Nursing Philosophies & Conceptual Models PDF

Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur THEORETICAL FOUNDATION IN NURSING Nursing Philosophies MIDTERM PERIOD 1...

Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur THEORETICAL FOUNDATION IN NURSING Nursing Philosophies MIDTERM PERIOD 1. FLORENCE NIGHTINGALE ENVIRONMENTAL THEORY NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 1 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur Nursing “is an act of utilizing the environment of the patient to assist him in his recovery” Stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” ENVIRONMENTAL FACTORS Her concern about healthy surroundings included not only the hospital settings in both the Crimea and England, but it also extended to the private homes of patients and to the physical living conditions of the poor. She believed that healthy surroundings were necessary for proper nursing care. Her theory of the five essential components of environmental health (pure air, pure water, efficient drainage, cleanliness, and light) are as essential today as they were 150 years ago. 1. PURE OR FRESH AIR. Proper ventilation for the patient seemed to be of greatest concern to Nightingale; her charge to nurses was to "keep the air he breathes as pure as the external air, without chilling him. Nightingale's emphasis on proper ventilation seemed to recognize this environmental component as a source of disease and recovery. 2. LIGHT. The concept of light was also of importance in Nightingale's theory. In particular, she identified direct sunlight as a particular need of patients. She specifically noted that "light has quite as real and tangible effects upon the human body. Who has not observed the purifying effect of light, and especially of direct sunlight, upon the air of a room?” To achieve the beneficial effects of sunlight, nurses were instructed to move and position patients to expose them to sunlight. 3. CLEANLINESS. Cleanliness as a concept is another critical component of Nightingale's environmental theory. Regarding this concept, she specifically addressed the patient, the nurse, and the physical environment. She noted that a dirty environment (floors, carpets, walls, and bed linens) was a source of infection through the organic matter it contained. Even if the environment was well ventilated, the presence of organic material created a dirty area; therefore, the appropriate handling and disposal of bodily excretions and sewage was required to prevent contamination of the environment. 4. PURE WATER. Finally, Nightingale advocated the bathing of patients on a frequent, even daily, basis at a time when this practice was not the norm. In addition, she required that nurses also bathe daily, that their clothing was clean, and that they washed their hands frequently. 5. EFFICIENT DRAINAGE. This concept held special significance not only for individual patient care, but it was also critically important in improving the health status of the poor living in crowded, environmentally inferior conditions with inadequate sewage and limited access to pure water. TYPES OF ENVIRONMENT 1. Physical Environment. Where the patient is being treated. Ex: Cleanliness, Ventilation, air, light, noise, water, bedding, drainage, diet 2. Psychological Environment. Affected by a negative physical environment which then cause by STRESS. Ex: Communication, advice 3. Social Environment. Person’s home or hospital room. Ex: Mortality data; Prevention of disease 13 CANONS OF ENVIRONMENTAL THEORY 1. VENTILATION AND WARMTH. Keep the air he breathes as pure as the external air, without chilling him”. Keeping patient, patient’s room warm; Keeping patient’s room well-ventilated and free of odors. Keep the air within as pure as the air external air/without noxious smells. Provided description for measuring the patient's body temperature through palpation of extremities. Nurses were instructed to manipulate the environment to maintain both ventilation and patient warm by good fire, opening windows and properly positioning the patient in the room. 2. HEALTH OF HOUSES. "Badly constructed houses do for the healthy what badly constructed hospitals do for the sick." This canon includes five essentials of: Pure air, Pure water, Efficient drainage, Cleanliness, Light. Examples include removing garbage or standing water; ensuring clean air and water and free from odor and that there is plenty of light. 3. PETTY MANAGEMENT. Continuity of the care, when the nurse is absent. Documentation of the plan of care and all evaluation will ensure others give the same care to the client in your absence. All the results of good nursing may be negated by one defect: not knowing how to manage what you do when you are NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 2 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur there and what shall be done when you are not there. 4. NOISE. Avoidance of sudden/startling noises. Keeping noise in general to a minimum. Refrain from whispering outside the door. 5. VARIETY. Provide variety in the patient’s room to help him/her avoid boredom and depression. This is accomplished by cards, flowers, pictures, books or puzzles (presently known as diversional therapy). Encourage significant others to engage with the client. the nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two rooms. The majority of cheerful cases are of those patients who are not confined to one room. Most depressed cases will be subjected to a long monotony of objects around them. 6. FOOD INTAKE. Assess the diet of the client. Documentation of amount of foods and liquids ingested at every meal. The nurse should be conscious of patients’ diets and remember how much food each patient has had and ought to have each day. 7. FOOD AND NUTRITION. Nightingale addressed the variety of food presented to the patients and discussed the importance of variety in the food presented. Instructions include trying to include patient’s food preferences. Attempt to ensure that the client always has some food or drink available that he/she enjoys. 