NCMA 110 Theoretical Foundations Midterm Notes PDF

THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE NURSING THEORISTS OF HISTORICAL SIGNIFICANCE OPEN SYSTEMS → This means that both human and environmental...

THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE NURSING THEORISTS OF HISTORICAL SIGNIFICANCE OPEN SYSTEMS → This means that both human and environmental fields are not isolated; MARTHA ROGERS: UNITARY HUMAN BEINGS THEORY → They constantly exchange energy and “Science of Unitary Human Beings” information with one another INTEGRAL NATURE → The idea that these fields are integral with one Bachelor of Science degree from George Peabody another means that they are essential to each College in other’s existence and functioning. Tennessee → Changes in one field (like a person's emotional state) can affect others (like the supportive Experience: Rural public health nursing in atmosphere of a community or environment). Michigan, Professor PATTERN → Pattern identifies energy fields. and head of the Division of Nursing at New York → It is perceived as a single wave. University. → Pattern changes continuously and innovatively. → Each human field pattern is unique and is integral SCIENCE OF UNITARY HUMAN BEINGS (SUHB) with the environmental field. → The theory views nursing as both a science and an art as it provides a way to → Pattern is changing continually and may view the unitary human being, who is integral with the universe. manifest disease, illness, or well-being. → The unitary human being and his or her environment are one. → Some variations in pattern manifestations have → Nursing focuses on people and the manifestations that emerge from the been described in phrases such as “longer versus mutual human-environmental field process. shorter rhythms,” “pragmatic versus imaginative,” and time experienced as “fast” or 5 BASIC ASSUMPTIONS “slow.” → that describes the life processes in human beings PANDIMENSIONALITY → provides for an infinite domain without limit. WHOLENESS man is unified whole possessing his own integrity and → It best expresses the idea of a unitary whole manifesting characteristics more than and different from → Not just physical dimensions but includes an the sum of his parts. array of dimensions— emotional, spiritual, social, OPENNESS man and environment are continuously exchanging and more. matter and energy with one another. → An infinite range of human experiences and UNDIRECTIONALITY the life process evolves irreversibly & unidirectionally expressions. along the time continuum. PATTERN AND identify man and reflect his innovative wholeness. HOMEODYNAMIC PRINCIPLES ORGANIZATION RESONANCY / → the changes from lower to higher frequency wave SENTINENCE OF man is characterized by the capacity for abstraction, RESONANCE pattern in human and environmental fields. THOUGHT imagery, language and thought, sensation, and emotion. → Human beings are perceived as wave patterns (sleep-wake rhythm, hormone levels and fluctuating MAJOR CONCEPTS & DEFINITION emotional states). → REMEMBER: EO Pat Pan (Energy Field, Openness [Universe of Open Systems], HELICY → continuous, unpredictable, nonlinear evolution of Pattern, Pan dimensionality) energy fields → Humans do not ever return to exactly the same place ENERGY FIELD → the fundamental unit of both the living and the as before. Unitary persons do not go backward. nonliving. Energy fields are infinite and pan INTEGRALITY → the relationship of the human energy field and the dimensional. environmental energy field. → More like how other people perceives you; Aura → Mutual process between humans and environment. → irreducible, pandimensional energy field → Ex: Meditation identified by pattern and integral with the human field. → Each environmental field is specific to its given METAPARADIGM human field PERSON ENVIRONMENT → Example: The healing garden serves as an Unitary Human Being as “irreducible, “An irreducible, pandimensional environmental field that can positively influence indivisible, pandimensional energy energy field identified by pattern and patients' well-being. field identified by pattern and manifesting characteristics different UNITARY HUMAN → irreducible, indivisible, pandimensional energy manifesting characteristics that are from those of the parts. Each BEING (HUMAN FIELD) field identified by pattern and manifesting specific to the whole” environmental field is specific to its characteristics that are specific to the whole and given human field. Both change that cannot be predicted from knowledge of the continuously and creatively parts. HEALTH NURSING → Group Therapy Session — each individual brings She uses the term passive health to Nursing is a learned profession and is their own unique energy field (emotions, symbolize wellness and the absence both a science and an art. — Rogerian thoughts, and experiences) of disease and major illness (Rogers, nursing focuses on concern with UNIVERSE OF OPEN → The concept of the universe of open systems 1970). — Her promotion of positive people and the world in which they SYSTEMS holds that energy fields are infinite, open, and health connotes direction in helping live—a natural fit for nursing care, as it integral with one another. people with opportunities for encompasses people and their → The human and environmental fields are in rhythmic consistency (Rogers, 1970). environments. continuous process and are open systems. Later, she wrote that wellness “is a INFINITE → Energy fields are boundless. much better term… because the term → Each person’s energy field interacts with others health is very ambiguous” (Rogers, and with their environment, creating a dynamic 1994b, p. 34). web of relationships.  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE ANALYSIS OF THEORY UNIVERSAL SELF- 01. Air 03. Water CLARITY Rogers’ ideas continue to demonstrate clarity for nursing CARE REQUISITES 02. Food 04. Elimination processes and research with human beings of all ages. excrements SIMPLICITY “With only three principles (Resonancy, Helicy, Integrality), a 05. Balance between activity and rest few major concepts (Energy Field, Universe of Open Systems, 06. Balance between solitude and social interaction Pattern, Pandimensionality), and five assumptions 07. Prevention of hazards to human life (Wholeness, Openness, Unidirectionality, Pattern & 08. Promotion of human functioning and Organization, Sentience of Thought). Rogers has explained development within social groups and the human the nature of man and the life process” desire to be normal GENERALITY Rogers’ conceptual model is abstract and therefore DEVELOPMENTAL supporting growth & development throughout life generalizable and powerful. SELF-CARE ACCESIBILITY The development of the model by Rogerian scientists has REQUISITES Three sets of DSCRs have been identified: resulted in the generation of testable theories accompanied 01. Provision of conditions that promote development by tools of measurement. 