TFN-2ND-EXAM-1_074817.pdf

FLORENCE NIGHTINGALE Florence and the Patient - Nightingale believed that caring for the sick was a component of Christianity - Cures were not limited to medical acts but also acts of God - Patient's needs should be prioritized according to Maslow Hierarchy - Heath Promotion occu...

FLORENCE NIGHTINGALE Florence and the Patient - Nightingale believed that caring for the sick was a component of Christianity - Cures were not limited to medical acts but also acts of God - Patient's needs should be prioritized according to Maslow Hierarchy - Heath Promotion occurred through providing a sanitary environment, adequate nutrition, patient comfort, and conservation of the patient's energy - Considered a client to have the capability to be healthy, however, he/she did not have the power to control their unsanitary environment or poor access to essential nutrient - Although Florence Nightingale was bedridden, she continued to campaign to improve the health standards, publishing 200 books, reports and pamphlets. - She believed that infection arose spontaneously in dirty and poorly ventilated places - Her beliefs lead to improvements in hygiene and healthier living and working environments. - Florence Nightingale's vision of health care included professional nursing for the sick and the poor - One of the first people to examine data on occupational health and safety - Systemic approach to health care with a major role for prevention, clean air, clean water, decent housing and good infant care - Promoted uniform hospital statistics so that results could be compared by country, institution and type of treatment. - Mother’s responsibility to teach her children cleanliness mind, body, and spirit. This included waste management and tidiness in and around home. - Bad smells were to be considered a sign of danger - Florence Nightingale is the reason why nursing is considered a profession today and recognized that educated nurses would be viewed with the public as professional - First nursing school at St. Thomas Hospital in London - She believed that God called her to be a nurse and that he had natural laws that were to be followed - According to Nightingale, the aim of nursing education was to train woman to become nurses in order to serve society for the alleviation of the suffering of the sick, for the amendment of the living conditions of the health of the population (Nightingale 1859) Florence and the Environment - In order for healing to occur, all environmental aid sanitary conditions must improve - Ventilation/ Clean /Air and light were considered key factors in hygiene The Effect on Nursing Practice - Stressed the importance of hygiene and believed that it aided in the prevention of disease spreading - Focused on a holistic caring perspective - Aseptic practices  - Nursing is a continuous learning process because new and better practices are always being developed What it is, or what it should be? - Maintaining a clean environment. Within the healthcare setting is essential to prevent nosocomial infections ✔ Gloves and other PPE ✔ Bed linens ✔ Handwashing ✔ Keeping a clear path for the safety - However not everyone always follows the rules: Carts, etc. obstructing the hallways - Not everyone wears gloves when they are supposed to Handwashing - Florence Nightingale's Theory is one that every nurse should strive to achieve by maintaining a healthy environment not only for their patients, but also for themselves. JEAN WATSON “Theory of Transpersonal Nursing/Philosophy and Science of Human Caring” Theory of Transpersonal Nursing The Major elements of her theory are: A. Carative factors B. Transpersonal caring relationship C. The caring occasion/ caring moment Carative - Means caring with love - “Caritas”- to cherish, appreciate, and give special attention  - Watson views the "Carative factors" as guide for the core of nursing. - Caring is central to nursing. - Caring is more, "healthogenic" than is curing. - Effective caring promotes health and individual or family growth. 10 carative factors 1. Humanistic-altruistic system of values. 2. The instillation of faith-hope 3. The cultivation of sensitivity to one's self and to others. 4. Developing helping-trust relationship, caring relationship 5. Expressing positive and negative feelings and emotions 6. The systematic use of the scientific problem-solving method for decision making 7. Promotion of interpersonal teaching-teaming 8. Provision of a supportive, protective and/or factors corrective mental, physical, socio-cultural and spiritual environment. 9. Assistance with gratification of human needs. 