8. BED AND BEDDINGS. Comfort measures related to keeping the bed dry, wrinkle-free and at the lowest height to ensure the client’s comfort. Noted that a dirty environment (floors, carpets, walls and bed linens) was a source of infection through the organic matter it contained. The appropriate handling and disposal of bodily excretions and sewage was required to prevent contamination of the environment. 9. LIGHT. "Light has quite as real and tangible effects upon the human body...who has not observed the purifying effect of light, and especially of direct sunlight, upon the air of the room". Assess the room for adequate light. Sunlight works best. Develop and implement adequate light without placing the client in direct light. 10. PERSONAL CLEANLINESS. Bathing of patients on a frequent, even daily, basis. Nurses should wash their hands regularly. Always keeping the patient clean and dry Frequent assessment of client’s skin is needed to maintain adequate moisture. 11. CLEANLINESS OF ROOMS. Assess the room for dampness, darkness and dust or mildew. Keeping the environment clean (free from dust, dirt, mildew and dampness) 12. CHATTERING HOPE AND ADVICES. Avoidance of talking without reason or giving advice that is without fact. Continue to talk to the client as a person and to stimulate the client’s mind. She believed that sick persons should hear good news that would assist them in becoming healthier. 13. OBSERVATION OF THE SICK. Making and documenting observations. Continue to observe the client’s surrounding environment. NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 3 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur 2. JEAN WATSON’S HUMAN CARING THEORY Jean Watson's Theory of Caring focuses on transpersonal relationships that are formed between patients and caregivers that go beyond the surface. These connections allow the nurse to give care that heals the entire body - physically, mentally, and spiritually. MAJOR ELEMENTS Carative Factors Watson devised 10 caring needs specific carative factors critical to the caring human experience that need to be addressed by nurses with their patients when in a caring role. As carative factors evolved within an expanding perspective, and as her ideas and values evolved, Watson offered a translation of the original carative factors into clinical caritas processes that suggested open ways in which they could be considered. 1. Formation of a humanistic- altruistic system of values. [Embrace (Loving-Kindness)] - “Practice of loving-kindness and equanimity within the context of caring consciousness.” 2. The installation of faith-hope. [Inspire (Faith- Hope)] - “Being authentically present and enabling and sustaining the deep belief system and subjective life-world of self and one being cared for.” 3. The cultivation of sensitivity to oneself and to others. [Trust (Transpersonal)] - Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and self- actualization, in both the nurse and those with whom the nurse interacts. 4. The development of helping- trust relationship. [Nurture (Relationships)] - She has defined the characteristics needed to develop the helping-trust relationship. They are congruence, empathy and warmth. 5. The promotion and acceptance of the expression of positive and negative feelings. [(Forgive (Holding Space)] - “Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit and self and the one-being-cared for.” 6. The systematic use of the scientific problem- solution method for decision making. [Deepen (Creative Self)] - “Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices.” According to Watson, the scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. 7. The promotion of interpersonal teaching- learning. [Balance (Learning)] - “Engaging in genuine teaching-learning experience that attends to the unity of being and meaning, attempting to stay within others’ frame of reference.” 8. The provision for a supportive, protective and/or corrective mental, physical, socio- cultural and spiritual environment. [Co-create (Caritas Field)] - “Creating healing environment at all levels (physical as well as the nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated)” 9. Assistance with the gratification of human need. [Minister (Humanity)] - “Assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials,’ which potentiate alignment of mind-body-spirit, wholeness, and unity of being in all aspects of care.” 10. The allowance for existential- phenomenological forces. [Open (Infinity)]  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur - “Opening and attending to spiritual- mysterious and existential dimensions of one’s own life-death; soul care for self and the one-being-cared for” Transpersonal Caring Relationship  Transpersonal describes an intersubjective, human to human relationship that encompasses two individuals, both the nurse and the patient in a given moment.  Describes how the nurse goes beyond the objective assessment to show concern toward the person’s subjective/deeper meaning of their healthcare situation.  Involves mutuality between the two individuals involved Caring Occasion/ Caring Movements  A caring occasion is the moment when the nurse and another person come together in such a way that an occasion for human caring is created.  