Theoretical Foundation of Nursing Midterms PDF Summer 2023

THEORETICAL FOUNDATION OF NURSING: provide a way to define nursing as a unique discipline that is MIDTERMS separate from other disciplines (e.g., medicine). Evolution of Nursing...

THEORETICAL FOUNDATION OF NURSING: provide a way to define nursing as a unique discipline that is MIDTERMS separate from other disciplines (e.g., medicine). Evolution of Nursing a framework of concepts and purposes intended to guide BSN1-L | Prof. Micah Aquino, RN | Summer 2023 | transes by nursing practice at a more concrete and specific level. Brillantes, Ira L. INTRODUCTION TO NURSING THEORY IMPORTANCE OF THEORIES IN NURSING widely believed that use of theory offers structure and THEORY organization to nursing knowledge and provides a systematic described as a systematic explanation of an event in which constructs and concepts are identified and relationships are means of collecting data to describe, explain, and predict proposed and predictions made (Streubert & Carpenter, 2011). nursing practice. make nursing practice more overtly purposeful by stating not defined as a “creative and rigorous structuring of ideas that project a tentative, purposeful and systematic view of only the focus of practice but also specific goals and outcomes. phenomena” (Chinn & Kramer, 2011, p. 257). define and clarify nursing and the purpose of nursing practice to called a set of interpretative assumptions, principles, or distinguish it from other caring professions by setting professional boundaries. propositions that help explain or guide action (Young, Taylor, & Renpenning, 2001). Finally, use of a theory in nursing leads to coordinated and less In their classic work, Dickoff and James (1968) state that theory fragmented care (Alligood, 2010; Chinn & Kramer, 2011; Ziegler, 2005). is invented, rather than found in or discovered from reality. Furthermore, theories vary according to the number of elements, the characteristics and complexity of the elements, HISTORY OF NURSING THEORIES and the kind of relationships between or among the elements. The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education. “A set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically YEAR THEORISTS THEORY selected and organized as an abstract representation of some 1860 Florence Defined nursing in her phenomenon. (McEwen & Wills, 2019) Nightingale “Environmental Theory” as “the act of utilizing the patient’s environment to assist him in his recovery.” INFORMATION A theory is not fully (100%) accepted for it still have a lot of gray area; 1950 There is a consensus among it serves as a guide. nursing scholars that nursing ‒ An example is the Big Bang Theory which talks about how the needed to validate itself through the universe started. production of its own scientifically tested body of knowledge l LAW – statements that are 100% true/accepted; higher than theory. 1952 Hildegard introduced her Theory of Peplau Interpersonal Relations that WHAT ARE NURSING THEORIES? emphasizes the nurse-client are organized bodies of knowledge to define what nursing is, what nurses do, and why they do it.  relationship as the foundation of 1970 Martha Rogers Viewed nursing as both a science nursing practice. and an art as it provides a way to 1955 Virginia Conceptualized the nurse’s role as view the unitary human being, who is Henderson assisting sick or healthy individuals to integral with the universe. gain independence in meeting 14 1971 a) Dorothea a) - Stated in her theory that nursing fundamental needs. Thus, her Orem care is required if the client is unable Nursing Need Theory was to fulfill biological, psychological, developed. developmental, or social needs. 1960 Faye Abdellah Published her work “Typology of 21 Nursing Problems,” which shifted b) Imogene King b) - Theory of Goal attainment the focus of nursing from a disease- stated that the nurse is considered centered approach to a patient- part of the patient’s environment and centered approach. the nurse-patient relationship is for 1962 Ida Jean - Emphasized the reciprocal meeting goals towards good health. Orlando relationship between patient and 1972 Betty Neuman - States that many needs exist, and nurse and viewed nursing’s each may disrupt client balance or professional function as finding out stability. and meeting the patient’s immediate - Stress reduction is the goal of the need for help. system model of nursing practice 1979 a) Sr. Callista a) - Viewed the individual as a set of - Ida Jean Orlanda is one of the Roy interrelated systems that maintain the foundations of nursing. She defined balance between these various the “nursing process” stimuli NOTE: b) Jean Watson b) - Developed the philosophy of NURSING PROCESS: caring ▪ Assessment - Highlighted humanistic aspects of ▪ Diagnose nursing as they intertwine with ▪ Planning scientific knowledge and nursing ▪ Interventions practice. ▪ Evaluate 1968 Dorothy Pioneered the Behavioral System STAGES IN THE DEVELOPMENT OF NURSING THEORY Johnson Model and upheld the fostering of STAGE SOURCE OF IMPACT ON efficient and effective behavioral KNOWLEDGE THEORY AND functioning in the patient to prevent RESEARCH illness 1) SILENT Blind obedience to Little attempt to Nursing research Knowledge medical authority develop theory. focused on the nurse Research was limited rather than on clients to collection of and clinical epidemiologic data situations. 