10. Allowance for existential-phenomenological forces. Transpersonal caring relationship - "transpersonal" - means to go beyond one's own ego and the here and now, as it allows one to reach deeper spiritual connections in promoting the patient's comfort and healing. - Goal- correspond to protecting, enhancing and preserving the person's dignity, humanity, wholeness, and inner harmony. Caring Occasion/ - Nurse + another person= human caring - It becomes "transpersonal" when "it allows for the presence of the spirit of both- then the event of the moment expands the limits of openness and has the ability to expand human capabilities" (Watson; 1999) Watson’s theory & the nursing process A. Personhood (human being) - Viewed holistically wherein the body, mind and soul are interrelated; each part a reflection of the whole, yet the whole is greater than and different from the sum of parts. (Watson, 1979,1989) - Human being - valued person - The soul fully participates in healing. B. Healing space & environment - The nurse’s role - A caring attitude is not transmitted from generation to generation. It is transmitted by the culture of the profession as a unique way of coping with its environment. - The nurse becomes the environment in which "sacred space" is created C. Health, Illness & Disease Illness- subjective turmoil or disharmony within a person's inner self or soul at some level of disharmony within spheres of mind, body & soul. Disease- associated with disharmony between the person and the environment or nature Within the transpersonal caring relationship and the caring moment, there is healing potential “The fact remains that we hold another life in our hands” - (Watsons,2005) PATRICIA BENNER Novice-Expert Model Born: August 1942 Known for: from novice to expert excellence and power in clinical nursing practice Benner: As Author Dr. Benner is the author of books including: 1.From Novice to Expert 2. The Primacy of Caring 3. Interpretive Phenomenology: Embodiment, Caring and Ethics in Health and Illness 4. The Crisis of Care Practice: Caring, 5. Expertise in Nursing Clinical Judgment, and Ethics. 6. Caregiving 7. Clinical Wisdom and Interventions in Critical Care: A Thinking-In-Acting Approach Is an internationally noted researcher and lecturer on health, stress and coping, skill acquisition and ethics. Recently elected an honorary fellow of the Royal College of Nursing. Staff nurse in the areas of medical-surgical, emergency room, coronary care, intensive care units and home care. Currently, her, research includes the study of nursing practice in intensive care units and nursing ethics. Scope of vision & range capability Novice Advance Beginner Competent Only feels Follow specific Still does not Begins to Sense of Uses pattern responsible to rules for experience create and responsibility recognition to follow the specific personal identify arises from assess what to rules situations. responsibility. conditional actively do. Uses refer rules. All making to determine Rules are not decisions still decisions. how to do it. conditional follow rules. “Higher order “Only capable "Rules have rules shape of following and contexts and the rules” conditional in conditions nature” Proficient Expert Sense of responsibility Uses pattern Responsibility extends No analysis or increases with recognition what to do. to others and the planning. Pattern experience Uses rules to environment. recognition extends to determine how to do it plan as well as action. “Institution guides in “Just does what identifying the works.” situation: the actions are governed by the principles.” 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) 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 changing area of or nurse 2009) practice (Frisch, Generally, this level applies to nursing students These inexperienced nurses’ function at level the of instruction from nursing school They are unable to make the leap from the classroom lecture to individual patients. Often, they 'apply rules learned in nursing school to all patients and are unable to discern individual patient needs. These new nurses are usually new graduates, or those nurses who return to the workplace after a long absence and are reeducated in refresher programs. Advanced Beginner The advance beginner stage in the Dreyfus model develops who the person can demonstrate marginally acceptable performance having coped with enough real situations to note, or to have pointed out by mentor, the recuring meaningful components of the situation. Nurses functioning at this level are guided by rules and oriented by task completion. Still requires mentor or experienced nurse to assist with defining situations, to set priorities, and to integrate practical knowledge (English, 1993) Competent After two to three, years in the same area of nursing the nurse moves into the Competent Stage of skill acquisition. The competent stage is the most pivotal in clinical learning because the Tearner must begin to recognize patterns and determine which elements of the situation warrant attention and which can be ignored. 