. Space expands and contracts based on the  Friendship-Warmth Touch Zones - Involves a situation. hug in greeting, an arm thrown around the shoulder of a good friend, or the back slapping some men use to greet friends and Privacy and Respecting Boundaries relatives. Proxemics = Distance Zone  Love-Intimacy Touch - Involves tight hugs An interpersonal interaction between the nurse and kisses between lovers or close relatives and client during which the nurse focuses on the client‘s specific needs to promote an  Sexual-Arousal Touch – Used by lovers. effective exchange of information. FACTORS INFLUENCING PERSONAL SPACE THEORIES OF COMMUNICATION 1. Personal preference  Intimate Zones - (0-18 inches) Space 2. The relationship between the between people who mutually desire communicators 3. The nature of the topic discussed 15  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING 4. Cultural heritage of the participants CHARACTERISTICS OF CRISIS 5. The nature of the communication context 1. Presence of danger and opportunity 2. Complicated symptomatology The kind of theory will generally influence how 3. Seeds of growth and change much personal space a person can expect to 4. No panaceas or quick fixes have. 5. The necessity of choice 6. Universality or idiosyncrasy TYPES PUBLIC TERRITORY Public Territory THEORIES OF CRISIS AND CRISIS INTERVENTION - is a setting that is open to anyone. 1. Basic Crisis Theory Ex. parks, bars, hospitals 2. Expanded Crisis Theory 3. Applied Crisis Theory Interactional Territory - is a space reserved for particular 1. Basic Crisis Theory people during a specific period of - Asserted that impediments to life goals that time. cannot be overcome through customary behaviors. He believed that the most Home Territory important aspects of mental health are the - is a space in which individuals live state of ego, state of maturity and quality of and work. its structure. - Crisis ensues when a person faces an M2 LESSON 5: CRISIS INTERVENTION THEORY obstacle to important life goals that cannot  Offers immediate help to establish be resolved by using the usual coping equilibrium. strategies.  The immediate goal is to reinforce the individuals strengths and minimize weakness, CAPLAN: Assessment is based on 3 to move from a state of being passive and additional areas dependent to an adult, independent state  Capacity of the person to withstand in a short period of time. stress and anxiety and maintain equilibrium HISTORY: Crisis Intervention  Degree of reality recognized and  Lindemann in 1944 formally developed Crisis faced in problem solving Intervention in handling bereaved fire  Stock coping mechanisms used to victims. Later, Caplan elaborated on this, maintain balance. becoming the father of modern crisis treatment measures intervention.  Parad, Rapoport, Jacobson and Aguilera refined crisis theory and developed treatment models for crisis in marital, family conflicts and suicide prevention. 16  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING TYPES OF EMOTIONAL CRISIS Baldwin (1978) developed a classification system  Third Phase that describes six general types of crises: - The person‘s anxiety continues to escalate and he usually feels forced 1. Dispositional Crises to reach out for help. - caused by distress that arises from a problematic situation in which intervention is  Fourth Phase not directed at the emotional level. - Is the active state of crises wherein the individual‘s inner resources and 2. Anticipated Life Transition Crises support system are inadequate. - Relate to normal life transitions over which the person may or may not have control. 2. Expanded Crisis Theory Ego-analytic Theory (Hartmann) 3. Crises Resulting From Traumatic Stress  Considered reality functions - Precipitated by externally imposed stressors important in the adaptation of the that are unexpected and uncontrolled. individual to the environment.  Emphasized that the individuals 4. Maturational or Developmental adaptation in early childhood - Relate to an attempt to achieve emotional affects his ability to continue maturity by completing developmental adapting to the environment in later tasks; involves struggle with a deep seated life. unresolved issue.  The fitting of the individual and society is important. 5. Psychopathological Crises - Pre-existing psychopathological condition Adaptational Theory precipitates the crises or complicates  Crisis is seen as being sustained through resolution of crises. maladaptive behaviors, negative thoughts, and destructive defense mechanisms. 6. Psychiatric Emergency Crises  Crisis is resolved when malaptive coping - Severe psychiatric disorder with severe behaviors are changed to adaptive impairment; incompetent; danger to self or behaviors. others. Adaptational Psychodynamics (Rado) PHASES OF CRISIS  Rado saw human behavior as being based  First Phase on the dynamic principle of motivation and - Is a rise in anxiety as a response to adaptation trauma. The individual tries to use his  Behavior is viewed in terms of its effect on usual coping mechanisms to resolve the welfare of the individual the feeling of increased anxiety.  His adaptational psychotherapy emphasizes the immediate present without neglecting  Second Phase the influence of the developmental past. - Characterized by increased anxiety due to failure in coping. 17  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING Interpersonal Theory problems. Lack of support system makes the  People cannot sustain a personal state of individual vulnerable and increases disequilibrium crisis if they believe in themselves and in others and have confidence that they can 3. COPING MECHANISMS become self-actualized and overcome the - Lifestyles are developed around patterns crisis. of response which in turn are established to  Return the power of self-evaluation to the cope with stressful situations person. 4. Applied Thesis Theory Epigenetic Development (Erikson) CRISIS INTERVENTION MODELS  Developed ego psychology by focusing on  Equilibrium Model the epigenesist of the ego.  