Nursing Theories PDF

TFN BULLETS POINTS Theory Defined A set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically selected and organized as an abstract representation of some phenomenon (McEwen & Wills, 2019). Nursing Theories organized bodies of...

TFN BULLETS POINTS Theory Defined A set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically selected and organized as an abstract representation of some phenomenon (McEwen & Wills, 2019). Nursing Theories organized bodies of knowledge to define what nursing is, what nurses do, and why do they do it. a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine). guide the practice of nursing at a more concrete and specific level. History of Nursing Theories 1952, Hildegard Peplau -Theory of Interpersonal Relations. 1962, Ida Jean Orlando - finding out and meeting the patients immediate need for help. 1970, Martha Rogers -both science and an art. 1971, Dorothea Orem -- nursing care is required if the client is unable to fulfill needs. 1971, Imogene King's -Theory of Goal Attainment- nurse-patient relationship in meeting goals. 1979, Sr. Callista Roy- maintain the balance **Stages in the Development of Nursing Theory** Silent Knowledge Blind obedience to medical authority. Little attempt to develop theory. Received Knowledge Learning through listening to others. Borrowed from other disciplines. relied on the authority of educators, sociologists, psychologists, physiologists, and anthropologists Subjective Knowledge Authority was internalized to foster a new sense of self. Focused on defining nursing and on Developing theories about and for nursing. Focused on the nurse rather than on clients and clinical situations. Procedural Knowledge both separate and connected knowledge. Application of theory in practice used to acquire knowledge, with focused attention to the appropriateness of methodology, the criteria for evolution, and statistical procedures for data analysis. Constructed Knowledge different types of knowledge (intuition, reason, and self-knowledge). based on prior empirical studies, theoretical literature, client reports of clinical experience and feelings, and the nurse scholar's institution or related knowledge about the phenomenon of concern. Integrated Knowledge Assimilation and application of "evidence" Nursing theory will increasingly incorporate information from published literature with enhanced emphasis on clinical application as situation-specific/ practice theories and middle range theories. Components of a Theory -Concepts building blocks of theories. vehicles of thought that involve images. abstract or concrete. Examples: Noise, Cleanliness, Ventilation, Bed and Beddings, Warmth -Definitions general meaning of the concepts in a manner that fits the theory. EX; Newman's Theory , = stressor as any stimuli that can produce tension and cause instability within the system. Two Types of Definition Theoretical definition Operational definition -Assumptions describe concepts or connect two concepts that are factual. "taken for granted" statements that determine the nature of the concepts, definitions, purpose, relationships and structure of the theory. Example of Assumption Neuman's systems model of the assumptions ;patients are dynamic. -Phenomenon term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. EX; caring, self-care, and patient responses to stress. Conceptual Framewok A set of interrelated concepts,conveys a mental image of a phenomenon. identify concepts and describe their relationships to the phenomena of central concern to the discipline: person, environment, health and nursing Hypothesis educated guess based upon observation. supported or proven false by experimentation or continued observation. Theoretical Model representation of the interaction among and between the concepts showing patterns. pictorial representation of the variables and their interrelationships. Classification of Nursing Theories Based on scope (complexity and degree of abstraction). Based on types of Purpose. According to Meleis. Types of Theory Based on Scope a\. Metatheory (theories about theories). Nursing Philosophies). The highest level of theory in terms of abstraction thus very difficult to for practical application. b\. Grand Theory comprehensive conceptual frameworks (a.k.a. Nursing Conceptual Models). broad in scope and complex and Focus on broad, nonspecific, and general areas and concepts. lack operational definitions. Ex; Roy Adaptation Model Self-Care Theory by Orem Philosophy and Theory of Transpersonal Caring- Jean Watson King's Goal Attainment Theory Nightingale's Environmental Theory c\. Middle-Range Theories more limited scope, less abstraction, address specific phenomenon or concepts and reflect practice (e.g. pain, stress, adaptation). more precise and highly specific "best of both worlds" -- i.e. easy applicability in practice and abstract easier to apply as frameworks Ex; of Middle-Range Theories Benner's Skill Acquisition Model Leininger's Cultural Care Diversity and Universality Theory Pender's Health Promotion Model Mercer's Conceptualization of Maternal Role Attainment/ Becoming a Mother c\. Practice Theory situation-specific theories, prescriptive theories, and are the least complex and "action-oriented". more specific than middle-range theories and produce specific directions for practice. limited to specific populations or fields of practice. Ex of Practice Theories theories of postpartum depression, infant bonding, and oncology pain management. Types of Purpose Theory 1\. Factor-isolating theories (descriptive theories) describe, observe, and name concepts, properties, and dimensions but does not explain how or why the concepts are related. generated and tested by descriptive research techniques (case studies, literature review phenomenology, EX; of Descriptive Theory experience of caring for a dying spouse. 1\. Factor- relating theories (explanatory theories) relate concepts to one another, describe the interrelationships among concepts or propositions. tell how or why the concepts are related and may deal with cause and effect and correlations or rules that regulate interactions. correlational research. Ex: Theory of spirituality-based nursing practice by Nardi & Rooda 2\. Situation-relating theories (predictive theories or promoting or inhibiting theories) predicts occurrence of a phenomenon when the cause is present. Experimental research Ex: The relationship between spirituality and health status among adults living with HIV by Cobb. 3\. Situation-producing theories (prescriptive theories) nursing therapeutics and consequences of interventions. Prevents"occurrence of the phenomenon by controlling or eliminating possible causes. Example: medical acupuncture to reduce stress and enhance well-being. Nursing Theories Classification According to Meleis (2011) "Needs" Theories Interaction" Theories "Outcome" Theories LIFE OF FLORENCE NIGHTINGALE: MOTHER OF MODERN NURSING "Nursing is the art of utilizing one's environment for his or her own recovery." May 12, 1820- August 13, 1910 first nurse theorist - the Environmental Theory "Mother/ Founder of Modern Nursing" "The Lady with the Lamp" Born in Florence, Italy on the 12th day of May 1820 older sister is Frances Parthenope. mother, Frances (Fanny) Nightingale, British family belonged to a rich, upperclass, well-connected British family. father, William Nightingale, a wealthy landowner \[ Lea Hurst, Derbyshire, and other in Hampshire, Embley Park\] --Nightingale \[5 years old.\] Her father provided her with a classical education, \[German, French and Italian.