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 Proficient After three to five years in the same area of nursing the nurse moves into the Proficient Stage "The nurse possesses a deep understanding of situations as they occur, less conscious planning is necessary, critical thinking and decision-making skills have developed" (Frisch, 2009)  The performer perceives, the information as a whole (total picture) rather than in terms of aspects and performance. Proficient level is a qualitative leap beyond the competent. Nurses at this lever demonstrate a new at to sea co situation including the recognition and the implementation of skilled responses to the situation as is it evolves. Expert This stage occurs after five years or greater in the same area of nursing (experienced nurses changing areas of nursing practice may progress more quickly through the five stages) 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 nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions. The expert operates from a deep understanding of the total situation Benner's Original Research Goal: Compare Novice & Expert Nurse's descriptions and responses to the same clinical situations Participants: 21 nurse preceptors & 21 new graduate nurses 51 experienced nurses 11 newly graduated nurses 5 senior nursing Collection of Research: - Intel Views with narrative accounts of situations - Observation of behaviors in clinical settings (Benner, 1984) Nursing Incorporates Education Benner's Goal: Goal: Identify if simulating unstable patient scenarios by providing interactive teaching will transition nursing students to higher levels of expertise Participants: 190 Adult Health Nursing Students Collection of Research: Observation of students in simulated patient rooms with manikins providing clues to clinical scenarios Conclusion: Development of nursing Competency requires practice and clinical, simulation provides a safe, structured learning experience, (Larew, Lessans, Spunt, Foster, and Covington, 2006) Nursing Application of Benner’s Theory Nursing applies Benner's Theory through: Nursing school curriculum Building clinical ladders for nurses (Frisch, 2009) Developing mentorship programs o Preceptors for student nurses o Mentors for newly graduated nurses (Dracup and Bryan- Brown, 2004) Development of the Clinical Simulation Protocol, (Larew et al., 2006) Four Domains of Nursing Paradigm 1. Client/Person 2. Health 3. Environment/Situation 4. Nursing MARTHA ROGERS Science of Unitary Human Beings Theory of Unitary Human Beings views nursing as both a science and an art. The uniqueness of nursing, like any other science, is in the phenomenon central to its focus. The purpose of nurses is to promote health and well-being for all persons wherever they are. The development of Rogers' abstract system was strongly influenced by an early grounding in arts, as well as a background in science and interest in space. The science of unitary human beings began as a synthesis of ideas and facts. provides a way to view the unitary human being, who is integral with the universe.  The unitary human being and his or her environment are one. Nursing focuses on people and the manifestations that emerge from the mutual human-environmental field process. A change of pattern and organization of the human and environmental fields is transmitted by waves. The manifestations of the field patterning that emerge are observable events. By identifying the pattern, there can be a better ' understanding of human experience. There are Eight Concepts in Rogers' Nursing Theory 1. energy field, (emotions, thought, physical body) 2. openness, 3. pattern, (harmonious and balanced) 4. pan-dimensionality, 5. homeodynamic principles, 6. resonance, 7. helicy, and 8. integrality. 1. The energy field Is the fundamental unit both living and non-living. It provides a way to view people and the environment as irreducible wholes. The energy fields continuously vary in intensity, density, and extent. 2. Openness there are no boundaries that stop energy flow between the human and environmental fields. 3. Pan-dimensionality is defined as "non-linear domain without "spatial or temporal attributes." The parameters that humans use in language to describe events are arbitrary, and the present is relative; there is no temporal ordering of lives. 4. Pattern Rogers defines pattern as the distinguishing dimension of an energy field seen as a single wave. It is an abstraction, and gives identity to the field 5. Homeodynamic principles postulate a way of viewing unitary human beings. The three principles of homeodynamics are resonancy, helicy, and integrality. 6. Resonancy is an ordered arrangement of rhythm characterizing both the human and environmental fields that undergo continuous dynamic metamorphosis in the human environmental process. 7. Helicy Describes the unpredictable, nonlinear evolution of energy fields as seen in non-repeating rhythmicitres, and postulates an ordering of the human evolutionary emergency. 8. Integrality covers the mutual, continuous relationship of the human and environmental fields. Changes occur by the continuous repatterning of the human ad environmental fields by resonance waves. The fields are integrated into each other, but are also unique. Rogers defines health, as an expression of the life process. It is the characteristics and behavior coming from the mutual, simultaneous interaction of the human and environmental fields, and health and illness are part of the same continuum. The multiple events occurring during the life process show the extent to which a person is achieving his or her maximum health potential. The events vary in their expressions from greatest health to those conditions that are incompatible with the maintaining life process. - The nursing theory states that nursing encompasses two dimensions: nursing as art and nursing as science. From the science