02. Engagement in self-development IMPORTANCE Rogers suggested many ideas for future studies; on the basis 03. Prevention of or overcoming effects of human of this and the research of others, it can be said that the conditions and life situations that can adversely conceptual model is useful. Such utility has been proven in affect human development the arenas of practice, education, administration, and HEALTH DEVIATION Health deviation self-care requisites exist for persons research. SELF-CARE who are ill or injured, who have specific forms of REQUISITES pathological conditions or disorders, including defects DOROTHEA OREM: SELF-CARE DEFICIT THEORY and disabilities, and who are under medical diagnosis Nursing experiences: operating room nursing, and treatment. private duty nursing (home and hospital), THERAPEUTIC SELF- consists of the summation of care measures necessary hospital staff nursing on pediatric and adult CARE DEMAND at specific times or over a duration of time to meet all of medical and surgical units, evening supervisor in an individual’s known self- care requisites. the emergency room, and biological science teaching. performed by the individual (self-care agent) DEPENDENT-CARE the summation of care measures at a specific point in Dorothea Orem -> s DEMAND time or over a duration of time for meeting the dependent’s therapeutic selfcare demand when his or her self-care agency is not adequate or operational. SELF-CARE DEFICIT THEORY performed by a caregiver (dependent-care agent) for → proposes that patients have the innate ability and responsibility to care for someone who cannot do it themselves. themselves. SELF-CARE AGENCY the human’s ability or power to engage in self-care and → A nurse's role goes beyond tending to patients' physical needs; it involves is affected by basic conditioning factors. supporting them on their journey to regain independence DEPENDENT-CARE refers to the acquired ability of a person to know and AGENCY meet the therapeutic self-care demand of the 4 RELATED THEORIES TO SELF-CARE DEFICIT THEORY dependent person and/or regulate the development THEORY OF SELF- → why and how people care for themselves. and exercise of the dependent’s selfcare agency. CARE SELF-CARE DEFICIT The individual cannot meet their own self-care needs THEORY OF → how family members and/or friends provide due to physical or mental limitations and requires DEPENDENT CARE dependent-care for a person who is socially external support or nursing care. dependent. DEPENDENT-CARE The caregiver cannot adequately meet the self-care THEORY SELF- → which describes and explains why people can be DEFICIT needs of a dependent person and requires assistance, CARE DEFICIT helped through nursing training, or resources to provide proper care. THEORY OF → which describes and explains relationships that must NURSING AGENCY Nursing agency comprises developed capabilities of NURSING be brought about and maintained for nursing to be persons educated as nurses. SYSTEMS produced To help persons meet their therapeutic self- care MAJOR CONCEPTS & DEFINITION demands. SELF-CARE comprises the practice of activities that maturing and mature persons initiate and perform, within time Nursing agency also incorporates the capabilities of frames, on their own behalf in the interest of nurses to assist persons who provide dependent-care maintaining life, healthful functioning, continuing to regulate the development or exercise of their personal development, and well-being by meeting dependent-care agency. known requisites for functional and developmental NURSING DESIGN Refers to the plan or framework that nurses develop to regulations. guide their care for patients with self-care deficits. DEPENDENT-CARE Care that is provided to a person who, because of age or related factors, is unable to perform the self-care The purpose of nursing design is to provide guides for needed to maintain life, healthful functioning, achieving needed and foreseen results in the continuing personal development, and well-being. production of nursing toward the achievement of SELF-CARE Actions to be performed that are known to be necessary nursing goals; these units taken together constitute the REQUISITES in the regulation of an aspect of human functioning and pattern that guides the production of nursing. development.  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE HELPING METHODS Sequential series of actions that will overcome or  Supporting a patient with asthma by teaching compensate for the health-associated limitations of them how to use an inhaler correctly. individuals  Teaching lifestyle changes to promote long-term  Acting for or doing for another heart health.  Guiding and directing  Providing physical or psychological support CONCEPTUAL FRAMEWORK  Providing and maintaining an environment that supports personal development  Teaching BASIC Basic conditioning factors condition or affect the value CONDITIONING of the therapeutic self-care demand and/or the self- FACTORS care agency of an individual at particular times and under specific circumstances. 01. Age 07. Family system 02. Gender factors 03. Developmental 08. Sociocultural state factors 04. Health state 09. Availability of 05. Pattern of living resources 06. Health care system 10. External factors environmental factors THREE BASIC NURSING SYSTEMS WHOLLY the individual is unable “to engage in those self-care SELF-CARE AGENCY The individual's ability to perform self-care. This is COMPENSATORY actions requiring self-directed and controlled influenced by factors like age, developmental NURSING SYSTEM ambulation…” Persons with these limitations are socially state, health, and environmental conditions. dependent on others for their continued existence and SELF-CARE all activities that individual’s initiate and perform well-being. to maintaining life, health and well-being. THERAPEUTIC performed by the individual (self-care agent). Examples: SELF-CARE DEMAND  Feeding a patient who is unconscious.  