NCMA100 Midterm PDF

COURSE UNIT 7 ✓ The science of unitary human beings comprises of five assumption, four SCIENCE OF UNITARY HUMAN major concepts and three major BEINGS BY MARTHA E. ROGERS principles...

COURSE UNIT 7 ✓ The science of unitary human beings comprises of five assumption, four SCIENCE OF UNITARY HUMAN major concepts and three major BEINGS BY MARTHA E. ROGERS principles ✓ Major concepts are: Energy field, BACKGROUND openness, pattern, and pan ✓ Born: May 12, 1914, Dallas, Texas, dimensionality USA ✓ Major principles include resonancy, ✓ Diploma: Knoxville General Hospital helicy and integrity. It is also known as School of Nursing (1936) homeodynamic principles. ✓ Graduation in Public Health Nursing: George Peabody College, 1937 ASSUMPTIONS ✓ MA: Teachers college, Columbia university, New York, 1945 WHOLENESS ✓ MPH: Johns Hopkins University, Human being is considered as Baltimore, 1952 united whole ✓ Doctorate in nursing: Johns Hopkins University, Baltimore, 1954 OPENNESS ✓ Position: Professor at Division of A person and his environment Nursing, New York University and are continuously exchanging Consultant, Speaker energy with each other ✓ Died: March 13, 1994 UNIDIRECTIONALLY Publications of Martha Rogers The life process of human being Theoretical basis of nursing evolves irreversibly and (Rogers 1970) unidirectional i.e from birth to Nursing science and art a death prospective (Rogers 1988) Nursing science of unitary, PATTERN AND ORGANIZATION irreducible, human beings Pattern identifies individuals and (Rogers 1990) reflects their innovative Vision of space based nursing wholeness. (Rogers 1990) SENTENCE AND THOUGHT Introduction of Theory Humans are the only organisms ✓ The belief of the coexistence of the able to think, imagine, have human and the environment has greatly language and emotions influenced the process of change toward better health. MAJOR CONCEPTS ✓ In short, a patient can't be separated from his or her environment when ENERGY FIELD addressing health and treatment. It is inevitable part of life. ✓ This view lead and opened Martha E. Human and environment both Rogers' theory, known as the "Science have energy field which is open of Unitary Human Beings," which i.e. energy can freely flow allowed nursing to be considered one of between human and the scientific disciplines. environment. ✓ Rogers repeatedly stated that she did not create a "theory" but rather an OPENNESS abstract System, a science, from which There is no boundary or barrier many theories may be derived. that can inhibit the flow of  energy between human and interact with environment. A environment which leads to the person cannot be viewed as continuous movement or matter parts, it should be considered as of energy. a whole. PATTERN ENVIRONMENT Pattern is defined as the It includes the entire energy field distinguishing characteristic of other than a person. an energy field perceived as a These energy fields are single waves irreducible, not limited by space "pattern is an abstraction and and time, identified by its pattern it gives identity to the field” and organization. PAN DIMENSIONALITY HEALTH Pan dimensionality is defined as Not clearly defined by Rogers. It "non linear domain without is determined by the interaction spatial or temporal attributes" between energy fields i.e. Human being are pan human and environments. dimensional being and have Bad interaction or misplacing of more. than three dimension. energy leads to illness. HOMEODYNAMIC PRINCIPLES NURSING ✓ Homeodynamics refers to the balance Nursing exists to serve people. between the dynamic life process and Nursing is both science and art. environment. It is the direct and overriding ✓ These principles help to view human responsibility to the society as unitary human being. ✓ Three principle of homeodynamics CLINICAL PRACTICE are: ✓ Nursing action is always focused on unitary human being and change the RESONANCY energy field between human and Wave patterns are continuously environment. changing in environmental and ✓ Nursing action include all non-invasive human energy fields. actions such as guided imaginary, humor, therapeutic touch, music etc. which are HELICY used to increase the potential of human The nature of change is field. unpredictable, continuous, and ✓ The more importance should be on the an innovative. management of pain, supportive therapy and rehabilitation. INTEGRALITY Energy fields of humans and EXAMPLE environment are in a continuous ✓ Ritu 22 years old female was admitted mutual process. in psychiatric hospital with severe depression secondary to diagnosis of ROGER'S THEORY AND NURSING ovarian malignancy. She became tearfull META PARADIGM while history taking. Ritu was accompanied by her husband and 1 year UNITARY HUMAN BEING (PERSON) old child. Her husband appear anxious A unitary human being is open but supportive. Ritu was diagnosed with systems which continuously ovarian cancer 2 month ago and underwent surgery for same. From past an abstract, unified, and highly derived three week ritu started sitting alone, framework. decreased activity of daily living, ✓ Testing the concepts' validity is repeated crying spells, decreased talk, questionable because its concepts are decreased sleep, neglecting her child not directly measurable. care, and also attempted suicide. ✓ The theory was believed to be profound, and was too ambitious NURSING EDUCATION because the concepts are extremely ✓ Emphasis should be given on the abstract. understanding of the patient and self, ✓ Rogers claimed that nursing exists to energy field and environment. serve people; however, nurses' roles were not clearly defined. EXAMPLE ✓ Training should lay more focus on teaching non-invasive modalities such as therapeutic touch, meditation, humor, DOROTHEA OREM'S SELF-CARE regular in service education programme DEFICIT THEORY etc. BACKGROUND RESEARCH ✓ Born 1914 in Baltimore, US ✓ Roger theory has been used in many ✓ Earned her diploma at Providence research works and has always found Hospital Washington, DC testable and applicable in research. ✓ 1939-BSN Ed., Catholic University of America EXAMPLE ✓ 1945-MSN Ed., Catholic University of ✓ A study to assess the effectiveness of America music therapy on stress reduction among postmenopausal women residing in MAJOR CONCEPTS AND Hudco Colony, Coimbatore DEFINITIONS ✓ A Study to Assess the Effectiveness of Orem's general theory of nursing's Yoga Therapy in Reducing Stress among three related parts: Primary Care Givers of Psychiatric Theory of self care Patients. Theory of self care deficit Theory of nursing system STRENGTH ✓ Rogers' concepts provide a worldview Theory of Self Care from which nurses may derive theories and hypotheses and propose This theory Includes: relationships specific to different Self Care - practice of activities that an situations. individual initiates and performs on ✓ Rogers' theory is not directly testable his/her own behalf in maintaining life, due to lack of concrete hypotheses, but it health and well being. is testable in principle. Self Care Agency - is a human ability WEAKNESSES which is "the ability for engaging in self ✓ Overall this theory is considered as care"; conditioned by age, developmental very complex concept and quite difficult state, life experience, sociocultural to understand. orientation, health, and available ✓ Rogers' model does not define resources particular hypotheses or theories for it is Therapeutic self care demand - "totality ✓ Being aware of and attending to the of self care actions to be performed for effects and results of pathologic some duration in order to meet self care conditions requisites by using valid methods and ✓ Effectively carrying out medically related sets of operations and actions“ prescribed measures ✓ Modifying self concepts in accepting Self care requisites - action directed oneself as being in a particular state of towards provision of self care. health and in specific forms of health care ✓ Learning to live with effects of Three categories of self care pathologic conditions requisites are: 1. Universal self care requisites Theory of Self Care Deficit 2. Developmental self care ✓ Specifies when nursing is needed requisites ✓ Nursing is required when an adult (or 3. Health deviation self care in the case of a dependent, the parent) is requisites incapable or limited in the provision of continuous effective self care. Universal Self Care Requisites ✓ Associated with life processes and the Orem identifies 5 methods of helping: maintenance of the integrity of human - Acting for and doing for others structure and functioning - Guiding others ✓ Common to all; activities of daily living - Supporting another ✓ Identifies these requisites as: - Providing an environment - Maintenance of sufficient intake promoting personal of air, water, food development in relation to meet - Provision of care associated future demands with elimination process - Teaching another - Balance between activity and rest, between solitude and Theory of Nursing Systems social interaction ✓ Describes how the patient's self care - Prevention of hazards to human needs will be met by the nurse, the life well being and patient, or both - Promotion of human functioning ✓ Identifies 3 classifications of nursing system to meet the self care requisites of Developmental Self Care Requisites the patient: ✓ Associated with developmental 1. Wholly compensatory system processes/ derived from a condition...or 2. Partly compensatory system associated with an event. 