2) RECEIVED Learning through Theories were 4) PROCEDURAL Includes both Proliferation of Knowledge listening to others borrowed from other Knowledge separate and approaches to theory disciplines. As connected development. nurses acquired non- knowledge Application of theory nursing doctoral in practice was degrees, they relied frequently on the authority of underemphasized. educators, Emphasis was sociologists, placed on the psychologists, procedures used to physiologists, and acquire knowledge, anthropologists to with focused provide answers to attention to the nursing problems. appropriateness of methodology, the Research was criteria for evolution, primarily educational and statistical research or procedures for data sociologic research analysis 3) SUBJECTIVE Authority was A negative attitude 5) CONSTRUCTED Combination of Recognition that Knowledge internalized to foster toward borrowed Knowledge different types of nursing theory a new sense of self theories and science knowledge should be based on emerged. (intuition, reason, prior empirical and self- studies, theoretical Nurse scholars knowledge) literature, client focused on defining reports of clinical nursing and on experiences and developing theories feelings, and the about and for nurse scholar’s nursing. intuition or related knowledge about the  phenomenon of o The terms originate from the Analytic methods of Aristotle's concern Organon 6) INTEGRATED Assimilation and Nursing theory will o RATIONALIST: Views that emphasize the importance of a priori Knowledge application of increasingly knowledge “evidence” from incorporate o EMPIRICIST: Views that emphasize the importance of a nursing and other information from posteriori knowledge health care published literature disciplines with enhanced EMPIRICISM VS. RATIONALISM emphasis on clinical EMPIRCISIM RATIONALISM application as In philosophy, it is a Is the epistemological situationspecific/ theory that states that view that reason is the practice theories and knowledge comes only or chief source of middle range primarily from sensory knowledge and the main theories. experience. determinant of what Emphasizes the role of constitutes knowledge HISTORY AND PHILOSOPY OF SCIENCE empirical evidence in the It can also refer to any EPISTEMOLOGY formation of ideas, rather view which appeals to Is the branch of philosophy concerned with knowledge than innate ideas or reason as a source of Epistemologists study the nature, origin, and scope of traditions. knowledge or knowledge, epistemic justification, the rationality of belief, and Was associated with the justification. various related issues. "blank slate" concept Rationalists claim that the Considered one of the four main branches of philosophy, along (tabula rasa)-- according mind, through the use of with ethics, logic, and metaphysics. to which the human mind reason, can directly grasp is "blank" at birth and certain truths in various PRIORI POSTERIORI develops its thoughts domains, including logic, Is knowledge that is Is known by experience only through experience. mathematics, ethics, and known independently of Empirical In the philosophy of metaphysics. experience Arrived through science emphasizes Non-empirical experience evidence, especially as Arrived at before discovered in experience usually by experiments. reason A fundamental part of the scientific method that all NOTE: hypotheses and theories o One of the most important distinctions in epistemology is must be tested against between what can be known a priori and posteriori observations of the natural world rather than  resting solely on a priori The ultimate goal of nursing theories is to improve reasoning, intuition, or patient care. revelation. Often used by natural THE FOUR FUNDAMENTAL WAYS OF KNOWING scientists, says that "knowledge is based on INFORMATION experience.” In healthcare, Carper's fundamental ways of knowing is a typology that attempts to classify the different sources from which STRUCTURE OF NURSING KNOWLEDGE knowledge and beliefs in professional practice can be or have been derived. It was proposed by Barbara A. Carper, a professor THE NURSING METAPARADIGM at the College of Nursing at Texas Woman's University, in 1978. 1. PERSON is the recipient of nursing care and may include individuals, patients, groups, families, and 1. PERSONAL Knowing communities. refers to the knowledge we have of ourselves and what Referred to as Client or Human Beings we have seen and experienced. comes to us through the process of observation, 2. ENVIRONMENT or Situation reflection, and self-actualization defined as the internal and external surroundings is through knowledge of ourselves that we are able to that affect the client establish authentic, therapeutic relationships as it includes all positive or negative conditions that propels us towards wholeness and integrity (Chinn & affect the patient, the physical environment, such Kramer, 2015). as families, friends, and significant others, and the setting for where they go for their healthcare. 2. EMPIRICAL Knowing We gain EMPIRICAL knowledge from research and 3. HEALTH objective facts. This knowledge is systematically is defined as the degree of wellness or well-being organized into general laws and theories that the client experiences. One of the ways we employ this knowledge is through may have different meanings for each patient, the the use of evidenced-based practice (EBP). clinical setting, and the health care provider. This way of knowing is often referred to as the “science” of nursing (Chinn & Kramer, 2015). 