\] excellent in Mathematics. active in philanthropy, ministering to the ill and poor people. a call from God in February 1837 (17 y/o), Florence = enter nursing in 1844 (24y/o), Elizabeth Blackwell at St. Bartholomew's Hospital, first woman doctor in US. 1849, Blackwell graduated first in her class. \[London and Paris\] enrolled as a nursing student in 1844 at the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany. suitor- Richard Monckton Milnes, 1st Baron Houghton, income \[father\] of £500 (roughly £25, 000/ USŚ50,000 in present terms) Lutheran Hospital in Germany as A TURNING POINT IN HER LIFE, 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. = first published work. In 1853,accepted the position of superintendent at the Institute for the Care of Sick Gentlewomen (Invalid women) in Upper Harley Street, London. She held this position until October 1854. Crimean War In March 1853, the Crimean War\[ Russia and Turkey\], with British and French forces aiding Turkish armies cholera and malaria(around 8,000 men). On October 21, 1854, \[ 38 women volunteer nurses,\] W/ her aunt Mai Smith, were sent (under the authorization of Sidney Herbert, the Secretary of War) across the Black Sea from Balaklava in the Crimea, \[main British camp\] 38 "handmaidens of the Lord" (as she called them) arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Uskudar in Istanbul). first winter at Scutari, 4, 077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. mortality rate (from 42% to 2%). advocated sanitary living conditions Crimean War, -"The Lady with the Lamp", a report in The Times: (by William Howard Russell). Notes on Matters Affecting The Health, Efficiency and Hospital Administration of the British Army, an 830-page report Letter from Queen Victoria Thanking "Miss Nightingale and her ladies" a diamond brooch with "Blessed are the merciful" Post- War Contributions Using the money (Ś250,000) she got from the British government, she funded the establishment of St. Thomas' Hospital, and within it, the Nightingale Training School for Nurses, now part of the King's College London. In 1860-, "Notes on Nursing", outlining principles of nursing, a slim 136-page book \[curriculum at the Nightingale School \] a classic introduction to nursing. Notes on Hospitals, which deals with the correlation of sanitary techniques to medical facilities. Suggestions for Thought to Searchers after Religious Truths, -removal of restrictions that prevented women having careers. 1870s, mentored Linda Richards "America's first trained nurse", USA and Japan. Crimean Monument in Waterloo Place, London King Edward VII bestows the Order of Merit a Fellow of the Royal Statistical Society\["Nightingale Rose Diagram".\] Honorary member of the American Statistical Association. International Nurses Day- on her birthday her picture was on our British £10 note died peacefully unexpectedly in her sleep at 2:00pm, Saturday, August 13, at her home in London. churchyard of St. Margaret's Church, East Wellow, England. Florence Nightingale pledge before being formally initiated into the profession of Nursing. nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health. manipulation of the physical environment as a major component of nursing care. Notes on Nursing: What it is, What it is Not. Sub-Concepts of Environmental Theory 1\. Health of Houses pure air, pure water, efficient drainage, cleanliness, and light. "Badly constructed houses do for the healthy what badly constructed hospitals do for the sick -- Nightingale" 2\. Ventilation and Warning "Keep the air he breathes pure as the external air, without chilling him" "Noxious air", or "effluvia" or foul odors (excrement, bedpans, urinals). room temperature (should be too warm or too cold). 3\. Light fresh air and light- direct sunlight w Lack of environmental stimuli (e.g isolation, NICU, ICU) can lead to confusion or "intensive care psychosis" related to the lack of the usual cycling of day and night. 4\. Noise never be waked intentionally or accidentally jewelries worn by nurses, keys that jingle, snapping of rubber gloves, the clank of the stethoscope against metal bed rails, telephones ringing. 5\. Variety avoid boredom and depression. engage with the client. changes in color and form (presently known as diversional therapy). reading, writing, and cleaning 6\. Bed and Bedding exhales about 3 pints of moisture through the lungs and skin in a 24-hour period. hanged and aired frequently. Beds - in the lightest part of the room. keep bedding clean, neat, dry, and to position for maximum support. 7\. Cleanliness of Rooms and Walls Removal of dust with a damp cloth Clean room is a healthy room. 8\. Personal Cleanliness Bathing and drying the skin provide great relief to the patient. 9\. Nutrition and Taking Food different foods at different times of the day. Frequent small servings No (distraction).,while they are eating Right food at the right time. 10\. Chattering Hopes and Advice Sick persons should hear good news that would assist them in becoming healthier. 11\. Observation of the Sick Nurses must be taught.\[What &,How to observe (what symptoms indicate improvement). What is the reverse , importance, evidence of neglect. obtain complete and accurate information about patients. The most important practical lesson that can be given to nurses is to teach them what to observe. -Florence Nightingale 12\. Petty Management Continuity of the care, Documentation of the plan of care and all evaluation \[ give the same care to the client in your absence.\] "what you do when you are there, shall be done when you are not there." Major Concepts (Metaparadigm) A. Environment Physical components \- ventilation, warmth, light, nutrition, medicine, stimulation, room temperature, and activity. Psychological \- avoid chattering hopes and advices and providing privacy. B. Person- receiving care: a dynamic and complex being. C. Health \- "Healthy is not only to be well, but to be able to use well every power we have." \- "not only to be well, but to be able to use well every power we have." \- Disease -absence of comfort. (Six D's of Dys-ease are: Dirt, Drink, Diet, Damp, Draughts and Drains -REPARATIVE PROCESS D. Nursing -- a spiritual calling; provide physicians with accurate information about patients Different Types of Nursing a\. Nursing Proper- nursing the sick b\. General Nursing- health promotion c\. Midwifery Nursing JEAN WATSON- THEORY OF HUMAN CARING (June 10, 1940 -- present) -American nurse theorist& professor "Philosophy and Theory of Transpersonal Caring" or "Caring Science" ART and HUMAN SCIENCE through TRANSPERSONAL TRANSACTIONS born in West Virginia. Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in educational psychology and counseling. 1997, - accidental injury - loss of her left eye. 1998, husband-passed away. "attempting to integrate these wounds into my life and work. ' 7 Assumptions of the Caring Science 1\. Caring can be effectively demonstrated and practiced only interpersonally. 2\. Caring consists of carative factors that result in the satisfaction of certain human needs. 3\. Effective caring promotes health an individual or family growth. 4\. Caring responses accept a person not only as he or she is now but as what he or she may become. 5\. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself at a given point in time. 6\. A science of caring is therefore complementary to the science of curing. 7\. The practice of caring is central to nursing. Major Elements of Caring Theory 1\. Transpersonal Caring Relationship showing concerns toward the person's subjective and deeper meaning regarding their own health care situation. 2\. Caring Occasion/ Moment come together=an occasion for human caring is created. 3\. Carative Factors Ten Carative Factors Guide for the core of nursing, CARATIVE term to contrast with curative. It honors the inner life world and subjective experiences of patients. clinical caritas processes that suggested ways to apply the 10 carative factors. CARATIVE FACTORS- CARITAS PROCESS 1\. "The formation of a humanistic- altruistic system of values" "Practice of loving-kindness and equanimity within the context of caring consciousness" 2. "The instillation of faith-hope" "Being authentically present and enabling and sustaining the deep belief system and subjective lifeworld of self and one being cared for" 3\. "The cultivation of sensitivity to one's self and to others" "Cultivation of one's own spiritual practices and transpersonal self-going beyond the ego self" 4\. "Development of a helping trust relationship" became "development of a helping-trust, human caring relation" "Developing and sustaining a helping trusting authentic caring relationship" 5\. "The promotion and acceptance of the expression of positive and negative feelings" "Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit and self and the one--being cared for" 6. "The systematic use of the scientific problem-solving method for decision making" became "systematic use of a creative problem solving caring process" "Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices" 7\. "The promotion of transpersonal teaching-learning" "Engaging in genuine teaching learning experience that attends to unity of being and meaning, attempting to stay within others' frame of reference" 8\. "The provision of supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment" "Creating healing environment at all levels (physical as well as nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace arepotentiated" 9\. "The assistance with gratification of human needs" "Assisting with basic needs, with an intentional caring consciousness, administering "human care essentials", which potentiate alignment of mind body spirit, wholeness, and unity of being in all aspects of care" 10\. "The allowance for existential-phenomenological forces" became "allowance forexistential -phenomenological spiritual forces" "Opening and attending to spiritual-mysterious and existential dimensions of one's own life-death; soul care for self and the one-being-cared for" patient as the Mind-Body-Spirit entity that needs holistic nursing care. BEDSIDE NURSING, care for the patient for who he is. Dorothea Elizabeth Orem (1914-2007) -Self-Care Theory Born in 1914 in Baltimore, Maryland. 