Both persons come together in a human-human transaction.  The one caring for and the one being cared for are influenced by the choices and actions decided within the relationship. Watson’s Hierarchy of Needs  Lower Order Biophysical Needs or Survival Needs o need for food and fluid, o need for elimination o need for ventilation.  Lower Order Psychophysical Needs or Functional Needs o need for activity-inactivity o need for sexuality.  Higher-Order Psychosocial Needs or Integrative Needs o need for achievement o need for affiliation.  Higher-Order Intrapersonal-Interpersonal Need or Growth-seeking Need o need for self-actualization. 3. PATRICIA BENNER’S STAGES OF NURSING EXPERTISE (NOVICE-EXPERT MODEL) An Influential Nurse in the Development of the Profession of Nursing Patricia Benner’s research and theory work provide the profession of nursing with what we now know as the Novice to Expert model, also known as Benner’s Stages of Clinical Competence. Benner’s work as applied to the nursing profession is adapted from the Dreyfus Model of Skill Acquisition. Skill Acquisition “The utility of the concept of skill acquisition lies in helping the teacher understand how to assist the learner in advancing to the next level” (McClure, 2005) Dr. Benner categorized nursing into 5 levels of capabilities: novice, advanced beginner, competent, proficient, and expert.  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur She believed experience in the clinical setting is key to nursing because it allows a nurse to continuously expand their knowledge base and to provide holistic, competent care to the patient. 5 STAGES OF ACQUIRING EXPERTISE 1. NOVICE  The person has no background experience of the situation in which he or she is involved.  There is difficulty discerning between relevant and irrelevant aspects of the situation.  Beginner to profession or nurse changing area of practice  Generally this level applies to nursing students.  These nurses are usually new graduates, or those nurses who return to the workplace after a long absence and are re-educated in refresher programs. 2. ADVANCED BEGINNER  Develops when the person can demonstrate marginally acceptable performance having coped with enough real situations to note, or to have pointed out by mentor, the recurring meaningful components of the situation.  Nurses functioning at this level are guided by rules and oriented by task completion.  Still requires a mentor or experienced nurse to assist with defining situations, setting priorities, and integrating practical knowledge  Principles, based on experiences, begin to be formulated to guide actions. 3. COMPETENT  Typically, a nurse with two to three years in the same area of nursing.  The experience may also be similar day-to-day situations. These nurses are more aware of long-term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization but lacks speed and flexibility of a proficient nurse.  The competent nurse devises new rules and reasoning procedures for a plan while applying learned rules for action on the basis of the relevant facts of that situation.  These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners. 4. PROFICIENT  After three to five years in the same area of nursing.  Concerned with long term goals, performance is fluid and flexible compared to competent nurse.  At this level, nurses can see situations as “wholes” rather than parts. Proficient nurses learn from experience what events typically occur and can modify plans in response to different events. 5. EXPERT  This stage occurs after five years or more in the same area of nursing.  The expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect her or his understanding of the situation to an appropriate action.  The expert operates from a deep understanding of the total situation.  Has high perceptual acuity or a clinical eye  Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don’t occur as expected.  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur 4. KATIE ERIKSSON’S CARITATIVE CARING THEORY CARITATIVE CARING THEORY The Theory of Caritative Caring was developed by Katie Eriksson. This model of nursing distinguishes between caring ethics, the practical relationship between the patient and the nurse, and nursing ethics. Nursing ethics are the ethical principles that guide a nurse’s decision-making abilities. Caritative caring consists of love and charity, which is also known as Caritas, and respect and reverence for human holiness and dignity. According to the theory, suffering that occurs as a result of a lack of caritative care is a violation of human dignity. CARITAS - Caritas means love and charity. In Caritas, eros and agapé are united, and Caritas is by nature, unconditional love. Caritas, which is the fundamental motive of caring science, also constitutes the motive for all caring. It means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and learning. CARING COMMUNION - Caring communion constitutes the context of the meaning of caring and is the structure that determines caring reality. Caring gets its distinctive character through caring communion (Eriksson, 1990). - It is a form of intimate connection that characterizes caring. Caring communion requires meeting in time and space, an absolute, lasting presence (Eriksson, 1992c). - Caring communion is characterized by intensity and vitality, and by warmth, closeness, rest, respect, honesty, and tolerance. It cannot be taken for granted but presupposes a conscious effort to be with the other. Caring communion is seen as the source of strength and meaning in caring. THE ACT OF CARING - The act of caring contains the caring elements (faith, hope, love, tending, playing, and