4. NURSING The nurse‘s attributes, characteristics, and 3. ETHICAL Knowing actions provide care on behalf of or in conjunction Helps one develop our own moral code; our sense of with the client. knowing what is right and wrong There are numerous definitions of nursing, though For nurses, our personal ethics is based on our nursing scholars may have difficulty agreeing on its obligation to protect and respect human life. exact definition  Our deliberate personal actions are guided by ethical Do not guide specific nursing interventions but rather knowing. The “Code of Ethics for Nurses” (American provide a general framework and nursing ideas. Nurses Association, 2015) can guide us as we develop Grand nursing theorists develop their works based on and refine our moral code. their own experiences and their time, explaining why there is so much variation among theories. 4. AESTHETIC Knowing Address the nursing metaparadigm components of The final way of knowing identified by Carper (1978) is person, nursing, health, and environment AESTHETIC Knowing. Aesthetic knowing makes nursing an “art.” 2. MIDDLE-RANGE Nursing Theories It takes all of the other ways of knowing and through it More limited in scope (compared to grand theories) and creates new understanding of a phenomenon present concepts and propositions at a lower level of Is that “aha” moment that we have when we uncovered abstraction. They address a specific phenomenon in something new; and just as an artist creates a painting, nursing. you are afforded the opportunity of new perspective. Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory ADD: EMANCIPATORY Knowing Most middle-range theories are based on a grand Most recently devised pattern theorist’s works, but they can be conceived from According Jackson (2009), emancipatory knowing is a research, nursing practice, or the theories of other combination of both a traditional social idea and a disciplines developing dimension of nursing knowledge (Chinn & Kramer, 2008) 3. PRACTICE-LEVEL Nursing Theories Elevate nurse leaders to the next step, and have actively Are situation-specific theories that are narrow in scope changed the work place environment, and have and focuses on a specific patient population at a specific positively impacted outcomes for both patients and time. nurses. Provide frameworks for nursing interventions and Contrary to other patterns, introducing and suggest outcomes or the effect of nursing practice. implementing the emancipatory way of thinking/knowing Theories developed at this level have a more direct may require months or perhaps years. effect on nursing practice than more abstract theories Is significantly important because it provide These theories are interrelated with concepts from organizational level playing field for nurse leaders with a middle-range theories or grand theories. vision of the future in health care systems. BASED ON PURPOSE (Dickoff and James, 1968) CLASSIFICATION OF NURSING THEORIES 1. DESCRIPTIVE (FACTOR-ISOLATING) Theories BASED ON SCOPE Are those that describe, observe, and name concepts, 1. GRAND Nursing Theories properties, and dimensions Are abstract, broad in scope, and complex, therefore requiring further research for clarification  Identifies and describes the major concepts of phenomena but does not explain how or why the concepts are related. The purpose of descriptive theory is to provide observation and meaning regarding the phenomena. It is generated and tested by descriptive research techniques including concept analysis, case studies, literature review phenomenology, ethnography, and grounded theory (Young et al., 2001) 2. EXPLANATORY (FACTOR-RELATING) Theories are those that relate concepts to one another, describe the interrelationships among concepts or propositions, and specify the associations or relationships among some concepts They attempt to tell how or why the concepts are related and may deal with cause and effect and correlations or rules that regulate interactions. They are developed by correlational research and increasingly through comprehensive literature review and synthesis. 3. PREDICTIVE (SITUATION-RELATING) Theories are achieved when the conditions under which concepts are related are stated and the relational statements are able to describe future outcomes consistently. move to prediction of precise relationships between concepts. Experimental research is used to generate and test them in most cases. 4. PRESPCRPTIVE (SITUATION-PRODUCING) Theories are those that prescribe activities necessary to reach defined goals. address nursing therapeutics and consequences of interventions. include propositions that call for change and predict consequences.  NURSING THEORISTS AND THEIR WORKS INFORMATION NUFSING PHILOSOPHIES Florence identified 5 environmental factors: ▫ fresh air ▫ pure water ▫ efficient drainage ▫ cleanliness/sanitation ▫ light/direct sunlight x Deficiencies in these 5 factors produce illness or lack of health. But with a nurturing environment, the body could repair itself; considered a clean, well-ventilated, quiet environment is essential for recovery. Seven assumptions made in the Environment Theory: ✓ natural laws FLORENCE NIGHTINGALE ✓ mankind can achieve perfection Was born on 1820 in Florence, Italy. ✓ nursing is a calling Considered the founder of modern ✓ nursing is an art and a science (educated and scientific) nursing. ✓ nursing is achieved through environmental alteration Mother of the modern nursing ✓ nursing requires a specific educational base Known as “the lady with the lamp”; ✓ nursing is distinct and separate from medicine coined to her because during the night during the Crimean War, 10 MAJOR CONCEPTS OR NIGHTINGALE’S CANONS where all the other staff are 1. Ventilation and warming resting, she would perform 2. Light and noise rounds, with a lamp on her hand, and made sure that the 3. Cleanliness of the area wounded soldiers are well-tended and comfortable. 