3. Supportive - educative system Example: Wholly Compensatory Systems - adjusting to a new job "nurse should be compensating - adjusting to body changes for a patient's total inability for (or prescriptions against) engaging in self-care activities Health Deviation Self Care that require ambulation and Required in conditions of illness, manipulation movements“ injury, or disease. These Partly Compensatory Systems include: "both nurse and patient perform ✓ Seeking and securing appropriate care measures or other actions medical assistance involving manipulative tasks or ambulation“ Supportive - Educative Systems capable of meeting the patient's "for situations where the patient self care needs is able to perform required To maintain a state of health measures of externally or To regain normal or near normal internally oriented therapeutic state of health in the event of self-care but cannot do so disease or injury without assistance” To stabilize, control, or minimize the effects of chronic poor health MAJOR ASSUMPTIONS or disability ✓ People should be self-reliant and responsible for their own care and others HEALTH in their family needing care. Health and healthy are terms ✓ People are distinct individuals. used to describe living things. ✓ Nursing is a form of action – It is when they are structurally interaction between two or more persons. and functionally whole or sound ✓ Successfully meeting universal and...wholeness or integrity. development self-care requisites is an.includes that which makes a important component of primary care person human,...operating in prevention and ill health conjunction with physiological ✓ A person's knowledge of potential and psychophysiological health problems is necessary for mechanisms and a material promoting self-care behaviors structure and in relation to and ✓ Self care and dependent care are interacting with other human behaviors learned within a socio-cultural beings. context ENVIRONMENT THEORETICAL ASSERTIONS Environment components are The model shows that when an enthronement factors, individual's self-care capabilities enthronement elements, are less than the therapeutic conditions, and developed self-care demand, the nurse environment. compensates for the self-care or dependent care deficits. HUMAN BEING Has the capacity to reflect, Orem’s Theory and Metaparadigm symbolize and use symbols Conceptualized as a total being NURSING with universal, developmental Is art, a helping service, and a needs and capable of technology continuous self care Actions deliberately selected A unity that can function and performed by nurses to help biologically, symbolically and individuals or groups under their socially care to maintain or change conditions in themselves or their environments GOAL ATTAINMENT THEORY BY Encompasses the patient's IMOGENE KING perspective of health condition, the physician's perspective, and BACKGROUND the nursing perspective ✓ Imogene King was born in West Point, Goal of nursing - to render the lowa on January 30, 1923, youngest of patient or members of his family three children. ✓ She completed her diploma in nursing According to Imogene King, human education in 1945, at St. John's Hospital being has three fundamental needs: in St. Louis, Missouri. ✓ Information on health that can be ✓ She received her BS and MS in accessed and utilized when needed nursing from St. Louis University in 1957, ✓ Care that aims to prevent illness ✓ She obtained her Doctorate in ✓ Care in times of illness/helplessness Education from Columbia University, N.Y. ✓ In 1981 she refined her concepts into HEALTH a nursing theory that consisted of the According to Imogene King, following basis: health involves dynamic life 1. An open system framework as experiences of a human being, the basis of goal attainment. which implies continuous 2. Nursing as a major system adjustment to stressors in the within the health care system. internal and external 3. Nursing process emphasis on environment through optimum interpersonal processes. use of one's resources to achieve maximum potential for ✓ She Died on December 24, 1997, 2 daily living. days after suffering from stroke. ENVIRONMENT THEORY OF GOAL ATTAINMENT It is the background for human ✓ Elements are seen in the interpersonal interactions. It involves: systems in which two people, who are usually strangers, come together in a ✓ Internal Environment - transforms health care organization to help and be energy to enable person to adjust to helped to maintain a state of health that continuous external environmental permits functioning of roles. changes. ✓ Reflects King's belief that the practice ✓ External Environment - involves of nursing is differentiated from other formal and informal organizations. Nurse healthcare professions by what nurses do is a part of the patient's environment. with and for individuals. ✓ Nurse and client communicate NURSING information, set goal mutually and then Nursing for Imogene King is an act to attain those goals. act wherein the nurse interacts and communicates with the Metaparadigm in Nursing: client. The nurse helps the client identify the existing health PERSON condition, exploring and Imogene King described a agreeing on activities to promote person existing in an open health. The goal of the nurse in system as a spiritual being and Imogene King's theory is to help rational thinker who makes the client maintain health choices, selects alternative through health promotion and courses of action, and has the maintenance, restoration, and ability to record their history caring for the sick and dying. through their own language and symbols, unique, holistic and Use of Empirical Evidence have different needs, wants and ✓ King used a "systems" approach in the goals. development of her Dynamic Interacting Systems Framework and in her subsequent Goal-Attainment Theory. INTERACTING SYSTEMS If role conflict is experienced by FRAMEWORK nurse or client or both, stress in Three systems in the conceptual nurse-client interaction will occur framework: If nurse with special knowledge and skill communicate appropriate information to client, mutual goal setting and goal attainment will occur. Acceptance By The Nursing Community RESEARCH Basis for development of middle-range nursing theories: Model for Multicultural Nursing Practice (Rooda, 1992) Theory of Personal System Empathy (Alligood & May, 2000) Theory of Family Health (Doornbos, 2000) EDUCATION Framework for the baccalaureate program (Ohio State University School of Nursing) Educational reform resulting in Theoretical Assertion nursing education (Sweden) ✓ From the theory of goal attainment Imogene King developed predictive PRACTICE propositions, which includes: A model for bedside nursing If perceptual interaction practice in the hospital setting accuracy is present in (Coker & Schreiber, 1990) nurse-patient interactions, a Managed care program in transaction will happen. hospital settings (Hampton, If nurse and client make 1994) transaction, goal will be Goal-Oriented Nursing Record attained. system for documentation If goal are attained, satisfaction Structure of Quality Assurance will occur. Program If goals are met, efficient nursing care will happen. ANALYSIS If transactions are made in nurse-client interactions, growth CLARITY and development will be Clear and conceptually derived enhanced from research literature at the If role expectations and role time the theory was developed. performance as perceived by nurse and client are congruent, transaction will occur GENERALITY It has been criticized for having limited applications in areas of nursing in which patients are unable to competently interact with the nurse. King has responded that 70% of communication is nonverbal. EMPIRICAL PRECISION From a study of 17 patients, goals were attained in 12 cases (70%). King believes that if nursing students are taught the theory of goal attainment and it is used in nursing practice, goal attainment can be measured and the effectiveness of nursing care can be demonstrated. Derivable Consequences: It focuses on all aspects of the nursing process: assessment, planning, implementation and evaluation. King believes that nurses must assess to set mutual goals, plan to provide