perspective, nursing is an organized body of knowledge specific to nursing, and arrived at by scientific research and logical analysis. The art of nursing is the creative use of science to better people, and the creative use of its knowledge is the art di its practice. Rogers claims that nursing exists to serve people, and the safe practice of nursing depends on the nature and amount of scientific nursing knowledge the nurse brings to his or her practice. The nursing process has three steps in Rogers' Theory of Unitary Human Beinas: assessment, voluntary mutual patterning, and evolution. The areas of assessment are: the total pattern of events at any given point in space-time,' simultaneous states of the patient and his or her environment, rhythms of the life process, supplementary data, categorical disease entities, subsystem pathology, and pattern appraisal. The assessment should be f comprehensive assessment of the human and environmental fields. Mutual patterning of the human and environmental fields includes: sharing knowledge offering choices empowering the patient  fostering patterning evaluation repeat pattern appraisal, which includes nutrition, work/leisure, activities, wake/sleep cycles, relationships, pain, and fear/hopes identify dissonance and harmony validate appraisal with the patient self-reflection for the patient - To prepare nurses to practice rogers’ model, the focus of nursing curriculum should be the transmission of the body of knowledge, teaching and practicing therapeutic touch, and conducting regular in-service education. Emphasis should be on developing self-awareness as a part of the patient's environmental energy field, as well as the dynamic role of the nurse pattern manifestation on the patient. There should also be an emphasis on laboratory study in a variety of settings, and the importance of the use of media in education. DOROTHEA OREM Self-Care Deficit Nursing Theory/Orem Model of Nursing The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles. The Major Assumptions of Orem’s Self-Care People should be self-reliant, and responsible for their care, as well as others in their family who need care. People are distinct individuals. Nursing is a form of action. It is an interaction between two or more people. Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health. A person's knowledge of potential health problems is needed for promoting self-care behaviors. Self-care and dependent care are behaviors learned within a sociocultural context. Orem's theory is comprised of three related parts: 1. theory of self-care; 2. self-care deficit theory, 3. theory of nursing systems The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is the ability for engaging in self-care," conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites. Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as: 1. the maintenance of sufficient intake of air, food, and water 2. provision of care associated with the elimination process 3. a balance between activities and rest, as well as between solitude and social interaction 4. the prevention of hazards to human life and well-being 5. the promotion of human functioning Developmental self-care requisites are associated with developmental processes. They are generally derived from a condition or associated with an event. Health deviation self-care is required in conditions of illness, injury, or disease. These include: 1. Seeking and securing appropriate medical assistance 2. Being aware of and attending to the effects and results of pathologic conditions 3. Effectively carrying out medically prescribed measures 4. Modifying self-concepts to accept oneself as being in a particular state of health and in specific forms of health care 5. Learning to live with the effects of pathologic conditions. According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. The theory identifies five methods of helping:  1. acting for and doing for others; 2. guiding others; 3. supporting another; 4. providing an environment promoting personal development in relation to meet future demands; and 5. teaching another. The theory of nursing systems describes how the patient's self-care needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive educative system. Orem recognized that specialized technologies are usually developed by members of the health care industry. The theory identifies two categories of technologies. The first is social or interpersonal. In this category, communication is adjusted to age and health status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination of efforts. The nurse should also maintain a therapeutic relationship in light of psychosocial modes of functioning in health and disease. In this category, human assistance adapted to human needs, actions, abilities, and limitations is given by the nurse. The second is regulatory technologies, which maintain and promote life processes. This category regulates psycho- and physiological modes of functioning in health and disease. Nurses should promote human growth and development, as well as regulating position and movement in space. Orem's approach to the nursing process provides a method to determine the self-care deficits