4. Health of houses Wrote the first nursing notes that became the basis of nursing 5. Bed and bedding practice and research. She wrote it in her book entitled 6. Personal cleanliness Notes on Nursing: What It Is, What Is Not (1859) 7. Variety Considered the first nursing theorist. 8. Offering hope and advice 9. Food ENVIRONMENTAL THEORY 10. Observation Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.” JEAN WATSON Focuses on changing and manipulating the environment in THE THEORY OF HUMAN CARING order to put the patient in the best possible conditions for nature to act (patient-centered/patient care theory).  The Philosophy and Science of Caring has a. The assessment includes observation, identification, and four major concepts: human being, review of the problem, as well as the formation of a health, environment/society, and hypothesis. nursing. b. Creating a care plan helps the nurse determine how holistic approach to health care variables would be examined or measured, and what data would be collected. INFORMATION c. Intervention is the implementation of the care plan and data Watson refers to the human being as "a valued person in and collection. of him or herself to be cared for, respected, nurtured, d. Finally, the evaluation analyzes the data, interprets the understood and assisted; in general, a philosophical view of a person as a fully functional integrated self. Human is viewed as results, and may lead to an additional hypothesis (if your goal greater than and different from the sum of his or her parts." will be met or unmet). l Caring is central to nursing practice, and promotes health Seven Assumptions: better than a simple medical cure. ✓ Caring can be effectively demonstrated and practiced only interpersonally. 1. Health is defined as a high level of overall physical, mental, and ✓ Caring consists of carative factors that result in the social functioning; a general adaptive-maintenance level of daily satisfaction of certain human needs. functioning; and the absence of illness, or the presence of efforts ✓ Effective caring promotes health and individual or family leading to the absence of illness. growth. 2. Watson's definition of environment/society addresses the idea ✓ Caring responses accept the patient as he or she is now, as that nurses have existed in every society, and that a caring well as what he or she may become. attitude is transmitted from generation to generation by the ✓ A caring environment is one that offers the development of culture of the nursing profession as a unique way of coping with potential while allowing the patient to choose the best action its environment. for him or herself at a given point in time. 3. The nursing model states that nursing is concerned with ✓ A science of caring is complementary to the science of promoting health, preventing illness, caring for the sick, and curing. restoring health. It focuses on health promotion, as well as the ✓ The practice of caring is central to nursing. treatment of diseases. Watson believed that holistic health care WATSON’S 10 CARATIVE FACTORS is central to the practice of caring in nursing. She defines nursing as "a human science of persons and human health-illness 1. Forming humanistic-altruistic value systems experiences that are mediated by professional, personal, ‒ Begins at an early age; the values shared by parents or scientific, esthetic and ethical human transactions." desire to help other people 4. The nursing process outlined in the model contains the same 2. Instilling faith-hope steps as the scientific research process: assessment, plan, ‒ Essential to the carative and curative process intervention, and evaluation.  SUPPLEMENTS ‒ Helps the nurse to reconcile and mediate the incongruity of When modern science has nothing more to offer to a viewing the patient holistically while at the same attending patient, a nurse can continue to use faith and hope to to the hierarchy of needs. This helps the nurse assist the provide the sense of well-being through a belief system patient to find strength and courage to confront life or death. meaningful to the individual. PATRICIA BENNER 3. Cultivating a sensitivity to self and others STAGES OF NURSING EXPERTISE ‒ The development of nurse’s own feelings is needed to Benner’s model is one of the most useful interact and sensitively with patient to promotes health and frameworks for assessing nurses’ needs at higher-level functioning in their interaction different stages of professional growth and 4. Developing a helping-trust relationship has changed the perception of what it ‒ Includes congruence, empathy, and warmth. means to be an expert nurse. It explains how nurses develop skills in SUPPLEMENTS understanding patient care overtime from the combination of The strongest tool a nurse have is his/her mode of strong educational foundation and personal experiences. communication (verbal and non-verbal) which establishes The theory identifies FIVE LEVELS of nursing experience: rapport to the patient as well as caring by the nurse; it also LEVEL DESCRIPTION involves listening that connotes empathetic understanding. Novice is a beginner; no experience Advanced has gained prior experience that helps nurses 5. Promoting an expression of feelings beginner recognize requiring meaningful components so ‒ Awareness of feelings allows the patient and the nurse that principles begin to formulate in order to guide understand the behavior it causes. actions. 