TFN Notes Reviewer.docx

**Lecture Notes on Florence Nightingale** **METAPARADIGM IN NURSING** Major concepts in nursing as defined by Nightingale 1. **Nursing**\ The act of utilizing the environment of the patient to assist him in his recovery. 2. **Person**\ They are defined in relation to their environm...

**Lecture Notes on Florence Nightingale** **METAPARADIGM IN NURSING** Major concepts in nursing as defined by Nightingale 1. **Nursing**\ The act of utilizing the environment of the patient to assist him in his recovery. 2. **Person**\ They are defined in relation to their environment and the impact of environment upon them. 3. **Health**\ \"being well and using every power that the person has to the fullest extent\" 4. **Environment**\ Reflects a community health model in which all that surrounds human beings is considered concerning their health state. **Slide 2** Florence Nightingale (1820-1910) is a foundational figure in the history of nursing. Here\'s a quick glimpse into her life and achievements: 1. **Matriarch of Modern Nursing:** Florence Nightingale is widely recognized as the founder of modern nursing. She transformed nursing into a respected profession, emphasizing hygiene, sanitation, and patient care, which laid the foundation for current nursing practices. 2. **First Nurse Educator:** Nightingale established the **Nightingale School of Nursing** in 1860 at St. Thomas\' Hospital in London. This was the first secular nursing school in the world, and it revolutionized nursing education by providing formal training and elevating the standards of care. 3. **Superintendent:** Before the Crimean War, Nightingale served as the superintendent of the **Institute for the Care of Sick Gentlewomen** in London in the early 1850s. Her work there, focusing on organizational efficiency and patient care, prepared her for the immense responsibilities she would later take on during the Crimean War. In 1853 Nightingale sought to break free from her family *environment*. Through social connections, she became the superintendent of the **Institution for Sick Gentlewomen** (governesses) in Distressed Circumstances, in London, where she successfully displayed her skills as an administrator by improving nursing care, working conditions, and *efficiency* of the hospital. **Lady with the Lamp during the Crimean War:** Nightingale became famous for her work during the **Crimean War** (1853-1856), where she organized care for wounded soldiers. Her nightly rounds with a lamp earned her the nickname \"Lady with the Lamp,\" symbolizing her dedication to patient care. Sidney Herbert, secretary of state at war for the British government, wrote to Nightingale requesting that she lead a group of nurses to Scutari. At the same time, Nightingale wrote to her friend Liz Herbert, Sidney\'s wife, asking that she be allowed to lead a private expedition. Their letters crossed in the mail, but in the end their mutual requests were granted. Nightingale led an officially sanctioned party of 38 women, departing October 21, 1854, and arriving in Scutari at the **Barrack Hospital** on November 5. Not welcomed by the medical officers, Nightingale found conditions filthy, supplies inadequate, staff uncooperative, and overcrowding severe. Few nurses had access to the *cholera wards*, and Nightingale, who wanted to gain the confidence of army surgeons by waiting for official military orders for assistance, kept her party from the wards. Five days after Nightingale\'s arrival in Scutari, injured soldiers from the **Battle of Balaklava** and the **Battle of Inkerman** arrived and overwhelmed the facility. Nightingale said it was the \"Kingdom of Hell.\" **Nurse Statistician:** Nightingale was also a pioneering statistician. She used statistical data and graphical representation (such as the \"coxcomb\" diagram) to highlight unsanitary conditions and high mortality rates in military hospitals, leading to healthcare reforms. 1. **Order of Merit:** In 1907, Nightingale became the **first woman to receive the Order of Merit**, one of the highest British honors, in recognition of her lifelong contributions to nursing and healthcare. Nightingale\'s legacy endures through the principles of nursing care, public health, and healthcare management. **Florence** Nightingale was honoured in her lifetime by receiving the title of Lady of Grace of the **Order of St. John of Jerusalem** and by becoming the first woman to receive the **Order of Merit**. **Slide 4** **Ventilation and Warmth-** keep the room well-ventilated. Check room temperature, client's body temperature, ventilation and odor. - **Canon:** Ensure that the patient\'s environment has proper ventilation and that they are kept warm, but not