Turning and repositioning a bedridden.  Performing all hygiene care (bathing & oral care) ANALYSIS OF THEORY for a patient with advanced paralysis. CLARITY The terms Orem used are defined precisely.  Ventilator management for a patient with SIMPLICITY Orem’s theory is expressed in a limited number of terms. respiratory failure. These terms are defined and used consistently in the PARTLY “both nurse and patient perform care measures or expression of the theory. COMPENSATORY other actions involving manipulative tasks or GENERALITY A review of the research and other literature attests to the NURSING SYSTEM ambulation… [Either] the patient or the nurse may have generality of the theory. the major role in the performance of care measures. ACCESIBILITY As a general theory, the SCDNT provides a descriptive explanation of why persons require nursing and what Examples: processes are needed for the production of required nursing  Assisting a post-operative patient in walking while care. they regain strength. IMPORTANCE The significance of Orem’s work extends far beyond the  Helping a patient with limited mobility to dress or development of the SCDNT. In her works, she provided bathe. expression of the form of nursing science as practical  Providing set-up assistance for meals to a patient science, along with a structure for ongoing development of who can feed themselves. nursing knowledge in the stages of theory development  Guiding a patient with mild dementia to remember daily hygiene routines. IMOGENE KING: GOAL ATTAINMENT THEORY SUPPORTIVE- also known as supportive-developmental system She worked as an instructor in Medical-Surgical EDUCATIVE SYSTEM Nursing and was an assistant director at St. John’s the person “is able to perform or can and should learn Hospital School of Nursing. to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without Imogene King -> Goal Attainment Theory assistance.” Specific example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on GOAL ATTAINMENT THEORY more adaptive coping strategies. → The nurse and patient relationship includes communicating information, setting goals together, and then taking appropriate action to achieve those Examples: goals (King, 1981).  Teaching a diabetic patient how to monitor blood glucose levels and administer insulin.  Educating a patient about wound care and infection prevention.  Providing dietary counseling to a patient with hypertension.  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE MAJOR CONCEPTS & DEFINITION POWER the capacity to use resources in organizations to HEALTH defined as dynamic life experiences of a human being, which achieve goals implies continuous adjustment to stressors in the internal and STATUS the position of an individual in a group external environment through optimum use of one’s resources to achieve maximum potential for daily living (King, 1981, p. 5). A MODEL OF TRANSACTION NURSING defined as a process of action, reaction, and interaction whereby → process of human interactions that lead to transactions nurse and client share information about their perceptions in the → According to King, “The human process of interactions formed the basis for nursing situation. designing a model of transactions that depicted theoretical knowledge SELF “The self is a composite of thoughts and feelings which constitute used by nurses to help individuals and groups attain goals.” a person’s awareness of his [or her] individual existence, his [or her] conception of who and what he [or she] is. A person’s self is the sum total of all he [or she] can call his [or hers]. The self includes, among other things, a system of ideas, attitudes, values, and commitments…” DYNAMIC CONCEPTUAL SYSTEMS PROPOSITIONS WITHIN KING’S THEORY OF GOAL ATTAINMENT 01. If perceptual interaction accuracy (accurately understand patient’s needs) is present in nurse-patient interactions, the transaction will occur. 02. If the nurse and patient make the transaction, the goal or goals will be achieved. 03..…satisfaction will occur. 04. …effective nursing care will occur. PERSONAL SYSTEM Concepts: body image, growth and development, 05. If transactions are made in nurse-patient interactions, growth and perception, self, space, and time to comprehend development will be enhanced. human beings as persons. 06. If role expectations and role performance perceived by the nurse and SELF system of ideas, attitudes, values, and commitments. patient are congruent, the transaction will occur. Person’s total subjective environment. 07. If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur. It is that to which we refer when we say “I.” 08. If a nurse with special knowledge communicates appropriate information GROWTH AND from a potential for achievement to the actualization of DEVELOPMENT self. to the patient, mutual goal setting and goal achievement will occur. SPACE physical area known as “territory” and by the behaviors of those occupying it. METAPARADIGM TIME “it is the relation of one event to another event.” PERSON ENVIRONMENT INTERPERSONAL Two or more individuals interact, forming dyads (two Individuals are spiritual beings. “an understanding of the ways that SYSTEMS people) or triads (three people). human beings interact with their Individuals have the ability to record environment to maintain health was The dyad of a nurse and a patient. Families, when acting their history and preserve their essential for nurses” as small groups, also can be considered interpersonal culture. systems. Individuals are unique and holistic, of Concepts of communication, interaction, role, stress, intrinsic worth, and capable of and transaction. rational thinking and decision making COMMUNICATION Information is given from one person to another in most situations INTERACTION Observable behaviors of two or more individuals in mutual presence Individuals differ in their needs, wants, and goals ROLE Reciprocity (a person may be a giver at one time and a taker at another time) SOCIAL SYSTEMS Groups that make-up society Religious, educational, and health care systems are examples of social systems.  