1939- BSN, Catholic University of America staff nurse, private duty nurse, nurse educator and administrator and nurse consultant. Doctor of Science degree in 1976. Concepts of Practice in 1971, second in 1980, and in 1995. died on June 22, 2007 at 92. patients are encouraged to bring out the best in them despite being ill for a period of time. =rehabilitation settings be more independent after being cared for by physicians and nurse." grand nursing theory = covers a broad scope with general concepts that can be applied to all instances of nursing. "The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness." individual's ability to perform SELF-CARE, SELF-CARE \- practice of activities that individual initiates and perform on their own behalf in maintaining life, health and well-being. SELF-CARE AGENCY -- is a human ability which is "the ability for engaging in self-care" THERAPEUTIC SELF-CARE DEMAND "totality of self-care actions to be performed for some duration in order to meet self care requisites. SELF-CARE REQUISITES -- action directed towards provision of self-care. 3 Categories of Self-Care Requisites a\. Universal Self-Care Requisites (needs that all people have). Identifies these requisites as: a\. air, water, food. b\. elimination process. c\. activity and rest, \|solitude and social interaction. d\. Prevention of hazards e\. Promotion of human functioning. b\. Developmental Self-Care Requisites developmental processes/ derived from a condition... Or associated with an event. E.g. adjusting to a new job\|body changes c\. Health Deviation Self-Care Requisites Required in conditions of illness, injury, or disease. medical assistance aware of and attending to the effects and results of pathologic conditions. medically prescribed measures. live with effects of pathologic conditions. Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency. Theory of Self-Care Deficit Nursing is required when - incapable or limited in the provision of continuous effective self-care. Orem identifies 5 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 5\. Teaching another Theory of Nursing Systems 3 classifications of nursing system to meet the self-care requisite of patient: a\. Wholly Compensatory System Patient -DEPENDENT. Nurses -ALL \|compensate for the patient's inability to engage in self-care. Example: care of a new born, care of client recovering from surgery in a post-anesthesia care unit b\. Partially Compensatory System Patient- SOME needs\| NEEDS NURSING assistance. Both the nurse and the patient engage Ex: Nurse can assist post-operative client to ambulate. \| bring a meal tray for client who can feed himself. b\. Supportive Educative System CAN MEET \| but needs assistance with decision making or knowledge and skills to learn self-care. Ex: Nurse guides a mother how tobreastfeed her baby. Counseling a psychiatric client on more adaptive coping strategies. Application of Orem's Theory self- care in promotion of health. patient's capacity to perform selfcare activities. should not move away education and supportive measures LYDIA ELOISE HALL:CARE, CORE, CURE THEORY (September 21, 1906-February 27, 1969) "Nursing is a distinct body of knowledge that provides nursing care to patients who are in need of medical interventions, in collaboration with the members of the health team, or exclusively and independently by the nurse herself." Born in New York City on September 21, 1906. psychiatry and nursing experiences in the Loeb Center about her transparent thoughts and remarkable ideas of nursing care nursing functions differ in so far as aspects of patient care is concerned. "The Three Cs of Lydia Hall" three independent but interconnected circles: "CORE" --Interdependent person or recipient of care. relate with the patient and is shared with other members of the health team. The motivation an energy for healing exist \| WITHIN THE PATIENT. social, emotional, spiritual, and intellectual needs of the patient. help the patient verbally express feelings regarding the disease process and its effects by the use of reflective technique. social sciences. Shared with social workers, psychologists, clergy, and professions. Reflective technique \- he or she acts as a mirror to the patient to help the latter explore his or her own feelings regarding his or her current health status and related potential changes in lifestyle. "CARE" -- Independent exclusive domain of nursing. nursing component of care. natural and biological sciences. role of nurses, \[performing the task of nurturing patients\] complete basic daily biologic activities (e.g. eating, elimination, bathing, and dressing,vital signs,) "CURE" -- Dependent medical interventions pathological and therapeutic sciences \[microbiology, parasitology, and pathology.\] dependent upon the orders of the physician.\|medication administration motivation and energy =healing exist within the patient, The three aspects interact, and the circles representing them change in size, depending on the patient's total course of progress. ERNESTINE WIEDENBACH: HELPING ART OF CLINICAL NURSING August 18, 1900- March 8, 1998 "Nursing is the art of nurturing or caring for someone in a motherly fashion." Born in in Hamburg, Germany. BSN -- John Hopkins School of Nursing. Yale faculty in 1952 as an instructor in maternity nursing. the youngest of four daughters, that had immigrated from Germany when she was just a young child. she watched how her sick **grandmother** was taken care of and then later was influenced after hearing accounts of hospital experiences from a family friend. A Need-for-Help Defined "any measure desired by the patient that has the potential to restore or extend the ability to cope with various life situations that affect health and wellness" based on the individual perception of his own situation. identifying a patient's need for help. 4 Main Elements of Clinical Nursing 1\. The Philosophy attitude and belief about life and how that affected reality for them 3 essential components associated with a nursing philosophy: 1\. Reverence for life 2\. Respect for the dignity, worth,autonomy and individuality of each human being and 3\. Resolution to act on personally and professionally held beliefs. 2\. The Purpose wants to accomplish through what she does. activities directed towards the overall good of the patient. 3\. The Practice observable nursing actions that are affected by beliefs and feelings about meeting the patient's need for help. 4\. The Art Understanding patients needs and concerns Developing goals and actions Directing the activities related to the medical plan prevention of complications related to reoccurrence or development of new concerns. PRESCRIPTIVE THEORY (3) factors: central purpose - practitioner recognizes as essential to the particular discipline. prescription - fulfillment of central purpose. realities- immediate situation that influence the central purpose. CENTRAL PURPOSE wants to accomplish through what she does \|overall goal toward which she is striving. THE PRESCRIPTION directive to activity. specifies both the nature of the action (voluntary or involuntary) that will most likely lead to fulfillment of the nurse's central purpose. 