6. Using problem-solving for decision-making Competent 2-3 years’ experience; these nurses are more ‒ Systematic use of this allows for control, prediction, and aware of long-term goals and they gain permits self-correction. perspective from planning their own actions which helps them achieve greater efficiency and 7. Promoting teaching-learning organization in work. ‒ Understanding a person’s perception of the situation assist Proficient perceive and understand whole situation; have a the nurse to prepare a cognitive plan. more holistic understanding of nursing which 8. Promoting a supportive environment improves decision making. ‒ The nurse must provide comfort, privacy, and safety. Expert has deeper background of experience; these 9. Assisting with the gratification of human needs. nurses no longer rely on rules to guide their ‒ All needs deserve to be valued and attended by the nurse actions under certain situations. They have an and the patient (similar to Maslow’s Hierarchy Needs). intuitive grasp of the situation. 10. Allowing for existential-phenomenological forces  These different levels of skills show changes in the three SUPPLEMENTS aspects of skilled performance: The starting point for all practical nursing activities is a 1. Movement from relying on abstract principles to using past conceptual model. Each conceptual model of nursing is a experiences to guide actions distinctive frame of reference—called “a horizon of expectations” (Popper, 1965). 2. Change in the learner’s perception of situations as whole Function: provides a different way of thinking about the nursing parts rather than separate pieces metaparadigm concepts—human beings, environment, health, 3. Passage from a detached observer to an involved performer, and nursing—and a different way to guide practical activities, engaged in the situation rather than simply outside of it. such as nursing practice, nursing QI projects, and nursing research. KATIE ERIKSSON Why is it needed: it guides advancement of the knowledge CARITATIVE CARING THEORY needed to care for those who seek nursing services, and all practical nursing activities. K. Eriksson is a Finland-Swedish nurse. This model distinguishes between caring ethics, the practical relationship between the patient and the nurse, and nursing ethics. INFORMATIONx  Nursing ethics are the ethical principles that guide a nurse’s decision-making abilities. Caritative caring consists of love and charity, which is also known as caritas, and respect and reverence for human holiness and dignity. According to the theory, suffering occurs as a result of a lack of caritative care is a violation of human dignity. CONCEPTUAL MODELS MARTHA ROGERS An abstract and general representation for phenomena (things SCIENCE OF UNITARY BEING or circumstances) that are interest to the members of the According to Rogers’s model, patients discipline. have the capacity to participate knowingly Addresses things within the context of concepts of in the process of change. The environment metaparadigm of nursing, human beings, environment, health & is also irreducible, and coexists with unitary nursing (Fawsett & De Santo-Madeya, 2013) human beings. Defined as a set of relatively abstract and general concepts and humans are viewed as integral with the propositions about those concepts that address the concepts of universe (the patient and his/her the nursing metaparadigm. environment are one). health as an expression of the life process.  BASIC CHARACTERISTICS THAT DESCRIBE THE LIFE developed as a result of working toward her goal of improving PROCESS OF THE PATIENTS the quality of nursing in general hospitals in her state. o Energy field - is the fundamental unit of all, both the living and The model interrelates concepts in such a way as to create a unliving; provides a way to view the patient and his or her different way of looking at a particular phenomenon. The theory environment as wholes, and it continuously changes in is relatively simple, but generalizable to apply to a wide variety intensity, density, and extent. of patients. It can be used by nurses to guide and improve o Openness - refers to the fact that the human and environmental practice, but it must be consistent with other validated theories, fields are constantly exchanging their energies; there are no laws and principles. boundaries that block the flow of energy between fields. o Pattern - is the distinguishing characteristic of an energy field SELF-CARE REQUISUITES that is seen as a single wave; an abstraction that simply serves UNIVERSAL SELF- DEVELOPMENTAL HEALTH DEVIATION CARE SELF-CARE REQUISITES to give identity to the field. REQUISITES REQUISITES needs that all people two sub-categories: needs that come up have; based on the patient’s PAN DIMENSIONALITY: is a domain that has no spatial or 1. Maturational - which condition. temporal attributes. air, water, food, progress the patient to activity and rest, and a higher level of maturation. hazard prevention The nursing theory states that nursing encompasses two 2. Situational - which dimensions: nursing as art and nursing as science. prevent against 1. Science-Nursing is an organized body of knowledge harmful effects in development. specific to nursing, and arrived at by scientific research and logical analysis. 