alternative means to achieve goals, and evaluate to determine if the goal was attained. COURSE UNIT 8 SYSTEMS MODEL BY BETTY NEUMAN BRIEF INTRODUCTION ✓ Born in 1924 in Ohio. ✓ Diploma-1947, from People's hospital ✓ B.S. in public health nursing – 1957 ✓ M.S. as public health- mental health nurse consultant-1966, California ✓ Doctorate in clinical psychology from ✓ Pacific Western University- 1985 ✓ Multiple Honorary doctorate ✓ Contribution Areas: Public health, hospital, school health, industry and mental health settings. THE NEUMAN SYSTEMS MODEL Provides a comprehensive, flexible, holistic and system based perspective for nursing. Deals with stress and stress reduction and is primarily concerned with the effects of stress on health. According to her, this model provides a total approach to client problems by providing a multidimensional view of the person as an individual. CLIENT VARIABLES ✓ Each concentric circle or layer is made up of the five variable areas which occur simultaneously in each client : Physiologic variables Psychological variables Socio-cultural variables Developmental variables Spiritual variables- added in 1989 ✓ In ideal situation these variables function in harmony. ✓ Each of the variables should be considered when assessing system reactions to stressors for each of the Medication management for concentric circles in the model diagram. chronic conditions (e.g., diabetes) NURSING INTERVENTIONS Support groups for mental ✓ Focus on retaining or maintaining health system stability. ✓ Are carried out on three preventive METAPARADIGM levels. - Primary prevention as HUMAN BEING (PERSON) intervention Is viewed as an open system - Secondary prevention as that interacts with both internal intervention and external environmental - Tertiary prevention as forces and stressors. intervention The human is in constant change, moving towards a Primary Prevention dynamic state of system stability ✓ This level aims to prevent disease or or towards illness of varying injury before it occurs. It involves degrees. strategies that promote overall health and well-being. ENVIRONMENT Examples The environment may be viewed Vaccinations as all factors that affect and Health education and promotion affected by the system. It (e.g., nutrition and exercise includes interpersonal, programs) intrapersonal and extra-personal Policies to reduce exposure to stressors that interfere with harmful substances (e.g., person's normal line of defense anti-smoking laws) and can affect the system's stability. Secondary Prevention ✓ This level focuses on early detection HEALTH and prompt intervention to address a Defined as condition or degree disease or condition before it progresses. of system stability and is viewed It often involves screening and regular as a continuum from wellness to check-ups. illness. Examples Stability occurs when all Mammograms for early system's parts and subparts are detection of breast cancer in balance or harmony so that Blood pressure screening to the whole system is in balance. identify hypertension Regular cholesterol tests NURSING As actions that assist persons, Tertiary Prevention families and groups to attain and ✓ This level aims to reduce the impact of maintain a maximum level of an already established disease by wellness. managing complications and improving Nursing uses primary, quality of life. It focuses on rehabilitation secondary and tertiary and support. interventions to reduce client's Examples stressors. It consist of three Physical therapy for stroke steps: Nursing diagnosis, recovery  nursing goals and nursing LIMITATIONS outcomes. ✓ Some concepts like level of wellness, and concept on reconstitution requires APPLICATION IN EDUCATION, clearer definition and further RESEARCH AND PRACTICE explanations. ✓ Components of the flexible line of EDUCATION defense interact in very complex ways ✓ Accelerated in education at all levels and it may be difficult to overgeneralize of practice in varied settings. their interaction. ✓ Many schools of nursing in the world ✓ Although reaction is identified in the (usa, canada, australia, india, nepal etc.) pictorial model, it is not discussed use the Neuman Systems Model as a separately. curriculum framework or for selected courses. ✓ B.sc. Nursing course of Nepal incorporate this model in the curriculum. ADAPTATION MODEL BY SISTER CALLISTA ROY RESEARCH ✓ In order to facilitate the use of nursing Biography of "Callista Roy” research with the Neuman Systems ✓ Sister Callista L. Roy is a nursing Model, Fawcett has offered guidelines for theorist born October 14, 1939. constructing Neuman Systems ✓ Bachelor of Arts Major in Nursing from Model-based studies. Mount Saint Mary's College in Los ✓ Neuman model has guided a range of Angeles in 1963. study designs, from qualitative ✓ Master's degree in nursing from the descriptions of relevant phenomena to University of California in 1966. quantitative experiments that tested the ✓ She developed the basic concepts of effects of prevention interventions on a the model while she was a graduate variety of client-system outcomes student at the University of California from 1964 to 1966. PRACTICE ✓ Roy's Adaptation Model of Nursing ✓ Used in different settings developed in 1976. ✓ Used to guide practice with clients with cognitive impairments, meeting the family Callista Roy's Adaptation Model needs of clients in critical care, to provide ✓ The RAM presents the person as a stable support groups for parents with holistic adaptive system in constant infants in NICU and to meet the needs of interaction with the internal and external home caregivers, with emphasis on environment. clients with cancer, HIV/AIDS, and head ✓ Roy conceptualizes the person in a traumas. holistic perspective. ✓ The main task of the human system is to maintain integrity in response to STRENGTHS AND LIMITATIONS environmental stimuli. STRENGTHS Adaptation is the process of ✓ Provides clear direction for fitting or conforming of an interventions through primary, secondary, individual to the environment, and tertiary prevention which have the end result of successful gained universal acceptance. adaptation is known as ✓ Provide important guidelines for "Adjustment". On the other nursing research, education and practice.  hand unsuccessful attempts at Example: A patient with a history of adaptation are known as anxiety may have residual stimuli "Maladjustment“ or Integration affecting their response to the pain and of human and environment limitations caused by their injury. Their meanings results in adaptation. past experiences with pain management, coping strategies, and emotional Theory Description responses to stress can shape how they adapt to their current situation. Description of Stimuli Three Types of Stimuli Control Processes 1. Focal Stimuli Regulator Subsystem ✓ Focal stimuli are the most immediate ✓ The regulator subsystem operates and direct stimuli affecting an individual at automatically and is primarily responsible a given time. They demand attention and for physiological responses. It includes: prompt an adaptive response. Neural Processes: Involves the Example: A patient experiencing acute nervous system's immediate pain from a broken leg is experiencing a responses to stimuli, such as focal stimulus. The pain is the central reflex actions. issue that requires immediate attention, Chemical Processes: Relates leading to responses such as medication to the body’s biochemical administration and mobility assistance. reactions, like hormonal responses to stress. 2. Contextual Stimuli Endocrine Processes: Involves ✓ Contextual stimuli are the background the release of hormones that factors surrounding the focal stimulus help regulate various bodily that can influence the individual's functions, such as metabolism response. These may include and stress response. environmental, social, cultural, and situational factors. ✓ Together, these processes help maintain homeostasis, enabling the body Example: In the case of the patient with to react to internal and external changes a broken leg, contextual stimuli might without conscious thought. include the patient's home environment (e.g., presence of stairs), the support Cognator Subsystem from family and friends, and the ✓ The cognator subsystem is more healthcare resources available (e.g., complex and involves higher-level access to rehabilitation services). If the cognitive functions. It encompasses: patient lives alone in a multi-story house without support, these contextual factors Perceptual Information will affect their recovery process and Processing: How individuals adaptation to the injury. interpret and make sense of their experiences and 3. Residual Stimuli surroundings. ✓ Residual stimuli are factors that have Learning: The ability to acquire an enduring impact on the individual but knowledge or skills through may not be immediately apparent. These experience or education. can include past experiences, beliefs, Judgment: Involves and learned behaviors that influence decision-making processes current responses.  