3 Kinds of Voluntary Action 1\. Mutually understood and agreed upon action (the patient and the nurse) 2\. Recipient- directed action -- the patient directs the way it is to be carried out. 3\. Practitioner- directed action- the nurse carries out the action. The Realities consist of all factors- physical, psychological, physiological, emotional, spiritual- that influence the situation in which nursing actions occur at any given moment. The Agent practicing nurse or her delegate, \[personal attributes, capacities, commitment and competence\] The Recipient patient, \[ personal attributes, problems, capabilities ,ability to cope with the concerns or problems being experienced. The Goal desired outcome the nurse wishes to achieve. The Means the activities and devices through which the nurse is enabled to attain her goal. The Framework environmental, professional, and organizational facilities DOROTHY E. JOHNSON:BEHAVIORAL SYSTEM MODEL (August 21, 1919-February 1999), Savannah, Georgia. Nursing Care facilitates the client's maintenance of a STATE OF EQUILIBRIUM. Clients are "STRESSED" by a stimulus of either an internal or external nature. human beings as having two major systems: the biological system\[medicine \] and the behavioral system\[nursing\]. Equilibrium \- in harmony with himself and with his environment. Tension \- state of being strained \| end-product of a disturbance Stressor \- stimuli (external/internal) that produce tension and result in a degree of instability. Two (2) Areas of Focus to return the client to a state of equilibrium 1\. Reduce stressful stimuli 2\. Support natural and adaptive processes Seven (7) Subsystems- has three functional requirements "PROTECTED" -noxious influences with which systems cannot cope". "NURTURED" - input of appropriate supplies from the environment. "STIMULATED" -growth and prevent stagnation. 1\. Attachment or Affiliation subsystem basis of all social organization. survival and security. consequences =social inclusion, intimacy and the formation and maintenance of a strong social bond. Ex: Allowing family members to visit. 2\. Achievement subsystem Control or mastery of an aspect of self or environment Intellectual, physical, creative, mechanical and social skills achievement Ex: Giving positive feedback \\ praises after completing a task. 3\. Ingestion Subsystem meaning and structures of the social events surrounding the occasion when the food is eaten. Has to do with when, how, what, how much, and under what conditions we eat. Ex: Considering patient preferences in food choices 4\. Elimination Subsystem "when, how, and under what conditions we eliminate." Ex: Promoting regular bowel elimination 5\. Aggressive Subsystem behaviors concerned with protection and self-preservation. one that generates defensive response from the individual when life or territory is being threatened. Ex; patient refuses to take the medication as she thinks it is more harmful and the nurse explains its mechanism. 6\. Dependency Subsystem Promotes helping behavior Approval, attention, or recognition and physical assistance. develops from the complete reliance on others for survival. Ex; giving approval, attention, or recognition and physical assistance. 7\. Sexual Subsystem procreation and gratification. development of gender role identity and \[sex role behaviors.\] Both biological and social factor Ex; promoting a mother perform her maternal role. ----------------------- --------------------------------- FLORENCE NIGHTINGALE Environmental Theory JEAN WATSON Theory of Human Caring DOROTHEA OREM Self-Care Theory LYDIA HALL CARE, CORE, CURE THEORY ERNESTINE WIDENBACH HELPING ART OF CLINICAL NURSING DOROTHY JOHNSON BEHAVIORAL SYSTEM MODEL HILDEGARD PEPLAU Interpersonal Relations IMOGENE KING Goal-Attainment VIRGINIA HENDERSON THE 14 BASIC HUMAN NEEDS \- FAYE ABDELLAH 21 Nursing Problems Theory NOLA PENDER Health Promotion Model MADELEINE LEININGER: Transcultural Nursing Theory CARMENCITA ABAQUIN The "PREPARE ME" Theory LETTY KUAN "GRACEFUL AGING THEORY" MYRA ESTRIN LEVINE: THE CONSERVATION MODEL ROSEMARIE RIZZO PARSE Human Becoming Theory PATRICIA BENNER "From Novice to Expert." MARTHA E. ROGERS Science of Unitary Human Being BETTY NEUMAN Neuman Systems Model. ----------------------- --------------------------------- VIRGINIA AVENEL HENDERSON "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." November 30 1897- March 19 1996 Died at age of 98 First lady of nursing Nightingale of Modern Nursing Modern-day Mother of Nursing The 20th century Florence Nightingale born in Kansas City, Missouri, in 1897 Enrolled in the Army School of Nursing at Walter Reed Hospital in Washington D.C. in 1921 caring for world war 1 wounded nursings duty to the patient rather than to the doctor and providing a scientific basis for nursing. nurse makes the patient independent of him/her as soon as possible. THREE LEVELS OF NURSE PATIENT RELATIONSHIP SUBSTITUTIVE -doing the person (doer ) SUPPLEMENTARY -- (helper) COMPLEMENTARY -- working with the person (partner ) , with the goal of helping the person become as independent as possible. 14 COMPONENTS OF THE NEED THEORY Physiological Components\[1-9\] 1\. Breathe normally 2\. Eat and drink adequately 3\. Eliminate body wastes 4\. Move and maintain desirable postures 5\. Sleep and rest 6\. Select suitable clothes -- dress and undress 7\. Maintain body temperature within normal range by adjusting clothing and modifying environment 8\. Keep the body clean and well-groomed and protect the integument 9\. Avoid dangers in the environment and avoid injuring others Psychological Aspects of Communicating and Learning\[10&14\] 10\. Communicate with others in expressing emotions, needs, fears, or opinions. 14\. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. Spiritual and Moral 11. Worship according to one's faith Sociological ( Occupation and Recreation) 12\. Work in such a way that there is a sense of accomplishment 13\. Play or participate in various forms of recreation increasing the patient's independence to hasten their progress in the hospital. emphasizes the basic human needs and how nurses can assist those needs. The mind and body are inseparable and interrelated. FAYE GLENN ABDELLAH: 21 Nursing Problems Theory (MARCH 13, 1919 -- February 24, 2017) NURSE THEORIST, MILITARY NURSE, AND A LEADER IN NURSING RESEARCH. Born in New York City to a father of Algerian heritage and Scottish mother. On May 6, 1937, the German hydrogen-fueled airship Hindenburg exploded over Lakehurst. from a disease-centered approach to A PATIENT-CENTERED APPROACH. THE "PROGRESSIVE PATIENT CARE" i.e. from critical care, immediate care, to home care. She developed the PATIENT ASSESSMENT OF CARE EVALUATION (PACE). served in the military during the Korean War. COVERT PROBLEMS - emotional, sociological, and interpersonal in nature, they are often missed or perceived incorrectly. Categories of Patient Needs a\. BASIC NEEDS- covert or overt problems; common to all patients b\. SUSTENAL NEEDS- overt problems; physiologic body processes c\. REMEDIAL NEEDS- covert problems; emotional and interpersonal difficulties d\. RESTORATIVE NEEDS- overt or covert ; sociological or community 21 NURSING PROBLEMS BASIC TO ALL PATIENTS (1-4) 1\. To maintain good hygiene and physical comfort. 2\. To promote optimal activity, exercise, rest and sleep. 3\. To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection. 4\. To maintain good body mechanics and prevent and correct deformity. SUSTENAL CARE NEEDS (5-11) 5\. To facilitate the maintenance of a supply of oxygen to all body cells. 6\. To facilitate the maintenance of nutrition of all body cells. CPFVMW 7\. To facilitate the maintenance of elimination. 8\. To facilitate the maintenance of fluid and electrolyte balance. 9\. To recognize the physiological responses of the body to disease conditions. 10\. To facilitate the maintenance of regulatory mechanisms and functions. 11\. To facilitate the maintenance of sensory function. REMEDIAL CARE NEEDS (12-18) 12\. To identify and accept positive and negative expressions, feelings, and reactions. 13\. To identify and accept the interrelatedness of emotions and organic illness. 14\. To facilitate the maintenance of effective verbal and non-verbal communication. 15\. To promote the development of productive interpersonal relationships. 16\. To facilitate progress toward achievement of spiritual goals. 17\. To create and/ or maintain a therapeutic environment. 18\. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs. RESTORATIVE CARE NEEDS (19-21) 19\. To accept the optimum possible goals in the light of limitations, physical and emotional. 20\. To use community resources as an aid in resolving problems arising from illness. 21\. To understand the role of social problems as influencing factors in the case of illness. NOLA PENDER: Health Promotion Model (August 16, 1941-present) preventative health measures LIVING LEGEND OF THE AMERICAN ACADEMY OF NURSING. Born in Lansing, Michigan - advocated education for women. 