learning), involves the categories of infinity and eternity, and invites deep communion. The act of caring is the art of making something very special out of something less special. CARITATIVE CARING ETHICS - Caritative caring ethics comprises the ethics of caring, the core of which is determined by the Caritas motive. Eriksson makes a distinction between caring ethics and nursing ethics. She also defines the foundations of ethics in care and its essential substance. Caring ethics deals with the basic relation between the patient and the nurse—the way in which the nurse meets the patient in an ethical sense. It is about the approach we have toward the patient. DIGNITY - Dignity constitutes one of the basic concepts of caritative caring ethics. Human dignity is partly absolute dignity, and partly relative dignity. Absolute dignity is granted to the human being through creation, while relative dignity is influenced and formed through culture and external contexts. A human being’s absolute dignity involves the right to be confirmed as a unique human being. INVITATION - Invitation refers to the act that occurs when the carer welcomes the patient to the caring communion. The concept of invitation finds room for a place where the human being is allowed to rest, a place that breathes genuine hospitality, and where the patient’s appeal for charity meets with a response. SUFFERING - Suffering is an ontological concept described as a human being’s struggle between good and evil in a state of becoming. Suffering implies in some sense dying away from something, and through reconciliation, the wholeness of body, soul, and spirit is re-created, when the human being’s holiness and dignity appear. Suffering is a unique, isolated total experience and is not synonymous with pain. RECONCILIATION - Reconciliation refers to the drama of suffering. A human being who suffers wants to be confirmed in his or her suffering and be given time and space to suffer and reach reconciliation. Reconciliation implies a change through which a new wholeness is formed of the life the human being has lost in suffering. In reconciliation, the importance of sacrifice emerges CARING CULTURE NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 7 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur - Caring culture is the concept that Eriksson (1987a) uses instead of environment. It characterizes the total caring reality and is based on cultural elements such as traditions, rituals, and basic values. Caring culture transmits an inner order of value preferences or ethos, and the different constructions of culture have their basis in the changes of value that ethos undergoes. AXIOMS Eriksson regards axioms as fundamental truths in relation to the conception of the world.  The human being is fundamentally an entity of body, soul, and spirit.  The human being is fundamentally a religious being.  The human being is fundamentally holy. Human dignity means accepting the human obligation of serving with love, of existing for the sake of others.  Communion is the basis for all humanity. Human beings are fundamentally interrelated to an abstract and/or concrete other in a communion.  Caring is something human by nature, a call to serve in love.  Suffering is an inseparable part of life. Suffering and health are each other’s prerequisites.  Health is more than the absence of illness. Health implies wholeness and holiness.  The human being lives in a reality that is characterized by mystery, infinity, and eternity. THESES Theses are fundamental statements concerning the general nature of caring science, and their validity is tested through basic research.  Ethos confers ultimate meaning on the caring context.  The basic motive of caring is the caritas motive.  The basic category of caring is suffering.  Caring communion forms the context of meaning of caring and derives its origin from the ethos of love, responsibility, and sacrifice, namely, caritative ethics.  Health means a movement in becoming, being, and doing while striving for wholeness and holiness, which is compatible with endurable suffering.  Caring implies alleviation of suffering in charity, love, faith, and hope. Natural basic caring is expressed through tending, playing, and learning in a sustained caring relationship, which is asymmetrical by nature. NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 8 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur 1. MARTHA ROGERS’ SCIENCE OF UNITARY HUMAN BEING MODEL The belief of the coexistence of the human and the environment has greatly influenced the process of change toward better health. In short, a patient can’t be separated from his or her environment when addressing health and treatment. This view leads and opened Martha E. Rogers’ theory, known as the “Science of Unitary Human Beings,” which allowed nursing to be considered one of the scientific disciplines. SCIENCE OF UNITARY HUMAN BEINGS Two Dimensions: 1. The Science of Nursing - which is the knowledge specific to the field of nursing that comes from scientific research; 2. The Art of Nursing - , which involves using the science of nursing creatively to help better the lives of the patient. WHOLENESS - Human being is considered as united whole OPENNESS - A person and his environment are continuously exchanging energy with each other UNIDIRECTIONALITY - The life process of human being evolves irreversibly and unidirectional ie. From birth to death PATTERN & ORGANIZATION - Pattern identifies individuals and reflects their innovative wholeness SENTENCE & THOUGHT - Humans are the only organisms able to think, imagine, have language and emotions MAJOR CONCEPTS OF SCIENCE OF UNITARY HUMAN BEINGS  Energy field It is inevitable part of life. Human and environment both have energy field which is open i.e. energy can freely flow between human and environment.  