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE HEALTH NURSING 01. The measure of effective adaptation is Health “implies continuous “Nursing is an observable behavior compatibility with life. adjustment to stress in the internal found in the health care systems in 02. A poor adaptation may threaten life itself, but at and external environment through the society” (King, 1971, p. 125). The goal of the same time. optimum use of one’s resources to nursing “is to help individuals 03. the degree of adaptive potential available to the achieve the maximum potential for maintain their health so they can individual may be sufficient to maintain life at a daily living” function in their roles” different level of effectiveness. → 3 Characteristics of Adaption: Nursing is an interpersonal process of HISTRORICITY → patterned responses passed on through genetics. action, reaction, interaction, and SPECIFICITY → unique adaptive responses to specific environmental challenges. transaction. REDUNCANCY → availability of multiple adaptive responses ENVIRONMENT ANALYSIS OF THEORY INTERNAL → Physiological E. & Pathophysiological processes CLARITY A major strong point of King’s conceptual system and theory → “Bernard identified the primordial seas, captured within the of goal attainment is the ease with which it can be integument of the human body and providing the organism with a understood by nurses. Concepts are concretely defined and tightly regulated solution of substances essential to its continued well- illustrated. being… Man carried the essentials with him, safely packaged inside his SIMPLICITY King’s definitions are clear and are conceptually derived skin” from research literature. EXTERNAL E. PERCEPTUAL: aspects of the world that individuals intercept GENERALITY King maintained the broad use of the theory in most nursing (POC) and interpret with their sense organs. situations. In support of King’s perspective, health care OPERATIONAL: environmental components that physically professionals have documented examples of the affect individuals, although they cannot directly perceive application of the theory of goal attainment with patients them (microorganisms) with diabetes (Maloni, 2007) and surgical patients (Bruns et CONCEPTUAL: characterized by cultural patterns, spirituality, al., 2009; Sivaramalingam, 2008). and aspects mediated through the symbols of language, ACCESIBILITY A descriptive study was conducted to identify the thought, and history characteristics of transaction and whether nurses made ORGANISMIC RESPONSE (Integrated or Holistic Response) transactions with patients. RESPONSE TO → the most primitive response IMPORTANCE Focused on all aspects of the nursing process: assessment, FEAR (Fight or → adrenocortical-sympathetic reactions planning, goal setting, implementation, and evaluation. Flight) → Hospitalization, illness, and new experiences elicit this response MYRA LEVINE: CONSERVATION THEORY INFLAMMATOR → Protects the organism from irritants and pathogens Private duty nurse, a civilian nurse in the U.S. Army, Y – IMMUNE → Way of healing; it drains energy reserves a preclinical instructor in the physical sciences at RESPONSE → NI focus: minimizing tissue damage, minimize exposure Cook County School of Nursing. to irritants RESPONSE TO → Selye’s model of the adaptive stress response, Director of nursing at Drexel Home in Chicago and STRESS characterized by predictable behavioral and biological surgical supervisor at both the University of responses (adrenocortical hormones) to various Chicago Clinics and the Henry Ford Hospital in nonspecific stressors of life. Detroit → Long-term stress can take a toll on the individual, leading to a state of exhaustion. SENSORY → Perceptual awareness as individuals experience the CONSERVATION THEORY RESPONSE world around them through sensory stimuli. → nursing aims to promote adaptation and maintain wholeness using the four → Responsiveness to this sensory input prompts principles of conservation. individuals to maintain safety and seek wholeness → Wholeness, Adaptation, Conservation NURSING → has a conservative function, seeking to actively support the patient’s adaptive efforts to achieve the best MAJOR CONCEPTS & DEFINITION available environmental fit, thus conserving wholeness WHOLENESS → A person can experience wholeness when they are physically, socially and integrity. and psychologically stable. → Goal of Nursing care: Support adaptation and the strong → Human life must be described in the language of “wholes”. drive of the individual to seek wholeness HEALTH → comes from the Anglo-Saxon word ha-l THERAPEUTIC → focuses on enhancing adaptation and improving well- INTEGRITY → the wholeness of the individual (sense of independence & selfhood). NURSING being → Conserving the integrity of the individual is the hallmark of nursing CARE intervention SUPPORTIVE → used when nursing care is unable to improve the HEALING → the defense of wholeness INTERVENTION adaptive response or “fail to halt a downhill course”, → the avenue of return to the daily activities compromised by ill health. S including nursing care for the dying patient. → It is not only the insult or injury that is repaired but the person himself MYRA LEVINE’S FOUR CONSERVATION PRINCIPLES or herself… → Conservation - Latin word conservatio — “to keep together”. → It is not merely the healing of an affected part. → It is a return to selfhood and the individual is free to pursue once more his or her own interests without constraint. ADAPTION → the process by which individuals ‘fit’ the environments in which they live. → critical for conserving wholeness in the midst of constant environmental change → Change is characteristic of life.  