2. Art of Nursing -the creative use of science to better people, If a patient is unable to meet their self-care requisites, a “self- and the creative use of its knowledge is the art of its practice. care deficit” occurs. In this case, the patient’s nurse steps in Nursing exists to serve people, and the safe practice of nursing with a support modality which can be total compensation, depends on the nature and amount of scientific nursing partial compensation, or education and support. knowledge the nurse brings to his or her practice. Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system. DOROTHEA OREM SELF-CARE DEFICIT NURSING THEORY It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts that can be applied to all instances of nursing.  1. The Theory of Self-Care includes: e.g. nurse assisting a post-operative client to Self-care is the practice of activities that an individual initiate ambulate; nurse bringing a meal tray to client who and performs on his or her own behalf to maintain life, health, can feed himself. and well-being; ▫ Supportive-educative system where the nurse’s help Self-care agency is a human ability that is “the ability for the client develop or learn their own self-care abilities engaging in self-care,” conditioned by age, developmental through knowledge, support, and encouragement. state, life experience, socio-cultural orientation, health, and e.g. nurse guides a mother how to breastfeed a baby; available resources; giving health teaching or education; counseling a Therapeutic self-care demand is the total self-care actions to psychiatric client on more adaptive coping be performed over a specific duration to meet self-care strategies/mechanisms requisites by using valid methods and related sets of operations and actions; and ‒ The major assumptions of Orem’s Self-Care Deficit Theory Self-care requisites include the categories of universal, are: developmental, and health deviation self-care requisites. ✓ People should be self-reliant, and responsible for their care, as well as others in their family who need care. 2. The theory of self-care deficit which specifies when nursing ✓ People are distinct individuals. is needed. The theory identifies five methods of helping: ✓ Nursing is a form of action. It is an interaction between two ▫ acting for and doing for others or more people. ▫ guiding others ✓ Successfully meeting universal and development self-care ▫ supporting another requisites is an important component of primary care ▫ providing an environment promoting personal prevention and ill health. development in relation to meet future demands ✓ A person’s knowledge of potential health problems is needed ▫ teaching another for ✓ promoting self-care behaviors. SUPPLEMENTS ✓ Self-care and dependent care are behaviors learned within a According to Orem, nursing is required when an adult is socio incapable or limited in the provision of continuous, effective self-care. IMOGENE KING 3. The Theory of Nursing System describes how the patient’s THEORY OF GOAL ATTAINMENT self-care needs will be met by the nurse, the patient, or by The basic concept of the theory is that both. Orem identified three classifications of nursing system the nurse and patient communicate to meet the self-care requisites of the patient: information, set goals together, and then ▫ Wholly compensatory system where the nurse provides entire self-care for the patient; those who are unable to do take actions to achieve those goals. things for themselves. It describes an interpersonal relationship e.g. A newborn; a patient recovering from surgery in a that allows a person to grow and develop post anesthesia caring unit in order to attain certain life goals. ▫ Partly compensatory system where nurse and patient The factors that affect the attainment perform care; client can perform selective healthcare of goals are roles, stress, space, and time. activities but also accepts care from the nurse the he/she can’t do independently.  The patient is a social being who has three fundamental According to King, nursing’s focus is on the care of the patient, needs: and its goal is the health care of patients and groups of patients. 1. the need for health information According to King, the goal of the nurse is to help patients maintain 2. the need for care that seeks to prevent illness health so they can function in their individual roles. 3. the need for care when the patient is unable to help him or herself. INFORMATION ‒ She explains health as involving life experiences of the patient, i In the healthcare field, the ultimate goal in the nurse-patient which includes adjusting to stressors in the internal and external relationship is to help the patient achieve his or her goals and that a nurse is considered part of the patient’s environment. for getting healthy. SUPPLEMENTS ‒ The nurse’s function is to interpret information in the nursing The environment is the background for human interaction. It process, to plan, implement, and evaluate nursing care. involves: ✓ The internal environment, which transforms energy to enable people to adjust to external environmental changes. ✓ The external environment, which is formal and informal organizations. 1. Assessment occurs during interaction. The nurse brings special knowledge and skills whereas the patient brings knowledge of him or herself, as well as the perception of problems of concern to the interaction; the nurse collects data regarding the patient including his or her growth and development, the perception of self, and current health status. SUPPLEMENTS Perception is the base for the collection and Defines nursing as “process of action, reaction and interaction interpretation of data. by which nurse and patient share information about their perception in nursing situation.”  