7 years old and witnessed the care given to her hospitalized aunt by nurses. goal was to help people care for themselves. "complementary counterpart to models of health protection" health = positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client's level of well-being. Health promotion \- behavior motivated by the desire to increase well-being and actualize human health potential. \| approach to wellness. Health protection or illness prevention \- behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. Three Areas of Health Promotion Model -Individual characteristics and experiences -Behavior-specific cognitions and affect -Behavioral outcomes Individual Characteristics and Experiences PRIOR RELATED BEHAVIOR frequency of the same or similar behavior in the past. PERSONAL FACTORS predictive of a given behavior and shaped by the nature of the target behavior being considered. -Personal biological factors -Personal psychological factors -Personal socio-cultural factors PERSONAL BIOLOGICAL FACTORS age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, or balance. \- Ex: An elderly person does not have enough strength to exercise PERSONAL PSYCHOLOGICAL FACTORS self-esteem, self motivation, personal competence, perceived health status, \- Ex: A woman believes that eating low carbohydrate diet will help her lose weight. PERSONAL SOCIO-CULTURAL FACTORS race ethnicity, acculturation, education, and socioeconomic status. -Ex: A poor person cannot afford enough variety of food choices to promote health. BEHAVIOR- SPECIFIC COGNITIONS AND AFFECT PERCEIVED BENEFITS OF ACTION anticipated positive outcomes that will occur from health behavior. -Example: A woman is exercising to have a \"beach body\" for a summer vacation PERCEIVED BARRIERS TO ACTION anticipated, imagined or real blocks and personal costs of understanding a given behavior. -Ex: A pregnant woman does not visit the health center as it is far from their home. PERCEIVED SELF-EFFICACY Judgment of personal capability to organize and execute health-promoting behavior. It influences perceived barriers to action so higher efficacy = lowered perceptions of barriers to the performance of the behavior. -Example: A pregnant woman highly values her baby thus visits the health center despite being far from home. ACTIVITY RELATED AFFECT Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behavior itself. influences perceived self-efficacy,\[more positive the subjective feeling, the greater the feeling of efficacy.\] -Ex: A woman felt good about herself after working out in the gym. INTERPERSONAL INFLUENCES Cognition concerning behaviors, beliefs, or attitudes of the others. norms (expectations of significant others), social support (instrumental and emotional encouragement) and modelling (vicarious learning through observing others engaged in a particular behavior). Primary sources = families, peers, and healthcare providers. -Ex: A mother goes Zumba with her friends. SITUATIONAL INFLUENCES Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. -perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Ex: The scorch hot environmental temperature makes it difficult for a person to exercise. BEHAVIORAL OUTCOMES COMMITMENT TO PLAN OF ACTION The concept of intention and identification of a planned strategy leads to implementation of health behavior. IMMEDIATE COMPETING DEMANDS AND PREFERENCES COMPETING DEMANDS \- alternative behavior over which individuals have LOW CONTROL because there environmental contingencies such as work or family care responsibilities. COMPETING PREFERENCES -alternative behavior over which individuals exert relatively HIGH CONTROL, \[choice of ice cream or apple for a snack.\] HEALTH PROMOTING BEHAVIOUR -Endpoint or action outcome directed toward attaining positive health outcome \[optimal well-being, personal fulfillment, and productive living.\] APPLICATION TO THEORY-Community health care setting \[ promoting health and preventing illnesses\] MADELEINE LEININGER: Transcultural Nursing Theory \"a substantive area of study and practice focused on comparative CULTURAL CARE (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of PROVIDING CULTURESPECIFIC AND UNIVERSAL NURISNG CARE PRACTICES in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways.\" (July 13, 1925- August 10, 2012) Born in Sutton, Nebraska. aunt who suffered from congenital heart disease that led her to pursue a career in nursing. first professional nurse to earn in PhD in anthropology (University of Washington). how to deal with patients of different culture and cultural background. \"CULTURALLY CONGRUENT CARE\" AKA CULTURE CARE THEORY. both a specialty and a general practice area. knowing and understanding different cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care. CULTURE learned, shared and transmitted values, beliefs, norms and life way practices of a particular group that guide thinking, decisions, and actions in patterned ways. CULTURAL IDENTITY the sense of being part of an ethnic group or culture. CULTURE-UNIVERSALS commonalities of values, norms of behavior, and life patterns that are similar among different cultures CULTURE-SPECIFIES values, beliefs, and patterns of behavior that tend to be unique to a designate culture. MATERIAL CULTURE objects (dress, art, religious artifacts). NON- MATERIAL CULTURE beliefs customs, languages, social institutions. DIVERSITY fact or state of being different. Diversity occur between cultures and within a cultural group. ACCULTURATION people of a minority group tend to assume the attitudes, values beliefs, find practices of the dominant society resulting in a blended cultural pattern. CULTURAL SHOCK the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity, and incompatibility to the stranger\'s perceptions and expectations at is differentiated from others by symbolic markers (cultures, biology, territory, religion). GENERIC (FOLK OR LAY) CARE SYSTEMS These are culturally learned and transmitted, indigenous (or traditional), folk (home-based) knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts to ameliorate or improve a human life way, health condition (or well-being), or to deal with handicaps and death situations. EMIC Knowledge gained from direct experience or directly from those who have experienced. It is generic or folk knowledge. ETIC Knowledge which describes the professional perspective. It is professional care knowledge. CULTURAL AWARENESS it is an in-depth self-examination of one\'s own background recognizing biases and prejudices and assumptions about other people. CULTURALLY CONGRUENT CARE care that fits the people\'s valued life patterns and set of meanings- which is generated from the people themselves, rather than based on predetermined criteria. Sunrise Model of Madeleine Leininger\'s Theory cultural care worldview flows into knowledge about individuals, families, groups communities, and institutions in diverse health care systems. CULTURAL CARE PRESERVATION OR MAINTENANCE assists, supports, enables, and facilitates the help needed by clients to retain or maintain meaningful care values and lifeways for their wellbeing, and to recover from illness or to deal with handicaps or death. CULTURAL CARE ACCOMMODATION OR NEGOTIATION assists, supports, enables, and facilitates the help needed by clients to adapt to or negotiate with others for meaningful, beneficial and congruent health care. CULTURAL CARE REPATTERNING OR RESTRUCTURING assists, supports, enables, and facilitates the needed by clients to reorder, change, or modify their lifeways for new, different, and beneficial outcomes. CARMENCITA ABAQUIN;"PREPARE ME" Theory "To Nursing... may be able to provide the cure that our clients need in maintaining their quality of life and being instrumental in "birthing" them to external life." born on December 12, 1940 and died last April 8, 2021. staff nurse and become the head nurse at Philippine General Hospital. expert in Medical-Surgical Nursing with a subspecialty in Oncologic Nursing. notable courage and compassion in her efforts to restore the dignity and integrity of the PRC- Board of Nursing, for which she was awarded the 2018 Julita V. Sotejo Medallion of Honor. holistic care of patients, particularly those with advanced stage cancer. as facilitators of peaceful acceptance of the patient's condition. dissertation in October 1999. Patients with advanced progressive cancer have more complex needs. address the multi-dimensional problems of cancer patients Inclusion criteria: Conscious and alert Aware of diagnosis Able to participate Gave consent to be included in this study. Without difficulty in communicating. Did not have any of the following tubes(endotracheal, tracheostomy, and chest tubes). 6 Components of PREPARE ME Theory PRESENCE \- Being with another person during the times of need. \[therapeutic communication, active, listening, and touch.