and then to define the roles of patient or nurse to meet the self-care demands. The steps in the approach are thought of the technical component of the nursing process. Orem emphasizes that the technological component "must be coordinated with interpersonal and social pressures within nursing situations. IMOGENE KING King’s General System Framework/Goal Attainment Theory The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. The theory explains that factors which can affect the attainment of goals are roles, stress, space, and time. The model has three interacting systems: personal, interpersonal, and social. Each of these systems has its own set of concepts. The concepts for the personal system are perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are interaction, communication, transaction, role, and stress. The concepts for the social system are organization, authority, power, status, and decision-making. The following propositions are made in the Theory of Goal Attainment: If perceptual interaction accuracy is present in nurse patient interactions, transaction will occur. If the nurse and patient make transaction, the goal or goals will be achieved. If the goal or goals are achieved, satisfaction will occur. If transactions are made in nurse patient interactions, growth and development will be enhanced. If role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur. If role conflict is experienced by either the nurse or the patient (or both). stress in the nurse patient interaction will occur. If a nurse with special knowledge communicates appropriate information to the patient, mutual goal- setting and goal achievement will occur. There are also assumptions made in the model. They are: The focus of nursing is the care of the human being (patient), The goal of nursing is the health care of both individuals and groups.  Human beings are open systems interacting with their environments constantly. The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process. Patients perceive the world as a complete person making transactions with individuals and things in the environment. Transaction represents a life situation in which the perceiver and the thing being perceived are encountered, It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences. According to King, a human being refers to a social being who is rational and sentient. He or she has the ability to perceive, think, feel, choose, set goals, select means to achieve goals, and make decisions. He or she has three fundamental needs: the need for health information when it is needed and can be used; the need for care that seeks to prevent illness; and the need for care when he or she is unable to help him or herself. Health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of resources to achieve maximum potential for daily living. Environment is the background for human interaction. It involves the internal and external environments. The internal environment transforms energy to enable a person to adjust to continuous external environment changes. The external environment involves formal and informal organizations. In this model, the nurse is part of the patient's environment. The Theory of Goal Attainment defines nursing as "a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation" and "a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals." In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse "includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying." The function of a professional nurse is "to interpret information in the nursing process to plan, implement, and evaluate nursing care." King gives detailed information about the nursing process in her model of nursing. The steps of the nursing process are: Assessment, nursing Diagnosis, Planning, Implementations, and Evaluation. BETTY NEUMAN Neuman’s System Model Betty Neuman's Systems Model provides a comprehensive holistic and system-based approach to nursing that contains an element of flexibility. The theory focuses on the response of the patient system to actual or potential environmental stressors and the use of primary, secondary, and tertiary nursing prevention intervention for retention, attainment, and maintenance of patient system wellness. The basic assumptions of the model are: Each patient system is a unique composite of factors and characteristics within a range of responses contained in a basic structure. Many known, unknown, and universal stressors exist. Each differ in their potential for upsetting a client's usual stability level. Each patient has evolved a normal range of responses to the environment referred to as the normal line of defense. It can be used as a standard by which to measure health deviation. The particular inter-relationships of patient variables can, at any point in time, affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors. When the flexible line of defense is incapable of protecting the patient against an environmental stressor, that stressor breaks through the line of defense. The client is a dynamic composite of the inter-relationships of the variables, whether in a state of illness or wellness. Wellness is on a continuum of available energy to support the system in a state of stability. Each patient has implicit internal resistance factors known as LOR, which function to stabilize and realign the patient to the usual state of wellness. Primary prevention is applied in patient assessment and intervention, in identification and reduction of possible or actual risk factors. Secondary prevention relates to symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects.  