based on the information threatened. They might adapt by seeking processed. new job opportunities while also Emotion: Refers to the affective reallocating time to engage more deeply responses that influence with their children, redefining their role in behavior and adaptation. the family and finding fulfillment in other ways. ✓ This subsystem allows individuals to actively engage with their environment, Interdependence Mode assess situations, and make conscious ✓ This mode concerns the relationships decisions to adapt. and support systems individuals utilize. Example: An elderly person living alone Effectors-Adaptive Modes may face challenges with daily living ✓ These are the form or manifestation tasks. They adapt by reaching out to that the regulator and cognator family for assistance or joining a subsystems will take. community center, thereby enhancing ✓ These are the actual adaptive their support network and improving their responses and include four categories overall well-being. Physiological mode Self-concept Roy’s Theory into Nursing Practice Role function ✓ Implementing Roy's theory into Interdependence nursing practice is a six-step process; 1. Assess the behaviors Physiological Mode manifested from the four ✓ This mode involves the biological and adaptive modes physical responses of the body. 2. Assess the stimuli for those Example: A patient recovering from behaviors and categorize them surgery might experience pain (a as focal, contextual, or residual physiological challenge). The body 3. Make a nursing diagnosis of the adapts by releasing endorphins to person's adaptive state manage pain, and the patient may also 4. Sets goals to promote engage in deep breathing exercises to adaptation promote relaxation and recovery. 5. Implements interventions 6. Evaluate if goals have been met Self-Concept Mode ✓ This mode pertains to an individual’s Case Study Related to Roy’s Theory beliefs and self-image, affecting their ✓ A 51 year old male with Diabetes Type emotional and psychological responses. II for 13 years. Following an amputation Example: An individual diagnosed with a of his right great toe, the wound become chronic illness might struggle with their infected and non-healing. His medical self-concept. They may initially feel a loss team is recommending a below the knee of identity but adapt by engaging in amputation. support groups or finding new hobbies ✓ Using the first RAM step the nurse that align with their health status, helping assesses the patient in all four adaptive to rebuild a positive self-image. modes; in the Physiological mode examples include heart sound, Role Function Mode oxygenation, and all physical responses ✓ This mode focuses on how individuals perform their social roles and In the Self Concept Mode this responsibilities. patient may be anxious about Example: A parent dealing with job loss changes in body image. may feel their role as a provider is  In the Role Performance mode BEHAVIORAL SYSTEMS MODEL BY he may be worried about his DOROTHY JOHNSON ability to support his family. In the Interdependence Mode BACKGROUND OF DOROTHY he may wonder where his social JOHNSON support may come from i.e. ✓ Dorothy Johnson Born on 21st August friends, family, etc. 1919 in Georgia USA ✓ 1942 BS Nursing from Nashville ✓ In Step 2 of assessment the stimuli Tennessee are considered. ✓ Master in public health from Harvard Focal stimuli are the University Boston in 1948. non-healing wound and the ✓ Creation of her theory began in 1940's immediate below the knee when she began to teach. amputation. ✓ Retired in 1978 and died in 1999 Contextual stimuli are his diabetes for the past 13 years DEFINITION OF NURSING and compliance with medical ✓ An external regulatory force which advice. acts to preserve the organization and Residual stimuli are other integration of the patients' behaviors at medical conditions, his family an optimum level under those conditions status, etc. in which the behaviors constitutes a threat to the physical or social health, or ✓ The following four steps of the RAM in which illness is found” are the usual steps in the Nursing process. THE JOHNSON’S MODEL PURPOSES ✓ Following this six step process takes a ✓ Nurse creates a balance between Grand Nursing Theory into a practical client and environment. pathway for nurses to follow. ✓ Protection from noxious stimuli that threaten the survival of the behavioral Critiques and Strengths system. ✓ One criticism is the model is that it is ✓ Nurturance, which provides adequate behavior oriented and not holistic. Roy input to sustain behavior. addresses this herself when she shows ✓ Stimulation to continue growth of the people as an adaptive force in the behavior. universe modeling their environment and with her worldview of veritivity (a ASSUMPTION OF BEHAVIOR SYSTEM worldview of common destiny with all MODEL humanity and everyone having a purpose ✓ First assumption states that there is in life). organization interaction, interdependency and integration of the parts and elements ✓ One strength I liked of RAM is it of the behaviors that go to makeup the focuses on the patient with the nurse as a system. helper(change agent). ✓ A system tends to achieve a balance among the various forces operates within and upon it, and that man strives continually to maintain a behavior system balance and steady state by or less automatic adjustment and adoptions to the natural forces impinging upon him. ✓ A behavioral system, which both Elimination/Subsystem require and results in some degree of ✓ This subsystem relates to the regularity and constancy in behavior is processes of waste removal from the essential to man that is to say, it is body. It highlights the importance of functionally significant that it serves maintaining bodily functions. useful purpose, both in social life and for Example: A patient with a the individual. gastrointestinal issue may require monitoring of bowel movements.Nurses ✓ The final assumption states system can educate the patient on dietary balance reflects adjustments and changes to improve elimination. adoptions that are successful in some way and to some degree. Sexual/Subsystem ✓ This subsystem encompasses the JOHNSONS BEHAVIORAL SUB- individual's sexual health and SYSTEM relationships. It acknowledges the importance of sexual identity and Attachment or Affiliative Subsystem intimacy. ✓ This subsystem focuses on the Example: A patient undergoing treatment emotional bonds and relationships for cancer may have concerns about individuals form with others. It sexual function.Nurses can provide a emphasizes the need for security and safe space to discuss these concerns acceptance. and refer them to specialists if needed. Example: A patient recovering from surgery may express anxiety about being Achievement/Subsystem away from family. Nurses can encourage ✓ This subsystem focuses on the visits or video calls to strengthen individual's ability to set and reach goals. emotional support and alleviate anxiety. It emphasizes motivation and personal growth. Dependency/Subsystem Example: A patient in rehabilitation may ✓ This subsystem pertains to the set a goal to walk unaided. Nurses can individual's need for assistance and care support this goal by creating a tailored from others. It highlights the importance exercise plan and celebrating milestones. of social support in coping with illness. Example: A patient with chronic illness Aggressive/Subsystem may require help with daily activities. ✓ This subsystem involves the Nurses can assess the level of support expression of anger or assertiveness. It the patient has and facilitate access to can be essential for individuals to home care services. communicate their needs and boundaries. Ingestion/Subsystem Example: A patient expressing ✓ This subsystem deals with the intake frustration about their condition may need of food and fluids, emphasizing the help finding constructive ways to cope. importance of nutrition and hydration in Nurses can facilitate communication skills health. workshops or counseling sessions. Example: A patient on a special diet after surgery may need education on nutritional choices.Nurses can provide information on appropriate foods that support recovery JOHNSON’S BSM AND NURSING PROCESS LIMITATIONS ✓ Johnson does not clearly interrelate ASSESSMENT her concepts of subsystem. ✓ In the assessment phase of the ✓ The definition of concept is so abstract nursing process, questions related to that they are difficult to use. specific subsystem are developed. ✓ It is difficult to test Johnson's model by Affiliation or attachment development of hypothesis. Dependency ✓ The focus on the behavioral Aggression