Openness There is no boundary or barrier that can inhibit the flow of energy between human and environment which leads to the continuous movement or matter of energy  Pattern Pattern is defined as the distinguishing characteristic of an energy field perceived as a single waves "pattern is an abstraction and it gives identity to the field”  Pandimensionality Pandimensionality is defined as "non-linear domain without spatial or temporal attributes". Human being are pan dimensional being and have more than three dimension. HOMEODYNAMIC PRINCIPLES Homeodynamics refers to the balance between the dynamic life process and environment. These principles help to view human as unitary human being. Three principle of homeodynamics:  Principle of Resonancy - “the continuous change from lower to higher frequency wave patterns in human and environmental fields.” It  Principle of Helicy - “continuous, innovative, unpredictable, increasing diversity in human and environmental field patterns.” The human- environment field is a dynamic, open system in which change is continuous due to the constant interchange between the human and environment. This change is also innovative. Because of constant interchange, an open system is never the same at any two moments; rather, it is continually new or different.  Principle of Integrality (Synchrony + Reciprocity) - “continuous mutual human and environmental field process.” Because of the inseparability of human beings and their environment, sequential changes in the life processes are continuous revisions occurring from the interactions between human beings and their environment. Between the two entities, there is a constant mutual interaction and mutual change whereby NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 9 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur simultaneous molding is taking place at the same time. NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 10 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 2. DOROTHEA OREM’S SELF-CARE DEFICIT MODEL Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self- care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.” The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive-educative. There are instances wherein patients are encouraged to bring out the best in them despite being ill for a period of time. This is very particular in rehabilitation settings, in which patients are entitled to be more independent after being cared for by physicians and nurses. THEORY OF SELF CARE - the individual’s ability to perform self-care activities.  SELF CARE – practice of activities that an individual initiates and performs on his/her own behalf in maintaining life, health and well- being.  SELF CARE AGENCY – is a human ability which is "the ability for engaging in self-care“; conditioned by age, developmental state, life experience, sociocultural orientation, health, and available resources. Consists of 2 agents: Self-care Agent - person who provides the self-care Dependent Care Agent - person other than the individual who provides the care (such as a parent) SELF-CARE REQUISITES - action directed towards the provision of self-care. 3 categories of self-care requisites are:  Universal self-care requisites - requisites/needs that are common to all individuals. (e.g. air, water, food, elimination, rest, activity, etc.)  Developmental self-care requisites - needs resulting from maturation or development due to a condition or even. (e.g. adjustment to new job, puberty)  Health deviation self-care requisites - needs resulting from illness, injury & disease, or its treatment. (e.g. learning to walk with crutches after a leg fracture). THEORY OF SELF-CARE DEFICIT  Specifies when nursing is needed  Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the provision of continuous effective self-care. THEORY OF NURSING SYSTEMS  Describes how the patient’s self-care needs will be met by the nurse, the patient, or both  Identifies 3 classifications of the nursing system to meet the self-care requisites of the patient:  Ex: care of a newborn, care of a client recovering from surgery in a post-anesthesia care unit.  Partly compensatory system – “both nurse and patient perform care measures or other actions involving manipulative tasks or ambulation” Either] the patient or the nurse may have a major role in the performance of care measures.”  Example: Nurse can assist the postoperative client in ambulating, Nurse can bring a meal tray for a client who can feed himself.  Supportive – educative system – “for situations where the patient is able to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance”  Example: Nurse guides a mother on how to breastfeed her baby, Counseling a psychiatric client on more NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 11 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences adaptive coping strategies. 3. IMOGENE KING’S GOAL ATTAINMENT THEORY King developed a general systems framework and a theory of goal attainment where the framework refers to the three interacting systems - individual or personal, group or interpersonal, and society or social, while the theory of goal attainment pertains to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space. PERSONAL SYSTEM The concepts for the personal system are: perception, self, growth and development, body image, space, and time. These are fundamentals in understanding human being because this refers to how the nurse views and integrates self-based from personal goals and beliefs. Among all these concepts, the most important is perception, because it influences behavior.  