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE  Provide support and assistance to family (care of patient and family) — transition of care from nurse to patient and family  Ethnic and subcultural affiliations  Socially connected religious needs  Nurse - patient interaction LEVINE’S CONSERVATION MODEL OF NURSING CONSERVATIO → refers to balancing energy input and output to avoid N OF ENERGY excessive fatigue METAPARADIGM → during illness demands nursing intervention that PERSON ENVIRONMENT balances the individual’s resource with the expenditure described as a holistic being; “an understanding of the ways that he can safely afford. wholeness is integrity human beings interact with their → Examples: environment to maintain health was  Activity as tolerated “system of systems, and in its essential for nurses”  Complete bed rest wholeness expresses the organization  Complete bed rest without bathroom privilege of all the contributing parts”  Bed rest with bathroom privilege  Bed rest without bathroom privilege The word patient comes from the  Ambulate with assistance Latin ‘to suffer’ while the word client  Non-weight bearing comes from the Latin ‘to follow’… Any CONSERVATIO → Refers to maintaining or restoring the structure of body individual who enters into the N OF preventing physical breakdown and promote healing dependency of health care is a STRUCTURAL → Examples: patient. INTEGRITY  Assist client in range of motion exercises HEALTH NURSING  Turning patient side to side ability to function in a reasonably a profession and scientific discipline  Personal hygiene (Bed bathing, Grooming, normal manner Oral care, Perineal/genital care “Nursing is a human interaction.” FOCUS → Minimize structural damage and prevent disability Health is the return to self; individuals (Levine, 1973, p. 1) → Levine noted that “all varieties of surgical intervention are free and able to pursue their own are designed to restore or redesign structural integrity” interests within the context of their and “every infection is an assault on structural integrity”. own resources. CONSERVATIO → Value of self-identity, self-worth, and self-respect. N OF → The body does not exist separately from the mind, ANALYSIS OF THEORY PERSONAL emotions, and soul. CLARITY Levine’s model possesses clarity. Holistic view of the person. INTEGRITY → Examples: George (2002) affirms, “this theory directs nursing actions  Respect client’s autonomy (consent to that lead to favorable outcomes” treatment) SIMPLICITY The four conservation principles appear simple initially, they  Right of client to be informed contain sub concepts and multiple variables. Nevertheless,  Right of client to participate in his/her care this model is still one of the simpler ones to understand  Protect patient privacy  Recognition of holiness (spiritual nature) GENERALITY The four conservation principles can be used in all nursing contexts. CONSERVATIO → Social integrity is reflected in dynamic relationships N OF SOCIAL among human beings. ACCESIBILITY Levine used deductive logic to develop her model. As she INTEGRITY → Exists when a client is recognized as someone who lived her conservation model, she verified the use of resides within a family, a community, a religious group, inductive reasoning to further develop and inform her mode an ethnic group, a political system, and a nation IMPORTANCE The model continues to demonstrate powerful evidence of → Examples: its utility for nursing practice and research and is receiving  Visitation increased recognition in this 21st century.  Position patient to facilitate communication  Promote client’s use of news paper, magazines, radio and television  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE BETTY NEUMAN: NEUMAN SYSTEMS MODEL → Primary prevention – includes health promotion Neuman was a pioneer of nursing involvement in and maintenance of wellness. mental health. NORMAL LINE OF → The model’s outer solid circle DEFENSE → An adaptational level of health developed over Completed her initial nursing education with time and is considered normal for a particular double honors at Peoples Hospital School of individual client or system. Nursing (now General Hospital) → It becomes a standard for wellness-deviance determination → Secondary Protection – preventive measures that lead to early diagnosis and prompt illness. LINES OF → A series of broken rings surrounding the basic core NEUMAN’S SYSTEMS MODEL RESISTANCE structure. → Views a person as an open system that responds to stressors in the → Protection factors are activated when stressors environment. have penetrated the normal line of defense, → Emphasizes the interaction between various factors in an individual’s life, causing reaction symptomatology. including physical, psychological, sociocultural, developmental, and spiritual → Tertiary elements. 3 LEVELS OF INTERVENTION 1 PRIMARY → Used when a stressor is suspected or identified. MAJOR CONCEPTS PREVENTION → “A reaction has not yet occurred,” but the degree LINES OF DEFENSE 01. F - Flexible line of defense of risk is known. 02. N - Normal Line of defense → The purpose is to reduce the possibility of 03. R - Lines of resistance encounter with the stressor or to decrease the LEVELS OF → As intervention possibility of a reaction. PREVENTION 01. Primary 2 SECONDARY → Involves interventions or treatment 02. Secondary PREVENTION → The client’s internal and external resources are 03. Tertiary used to strengthen internal lines of resistance, WHOLISTIC → Clients are viewed as a whole whose parts are in reduce the reaction, and increase resistance APPROACH dynamic interaction. factors. → Variables affecting the client system: physiological, 3 TERTIARY → Occurs after the active treatment psychological, sociocultural, developmental, and PREVENTION → Focuses on readjustment toward optimal client spiritual. system stability. OPEN SYSTEM → System is open where “there is a continuous flow of → Goal is to maintain optimal wellness by input and process, output, and feedback.” preventing recurrence of reaction or regression. INPUT AND OUTPUT → Matter, energy, and information that are STRESSORS → Tension-producing stimuli “that have the exchanged between the client and the potential to disrupt system stability, leading to an environment. outcome that may be positive or negative” FUNCTION OR → Exchanges “energy with the environment as well as → They mar arise from the following: PROCESS other parts and subparts of the system” as it uses INTRAPERSONAL FORCES → Occurring within the individual (anxiety, negative available energy resources “to move toward self-talk) stability and wholeness” INERPERSONAL FORCES → Occurring between one or more individuals (role FEEDBACK → System output in the form of “matter, energy, and expectations, peer pressure, social rejection) information serves as feedback for future input” “for EXTRAPERSONAL FORCES → Occurring outside the individual (financial corrective action to change, enhance, or stabilize circumstances, noisy polluted area, job