subsystem makes it difficult for nurses to Elimination work with physically impaired individual to Ingestion use this theory. Achievement ✓ The model is very individual oriented so the nurses working with the group DIAGNOSIS have difficulty in its implementation. ✓ Insufficiency: particular system not ✓ Johnson's behavioral system model is functioning properly not flexible. ✓ Discrepancy: a behavior that does not meet the intended goal (lack of balance) PLANNING AND IMPLEMENTATION ✓ The plan will focus on nurses actions to modify clients behavior, these plan then have a goal, to bring about homeostasis in a subsystem, based on nursing assessment of the individuals drive, The plan may include protection, nurturance or stimulation of the identified subsystem. EVALUATION ✓ Evaluation is based on the attainment of a goal of balance in the identified subsystems. CHARACTERISTICS OF THE THEORY ✓ Interrelate concepts to create a different way of viewing a phenomenon. ✓ Theories must be logical in nature. ✓ Theories must be simple yet generalizable. ✓ Theories can be the bases of hypothesis that can be tested. ✓ Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them. ✓ Theories can be utilized by practitioners to guide and improve their practice. COURSE UNIT 9 Resource person: providing specific answers to questions within a larger HILDEGARD E PEPLAU context PSYCHODYNAMIC NURSING THEORY Teacher: helping the client to learn formally or informally BACKGROUND Leader: offering direction to the client or ✓ Name: Hildegard Elizabeth Peplau group ✓ Nickname: Hilda Surrogate: serving as a substitute for ✓ Birthday: September 1, 1909 another such as a parent or a sibling ✓ Died: March 17, 1999 in Sherman Counselor: promoting experiences Oaks, California leading to health for the client such as ✓ Birthplace: Reading, Pennsylvania expression of feelings Technical Expert: providing physical CAREER TIMELINE care for the patient and operates 1931 - Diploma program in Pottstown, equipment Pennsylvania 1943 - BA in interpersonal psychology - Additional roles include: Bennington College Technical expert 1947 - MA in psychiatric nursing from Consultant Colombia University, New York Health teacher 1952 - Published Interpersonal Relations Tutor in Nursing Socializing agent 1968 - interpersonal techniques - the crux Safety agent of psychiatric Nursing Manager of environment Worked as executive director Mediator and president of ANA Administrator Worked with WHO and NIMH Recorder observer Researcher INTRODUCTION TO THEORY BY ✓ The nurse and patient work together Four Phases of the Therapeutic so that both become mature and Nurse - Patient Relationship knowledgeable in the process. ✓ It is psychodynamic in nature and it ORIENTATION PHASE facilitates ✓ This initial phase involves the nurse - Understanding of one's own and patient coming together. The nurse behavior establishes rapport, assesses the - Helping others identify felt patient's needs, and clarifies the purpose needs or difficulties and goals of the relationship. During this - Therapeutic Nurse Patient phase, trust is built, and boundaries are relationship set. - Application of human relations to problem-solving at all levels of experience. PEPLAU'S SEVEN ROLES OF A NURSE Stranger: offering the client the same acceptance and courtesy that the nurse would respond to any stranger IDENTIFICATION PHASE ✓ BS in public health nursing - St. John's ✓ In this phase, the patient begins to University, NY, identify with the nurse and feels ✓ MA in mental health nursing - comfortable sharing thoughts and Columbia University, New York. feelings. The patient recognizes their ✓ Associate Professor at Yale School of needs and seeks help. The nurse Nursing and Director of the Graduate supports this exploration, helping the Program in Mental Health Psychiatric patient articulate their concerns and Nursing. goals. DEFINITIONS EXPLOITATION PHASE ✓ Distress is the experience of a patient ✓ This is the working phase where the whose need has not been met. patient utilizes the resources provided by ✓ Nursing role is to discover and meet the nurse. The patient engages in various the patient's immediate need for help. therapeutic activities, explores feelings, - Patient's behavior may not and works on problem-solving. The nurse represent the true need. acts as a facilitator, guiding the patient - The nurse validates his/her through challenges and promoting understanding of the need with personal growth. the patient. ✓ Nursing actions directly or indirectly RESOLUTION PHASE provide for the patient's immediate need. ✓ The final phase occurs when the ✓ An outcome is a change in the therapeutic relationship ends. The nurse behavior of the patient indicating either a and patient review the progress made, relief from distress or an unmet need. discuss feelings about the termination, - Observable verbally and and reinforce the patient's newfound nonverbally. skills and insights. The focus is on ✓ Nursing client - patients who are ensuring the patient can apply what under medical care and who cannot deal they've learned independently in the with their needs or who cannot carry out future. medical treatment alone ✓ Nursing problem - distress due to CONCLUSION unmet needs due to physical limitations, ✓ Peplau's theory explains the phases of adverse reactions to the setting or interpersonal process, roles in nursing experiences which prevent the patient situations and methods for studying from communicating his needs nursing as an interpersonal process. ✓ Nursing process - the interaction of Nursing is therapeutic in that it is a 1) the behavior of the patient, 2) the healing art, assisting an individual who is reaction of the nurse and 3) the nursing sick or in need of health care. actions which are assigned for the patients benefit ✓ Nurse - patient relations - central in theory and not differentiated from nursing IDA JEAN ORLANDO'S DELIBERATIVE therapeutics or nursing process NURSING PROCESS THEORY ✓ Nursing therapeutics - Direct function: initiates a process of helping the BACKGROUND patient express the specific meaning of ✓ Born in 1926. his behavior in order to ascertain his ✓ Wrote about THE NURSING distress and helps the patient explore the PROCESS. distress in order to ascertain the help he ✓ Nursing Diploma - New York Medical requires so that his distress may be College relieved. ✓ Indirect function - calling for help of Immediate Reaction others, whatever help the patient may - Internal Response require for his need to be met ✓ Automatic activities - perception by ✓ Person perceives with any one of his five senses, automatic thoughts, five sense organs an object or objects automatic feeling, action ✓ The perceptions stimulate automatic thought CONCEPTS ✓ Each thought stimulates an automatic Function of professional nursing feeling - organizing principle ✓ Then the person acts Presenting behavior ✓ The first three items taken together - problematic situation are defined as the person's immediate Immediate reaction reaction - internal response Nursing process discipline Nursing Process Discipline - investigation - Investigation Improvement - resolution ✓ Any observation shared and explored with the patient is immediately useful in Function of professional nursing ascertaining and meeting his need or - Organizing Principle finding out that he is not in need at that time. ✓ Finding out and meeting the patient ✓ The nurse does not assume that any immediate needs for help aspect of her reaction to the patient is ✓ "Nursing....is responsive to individuals correct, helpful or appropriate until she who suffer or anticipate a sense of checks the validity of it in exploration with helplessness, it is focused on the process the patient. of care in an immediate experience, it is ✓ The nurse initiates a process of concerned with providing direct exploration to ascertain how the patient is assistance to individuals in whatever affected by what she says or does. setting they are found for the purpose of ✓ When the nurse does not explore with avoiding, relieving, diminishing or curing the patient her reaction it seems the individuals sense of helplessness." reasonably certain that clear - Orlando communication between them stops. Presenting Behavior Improvement - Problematic Situation - Resolution ✓ To find out the immediate need for ✓ It is not the nurse's activity that is help the nurse must first recognize the evaluated but rather its result: whether situation as problematic the activity serves to help the patient ✓ The presenting behavior of the patient, communicate her or his need for help and regardless of the form in which it how it is met. appears, may represent a plea for help ✓ Each contact the nurse repeats a ✓ The presenting behavior of the patient, process of learning how to help the the stimulus, causes an automatic individual patient. internal