Tertiary prevention relates to adjustive processes taking place as reconstitution begins, and maintenance factors move them back in a cycle toward primary prevention. The patient is in dynamic, constant energy exchange with the environment. The major concepts of Neuman's theory are content, which is the variables of the person in interaction with the environment; basic structure or central core; degree to reaction; entropy, which is a process of energy depletion and disorganization moving the client toward illness; flexible line of defense; normal line of defense; line of resistance; input-output; negentropy, which is a process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness; open system; prevention as intervention; reconstitution; stability; stressors; wellness/illness; and prevention. In the Systems Model, prevention is the primary intervention. It focuses on keeping stressors and the stress response from having a detrimental effect on the body. Primary prevention occurs before the patient reacts to a stressor. It includes health promotion and maintaining wellness. Secondary prevention occurs after the patient reacts to a stressor and is provided in terms of the existing system. It focuses on preventing damage to the central core by strengthening the internal lines of resistance and removing the stressor. Tertiary prevention occurs after the patient has been treated through secondary prevention strategies. It offers support to the patient and tries to add energy to the patient or reduce energy needed to facilitate reconstitution. In the Neuman's theory, a human being is a total person as a client system and the person is a layered, multidimensional being. Each layer consists of a five-person variable or subsystem. The subsystems are physiological -which refers to the physiochemical structure and function of the body; psychological -which refers to mental processes and emotions; socio-cultural - which refers to relationship id social/cultural expectations and activities; spiritual, which - refers to the influence of spiritual beliefs; and developmental, which refers to those processes related to development over the lifespan. Neuman explains environment as the totality of the internal and external forces which surround a person, and with which they interact at any given time. These forces include the intrapersonal, interpersonal, and extra-personal stressors, which can affect the person's normal line of defense and so can affect the stability of the system. The environment has three components: the internal-which exists within the client system; the external- which exists outside the client system; and the created- which is an environment that is created and developed unconsciously by the client, and is symbolic of system wholeness. The Systems Model of health is equated with wellness- and defined as the condition in which all parts and subparts, or Variables, are in harmony with the whole of the client." The client system moves toward illness and death when more energy is needed than what's available. The client system moves toward wellness when more energy is available than is needed. Neuman view nursing as a unique profession concerned with the variables that influence the response the patient might have to a stressor. Nursing also addresses the whole person, giving the theory a holistic perspective. The model defines nursing as "actions which assists individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient-client system, through nursing interventions to reduce stressors." Neuman also says the nurse's perception must be assessed in addition to the patient's, since the nurse's perception will influence the care plan he or she sets up for the patient. The Systems Model views the role of nursing in terms of the degree of reaction to stressors, as well as the use of primary, secondary, and tertiary interventions. In Nueman’s System Model nursing process, there are six steps, each with specific categories of data about the patient. 1. First is the assessment of the patient, which looks at: actual and potential stressors; condition and strength of basic factors and energy sources; characteristics of flexible and normal lines of defense, lines of resistance, degree of reaction and potential for reconstitution; interaction between the patient and his or her environment; life process and coping factors for optimal wellness; and the perceptual difference between the care giver and the patient 2. Second, the nurse makes a diagnosis by interpreting the data collected. The data includes health- seeking behaviors, activity intolerance, ineffective coping, and ineffective thermoregulation. 3. The third step in the nursing process is to set goals. The ultimate goal is to keep the client 5 system stable. 