\] REMINISCE THERAPY \- Recall of past experiences, feelings and thoughts to facilitate adaptation to present circumstances. PRAYER -Connection to a spiritual being without regard to religion. RELAXATION-BREATHING \- Techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms \[pain, muscle tension and anxiety.\] MEDITATION \- Encourages an elicit form of relaxation for the purpose of altering the patient's level of awareness by focusing on an image or thought to facilitate inner sight which helps establish connection and relationship with God. \[ use of music and other relaxation techniques.\] VALUES CLARIFICATION -Assisting another individual to clarify his/her own values about health and illness in order to facilitate effective decision making skills. \| develops an open mind that will facilitate acceptance of disease state or may help deepen or enhance values. \|helps one become internally consistent by achieving closer between what we do and what we feel. LETTY KUAN ;"GRACEFUL AGING THEORY" is preparing the person to have fulfillment in their retirement years, and assisting them in their elderly years in leaving a legacy. Born on November 19, 1936 at Katipunan- Dipolog, Zamboanga del Norte. Her father, a native Chinese, was a businessman, and her mother served as a home economics teacher. to put back what they have missed during childhood and to fill this gap. \| address the psychological and emotional needs of the patient, \[related to their early life experiences.\] dependent on positive childhood acquisitions. quality of what you have acquired from the beginning. An acquisition that starts from the womb of the pregnant mother, the love and support of the father to his family reflects good acquisitions to the person. comprises how we acquired the manner of speaking, talking and attitudes.\| from education emphasized the importance of a good school for better education -develops perseverance and hard work in an individual and equips him or her when trials, crises or life struggles come in. \"If you have a very happy and nice childhood, you will have a very fruitful aging, happy retirement and ultimately Legacy". LEGACY -act of giving, sharing, emblem of honesty and feeling of fulfillment and motivation. ROLE OF DISCONTINUITY It is the interruption in the line of status enjoyed or role performed \[an accident, emergency, and change of position or retirement.\] COPING APPROACHES interventions or measures applied to solve a problematic situation or state in order to restore or maintain equilibrium and normal functioning. CHANGE OF LIFE between near retirement and post retirement years. In medico-physiologic terms, - period of adjustment and readjustment to another tempo of life. RETIREE Is an individual who has left the position occupied for the past years of productive life because he/she has reached the prescribed retirement age of has completed the required years of service. Determinants of Positive Perceptions in Retirement and Positive Reactions toward Role Discontinuities. HEALTH STATUS physiological and mental state of the respondents, classified as either sick or healthy INCOME financial affluence of the respondent \[poor, moderate or rich.\] WORK STATUS individual's employment status. FAMILY CONSTELLATION type of family composition described either close knit or extended family where three or more generations of family members live under one roof; or distanced family whose members live in separate dwelling units; or nuclear type of family where only husband, wife and children live together. SELF-PREPARATION Act of getting oneself ready for the possible outcomes of life. MYRA ESTRIN LEVINE;THE CONSERVATION MODEL (1920-1996) "Nursing is human interaction." born in Chicago in 1920. father's persistent gastrointestinal illness lost her first child, Benjamin, who only lived three days. In 1944, she earned a diploma in nursing from the Cook County School of Nursing, then obtain her Bachelor of Science in Nursing from the University of Chicago in 1949. She also received an honorary doctorate from Loyola University in 1992. private duty nurse in 1944, a civilian nurse in the U.S. Army in 1945, a preclinical instructor in the physical sciences her publication, INTRODUCTION TO CLINICAL NURSING, - first published in 1969, with additional editions printed in 1973 and 1989 \[ how redundancy characterizes the availability of adaptive responses when stability is threatened\] died on March 20, 1996, at the age of 75. focused in promoting adaptation and maintaining wholeness using the principles of conservation. guides the nurse to focus on the influences and responses at the organismic level. accomplishes the goals of the model through the conservation of energy, structure, and personal and social integrity. help the person with the process of "keeping together" the total person through the least amount of effort. applied to ET specialty practice nursing. COMPONENTS Adaptation Conservation Wholeness Adaptation method for conserving wholeness (health) and integrity, with the adaptive capability of the individual critical for retaining organismic integrity in the midst of constant changes within the internal and external environments. individuals \'fit\' the environments in which they live. responses will vary based on heredity, age, gender, or challenges of an illness experience. Characteristics 1\. HISTORICITY- based on past experiences, both personal and genetic 2\. SPECIFICITY-has very specific responses 3\. REDUNDANCY- another pathway may be able to take over and complete the job. 4.ORGANISMIC RESPONSE A change in behavior of an individual during an attempt to adapt to the environment \| Individual help to protect and maintain their integrity. There are four Levels of Integration: 1\. Response to fear (fight or flight) adrenocortical-sympathetic reactions - most primitive biologic responses, \[perceive that they are threatened whether or not a threat actually exists. \] Ex;Hospitalization, illnesses, unsafe external environmental conditions, and new experiences 2\. Inflammatory-immune response protects the organism from environmental irritants and pathogens, Immune response -PRIMARY MECHANISM OF HEALING; however, it drains energy reserves. Environmental control measures to minimize exposure to pathogens and irritants 3\. Response to stress Selye\'s (1956) model of the adaptive stress response, -predictable behavioral and biological responses (particularly adrenocortical hormones) 4\. Sensory response perceptual components of the external environment through biologic sensory stimuli. \|prompts individuals to maintain safety and seek wholeness. Conservation Latin word conservatio, -\"to keep together\". complex systems are able to continue to function even when severely challenged. able to confront challenges, adapt accordingly, and maintain their uniqueness. GOAL OF NURSING CARE -conservation of the wholeness of the person. Wholeness \'OPEN AND FLUID\' SYSTEM, and a condition of health, wholeness, exists when the interaction or constant adaptations to the environment, permit ease the assurance of integrity. (1989) proposed the four conservation principles \"the unity and integrity of the individual.\" Conservation of [energy ] producing input (food, oxygen, fluids) to allow energy utilization output. balancing energy input and output to avoid excessive fatigue. to stay healthy and energetic during recovery. Ex; Availability of adequate rest and exercise Conservation of [structural integrity] maintaining or restoring the body's structure, preventing physical breakdown, and promoting healing. Ex; Assist in ROM (Range of motion) exercise. Preservation of personal hygiene make sure they are clean and healing well from the surgery. Conservation of [personal] integrity valuing of self-identity, self-worth, and self-respect, reflecting the understanding that \"the body does not exist separately from the mind, emotions, and soul\". patient education, promoting participation in decision-making and informed consent for treatments; protection of patient privacy and personal possessions; Support of cultural and religious practices. Ex: Acknowledge and preserve space needs or privacy. Assisting as needed only. Respecting patient autonomy Conservation of [social] integrity recognized as someone who resides with in a family, a community, a religious group, an ethnic group, a political system and a nation. The nurse-patient interaction \"can see his integrity mirrored in that of the nurse.