response in the nurse, and the nurses behavior causes a response in the patient 5 STAGES OF THE DELIBERATIVE ✓ Used at the patient care level, NURSING PROCESS managerial level, and nursing division level. ASSESSMENT ✓ In the assessment stage, the nurse EDUCATION completes a holistic assessment of the ✓ Orlando's process recording has made patient’s needs. This is done without a significant contribution to nursing taking the reason for the encounter into education. consideration. The nurse uses a nursing ✓ Process recording - a tool to facilitate framework to collect both subjective and self- evaluation of whether or not the objective data about the patient. process discipline was used. DIAGNOSIS RESEARCH ✓ The diagnosis stage uses the nurse's ✓ Enjoyed considerable acceptance by clinical judgment about health problems. the nursing profession in the area of The diagnosis can then be confirmed research and has been applied to a using links to defining characteristics. variety of research settings. related factors, and risk factors found in the patient's assessment. PLANNING HENDERSON'S NEED THEORY ✓ The planning stage addresses each of the problems identified in the diagnosis. BACKGROUND Each problem is given a specific goal or outcome, and each goal or outcome is INTRODUCTION ABOUT VIRGINIA given nursing intervention to help achieve HENDERSON the goal. By the end of this stage, the ✓ "The Nightingale of Modern Nursing“ nurse will have a nursing care plan. ✓ "Modern-Day Mother of Nursing." ✓ "The 20th century Florence IMPLEMENTATION Nightingale." ✓ In the implementation stage, the nurse ✓ Born in Kansas City, Missouri, in begins using the nursing care plan. November 30, 1897. ✓ Diploma in Nursing from the Army EVALUATION School of Nursing at Walter Reed ✓ Finally, in the evaluation stage, the Hospital, Washington, D.C. in 1921. nurse looks at the patient's progress ✓ Worked at the Henry Street Visiting toward the goals set in the nursing care Nurse Service for 2 years after plan. Changes can be made to the graduation. nursing care plan based on how well (or ✓ In 1923, started teaching nursing at poorly) the patient is progressing toward the Norfolk Protestant Hospital in Virginia the goals. If any new problems are ✓ In 1929, entered Teachers College at identified in the evaluation stage, they Columbia University for Bachelor's can be addressed, and the process starts Degree in 1932, Master's Degree in over again for those specific problems. 1934. ✓ Died: March 19, 1996 ACCEPTANCE BY THE NURSING ✓ In 1939, she revised: Harmer's classic COMMUNITY textbook of nursing for its 4th edition, and later wrote the 5th; edition, incorporating PRACTICE her personal definition of nursing ✓ Clearly applicable to nursing practice. (Henderson, 1991) ✓ Basis of practice in hospitals. DEFINITION OF NURSING ✓ The 10th and 14th are Her definition of NURSING was: psychological aspects of ✓ "The unique function of the nurse is to communicating and learning, assist the individual, sick or well, in the ✓ The 11th component is spiritual and performance of those activities moral contributing to health or its recovery (or to ✓ The 12th and 13th components are peaceful death) that he would perform sociologically oriented to occupation unaided if he had the necessary strength, and recreation. will or knowledge. And to do this in such a way as to help him gain independence ACCORDING TO HENDERSON (1990), as rapidly as possible" (Henderson, AN EXCELLENT NURSE CAN BE 1966). MEASURED IN THE FOLLOWING ✓ Decreased mortality rates among 14 COMPONENTS OF HENDERSON'S those she serves. THEORY ✓ Decrease in symptoms of nursing neglect such as pressure sores or 1. Breathe normally. incontinence. 2. Eat and drink adequately. ✓ Decrease in psychological withdrawal 3. Eliminate body wastes. symptoms, negativism, or mutism. 4. Move and maintain desirable ✓ Decrease in dependency with respect postures. to daily activities or the degree of 5. Sleep and rest. rehabilitation achieved. 6. Select suitable clothes-dress ✓ Favorable opinions of care given by and undress. the nurse as expressed by the patient, 7. Maintain body temperature his family, other nurses, or associated within normal range by adjusting medical personnel. clothing and modifying environment PURPOSES OF NURSING THEORIES 8. Keep the body clean and well groomed and protect the IN PRACTICE integument ✓ Assist nurses to describe, explain, and 9. Avoid dangers in the predict everyday experiences. environment and avoid injuring Serve to guide assessment, others. interventions, and evaluation of nursing 10. Communicate with others in care. expressing emotions, needs, ✓ Provide a rationale for collecting fears, or opinions. reliable and valid data about the health 11. Worship according to one's faith. status of clients, which are essential for 12. Work in such a way that there is effective decision making and a sense of accomplishment. implementation. 13. Play or participate in various ✓ Help to describe criteria to measure forms of recreation. the quality of nursing care. 14. Learn, discover, or satisfy the ✓ Help build a common nursing curiosity that leads to normal terminology to use in communicating with development and health and other health professionals. use the available health ✓ Ideas are developed and words are facilities. defined. ✓ Enhance autonomy (independence ✓ The first 9 components are and self-governance) of nursing through physiological. defining its own independent functions. IN EDUCATION Nursing, now known as Ann May School ✓ Provide a general focus for curriculum of Nursing. design ✓ Guide curricular decision making. 21 Nursing Problems Theory IN RESEARCH Description of the Theory ✓ Offer a framework for generating ✓ Abdellah's typology of 21 nursing knowledge and new ideas. problems is a conceptual model mainly ✓ Assist in discovering knowledge gaps concerned with patient's needs and in the specific field of study. nurses' role in problem identification ✓ Offer a systematic approach to identify using a problem analysis approach. questions for study; select variables, interpret findings, and validate nursing The 21 Nursing Problems fall into interventions. three categories: 1. Physical sociological and CONCLUSION emotional needs of clients ✓ In conclusion, Henderson's work is 2. Types of interpersonal considered a nursing theory because it relationships between the nurse contains a definition of nursing and basic and patient needs of nursing care. She focuses on 3. Common elements of client care patient care to help patients reach a level of independence which include nursing ✓ She used Henderson's 14 basic care and education. By exploring human needs and nursing research to Henderson's nursing theory and establish the classification of nursing understanding its origins and key problems. features, and how it relates to personal values and beliefs I am able to apply her Problem Solving theory to clinical situations. ✓ Is a process involves identifying the problem, selecting pertinent data, formulating hypothesis, testing hypothesis through the collection of data, ABDELLAH'S 21 NURSING and revising hypothesis where necessary PROBLEMS THEORY on the basis of conclusions obtained from the data. BACKGROUND ✓ Faye Glenn Abdellah (March 13, Classification of the 21 Nursing 1919-Febuary 24, 2017) Problems ✓ She is a nursing research pioneer who 1. Basic to all Patients developed the "Twenty- One Nursing 2. Sustenal Care Needs Problems." 3. Remedial Care Needs ✓ She was born in New York to a father 4. Restorative Care Needs of Algerian heritage and a Scottish mother. Her family subsequently moved BASIC TO ALL PATIENTS to New Jersey, where she attended high 1. To maintain good hygiene and physical school. comfort. ✓ She was the first nurse officer to rank 2. To promote optimal activity; exercise, a two-star rear admiral, the first nurse, rest, sleep. and the first woman to serve as a Deputy 3. To promote safety through prevention Surgeon General. of accident, injury or other trauma, and ✓ In 1942, she earned a nursing diploma through prevention of the spread of from Fitkin Memorial Hospital's School of infection. 4. To maintain good body mechanics and 21. To understand the role of social prevent and correct deformity. problems as influencing factors in the cause of illness. SUSTENAL CARE NEEDS 5. To facilitate the maintenance of a Application Nursing Practice supply of oxygen to all body cells. ✓ Abdellah's main goal is the 6. To facilitate the maintenance of improvement of nursing education nutrition for all body cells. ✓ The most important impact of 7. To facilitate the maintenance of Abdellah's theory to nursing practice is elimination. that, it helped transform the focus of the 8. To facilitate the maintenance of fluid profession from being "disease-centered" and electrolyte balance. to "patient-centered". 