Nursing Philosophies & Conceptual Models PDF

Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences THEORETICAL FOUNDATION IN NURSING...

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