Cognitive Model  Epigenetic development is characterized by  Eclectic Crisis Intervention Model an orderly sequence of development at  Psychosocial Transition Model particular stages, depending on the previous stages for successful completion. Equilibrium Model Lindemann, 1944; Chaos Theory Caplan, 1961;  Chaos is the result of overwhelming anxiety Leitner, 1974 CRISIS: The model underscores that the emotional state Chaos becomes self-organizing and client is unable during equilibrium leads to a person‘s stability, to identify patterns or preplan options to solve being in control and psychologically mobile. dilemmas at hand. The focus is to remain in pre-crisis state. EXPERIMENTATION: Trial and error, False starts, dead ends make sense The person must have the ability to use coping of and cope with crisis mechanisms and a problem solving approach. BALANCING FACTORS AFFECTING EQUILIBRIUM Cognitive Model Aguilera and Messick (1942) made the factors that This is based on the premise that crises are rooted in influence the crisis intervener in analyzing and faulty thinking about the events or situations that resolving a crisis situation. The factors are: surround the crisis. The goal of this model is to help people become aware of and to change their 1. PERCEPTION OF THE EVENT views and beliefs about the crisis events. - Is determined by the extent to which the event is a threat to the individual‘s values and life goals. A Eclectic Crisis Intervention Model crisis event may be perceived as a threat or a  Gelliland challenge where one is able to mobilize energies  James and engage in purposeful problem solving.  Bowman 2.SITUATIONAL SUPPORT  Thorne - This refers to the persons in the environment who can be depended on to help the individual solve Integration of concepts and strategies 18  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING from all available approaches to help clients. Play Is considered a significant part of gender Major Tasks: socialization that teaches children how to relate to 1. Identify valid elements in all systems and their environment. The most crucial period in the integrate them into an internally consistent formation of gender identity is from the age 3 to 6 whole. years old, during this period, boys, tend to receive 2. Consider all pertinent theories, methods and more negative reinforcement for gender standards. inappropriate behavior from parents. 3. Keep an open mind. Gender Relation Psychosocial Transition Model The importance of gender in understanding health  Adler practices and illness experiences is increasingly  Erikson recognized, and key to this work is a better  Minuchin understanding of the application of gender relations. The influence of masculinities and This model states that people are products of their femininities, and the interplay within and between hereditary endowment ad the learning they have them manifests within relations and interactions absorbed from their social environment. among couples, family members and peers to influence health behaviors and outcomes. The experiences which the individual has gone through will help him adjust to situations. Sociologists describe sex-role socializations: INSTRUMENTAL Significant others assist the individual welcoming Socialization is for men and this is characterized by challenges the ability to compete, aggressiveness, the ability to lead, wield power and accomplish rasks. M2 LESSON 6: GENDER CONCEPTS AND ISSUES IN HEALTH EXPRESSIVE Sex Socialization includes learning to nurture, to be Is the biological attribute that differentiates men affiliate and to be sensitive to the needs of others\ and women. THEORETICAL PERSPECTIVES ON GENDER ROLES Gender Socialization 1. Functionalism Is the process by which men and women learn and 2. Conflict Theory acquire their roles and responsibilities, qualities and 3. Symbolic Interactionism behaviors. 4. Feminist Sociological Theory 1. Functionalism Gender norms are powerful mechanisms that - Suggests that separate gender roles for women control human behavior (Strassen, 1992) and men are beneficial. GENDER SELF CONCEPT - Society maintain order by assigning different tasks A child learns self-concept by interacting with the to men and women. environment, family and peer group. 19  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING - Offers a reasonable explanation for the origin of must be able to acquire and exhibit both gender roles and demonstrates functional utility of masculine and feminine characteristics. assigning tasks on the basis of gender. Gender as a Predictor of Health 2. Conflict Theory - The ideological foundation for gender inequality in - Reflects Marxian (Karl Marx) ideas about class many 3rd world countries is Patriarchy-defined as a conflict and the relationship between the exploiter ―set of social relations with a material base that and the expolited. enables men to dominate women‖. This is reinforced by various institutions—economic, - Women are subordinate to men in the autocracy political, social, legal and religious—all of which of the household. emphasize women‘s inferior position in society. Men‘s economic advantage provides the basis for These have implications for women‘s health status gender inequality and health behaviors in the event of illness (Okojie, 1994). 