9. To recognize the physiological responses of the body to disease Conclusion conditions- pathological, physiology, and ✓ Abdellah's theory provides basis for compensatory. determining and organizing nursing care. 10. To facilitate the maintenance of The problems also provide a basis for regulatory mechanisms and functions. organizing appropriate nursing strategies. 11. To facilitate the maintenance of ✓ As a whole, the theory is intended to sensory function. guide care not just in the hospital setting, but can also be applied to community REMEDIAL CARE NEEDS nursing as well. 12. To identify and accept positive and ✓ This theory is mainly focused on the negative expressions, feelings, and clients and nurse's role in identification reactions. and solving these problems. 13. To identify and accept ✓ Her theory has changed the entire interrelatedness of emotions and organic nursing focus from disease to patient illness. centered approach. 14. To facilitate the maintenance of effective verbal and nonverbal communication. 15. To promote the development of productive interpersonal relationships. 16. To facilitate progress toward achievement and personal spiritual relationships. 17. To create or maintain a therapeutic environment. 18. To facilitate awareness of self as an individual with varying physical, emotional, developmental needs. RESTORATIVE CARE NEEDS 19. To accept the optimum possible goals in the light of limitations, physical and emotional. 20. To use community resources as an aid in resolving problems that arise from illness. COURSE UNIT 10 Human-To-Human Relationship Model By Joyce Travelbee BACKGROUND ✓ Born in 1926. ✓ Psychiatric nurse, educator, and a writer ✓ 1956 - completed her Bachelor of Science degree in Nursing at the Louisiana State University ✓ 1959 - she completed her Master of Science in Nursing at Yale University. ✓ 1973 - she started a doctoral program in Florida; however she didn't finish it because she died a year later at the age of 47 due to a brief sickness. Theory's Background ✓ "Actually there are no patients. There are only individual human beings in need of care, services and assistance of other human beings" From her experiences working with Catholic charity institutions, travelbee felt that. ✓ Compassion was lacking in nursing care. ✓ If nurses experience personal sufferings they would be better able to help patient deal with illness and suffering. These experiences of travelbee led her to formulate a theory where caring about the patient is central. Madeleine Leininger’s Transcultural Nursing BACKGROUND ✓ Born on July 13, 1925, in Sutton, Nebraska. ✓ Inspired to pursue nursing due to her aunt's congenital heart disease. ✓ Earned a nursing diploma from St. Anthony’s Hospital School of Nursing. ✓ Completed undergraduate degrees at MATERIAL CULTURE - refers to objects Mount St. Scholastica College and (dress, art, religious artifacts) Creighton University. ✓ Established a psychiatric nursing NON-MATERIAL CULTURE - refers to service and educational program at beliefs customs, languages, social Creighton University. institutions. ✓ Achieved the equivalent of a BSN through studies in biological sciences, SUBCULTURE - composed of people nursing administration, teaching, and who have a distinct identity but are curriculum from 1951 to 1954. related to a larger cultural group. MAJOR CONCEPTS AND BICULTURAL - a person who crosses DEFINITIONS two cultures, lifestyles, and sets of values TRANSCULTURAL NURSING - is a DIVERSITY - refers to the fact or state of comparative study of cultures to being different. Diversity can occur understand similarities (culture universal) between cultures and within a cultural and difference (culture- specific) across group. human groups (Leininger, 1991). ACCULTURATION - People of a minority CULTURE - Set of values, beliefs and group tend to assume the attitudes, traditions, that are held by a specific values, beliefs, find practices of the group of people and handed down from dominant society resulting in a blended generation to generation. cultural pattern. RELIGION - Is a set of belief in a divine CULTURAL SHOCK - the state of being or super human power (or powers) to be disoriented or unable to respond to a obeyed and worshiped as the creator and different cultural environment because of ruler of the universe. its sudden strangeness, unfamiliarity, and incompatibility to the stranger's ETHNIC - refers to a group of people who perceptions and expectations as it is share a common and distinctive culture differentiated from others by symbolic and who are members of a specific markers (cultures, biology, territory, group. religion). ETHNICITY - a consciousness of ETHNIC GROUPS - share a common belonging to a group. social and cultural heritage that is passed on to successive generations. CULTURAL IDENTITY - the sense of being part of an ethnic group or culture. ETHNIC IDENTITY - refers to a subjective perspective of the person's CULTURE-UNIVERSALS- commonalities heritage and to a sense of belonging to a of values, norms of behavior, and life group that is distinguishable from other patterns that are similar among different groups. cultures. RACE - the classification of people CULTURE-SPECIFICS - values, beliefs, according to shared biologic and patterns of behavior that tend to be characteristics, genetic markers, or unique to a designate culture. features. Not all people of the same race have the same culture. CULTURAL AWARENESS - an in-depth ✓ Professor and Coordinator of the self-examination of one's own Center for Nursing Research at Hunter background, recognizing biases and College, CUNY (1983-1993) prejudices and assumptions about other ✓ Professor and Niehoff Chair at Loyola people. University, Chicago (1993-2006) ✓ Consultant and Visiting Scholar at CULTURALLY CONGRUENT CARE - NYU College of Nursing (since January Care that fits the people's valued life 2007) patterns and set of meanings -which is generated from the people themselves, Assumptions about Human and rather than based on predetermined Becoming criteria. ✓ Human is open and free, choosing meaning in situation and bearing CULTURALLY COMPETENT CARE - responsibility for decisions the ability of the practitioner to bridge ✓ Becoming is the humans' pattern of cultural gaps in caring, work with cultural relating values and priorities differences and enable clients and families to achieve meaningful and MAJOR THEMES OF PARSE'S supportive caring. THEORY APPLICATION TO NURSING MEANING ✓ To develop understanding, respect ✓ Definition: Refers to the personal and appreciation for the individuality and significance individuals assign to their diversity of patients beliefs, values, experiences, actions, and existence. spirituality and culture regarding illness, ✓ Importance: Understanding and its meaning, cause, treatment, and finding meaning is essential for outcome. individuals to navigate their lives and ✓ To encourage in developing and health journeys. It helps patients maintaining a program of physical, articulate their desires, fears, and values, emotional and spiritual self- care. fostering a sense of purpose. RHYTHMICITY ✓ Definition: Refers to the patterns, Rosemarie Rizzo Parse "Theory of cycles, and rhythms inherent in life Human Becoming” experiences, including the flow of health and illness. BACKGROUND ✓ Importance: Recognizing rhythmicity ✓ Dr. Rosemarie Rizzo Parse allows individuals to understand that life ✓ Born: 1938, Pennsylvania is dynamic and that challenges may alternate with periods of well-being. It Education: emphasizes the need for flexibility and ✓ Bachelor’s, Master’s, and Doctorate adaptability in response to life's changes. degrees from Duquesne University, Pittsburgh, PA TRANSCENDENCE ✓ Definition: The process of rising Academic Positions: above or moving beyond one’s current ✓ Faculty member at the University of state or limitations, often leading to Pittsburgh personal growth and transformation. ✓ Dean of the Nursing School at ✓ Importance: Transcendence Duquesne University highlights the potential for individuals to overcome obstacles, redefine their identities, and achieve a higher level of understanding or well-being. It encourages a holistic view of health that PRINCIPLE 2: Cocreating rhythmical includes spiritual and existential patterns of relating is living the dimensions. paradoxical unity of revealing-concealing and enabling-limiting while connecting- The themes and principles of human separating. becoming a permeated by four postulates: REVEALING-CONCEALING - A pregnant youth must reveal ✓ ILLIMITABILITY is "the indivisible her secret to her parents. unbounded knowing extended to infinity, ENABLING-LIMITING the all-at-once remembering and - A patient chooses to refuse a prospecting with the moment" treatment. ✓ PARADOX is "an intricate rhythm CONNECTING-SEPARATING expressed as a pattern preference". - Parents want more