the system.” insecurity) ENTROPY → Process of energy depletion and disorganization DEGREE OF REACTION → The degree of reaction represents system moving the system toward illness or possible death. instability that occurs when stressors invade the NEGENTROPY → A process of energy conservation that increases normal line of defense. organization and complexity, moving toward → The person may begin to exhibit a degree of stability at a higher degree of wellness. reaction such as: STABILITY → “Desirable state of balance in which energy PHSYICAL SYMPTOMS → Insomnia, headaches, or stomach problems exchanges can take place without disruption of the EMOTIONAL INSTABILITY → Anxiety, depression, or irritability. character of the system,” which points toward BEHAVIORAL → Withdrawal from social interactions, increased optimal health. use of alcohol or other substances BASIC STRUCTURE AND ENERGY RESOURCES RECONSTITUTION → It represents return of the system to stability” → The basic structure or central core comprises of those basic survival which mat be at higher or lower level of wellness factors common to human beings. than before stressor invasion. → These factors include the system variables, genetic features, and HIGHER LEVEL OF → individual adopts new healthy behaviors strengths and weaknesses of the system parts. WELLNESS compared to their pre-accident state. FLEXIBLE LINE OF → Outer broken ring. LOWER LEVEL OF → Their system has stabilized with lasting impacts DEFENSE → 1st protective mechanism. WELLNESS on physical and mental health. → A protective buffer for preventing stressors from breaking through the usual wellness state. → “When the flexible line of defense expands, it provides greater short-term protection against stressor invasion; when it contracts, it provides less protection (Accordion-like Mechanism)”  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE METAPARADIGM COMPROMISED → The modes and subsystems are not adequately HUMAN BEINGS ENVIRONMENT PROCESS meeting the environmental challenge (hypoxia, The concept of human beings as an “the environment consists of both unresolved loss, abusive relationships) open client system in reciprocal internal and external forces FOCAL STIMULUS → “the internal or external stimulus most interaction with the environment. The surrounding the client” immediately confronting the human system” client may be an individual, family, (Asthma) group, community, or social issue. → The FRIST stimuli HEALTH NURSING → The CENTRAL stimulus “Health is a continuum of wellness to Neuman (1982) believes that nursing CONTEXTUAL STIMULI → “are all other stimuli present in the situation that illness that is dynamic in nature. is concerned with the whole person. contribute to the effect of the focal stimulus” Optimal wellness exists when the total She views nursing as a “unique (Dyspnea while taking shower) system needs are being completely profession in that it is concerned with → The SECONDARY stimuli. met” all of the variables affecting an → The surrounding factors that indirectly influence individual’s response to stress” the focal stimuli When system needs are met, optimal RESIDUAL STIMULI → “are environmental factors within or without the wellness exists. When needs are not The nurse’s perception influences the human system with effects in the current situation satisfied, illness exists. When the care given; therefore Neuman (1995) that are unclear” (Beliefs & thoughts of not being energy needed to support life is not states that the perceptual field of the able to take a shower safely) available, death occurs caregiver and the client must be → Residual stimuli are underlying, often vague assessed. factors whose effects are not fully understood but may still play a role in the overall adaptation ANALYSIS OF THEORY process. CLARITY Neuman presents abstract concepts that are familiar to INNATE COPING → generally viewed as automatic processes, nurses. The model’s essential concepts of client, MECHANISMS humans do not have to think about them. environment, health, and nursing are congruent with ACQUIRED COPING → developed through strategies such as learning. traditional understanding of the nursing metaparadigm. MECHANISMS The experiences encountered throughout life SIMPLICITY The model is complex; therefore it cannot be described as contribute to customary responses to particular being simple, yet nurses using the model describe it as easy stimuli. to understand, and it is used across cultures and in a wide COPING MECHANISM variety of practice settings. REGULATOR → The regulator subsystem is a person’s GENERALITY The Neuman systems model has been used in a wide variety physiological coping mechanism. of nursing situations; it is both comprehensive and → The body attempts to adapt via regulation of our adaptable. bodily processes, including neurochemical and ACCESIBILITY The model has been tested and is used extensively to guide endocrine systems. nursing research. → Oxygenation, Nutrition, Elimination, Activity & Rest, IMPORTANCE Neuman’s conceptual model includes guidelines for the Fluids & Electrolyte professional nurse for assessment of the client system, use COGNATOR → The cognator subsystem is a person’s mental of the nursing process, and implementation of preventive coping mechanism. interventions, which are all important to delivery of care → A person uses his brain to cope via self-concept, interdependence, and role function adaptive SISTER CALLISTA ROY: ADAPTATION MODEL modes Member of the Sisters of Saint Joseph of → Physical Self: Maintain positive view of physical Carondelet was born on October 14, 1939, in Los appearance Angeles, California. → Personal Self: Hopeful view of oneself To maintain close nurturing relationships with people who are Master’s degree in sociology and doctorate willing to give & receive love degree in sociology from the University of California. 4 ADAPTIVE MODES → Mnemonics: Please Self, magstudy ka ng Roles Interdependently PHYSIOLOGICAL- → the physical and chemical processes involved ADAPTATION MODEL PHYSICAL MODE in the function and activities of living organisms. → This model emphasizes the process of adaptation, which is essential for → 5 Basic needs of physiological integrity: health and well-being. 