overheated. - **Clinical Example:** In a hospital setting, ensuring that patient rooms have adequate airflow to prevent the buildup of pathogens, while adjusting room temperature to keep patients comfortable without overheating. **Light-** Adequate room light. Sunlight is beneficial for the client - **Canon:** Provide adequate natural light for the patient. - **Clinical Example:** Positioning the patient\'s bed near a window or ensuring that the room is well-lit during the day to support the patient\'s well-being and reduce feelings of isolation. **Health of Houses-** Fresh air, pure water, clean drainage, appropriate lighting - **Canon:** The hospital or healthcare facility should be clean and sanitary. - **Clinical Example:** Regular cleaning and sterilization of patient rooms and common areas to prevent the spread of infection in a healthcare setting. **Noise-** Check noise level in the room and surroundings. Keep noise level at the minimum - **Canon:** Minimize unnecessary noise that can disturb patients. - **Clinical Example:** Reducing noise from equipment, visitors, or loud conversations in hospital corridors to help patients rest and recover, especially in ICU settings. **Bed and Bedding-** Check for dampness, wrinkles and soiling. Keep bed dry, wrinkle-free and and at its lowest height to ensure comfort - **Canon:** Ensure that patients have a clean and comfortable bed. - **Clinical Example:** Regularly changing bed linens and ensuring the mattress and pillows are comfortable to prevent bedsores, especially for bedridden patients. **Cleanliness of Rooms and Walls-** Check and keep room free from dust, dampness and dirt. - **Canon:** Maintain a clean environment to reduce the spread of disease. - **Clinical Example:** Ensuring that surfaces in patient rooms are wiped down regularly, and walls are kept free from dust or contaminants, especially in environments like operating rooms or intensive care units. **Personal Cleanliness-** Keep patient dry and clean at all time. Frequent assessment of the client's skin is essential to maintain good skin integrity. - **Canon:** Ensure that the patient is kept clean and comfortable. - **Clinical Example:** Assisting patients with personal hygiene tasks, such as bathing, oral care, and handwashing, particularly for those unable to perform these tasks independently. **Chattering Hopes and Advices-** Avoid talking without giving advice that is without a fact. Respect the client as a person and avoid personal talks - **Canon:** Avoid giving patients false hopes or excessive, unhelpful advice. - **Clinical Example:** Providing realistic updates on a patient\'s condition and offering emotional support without giving false reassurances about the outcome of their illness. **Variety**- Attempt to accomplish a variety of things. Encourage friends or relatives to engage in stimulating activities - **Canon:** Provide variety in the patient\'s environment to reduce monotony and mental fatigue. - **Clinical Example:** Bringing in flowers, allowing access to natural light, or changing a patient\'s bed position to provide a change in scenery during long hospital stays. **Food Intake/Taking Food-** Check the diet of the client. Note the amount of food and fluids ingested by the client at every meal - **Canon:** Ensure that patients receive proper nutrition and are monitored for food intake. - **Clinical Example:** A nurse might work with a dietitian to ensure that a patient with specific dietary needs, such as diabetic or low-sodium diets, is receiving appropriate meals. **What Food?** - **Canon:** Ensure the quality and appropriateness of the food provided to patients. - **Clinical Example:** Monitoring a post-operative patient to ensure that their dietary progression from clear liquids to solid foods is handled appropriately, to avoid complications like nausea or constipation. **Petty Management-** ensures continuity of care. Document the plan of care and evaluate the outcomes to ensure continuity. - **Canon:** Consistency in care and ensuring that even small, seemingly insignificant details are addressed. - **Clinical Example:** Keeping accurate and consistent nursing notes to ensure continuity of care between shifts, avoiding missed medication times or important care details. **Observation of the Sick-** observe and record anything about the client. Continue observation in the client's environment and make changes in the plan of care if needed - **Canon:** Carefully observe the patient\'s condition and recognize early signs of changes. - **Clinical Example:** A nurse notices subtle changes in a post-surgical patient\'s vital signs that indicate the onset of infection and quickly reports it to the physician for immediate intervention. **Clinical Application** For example, in a hospital ICU setting, a nurse may apply Nightingale\'s canons by: 1. **Ventilation and Warmth:** Ensuring the room has proper air circulation and the patient\'s body temperature is regularly monitored to prevent hypothermia. 