PERCEPTION— a process of organizing, interpreting, and transforming information from sense data and memory that gives meaning to one's experience, represents one's image of reality, and influences one's behavior.  SELF— a composite of thoughts and feelings that constitute a person's awareness of individual existence, of who and what he or she is.  GROWTH AND DEVELOPMENT— cellular, molecular, and behavioral changes in human beings that are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move toward maturity.  BODY IMAGE—a person's perceptions of his or her body.  TIME—the duration between the occurrence of one event and the occurrence of another event.  SPACE—the physical area called territory that exists in all directions.  LEARNING—gaining knowledge. INTERPERSONAL SYSTEM This shows how the nurse interrelates with a co-worker or patient, particularly in a nurse-patient relationship. Communication between the nurse and the client can be verbal or nonverbal. Collaboration between the Dyads (nurse-patient) is very important for the attainment of the goal. The concepts associated for the interpersonal system are: interaction, communication, transaction, role, and stress. King refers to two individuals as dyads, three as triads and four or more individuals as small group or large group (King, 1981).  INTERACTIONS - the acts of two or more persons in mutual presence; a sequence of verbal and nonverbal behaviors that are goal directed.  COMMUNICATION - the vehicle by which human relations are developed and maintained; encompasses intrapersonal, interpersonal, verbal, and nonverbal communication.  TRANSACTION - a process of interaction in which human beings communicate with the environment to achieve goals that are valued; goal-directed human behaviors.  ROLE — a set of behaviors expected of a person occupying a position in a social system.  STRESS — a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, involving an exchange of energy and information between the person and the environment for regulation and control of stressors.  COPING—a way of dealing with stress. NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 12 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences SOCIAL SYSTEM The final interacting system is the social system. This shows how the nurse interacts with co- workers, superiors, subordinates and the client environment in general. These are groups of people within the community or society that share a common goals, values and interests. It provides a framework for social interaction and relationships and establishes rules of behavior and courses of action (King, 1971). Social systems are organized boundary systems of social roles, behaviors, and practices developed to maintain values and the mechanisms to regulate the practices and roles.  AUTHORITY — a transactional process characterized by active, reciprocal relations in which members' values, backgrounds, and perceptions play a role in defining, validating, and accepting the authority of individuals within an organization.  POWER — the process whereby one or more persons influence other persons in a situation  STATUS — the position of an individual in a group or a group in relation to other groups in an organization.  DECISION MAKING — a dynamic and systematic process by which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal.  CONTROL — being in charge. Among the three systems, the conceptual framework of Interpersonal system had the greatest influence on the development of her theory. She stated that “Although personal systems and social systems influence quality of care, the major elements in a theory of goal attainment are discovered in the interpersonal systems in which two people, who are usually strangers, come together in a health care organization to help and to be helped to maintain a state of health that permits functioning in roles”. 4. BETTY NEUMAN’S SYSTEMS THEORY MODEL Neuman’s model was influenced by the philosophy writers de Chardin and Cornu (on wholeness in system); Von Bertalanfy, and Lazlo on general system theory; Selye on stress theory; Lararus on stress and coping. CENTRAL CORE Made up of the basic survival factors common to all  Normal temperature range  Genetic structure  Response pattern  Organ strength or weakness  Ego structure  Knowns or commonalities Each concentric circle or layer is made up of the five variable: 1. Physiological 2. Psychological 3. Sociocultural 4. Spiritual 5. Developmental FLEXIBLE LINES OF DEFENSE Model’s outer broken ring  Can be altered over time; Protective buffer for preventing stressors from breaking through usual wellness state  Dependent on amount of sleep, nutritional status, quality and quantity of stress.  If the flexible LOD fails to provide adequate protection to the normal LOD, the lines of resistance become activated.  According to Neuman, “When the flexible line of defense expands, it provides greater short- term protection against stressor invasion; when it contracts, it provides less protection.” NORMAL LINES OF DEFENSE Model’s outer solid circle  Represents client’s usual wellness level.  Change in response to coping or responding to the environment. NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 13 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences  It includes intelligence, attitudes, problem solving, coping abilities  Represents stability for the individual or system  Maintained over time and serves to assess deviations from client’s usual wellness LINES OF RESISTANCE Innermost boundary - protects the basic structure  Get activated when environmental stressors invade the normal line of defense.  