01. Oxygenation → The nurse’s role is to assess how well patients are adapting and to help them 02. Nutrition reach better health by supporting their adaptation in physical, psychological, 03. Elimination social, and spiritual domains. 04. Activity and rest 05. Protection 2 SUB CONCEPTS → Contributes to physiological adaptation: ADAPTATION LEVEL (ICC) 01. Fluid INTEGRATED → The various modes and subsystems meet the 02. Electrolyte, and acid-base balance PROCESS needs of the environment. 03. Neurological function → These are usually stable processes (breathing, 04. Endocrine function spiritual realization, successful relationship). SELF-CONCEPT – → it focuses specifically on the psychological and COMPENSATORY → The cognator and regulator are challenged by the GROUP IDENTITY MODE spiritual aspects of the human system. PROCESS environment’s needs but are working to meet the → This includes body image and self-ideal. needs (grief, starting with a new job, → Basic needs: compensatory breathing). 01. Psychic and spiritual integrity  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE 02. Sense of unity METAPARADIGM 03. Meaning and purposefulness in the PERSON ENVIRONMENT universe According to Roy, humans are holistic, According to Roy, environment is “all → The group identity mode “reflects how people in adaptive systems. “As an adaptive the conditions, circumstances, and groups perceive themselves based on system, the human system is influences surrounding and affecting environmental feedback. The group identity described as a whole with parts that the development and behavior of mode [is composed] of interpersonal function as unity for some purpose. persons or groups, with particular relationships, group self-image, social milieu, Human systems include people as consideration of the mutuality of and culture”. individuals or in groups, including person and earth resources that ROLE FUNCTION MODE → focuses on the roles the person occupies in families, organizations, communities, includes focal, contextual, and society. and society as a whole” residual stimuli” → Set of expectations about how a person HEALTH NURSING occupying one position behaves. “Health is a state and a process of Nursing according to her model as → Basic need: Social Integrity being and becoming integrated and the science and practice that → Persons perform primary, secondary, and a whole person. It is a reflection of expands adaptive abilities and tertiary roles. adaptation, that is, the interaction of enhances person and environmental INTERDEPENDENCE → focuses on close relationships of people the person and the environment transformation. MODE (individually and collectively) and their purpose, structure, and development. → Basic need: Relational integrity ANALYSIS OF THEORY → involve the willingness and ability to give to CLARITY Roy clearly defines the four adaptive modes (physiological, others and accept from them aspects of all that self-concept, interdependence, and role function). one has to offer such as love, respect, value, SIMPLICITY The Roy model includes the concepts of nursing, person, nurturing, knowledge, skills, commitments, health-illness, environment, adaptation, and nursing material possessions, time, and talents. activities. It also includes two sub concepts (regulator and cognator) and four modes (physiological, self-concept, role function, and interdependence). GENERALITY The broad scope of Roy’s model is an advantage because it may be used for theory building and for deriving middle- range theories for testing in studies of smaller ranges of phenomena ACCESIBILITY Over the years, many testable hypotheses have been derived from the model IMPORTANCE The Roy adaptation model has a clearly defined nursing process and is useful in guiding clinical practice. The utility of the model has been demonstrated globally by nurses. DOROTHY JOHNSON: BEHAVIORAL SYSTEM MODE She received her associate’s degree from Armstrong Junior College in Savannah, Georgia Bachelor of Science Degree in Nursing from Vanderbilt University in Nashville, Tennessee BEHAVIORALSYSTEM MODEL → This model advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. → The patient is defined as a behavioral system composed of seven behavioral PERCEPTION subsystems. → the interpretation of a stimulus. → An imbalance in each system results in disequilibrium. → Perception links the regulator with the cognator and connects the → The nurse’s role is to help the patient maintain his or her equilibrium adaptive modes. → The person as a whole is made up of 6 subsystems. These subsystems BEHAVIORAL SYSTEM (the regulator, the cognator, and the four adaptive modes) are → encompasses the patterned, repetitive, and purposeful ways of behaving. interrelated to form a complex system for the purpose of adaptation. → 7 SUBSYSTEMS (ADIE ASA) ATTATCHMENT- → The attachment-affiliative subsystem is probably AFFILIATIVE the most critical because it forms the basis for all SUBSYSTEM social organization. → On a general level, it provides survival and security. → Its consequences are social inclusion, intimacy, and formation maintenance of a strong social bond  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE DPENDENCY → It promotes helping behavior that calls for a METAPARADIGM SUBSYSTEM nurturing response. PERSON ENVIRONMENT → Its consequences are approval, attention or Person as a behavioral system with Environment consists of all the factors recognition, and physical assistance. patterned, repetitive, and purposeful that are not part of the individual’s → Developmentally, dependency behavior evolves ways of behaving that link the person behavioral system, but that influence from almost total dependence on others to a with the environment the system. greater degree of dependence on self. HEALTH NURSING → A certain amount of interdependence is essential Johnson perceived health as an Nursing’s goal is to maintain and for the survival of social groups elusive, dynamic state influenced by restore the person’s behavioral INGESTIVE → The ingestive subsystem “has to do with when, biological, psychological, and social system balance and stability or to SUBSYSTEM how, what, how much, and under what conditions factors. help the person achieve a more we eat”. optimum level of balance and → “It serves the broad function of appetitive Health is reflected by the functioning. satisfaction”. organization, interaction, → This behavior is associated with