3. Symbolic Interactionism - Symbolic interactionism aims to understand Women’s Health human behavior by analyzing the critical role of - Women‘s health problems include those which symbols in human interaction. This is certainly affect their physical, social and mental well-being relevant to the discussion of masculinity and as well as those which lead to female mortality. femininity. Compounding health problems is the lack of access to health care including lack of access to 4. Feminist Sociological Theory information and health facilities. - Feminism is an inclusive world-wide movement to end sexism and sexist oppression by - It has also been recognized that women are empowering women. treated in an inferior way by health professionals and therefore are hesitant to seek treatment. - There is a move to erase the race-class-gender disparity and provide a link. Strategies to Reduce Gender Inequalities in Health  Given women‘s disadvantaged position Gender Socialization & Nursing in society, reducing gender inequalities - Historically, nursing is a profession for women. Its require measures and/or policies to founders were women with an exceptional gift for reduce discrimination against women social reform. Many of their efforts were directed which are even into the political, specifically at the welfare of women and children cultural, economic and religious fabric (Shea, 1990) of the society (Okojie, 1994). - According to Flanelly (1984) the conflict for the Robinson (1994) suggested steps in providing the nurse (male of female) is how to strike a balance best possible care to female patients. between caring traits often considered to be intrinsically female and the skills and leadership 1. Be aware of your own socialization and possible abilities usually thought of as characteristically sex-role biases that may affect your attitude toward male. Thus the nurse female patients. 20  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING 2. Avoid using patronizing, demeaning, or sexist dimension and strongly influence health status and language. health practices. 3. Be aware of socio-cultural stresses on women. Examples: The fact that they perform multiple roles in the The toddler just learning to walk is prone to fail home. Community and society renders women and injure himself. vulnerable to health hazards, physically and psychologically. The young woman who has a family history of breast cancer and diabetes and therefore is at a 4. See women‘s help-seeking behaviors as an higher risk to develop these conditions. opportunity for preventive healthcare: encourage them to give priority to their health.  Emotional Dimension - How the mind and body interact to affect body function and to respond to body conditions also 5. Take women‘s problems and symptoms influences health. Long term stress affects the body seriously. Make a thorough assessment rather systems and anxiety affects health habits; than prematurely deciding on physical or conversely, calm acceptance and relaxation can psychologic diagnosis, or judge her as a actually change body responses to illness. hypochondriac. Examples: 6. Routinely ask women about current or past o Prior to a test, a student always has abuse. Abuse can be physical, emotional or diarrhea. sexual. o Extremely nervous about a surgery, a man 7. Learn about incidences, causes, physical and experiences severe pain following his emotional consequences of violence against operation. women to improve diagnosis, treatment and care. o Using relaxation techniques, a young woman reduces her pain during the delivery Gender Sensitivity of her baby. This is being aware of, and being open and responsive to issue which have something to do  Intellectual Dimension with the social relations between women and men - The intellectual dimension encompasses cognitive within specific societies and cultures. Health abilities, educational background and past providers must develop themselves to have gender experiences. These influence a client‘s responses to sensitivity and gender awareness. teaching about health and reactions to health care during illness. They also play a major role in M2 LESSON 7: INTERLINKING RELATIONSHIPS OF health behaviors. FACTOR AFFECTING HEALTH Examples:  Physical Dimension o An elderly woman who has only a third- - Genetic make-up, age, developmental level, grade education who needs teaching race and sex are all part of an individual‘s physical about a complicated diagnostic test. 21  1ST SEMESTER BACHELOR OF SCIENCE IN NURSING o A young college student with diabetes who o Jehovah Witnesses‘ are opposed to follows a diabetic diet but continues to drink blood transfusions. beer and eat pizza with friends several times a week. MODULE 3: INTRODUCTION TO NURSING  Environmental Dimension THEORY - The environment has many influences on health Theory and illness. Housing, sanitation, climate and The doctrine or the principles underlying an art pollution of air, food and water are aspects of as distinguished from the practice of that environmental dimension. particular art. Examples: A formulated hypothesis or opinion not based a) Increased incidence of asthma and upon actual knowledge. respiratory problems in large cities with smog. A provisional statement or set of explanatory  Socio Cultural Dimension propositions that purports to account for or - Health practices and beliefs are strongly characterize some phenomenon. influenced by a person‘s economic level, lifestyle, family and culture. Low- income groups are less Theoretical Statement likely to seek health care to prevent or treat illness; Describes the relationship between two or more high-income groups are more prone to stress- concepts. related habits and illness. The family and the culture to which the person belongs determine patterns of CHARACTERISTICS OF A THEORY livings and values, about health and illness that are 1. Systematic, logical and coherent (orderly often unalterable. reasoning, no contradictions) Examples: 2. Creative structuring of ideas mental images o The adolescent who sees nothing wrong of one‘s experiences and create different with smoking or drinking because his parents ways of looking at a particular event or smoke and drink. object. o The person of Asian descent who uses 3. Tentative in nature ( change over time or herbal remedies and acupuncture to treat evolving but some remain valid despite an illness. passage of time)  Spiritual Dimension Spiritual and religious beliefs are important COMPONENTS/ELEMENTS OF THEORY components of the way the person behaves in 1. Purpose – ―Why is the theory formulated‖ health and illness. 2. Concepts – Are building blocks of theory – ideas, mental images of a phenomenon, an Examples: event or object that is derived from an o Roman Catholics require baptism for individual‘s experience and perception. both live births and stillborn babies. 22