If the lines of resistance are effective, the system can reconstitute  If the lines of resistance are not effective, the resulting energy loss can result in death.  Protection factors activated when stressors have penetrated the normal LOD, causing a reaction symptomatology.  Eg. Mobilization of WBC and activation of immune system mechanism STRESSORS  It is any environmental force which can potentially affect the stability of the system  Produce either a positive or negative effect on the client system. RECONSTITUTION  The return or maintenance of system stability following the treatment for stressor reaction.  Occurs after treatment for stressor reaction OPEN SYSTEM  FUNCTION OR PROCESS - Client as a system exchanges energy, information and matter with the environment as it uses available energy resources to move toward stability and wholeness  INPUT OR OUTPUT - Matter, energy, and information that are exchanged between the client and the environment  FEEDBACK - System output in the form of matter, energy, and information for corrective action to change, enhance or stabilize the system  NEGENTROPY - a process of energy conservation utilization that assists system profession toward stability or wellness  ENTROPY – A process of energy depletion and disorganization moving the system toward illness or possible death  STABILITY - Dynamic and desired state of balance. Copes with stressors to maintain an optimal level of health and integrity PREVENTION AS INTERVENTION  Purposeful actions to help client maintain system stability  Levels of Prevention:  Primary: Used when stressor is suspected or identified; Degree of risk in known. includes health promotion and maintenance of wellness. (vaccinations)  Secondary: Involves interventions or treatment initiated after symptoms occurred. screening to identify diseases in the earliest  Tertiary: Occurs after active treatment; maintenance. offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution. Managing disease post diagnosis to slow or stop 5. SR. CALLISTA ROY’S ADAPTATION THEORY Roy’s Adaptation Model for Nursing was derived in 1964 from Harry Helson’s Adaptation Theory – adaptive responses are a function of the incoming stimulus and the adaptive level. Roy combines Helson’s work with Rapport’s definition of system and views the person as an adaptive system. ROY’S ADAPTATION MODEL (RAM) NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 14 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences “Nursing is to help the person adapt to change in physiological needs, self-concepts, role function and interdependent relations during health and illness. SYSTEM A set of units so related or connected as to form a unity or whole and characterized by inputs, outputs, and control and feedback processes. ADAPTATION LEVEL A constantly changing point, made up of focal, contextual and residual stimuli, which represent the person’s own standard of the range of stimuli to which one can respond with ordinary adaptive responses. STIMULUS  FOCAL STIMULUS – the degree of change or stimulus most immediately confronting the person and the one to which the person must make an adaptive response, that is, the factor that precipitates behavior  CONTEXTUAL STIMULI – all other stimuli present that contribute to the behavior caused or precipitated by the focal stimuli  RESIDUAL STIMULI – factors that may be affecting behavior but whose efforts are not validated. Example: Smoking  Focal: Nicotine addiction  Contextual: Belief that smoking is enjoyable, relaxing, part of routine  Residual stimuli: Beliefs about body image, and weight gain with smoking cessation SUBSYSTEMS  REGULATOR – subsystem coping mechanism which responds automatically through neural- chemical-endocrine processes.  COGNATOR - subsystem coping mechanism which responds to complex processes of perception and information processing, judgment, and emotion. RESPONSES  ADAPTIVE RESPONSES – responses that promote integrity of the person in terms of goals of survival, growth, reproduction, and mastery.  INEFFECTIVE RESPONSES – responses that do not contribute to adaptive goals, that is, survival, growth, reproduction, and mastery. ADAPTIVE MODES 1. PHYSIOLOGICAL MODE – involve the body’s basic needs and ways of dealing with adaptation. 2. SELF-CONCEPT MODE – the composite of beliefs and feelings that one holds about oneself at a given time. It is formed from perceptions, particularly of other’s reactions, and directs one’s behavior. 3. ROLE PERFORMANCE MODE – role function is the performance of duties based on given positions in society. 4. INTERDEPENDENCE MODE – involves one’s relations with significant others and support systems. In this mode one maintains psychic integrity by meeting needs for nurturance and affection. RAM identifies essential concepts relevant to the nursing profession. The human adaptive system is constantly interacting with internal and external stimuli which affect individual’s health. It is the responsibilities of nurses to manipulate specific stimuli so as to help patient achieve optimal health. it is useful in analyzing groups, individuals and societies. It is the responsibility of nurses to facilitate adaptation of groups and persons so as to enhance their welfare wand well-being. LEVEL OF ADAPTATION  Integrated Process: The various modes and subsystems meet the needs of the environment.  