Communication is required to verify the accuracy of ‒ Nurse’s role: keep the system’s stability by using three levels the perception, as well as for interaction and of prevention. translation. 2. Nursing diagnosis is developed using the data collected in the assessment. In the process of attaining goals, the nurse identifies problems, concerns, and disturbances about which the patient is seeking help. 3. After the diagnosis, the nurse and other health care team members create a care plan of interventions to solve the problems identified. The planning is represented by setting goals and making decisions about the means to achieve those goals. This part of transaction and the patient’s participation is encouraged in making decisions on the means to achieve the goals. 4. The implementation phase is the actual activities done to achieve the goals; it is the continuation of transaction. 5. Evaluation involves determining whether or not goals were THREE LEVELS OF PREVENTION achieved; it addresses meeting goals and the effectiveness 1. Primary Prevention of nursing care. - protects the normal line and strengthens the flexible line of defense. BETTY NEUMAN - occurs before the patient reacts to a stressor SYSTEM MODEL - It includes health promotion and maintaining wellness. It is based on the patient’s relationship to stress, reaction to it, and reconstitution 2. Secondary Prevention factors that are dynamic. - used to strengthen the internal lines of resistance, which It is universal in nature, which allows it to reduces the reaction and increases resistance factors. be adapted to a variety of situations, and - occurs after the patient reacts to a stressor and is provided to be interpreted in many different ways. in terms of the existing system The central philosophy of Neuman’s nursing theory consists of energy resources that are surrounded by three 3. Tertiary Prevention things: - readapts, stabilizes, and protects the patient’s return to 1. Several lines of resistance - the internal factors helping the wellness after treatment. patient fight against a stressor - occurs after the patient has been treated through secondary 2. Normal line of defense - the patient’s equilibrium prevention strategies. 3. Flexible line of defense - the dynamic nature that can MAJOR CONCEPT OF NEUMAN’S THEORY rapidly change over a short time.  o Content which is the variables of the person in interaction with Neuman explains environment as the totality of the internal and the environment external forces which surround a person, and with which they o Basic structure or central core interact at any given time. These forces include the o Degree to reaction intrapersonal, interpersonal, and extra-personal stressors, o Entropy, which is a process of energy depletion and which can affect the person’s normal line of defense and so can disorganization moving the client toward illness affect the stability of the system. o Levels of defense (flexible line of defense; normal line of The environment has three components: defense; line of resistance) o the internal - exists within the client system; o Input-output o the external - exists outside the client system; and o Negentropy which is a process of energy conservation that o the created - an environment that is created and developed increases organization and complexity, moving the system unconsciously by the client, and is symbolic of system toward stability or a higher degree of wellness wholeness. o Open system o Prevention as intervention INFORMATION o Reconstitution The Systems Model of health is equated with wellness, and defined o Stability as “the condition in which all parts and subparts, or variables, are in o Stressors harmony with the whole of the client.” o Wellness/illness o Prevention The client system moves toward illness and death when more energy is needed than what’s available. NOTE: 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 The client system moves toward wellness when more energy is layer consists of a five-person variable or subsystem. available than is needed. FIVE-PERSON VARIABLE/SUBSYSTEM 1. Physiological the physiochemical structure and function SR. CALLISTA ROY of the body ADAPTATION MODEL Developed in 1976; the Adaptation Model of 2. Psychological mental processes and emotions Nursing asks three central questions: Who is the focus of nursing care? What is 3. Socio-cultural relationships, and social/cultural the target of nursing care? and When is expectations and activities nursing care indicated? This model looks at the patient from a 4. Spiritual the influence of spiritual beliefs holistic perspective. The three concepts of her model are the human being, 5. Developmental processes related to development over adaptation, and nursing. the lifespan  Under the concept of adaptation are four modes: TEN EXPELICIT ASSUMPTION physiological, self-concept, role function, and : interdependence.d ✓ The person is a bio-psycho-social being. ✓ The person is in constant interaction with a changing environment. ✓ To cope with a changing world, a person uses coping mechanisms, both innate and acquired, which are biological, psychological, and social in origin. ✓ Health and illness are inevitable dimensions of a person’s life. ✓ In order to respond positively to environmental changes, a person must adapt. ✓ A person’s adaptation is a function