aggressive Paradoxes are not "opposites to be treatment for their palliative care reconciled or dilemmas to be overcome daughter; her husband but, rather, lived rhythms". disagrees straining the ✓ FREEDOM is "contextually construed relationship. liberation" Humans are free and continuously choose ways of being with PRINCIPLE 3: Co-transcending with their situations. the possibles is powering the unique ✓ MYSTERY "is the unexplainable, that ways of originating in the process of which cannot be completely known" It is transforming. the inconceivable, unutterable, unknowable nature of the indivisible, POWERING unpredictable, everchanging human - Parents learn to be strong and universe move on with life after losing their youngest child in an THREE PRINCIPLES IN THE THEORY: accident. ORIGINATING PRINCIPLE 1: Structuring meaning - A woman raises money for multidimensionality is co-creating breast cancer research to honor reality through the language of valuing & her grandmother. imaging. TRANSFORMING - An elderly man finally accepts IMAGING outside help as he is no longer - An infertile couple believes there able to care for his wife. are many children in need of loving homes and plan to adopt. VALUING - An older woman putting her LYDIA ELOISE HALL health first as her children have Care, Core and Cure all moved out of the house. LANGUAGING BACKGROUND - Man diagnosed with terminal ✓ Was born in new York city on 21st sept cancer finds the words and the 1906. strength to talk to his family ✓ Basic nursing education in 1927. about it. ✓ Bachelor in public health nursing in 1937. ✓ Master's in teaching Natural sciences in 1942. ✓ First director of leob centre for nursing. THE CORE ✓ Nursing experience in clinical, education, research and supervisor role. Core (Patient): ✓ This level centers on the patient as a THEORY OVERVIEW whole person, considering their individual ✓ Theory developed in late 1960’s. needs, values, and experiences. ✓ Nursing care can be delivered on ✓ It underscores the significance of three interlocking levels. understanding the patient’s perspective, ✓ Cure = Disease. beliefs, and feelings, and emphasizes the ✓ Care = Body relationship between the nurse and the ✓ Core = Patient. patient. ✓ Defined nursing as care performed by trained nurses. THE CURE ✓ Care focused on maintaining optimal health and quality life from birth to end of Cure (Disease): life. ✓ This level focuses on the medical and ✓ Care is ongoing matrix of learning and physiological aspects of patient care, teaching. primarily addressing the treatment of diseases and conditions. ✓ It involves interventions aimed at diagnosing and managing health problems, often through medical procedures and therapies. ASSUMPTIONS ✓ The motivation and energy necessary for healing exist within the patient, rather than in the health care team. ✓ The three aspects of nursing should not be viewed as functioning independently but as interrelated. ✓ The three aspects interact, and the circles representing them change size, depending on the patient's total course of progress. THE CARE Care (Body): ✓ This aspect emphasizes the physical and emotional care provided to the patient. It includes actions that promote comfort, hygiene, nutrition, and overall well-being. ✓ Hall highlights the importance of nurturing the body and fostering a supportive environment that enhances healing. COURSE UNIT 11 - Personal biological factors Health Promotion Model By Nola Include variables such as age Pender gender, body mass index, pubertal status, aerobic BIOGRAPHY capacity, strength, agility, or ✓ Nola Pender was born on August 16, balance. 1941, in Lansing, Michigan. - Personal psychological factors ✓ Her first encounter with the nursing Include variables such as self- profession was when she was 7 years old esteem, self-motivation, and witnessed the care given to her personal competence, perceived hospitalized aunt by nurses. health status, and definition of ✓ This situation led her to the desire to health. care for other people and her goal was to - Personal socio-cultural factors help people care for themselves. Include variables such as race. ethnicity, acculturation, Nola Pender's Health Promotion Model education, and socioeconomic ✓ Nola Pender's Health Promotion status. Model theory was originally published in 1982 and later improved in 1996 and Perceived Benefits of Action 2002. ✓ Anticipated positive outcomes that will ✓ The Health Promotion Model notes occur from positive health behavior. that each person has unique personal characteristics and experiences that Perceived Barriers to Action affect subsequent actions. ✓ Anticipated, imagined or real blocks ✓ Health promoting behavior is the and personal costs of understanding a desired behavioral outcome and is the given behavior endpoint in the Health Promotion Model. Perceived Self-Efficacy Major Concepts of the Health ✓ Judgment of personal capability to Promotion Model organize and execute a health- promoting ✓ Health promotion is defined as behavior. Perceived self-efficacy behavior motivated by the desire to influences perceived barriers to action so increase well-being and actualize human higher efficacy results in lowered health potential. It is an approach to perceptions of barriers to the wellness. performance of the behavior. ✓ Health protection or illness prevention is described as behavior motivated desire Activity-Related Affect to actively avoid illness, detect it early, or ✓ Subjective positive or negative feeling maintain functioning within the that occurs before, during and following constraints of illness. behavior Sub-concepts of the Health Promotion Activity-related affect influences Model ✓ Perceived self-efficacy, which means the more positive the subjective feeling, Personal Factors the greater the feeling of efficacy. In turn, ✓ Personal factors categorized as increased feelings of efficacy can biological, psychological and socio- generate a further positive affect cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered.  ✓ Margaret Newman is born on October Commitment to Plan of Action 10, 1933, in Memphis, Tennessee. ✓ The concept of intention and ✓ Bachelor's degree in home economics identification of a planned strategy leads and English In 1954. to the implementation of health behavior ✓ Bachelor's degree in nursing - University of Tennessee in 1962. Immediate Competing Demands and ✓ Master's degree - University of Preferences California in 1964. ✓ Competing demands are those ✓ Doctorate - New York University in alternative behaviors over which 1971. individuals have low control because ✓ She has worked in University of there are environmental contingencies Tennessee, New York University, such as work or family care Pennsylvania State University of responsibilities. Competing preferences Minnesota are alternative behaviors over which individuals exert relatively high control, INTRODUCTION such as choice of ice cream or apple for ✓ The theory of health as expanding a snack consciousness stimulated by concern for those for whom health as the absence of Health-Promoting Behavior disease or disability is not possible, ✓ A health-promoting behavior is an (Newman, 2010). endpoint or action outcome that is ✓ The theory has progressed to include directed toward attaining positive health the health of all persons regardless of the outcomes such as optimal wellbeing, presence or absence of disease, personal fulfillment, and productive living. (Newman, 2010). ✓ The theory asserts that every person ACCEPTANCE BY NURSING in every situation, no matter how COMMUNITY disordered and hopeless it may seem, is part of the universal process of PRACTICE expanding consciousness, (Newman, ✓ Health promotion in nursing practice 2010). has proven to be a primary resource in the addition of health promotion to the Major Concepts practice of nursing. HEALTH EDUCATION ✓ In Newman's theory, health is an ✓ Use widely among undergraduate and expansion of consciousness defined as postgraduate Clinical education the informational capacity of the system and seen as the ability of the person to RESEARCH interact with the environment (Newman, ✓ It is a tool for research retested the 1994a). According to Newman (1999), empirical precision of the model "Health is the pattern of the whole, and wholeness is One cannot lose it or gain it” Theory of Health as Expanding CONSCIOUSNESS Consciousness By Margaret A. ✓ Consciousness includes not only the Newman cognitive and affective awareness normally associated with consciousness, BIOGRAPHY but also the interconnectedness of the entire living system, which includes physiochemical maintenance and growth ✓ Nursing is "caring in the human health processes as well as the immune system. experience".. Nursing is seen as a This pattern of information, which is the partnership between the nurse and client, consciousness of the