4. From the goals, a plan is created, which focuses on strengthening lines of defense and resistance. 5. That plan is implemented using primary, secondary, and tertiary preventions. 6. Finally, the nursing process is evaluated to determine whether or not balance was restored, and a stable state maintained. There are 3 types of stressors in Neuman’s theory, namely intrapersonal, interpersonal and extrapersonal. Embraces: Direct.observation skills & initial visit(s) Assessment *data.baseline recording & screening collection/referral history measures.interviews & discussions Assessment/planning.analysis of data.prioritise Implementation – nursing.consultation intervention.collaboration.co-ordination.implementation of person-centered therapies and delegation of interventions or therapies SISTER CALISTA ROY Roy’s Adaptation Model The Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. After working with Dorothy E. Johnson, Roy became convinced of the importance of describing the nature of nursing as a service to society. This prompted her to begin developing her model with the goal of nursing being to promote adaptation. She first began organizing her theory of nursing as she developed course curriculum for nursing students at Mount St. Mary's College. She introduced her ideas as a basis for an integrated nursing curriculum. The factors that influenced the development of the model included family, education, religious background, mentors, and clinical experience. Roy explained that adaptation occurs when people respond positively to environmental changes, and it is the process and outcome of individuals and groups who use conscious awareness, self-reflection, and choice to create human and environmental integration. The key concepts of Roy's Adaptation Model are made up of four components: person, health, environment, and nursing. The Adaptive Model makes ten explicit assumptions: 1. The person is a bio-psycho-social being. 2. The person is in constant interaction with a changing environment. 3. To cope with a changing world, a person uses coping mechanisms, both innate and acquired. which are biological, psychological, and social in origin. 4. Health and ill are inevitable dimensions of a person's life. 5. In order to respond positively to environmental changes, a person must adapt. 6. A person's adaptation is a function of the stimulus he is exposed to and his adaptation level. 7. The person's adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response. 8. The person has four modes of adaptation: physiologic needs, self-concept, role function, and interdependence. 9. Nursing accepts the humanistic approach of valuing others' opinions and perspectives. Interpersonal relations are an integral part of nursing 10.There is a dynamic objective for existence with the ultimate goal of achieving dignity and integrity. There are also four implicit assumptions which state: 1. A person can be reduced to parts for study and care. 2. Nursing is based on causality. 3. A patient's values and opinions should be considered and respected. 4. A state of adaptation frees a person's energy to respond to other stimuli. The goal of nursing is to promote adaptation in the four adaptive modes. Nurses also promote adaptation for individuals and groups in the adaptive modes, thus contributing to health, quality of life, with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions. The Four Adaptive Modes of Roy's Adaptation Model are physiologic Needs, self-concept, role function, and interdependence. The adaptation of model includes 6 step nursing processes 1. The first level of assessment, which addresses the patient’ behavior 2. The second level of assessment, which addresses ne patient's stimuli 3. Diagnosis of the patient 4. Setting goals for the patient's health 5. Intervention to take actions in order to meet those goals 6. Evaluation of the result to determine if goals were met DOROTHY JOHNSON Johnson’s Behavioral System Model Her theory of nursing defines nursing as external regulatory force which acts to preserve the organization and integration of the patients' behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found." Her nursing model states that "each Individual gas patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual." It advocates the fostering of efficient and effective behavior functioning in the patient to prevent illness. The patient is defined as a behavioral system. composed of seven behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each subsystem also has three functional requirements, which include 1. Protection from noxious influences, 2. provision for a nurturing environment, and 3. stimulation for growth. An imbalance in each system results in disequilibrium. The nurse's role is to help the patient maintain his or her equilibrium. Johnson’s Behavioral System Model advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. The patient is identified as a behavioral system composed of seven behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each subsystem's three functional requirement include protection from noxious influences, provision for a nurturing environment, and stimulation for growth. An imbalance in any of the behavioral subsystems results in disequilibrium. It is nursing's role to assist the client in returning to a state of equilibrium. Which acts to preserve organization and integration of the patient’s behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in' which found." According to the Behavior System Model, the goals of nursing are four-fold: 1. To assist the patient whose behavior is proportional to social demands. 