\" reflects the family and the community in which the client functions. they feel supported and not lonely. Example: Help preserve his or her place in a family, community, and society. Religious support Illness separates patients from society promotes conservation of wholeness and integrity by actively supporting the patients' adaptive efforts to achieve the best possible environmental fit. Rosemarie Rizzo Parse ;Human Becoming \"Nursing is a science, and the performing art of nursing is practiced in relationships with persons (individuals, groups, and communities) in their processes of becoming.\" Born on July 28, 1938 Graduated at Duquesne University, Pittsburg. published her first theory in 1981. guides nurses in their practice to focus on quality of life as it is described and lived (Karen & Melnechenko, 1995). presents an alternative to both the conventional biomedical approach and bio-psycho-social-spiritual approach quality of life from each person's own perspective as the goal of nursing practice. "MAN-LIVING-HEALTH" THEORY to"THE HUMAN BECOMING THEORY" in 1992 developed as a human science nursing synthesized from works by the European philosophers, Heidegger, Sartre, and Merleau-Ponty, Martha Rogers. three abiding themes: 1\. meaning, 2\. rhythmicity, 3\. transcendence. ABOUT MAN human is coexisting while co-constituting rhythmic patterns with the universe. is open, freely choosing meaning in a situation, bearing responsibility for decisions. unitary, continuously co-constituting patterns of relating. transcending multi-dimensionally with the possible. ABOUT BECOMING unitary human-living-health. rhythmically co constituting human-universe process. patterns of relating value priorities. process of transcending with the possibles. unitary human's emerging. focuses on the human universe-health process. \|to be present with people. principles ;describes the central phenomenon of nursing (human universe). (Smith & Parker, 2015) Principle 1: Meaning (Structuring meaning) persons structure, or choose, the meaning of their realities, and this choosing happens with explicit-tacit knowing. [ imaging and valuing of languaging.] persons give and take with others in speaking, moving, silence, and stillness. the significance of something and is chosen by people. 3 Concepts Imaging view of reality. \|shaping of personal knowledge in explicit and tacit ways. personal interpretation of meaning, possibility, and consequence. Valuing confirm and do not confirm beliefs in light of a personal perspective or worldview. Language a concept that is visible and relates to how humans symbolize and express their imaged realities and their value priorities. Principle 2: Rhythmicity (Configuring rhythmical patterns) [revealing-concealing and enabling-limiting of connecting-separating.] human beings create patterns in day-to-day life, and these patterns tell about personal meanings and values. patterns and possibility. 3 Concepts Revealing-concealing way persons disclose and keep hidden the persons \[ visible-invisible -the emerging now\] Enabling-limiting related to the potentials and opportunities that surface with the restrictions and obstacles of everyday living. choosing from the possibilities and living with the consequences of those choices. Connecting-separating to the ways persons create patterns of connecting and separating with people and projects. communion--aloneness and the ways people separate from some to join with others. Principle 3: Transcendence (Cotranscending With Possibles) powering and originating of transforming persons continuously change and unfold in life as they engage with and choose from infinite possibilities about how to be, what attitude or approach to have, whom to relate with, and what interests or concerns to explore. Transcendence CHANGE AND POSSIBILITY, the infinite possibility that is human becoming. 3 Concepts: Powering STRUGGLE AND LIFE and the will to go on despite hardship and threat. Originating strive to be like others, yet they also strive to be unique. Transforming is about the continuously changing and shifting views that people have about their lives as they live find ways to change in the direction of their cherished hopes and dreams. Patricia Benner; \"Novice to Expert\" theory \"The nurse-patient relationship is not a uniform, professionalized blueprint but rather a Kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life." August 31, 1942--present Birthplace: Hampton, Virginia nursing skill acquisition and clinical competence. clinical experience, ;acute medical-surgical, critical care, and home health care. 1984- published -dissertation "From Novice to Expert: Excellence and Power in Clinical Nursing Practice". five stages of clinical competence in nursing practice. importance of experiential learning and the acquisition of practical knowledge through real-world clinical situations. influenced by Virginia Henderson. The demand for this program has increased - (COVID-19) virus pandemic. guided by the moral art and ethics of care and responsibility.  combination of a strong educational foundation and personal experiences. could gain knowledge and skills without actually learning a theory. a nurse "knowing how" without "knowing that". development of knowledge in fields- research and understanding through clinical experience. adapted DREYFUS MODEL OF SKILL ACQUISITION -was applied situationally 5 levels of skill acquisition and development. Novice \| Advanced Beginner \|Competent Proficient \| Expert NOVICE no background experience difficulty discerning between relevant and irrelevant aspects of a situation. students of nursing. Context-free rules and objective attributes must be given to guide performance. NOTE! could also be classified at the novice level if they are placed in an area or situation completely foreign to them. Advanced Beginner demonstrate marginally acceptable performance, having coped with enough real situations to note, or to have pointed out by a mentor, the recurring meaningful components of the situation. guided by rules and are oriented by task completion. Characteristics: has enough experience to grasp aspects of the situation Clinical situations - a test of their abilities and the demands of the situation placed on them rather than in terms of patient needs and responses. Competent most pivotal in clinical learning recognize patterns and determine which elements of the situation warrant attention and which can be ignored level of efficiency is increased, but "the focus is on time management and the nurse's organization of the task world rather than on timing in relation to the patient's needs" allows the situation to guide responses. ACTIVE TEACHING AND LEARNING devises new rules and reasoning procedures for a plan, while applying learned rules for action on the basis of relevant facts of that situation. Through learning from actual practice situations and by following the actions of others Consistency, predictability, and time management A sense of mastery is acquired through planning and predictability. Proficient perceives the situation as a whole (total picture) rather than in terms of aspects, and the performance is guided by maxims. recognizes the most salient aspects and has an intuitive grasp of the situation based on background understanding. ability to see changing relevance in a situation recognition and implementation of skilled responses to the situation involve No longer rely on preset goals for organization and abilities more involvement with the patients and family Expert no longer relies on analytical principle (i.e., rule, guideline, maxim) to connect an understanding of the situation to an appropriate action have an intuitive grasp of the situation and are able to identify the region of the problem without losing time considering a range of alternative diagnoses and solutions. Knowing typical responses and knowing the patients as a person. has the ability to recognize patterns on the basis of deep experiential background. Meeting the patient's actual concerns and needs is of utmost importance, even if it means planning and negotiating for a change in the plan of care. clinical grasp and resource-based practice Possessing embodied know-how Seeing the big picture Seeing the unexpected Martha E. Rogers ;(Science of Unitary Human Being) "professional practice in nursing seeks to promote symphonic interaction between man and environment, to strengthen the coherence and integrity of the human field, and to direct and redirect patterning of the human and environmental fields for realization of maximum health potential" ---(Rogers, 1970, p. 122). Born: May 12, 1914, Dallas, Texas, USA Died: March 13 , 1994 Major concepts 1. pattern, 2.energy field, 3.pan dimensionality, 4.openness Major principles (homeo-dynamic principles.) 