of the stimulus he is exposed to and his adaptation level. ✓ The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response. ✓ The person has four modes of adaptation: physiologic needs, self-concept, role function, and interdependence. ✓ Nursing accepts the humanistic approach of valuing others’ opinions and perspectives. Interpersonal relations are an integral part of nursing. ✓ There is a dynamic objective for existence with the 1. Physiological mode deals with the maintenance of the ultimate goal of achieving dignity and integrity. physical body; includes basic human needs (air, water, food, and temperature regulation). DOROTHY JHONSON 2. Mode of self-concept function to deal with the need for the BEHAVIORAL SYSTEM MODEL maintenance of the mind; it includes the person’s perceptions Johnson’s theory of nursing defines of his or her physical and personal self. nursing as “an external regulatory force 3. Role function mode emphasizes social integrity; it which acts to preserve the organization addresses people’s adaptations to different role changes that and integration of the patient’s occur throughout a lifetime. behaviors at an optimum level under 4. Interdependence mode also addresses social integrity. It those conditions in which the behavior deals with the balance between independence and constitutes a threat to the physical or interdependence in a person’s relationships with other social health, or in which illness is found.” people.  The goals of nursing are fourfold, according to the ✓ The individual patient’s behavior produces an outcome that Behavior System Model: can be observed. 1. To assist the patient whose behavior is proportional to social Johnson explains four major concepts in her nursing model. demands. 1. The human being has two major systems: the biological and 2. To assist the patient who is able to modify his behavior in behavioral systems. The role of medicine is to focus on the ways that it supports biological imperatives. biological system, while nursing’s focus is on the behavioral 3. To assist the patient who is able to benefit to the fullest system. extent during illness from the physician’s knowledge and 2. Society relates to the environment in which the patient skill. exists; a patient’s behavior is directly influenced by the 4. To assist the patient whose behavior does not give evidence environment and events that occur in the environment. of unnecessary trauma as a consequence of illness. 3. Health is a purposeful adaptive response to internal and There are four assumptions about system in the model: external stimuli in order to maintain stability and control. The ✓ There is “organization, interaction, interdependency and responses include physical, mental, emotional, and social integration of the parts and elements of behaviors that go to realms. make up the system.” 4. The primary goal of nursing is to foster equilibrium in the ✓ A system “tends to achieve a balance among the various individual patient. One focus of nursing concerns the forces operating within and upon it, and that man strive organized and integrated whole, but the major focus is on continually to maintain a behavioral system balance and maintaining balance in the behavioral system during an steady state by more or less automatic adjustments and illness in the biological system. adaptations to the natural forces occurring on him.” ✓ A behavioral system, which requires and results in some BEHAVIORAL SYSTEM MODEL’S 7 IDENTIFIED SYSTEMS degree of regularity and constancy in behavior, is essential 1. Attachment or Affiliative Subsystem - social inclusion to man. It is functionally significant because it serves a intimacy and the formation and attachment of a strong social useful purpose in social life as well as for the individual. bond. ✓ “System balance reflects adjustments and adaptations that 2. Dependency Subsystem - approval, attention or recognition are successful in some way and to some degree.” and physical assistance. 3. Ingestive Subsystem - the emphasis is on the meaning and The four assumptions about structure and function are that: structures of the social events surrounding the occasion when ✓ “from the form the behavior takes and the consequences it the food is eaten. achieves can be inferred what ‘drive’ has been stimulated or 4. Eliminative Subsystem - human cultures have defined what ‘goal’ is being sought.” different socially acceptable behaviors for excretion of waste, ✓ Each individual person has a “predisposition to act with but the existence of such a pattern remains different from reference to the goal, in certain ways rather than the other culture to culture. ways.” This predisposition is called a “set.” 5. Sexual Subsystem - both a biological and social factor that ✓ Each subsystem has a repertoire of choices called a “scope affects behavior. of action.” 6. Aggressive Subsystem - relates to the behaviors concerning protection and self-preservation, generating a defense response when there is a threat to life or territory. 7. Achievement Subsystem - provokes behavior that tries to control the environment. There are three functional requirements for the subsystems: 1. The system must be protected from toxic influences with which the system cannot cope. 2. Each system has to be nurtured through the input of appropriate supplies from the environment. 3. The system must be stimulated for use to enhance growth and prevent stagnation. INFORMATION Johnson explains that these behaviors are “orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation.”