2. To assist the patient who can modify his behavior in ways that supports biological imperatives. 3. To assist the patient who can benefit to the fullest extent during illness from the physician's knowledge and skill. And 4. To assist the patient whose behavior does not give evidence of unnecessary trauma as a consequence of illness. Johnson identified several assumptions that are critical to understanding the nature of operation of the person as a behavioral model (1) There is "organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the system." (2) A system tends to achieve a balance among the various force operating within and upon it, and that man strives continually to maintain a behavioral system balance and steady-state by more less automatic adjustments and adaptations to the natural force occurring on him." (3) A behavioral system, which requires and results in regularity and constancy in behavior, is essential to man. It is functionally significant because it serves a useful purpose in social life and the individual. And (4) "System balance reflects adjustments and adaptations that are successful in some way and to some degree. HILDEGARD PEPLAU Interpersonal Relationship Model Peplau is a psychiatric nurse - Focus: Therapeutic process - Attained through: Healthy Nurse-Patient Relationship Four (4) Phases of Nurse-Patient Interaction 1. Orientation Nurse and patient test the role each one assumes Prepares patient for termination Patient identifies areas of difficulty 2. Identification Phase Patient identifies with the personnel who can satisfy his needs 3. Exploitation Phase Nurse maximizes all the resources to benefit the patient 4. Resolution Phase or Termination Phase Occurs when patient's needs have been met Application Significant in terms of the different phases of the N-Pt. interaction & the different ROLES the N can play in giving nursing care to pts. It thus becomes important for nurses to understand the, principles behind each of these concepts so that clinical nsg will be more meaningful for the nurse. Eventually, this will translate to pt. outcomes like: Improved health Prevention of Disease prevention Enhancement of care faculties IDA JEAN ORLANDO Nursing Process Theory The Nursing Process is an interaction of Three Basic Elements: 1. Patient's Behavior 2. Nurse's reaction 3. Nursing Actions - designed for the patient's benefit The Role of the Nurse is to find out & meet the patient's immediate need for help. Nurses should use his perception, thoughts about the perception or the feeling engendered from their thoughts to explore with patients the meaning of their behavior The use of the theory keeps the N's focus on the patient Application: The Theory increases the Therapeutic Effectiveness of nurses by the expression of Empathy, Warmth & Genuineness especially in the light of addressing the Stat Need of the Patient for help. This framework will be important for Ns who are assigned in special clinical areas that requires quick decision making & critical thinking skills. If the patient's condition improved, then the intervention is effective and the patient moves on to new problems JOYCE TRAVELBEE Interpersonal Aspects of Nursing Theory Human to human Relationship * Greatly emphasized on the Therapeutic Human Relationship between the Nurse & the Patient. * Her model emphasizes: Empathy Sympathy Rapport & the Emotional aspects of Nursing 4 Interlocking Phases that precedes RAPPORT And the establishment of N-Pt. Relationship: ✓ Original Encounter ✓ Emerging Identities ✓ Empathy ✓ Sympathy Application: The theory describes the various stages of interpersonal relations that occur between a Patient and a N. It thus becomes important for Ns to fully understand the phases and its effects to the patient's welfare. Due consideration should be given to the pt's inherent personal characteristics to interact w/ other people, most especially Ns & other members of the healthcare professions. The key concept of Empathy, Sympathy, Rapport & Emotional Understanding are very important for the Ns of today because it makes the patient feel human. LYDIA HALL Core, Care, Cure Model Individuals could be conceptualized in 3 Separate Domains: 1.CARE - hands on bodily care 2.CORE - using the self in relationship to the client 3. CURE - applying medical knowledge APPLICATIONS Foundation for classifying the Professional Nurse s functions today. Nurses are able to carry out Nursing Interventions: INDEPENDENTLY, DEPENDENTLY INTERDEPENDENTLY CORE - maintains that it is the N responsibility to make sure that the client receives the highest level of care possible from all concerned Hx Professionals. Nurse's ROLES: COLLABORATOR, COORDINATOR and in COOPERATION with other members of the HX team that pertains to PATIENT'S WELFARE.