1.resonancy, 2\. helicy 3\. integrity. Assumption of Science unitary human beings Wholeness- united whole Openness-continuously exchanging energy with each other Unidirectionality \- The life process of human being Pattern and organization \- identifies individuals and reflects their innovative wholeness Sentence and thought \- Humans are the only organisms able to think, imagine, have language and emotions MAJOR CONCEPTS Pattern identifies individuals and reflects their wholeness. distinguishing characteristic of an energy field that is perceived as a single wave. "an abstraction" that gives identity to the field" Patterning = "is the dynamic or active process of the life of the human being" (Alligood & Fawcett, 2004, p.11). Energy Field "potential for process, movement, and change" conceptual boundary of all that is, the living and the nonliving. "provides a way to perceive people and their environment as irreducible wholes" Pandimensionality "a nonlinear domain without spatial or temporal attributes" The universe encompasses infinite dimensions, providing an understanding of nonlocality, acausality, and unpredictability Openness The human field and the environmental field are constantly in mutual process. There are no boundaries or barriers to inhibit energy flow between fields "The human being openly participates in energy transformation with the environment creating mutual change" Homeodynamic Principles balance between the dynamic life process and environment. help to view human as unitary human being. Three principle of homeodynamics 1. Resonancy \- Wave patterns are continuously changing in environmental and human energy fields. 2. Helicy \- The nature of change is unpredictable, continuous, and an innovative. 3\. Integrality - Energy fields of humans and environment are in a continuous mutual process. BETTY NEUMAN; SYSTEMS MODEL (1924 - 2022) systems model that views patient "WHOLISTICALLY". born in near Lowell, Ohio. she took care of her father, -created her compassion for her chosen career path. During World War II, - aircraft instrument technician. In 1947, - RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio. Neuman System Model was developed in 1970 - introductory course nursing involvement in mental health. She and Donna Aquilina were the first two nurses to develop the nurse counselor role within community crisis centers in Los Angeles. Application to Nursing Education and Practice --- first edition in 1982: (NEUMAN 1989, 1995, 2002, 2011) "a unique, open-system-based perspective that provides a unifying focus for approaching a wide range of concerns. A system acts as a boundary for a single client, a group, or even several groups; it can also be defined as a social issue. A client system in interaction with the environment delineates the domain of nursing concerns." It focuses on the response of the patient system to actual or potential environmental stressors and the maintenance of the client system\'s stability through primary, secondary, and tertiary nursing prevention intervention to reduce stressors. A system acts as a boundary for a single client, a group, or even a number of groups; it can also be defined as a social issue. Open System: continuous flow of input and process, output and feedback It is a system of organized complexity, where all elements are in interaction. Wholistic Approach: Clients are viewed as wholes whose parts are in dynamic interaction. \| variables simultaneously affecting the client system: PHYSIOLOGICAL, PSYCHOLOGICAL, SOCIOCULTURAL, DEVELOPMENTAL, AND SPIRITUAL Basic Structure: composed of a central core surrounded by concentric rings. The INNER CIRCLE of the diagram -the basic survival factors or energy resources of the client. \| "consists of basic survival factors common to human beings," such as innate or genetic features Example: O Normal temperature range, genetic structure, response pattern, organ strength or weakness, ego structure. O Baseline characteristics associated with each of the variables are also present **Stability, or homeostasis,** - occurs when the amount of energy that is available exceeds that being used by the system. A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance. Client System/Variables: composed of the five system variables interacting with the environment. **Physiologic** variables -body structure and function. **Psychological** variables -mental processes in interaction with the environment. **Sociocultural** variables - effects and influences of social and cultural conditions. **Developmental** variables are age-related processes and activities throughout life. **Spiritual** variables refers to spiritual beliefs and influences. Spiritual - influence of spiritual beliefs. Permeates all other variables Used first by mind then by body Flexible Line of Defense: A protective buffer and accordion-like mechanism that SURROUNDS AND PROTECTS the normal line of defense from invasion by stressors. \[ dynamic or can be altered.\] Normal Line of Defense: \" adaptational level of health developed over the course of time and serves as the STANDARD by which to measure wellness deviation de-termination\". \[ dynamic and can expand or contract over time.\] Lines of Resistance: \"Lines of resistance serve as protection factors that are activated by stressors penetrating the normal line of defense\" E.g. mobilization of WBC and activation of immune system mechanism surrounds the basic structure. Input and Output: The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time Stressors: Any phenomenon that might penetrate both the Flexible and Normal Line of defense, \[ positive or negative outcome.\] Stressors outcome: Intrapersonal stressors/forces within the individual and correlate with the internal environment. e.g. emotion, feeling, autoimmune response Interpersonal stressors/forces outside the client system though at a proximal range e.g. Role expectation Extrapersonal stressors/forces outside the client system at a distal range (greater distance from the system that are interpersonal stressors) e.g. social policy, job, financial pressure Environment: \" both internal and external forces surrounding the client, influencing and being influenced by the client, at any point in time\" **Internal** Exist within system; intrapersonal exclusively within the boundaries of the client system **External** Exist outside the system; interpersonal and extrapersonal Interactive influences outside the system boundaries Created Environment - intra, inter and extra personal Developed unconsciously by client and symbolic of system wholeness Depicts unconscious mobilization of all system variables particularly psychological and sociocultural variables Purpose is integrity and stability of system To promote positive stimulus towards health for the client **Created** - process based concept of perpetual adjustment that may increase or decrease the client\'s state of wellness Stability: A state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity. Degree of Reaction: amount of system instability resulting from stressor invasion of the normal line of defense. Entropy: energy depletion and disorganization moving the system toward illness or possible death. Negentropy: energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness. Reconstitution: The return and maintenance of system stability, following treatment of stressor reaction, \[ higher or lower level of wellness\] Wellness: condition in which all system parts and subparts are in harmony with the whole system of the client. Illness: state of insufficiency with disrupting needs unsatisfied (Neuman, 2002). Prevention as Intervention: Interventions are purposeful actions to help the client retain, attain, or maintain system stability. They can occur before or after protective lines of defense and resistance are penetrated. Primary Prevention Occurs before the system reacts to a stressor Strengthens the PERSON (PRIMARY THE FLEXIBLE LOD) Includes health promotion and maintenance of wellness - immunization, health education, exercise, and lifestyle changes. Secondary Prevention Occurs after the system reacts to a stressor. Strengthening the INTERNAL LINES OF RESISTANCE AND/OR REMOVING THE STRESSOR. treatment of symptoms following a reaction to stressors Tertiary Prevention Occurs after the system has been treated through secondary prevention strategies. Offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution. maintain wellness or protect the client system reconstitution