Compensatory Process: The cognator and regulator are challenged by the needs of the environment, but are working to meet the needs  Compromised Process: The modes and subsystems are inadequately meeting the environmental challenge) NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 15 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 6. DOROTHY JOHNSON’S BEHAVIORAL SYSTEM THEORY It advocates the fostering of efficient and effective behavioral functioning of the patient to prevent illness. The patient is defined as a behavioral system composed of seven behavioral subsystems. Each subsystem is comprised of four structural characteristics. An imbalance in each results in disequilibrium. The nurses role is to help the patient maintain his or her equilibrium. Goals of Nursing according to BSM: 1. To assist the patient whose behavior is proportional to social demands. 2. To assist the patient who is able to modify his behavior in ways that it supports biological imperatives. 3. To assist the patient who is able to benefit to the fullest extent during illness from the physicians knowledge and skill. 4. To assist the patient whose behavior does not give evidence of unnecessary trauma as a consequence of illness. Three Categories: 1. Systems 2. Structure 3. Functions SUBSYTEM OF THE BEHAVIORAL SYSTEM 1. Affiliative or Attachment Subsystems - the “social inclusion intimacy and the formation and attachment of a strong social bond.” It forms the basis for all social organization. On a general level, it provides survival and security. - It is probably the most critical because it forms the basis for all social organizations. On a general level, it provides survival and security. Its consequences are social inclusion, intimacy, and the formation and maintenance of a strong social bond. 2. Dependency Subsystems - “approval, attention or recognition and physical assistance.” It promotes helping behavior that calls for a nurturing response. - Its consequences are approval, attention or recognition, and physical assistance. Developmentally, dependency behavior evolves from almost total dependence on others to a greater degree of dependence on self. 3. Ingestive Subsystems - the “emphasis on the meaning and structures of the social events surrounding the occasion when the food is eaten.” It should not be seen as the input and output mechanisms of the system. All subsystems are distinct subsystems with their own input and output mechanisms. The ingestive subsystem “has to do with when, how, what, how much, and under what conditions we eat.” 4. Eliminative subsystem - Eliminative subsystem states that “human cultures have defined different socially acceptable behaviors for excretion of waste, but the existence of such a pattern remains different from culture to culture.” It addresses “when, how, and under what conditions we eliminate. 5. Sexual Subsystems - Behavior associated with a specific gender based identity for the purpose of ensuring pleasure/procreation, and knowledge and behavior being congruent with biological sex. 6. Aggressive Subsystems - relates to protection and self-preservation, generating a defense response when there is a threat to life or territory. Its function is protection and preservation. Society demands that limits be placed on self- protection modes and that people and their property be respected and protected. 7. Achievement Subsystems - Its function is to control or mastery an aspect of self or environment to some standard of excellence. Areas of achievement behavior include intellectual, NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 16 of 17  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 7. MYRA ESTRINE LEVINE’S CONSERVATIONAL THEORY Levine’s Conservation Model is focused in promoting adaptation and maintaining wholeness using the principles of conservation. The model guides the nurse to focus on the influences and responses at the organismic level. The nurse accomplishes the goals of the model through the conservation of energy, structure, and personal and social integrity. ADAPTATION. Adaptation is the process whereby the patient maintains integrity within the realities of the environment. WHOLENESS. Exist when the interaction or constant adaptations to the environment permits the assurance of integrity. CONSERVATION. Product of adaptation CHARACTERISTICS OF ADAPTATION 1. HISTORICITY - Adaptation is a historical process, responses are based on past experiences, both personal and genetic 2. SPECIFICITY – Individual responses and their adaptive pattern varies on the base of specific genetic structure 3. REDUNDANCY – Safe and fail options available to the individual to ensure continued adaptation 4. ORGANISMIC RESPONSE – A change in behavior of an individual during an attempt to adapt to the environment. TYPES OF ORGANISMIC RESPONSE 1. FLIGHT OR FIGHT: an instantaneous response to real or imagined threat, most primitive response 2. INFLAMMATORY: response intended to provide for structural integrity and the promotion of healing 3. STRESS: developed over time and influenced by each stressful experience encountered by person 4. PERCEPTUAL: Involved gathering information from the environment and converting it in to a meaning experience. PRINCIPLES OF ADAPTATION 1. Conservation of Energy. Refers to balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition and exercise. 2. Conservation of Structural Integrity. Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing. 3. Conservation of Personal Integrity. Recognizes the individual as one who strives for recognition, respect, self-awareness, selfhood and self-determination. 4. Conservation of Social Integrity. An individual is recognized as someone who resides with in a family,: a community, a religious group, an ethnic group, a political system and a nation. NCM 100 l NURSING PHILOSOPHIES & CONCEPTUAL MODELS Page 17 of 17