social, interdependence, and integration of psychological, and biological considerations the subsystems of the behavioral ELIMINATIVE → The eliminative subsystem addresses “when, how, system. SUBSYSTEM and under what conditions we eliminate”. → As with the ingestive subsystem, the social and ANALYSIS OF THEORY psychological factors are viewed as influencing CLARITY A person is described as a behavioral system composed of the biological aspects of this subsystem and may seven subsystems. be, at times, in conflict with the eliminative SIMPLICITY The theory is potentially complex because there are a subsystem. number of possible interrelationships among the behavioral ACHIEVEMENT → The achievement subsystem attempts to system, its subsystems, and the environment. SUBSYSTEM manipulate the environment. GENERALITY Johnson’s theory has been used extensively with people who → Its function is control or mastery of an aspect of are ill or face the threat of illness. self or environment to some standard of ACCESIBILITY Accessibility is achieved by identifying empirical indicators excellence. for the abstract concepts of model. Empirical precision → Areas of achievement behavior include improves when the sub concepts and the relationships intellectual, physical, creative, mechanical, and between and among them become better defined. social skills. IMPORTANCE Johnson’s theory guides nursing practice, education, and SEXUAL SUBSYSTEM → The sexual subsystem has the dual functions of research; generates new ideas about nursing; and procreation and gratification. differentiates nursing from other health professions. → Including, but not limited to, courting and mating, this response system begins with the ANNE BOYKIN & SAVINA SCHOENHOFER: development of gender role identity and includes THEORY OF NURSING AS CARING: the broad range of sex-role behaviors. A MODEL FOR TRANSFORMING PRACTICE AGGRESSIVE- → The aggressive-protective subsystem’s function ANNE BOYKIN PROTECTIVE is protection and preservation. Director of the Anne Boykin Institute for the SUBSYSTEM → Society demands that limits be placed on modes Advancement of Caring in Nursing of self-protection and that people and their property be respected and protected Graduated from Alverno College in Milwaukee, Wisconsin DOROTHY JOHNSON’S BEHAVIORAL SYSTEM MODEL SAVINA SCHOENHOFER Co- founded Nightingale Songs, an early venue for communicating the beauty of nursing in poetry and prose. Professor of Nursing at University of Mississippi Medical Center School of Nursing THE THEROTY OF NURSING AS CARING: A MODEL FOR TRANSFORMING PRACTICE REGULATION → implies that deviations will be detected and → The point of departure from traditional thought was the acceptance that corrected. caring is the end rather than the means of nursing, and the intention of FEEDBACK → a requirement of effective control. nursing rather than merely its instrument. → The Theory of Nursing as Caring was born out of the early curriculum development work at Florida Atlantic University College of Nursing. → Anne Boykin and Savina Schoenhofer were among the faculty group revising the caring-based curriculum.  THEORETICAL FOUNDATIONS MIDTERM NOTES | A. GABRIELLE MAJOR CONCEPTS & DEFINITION STORY AS METHOD → Method for knowing nursing and a medium for all PERSPECTIVE OF → ALL persons are caring. FOR KNOWING forms of nursing inquiry. Nursing stories embody PERSONS AS CARING → Caring is lived by each person moment to NURSING the lived experience of nursing situations involving moment and is an essential characteristic of the nurse and the nursed. being human. → Nursing situations are best communicated → Each person grows in the capacity to express through aesthetic media such as storytelling, caring. poetry, graphic arts, and dance to preserve the → “fundamentally, potentially, and actually each lived meaning of the situation and the openness person is caring”, even though every act of the of the situation through text. person might not be understood as caring NURSING SITUATION → The nursing situation is what is present in the mind 6 MAJOR ASSUMPTIONS of the nurse whenever the intent of the nurse is “to PERSON nurse”. 01. Persons are Caring by Virtue of Their Humanness → It is within the nursing situation that the nurse - The assumption that all persons are caring does not require that each act attends to calls for caring or reaching out to the of a person be caring, but it does require the acceptance that one nursed. “fundamentally, potentially, and actually, each person is caring”. → The nursing situation involves an expression of 02. Persons are Whole and Complete in the Moment values, intentions, and actions of two or more - Respect is communicated by the notion of a person as whole or complete persons choosing to live a nursing relationship. in the moment. Being complete in the moment signifies that there is no PERSONHOOD → Process of living that is grounded in caring. insufficiency, no brokenness, and no absence of something. → Authentic caring person and being open to 03. Persons Live Caring, Moment to Moment unfolding possibilities for caring. - Caring is a lifetime process that is lived moment to moment and is → Within the nursing situation, the shared lived constantly unfolding. “How ought I act as caring person? experience of caring within enhances HEALTH personhood, and both the nurse and the nursed 04. Personhood is Living Life Grounded in Caring grow in caring. - The fullness of being human is expressed in living caring uniquely day to → In the intimacy of caring, respect for self as person day. It is being authentic, demonstrating congruence between beliefs and and respect for other are values that affirm behaviors, and living out the meaning of one’s life. personhood. ENVIRONMENT DIRECT INVITATION → Within the nursing situation, the direct invitation 05. Personhood is Enhanced Through Participating in Nurturing Relationships opens the relationship to true caring between the With Caring Others nurse and the nursed. - The nature of relationships is transformed through caring. “Through → With the intention of truly coming to know the one knowing self as caring person, I am able to be authentic to self, freeing me nursed [client], the nurse risks entering the other’s to truly be with others” world and comes to know what is meaningful to NURSING him or her. 06. Nursing is both a Disci