2. **Noise:** Limiting loud noises from monitors and alarms, providing a peaceful environment conducive to rest and recovery. 3. **Cleanliness of Rooms and Walls:** Regularly cleaning high-contact surfaces to reduce infection risks, especially with immunocompromised patients. These principles are still applicable in modern nursing practice and are integrated into many patient care protocols today. **Lecture notes on Jean Watson\'s Theory of Human Caring** Slide 2 Watson\'s main concepts include the 10 carative factors and transpersonal healing and transpersonal caring relationship, caring moment, caring occasion, caring healing modalities, caring consciousness energy, and phenomenal file/ unitary consciousness.\ She describes a \"Transpersonal Caring Relationship\" as foundational to her theory: it is a \"special kind of human care relationship - a union with another person - high regard for the whole person and their being-in-the-world\" Slide 3 **METAPARADIGM** **Nursing**, in Watson\'s view, goes beyond simply providing medical treatment; it is about engaging in a caring relationship that facilitates healing. Nurses use caring practices that promote health and support individuals in their healing process. **Person (Human Being):** - The person is viewed as a holistic individual with physical, mental, emotional, and spiritual needs. Watson describes humans as valued beings who deserve care, respect, and compassion. **Health:** - Health is a subjective experience that involves harmony, wholeness, and balance. It is not just the absence of illness but a state of physical, mental, and social well-being. Watson views health as congruence between a person\'s self and how they live their life. On Health, in addition to WHO\'s definition of health: The high level of overall physical, mental and social well-being with the inclusion of three-elements: 1. positive state of overall physical, mental and social functioning. 2. a general adaptive-maintenance level of daily functioning. 3. the absence of illness (or presence of efforts that leads to its absence). **Environment:** - The environment is seen as both internal and external factors that impact the individual. Watson emphasizes that the environment should support healing, peace, and dignity, incorporating physical, social, and spiritual aspects. on environment A caring attitude is not transmitted from generation to generation by genes. It is transmitted by the culture of the profession as a unique way of coping with its environment Slide 5 1. Caring can be effectively demonstrated and practiced only interpersonally. 2. Caring consists of carative factors that result in the satisfaction of human needs. 2. Effective caring promotes health and individual or family growth. 2. Caring responses accept a person not only as they are now but as what they may become. 5. A caring environment allows the development of potential and offers the individual choices for action 5. Caring promotes more health than curing. 5. Caring is central to nursing practice and helps maintain the ethical and moral idea of nursing. 1. **Humanistic-Altruistic System of Values (Embrace)-** Altruistic Values and Practice Loving Kindness with Self and Others - **Example:** A nurse demonstrates compassion and respect for all patients, regardless of their background, socio-economic status, or health condition. - **Application in Practice:** A nurse working in an emergency department takes extra time to listen to and comfort a homeless patient, providing dignity and kindness even amidst a busy shift. 2. **Instillation of Faith-Hope (Inspire)-** Faith and Hope and Honor Others - **Example:** Encouraging patients to believe in their ability to recover and offering hope during difficult times. - **Application in Practice:** A nurse caring for a cancer patient provides words of encouragement, supports the patient\'s belief in their treatment, and helps them stay optimistic during chemotherapy sessions. 3. **Sensitivity to Self and Others (Trust)-** Self and Others by Nurturing Individual Beliefs, Personal Growth and Practices - **Example:** Being mindful of one\'s own feelings while empathizing with others\' emotional needs. - **Application in Practice:** A nurse in a pediatric ward develops emotional sensitivity by reflecting on their own reactions and ensures they provide empathetic care to anxious parents and frightened children, offering reassurance and comfort. 3. **Developing a Helping-Trusting, Human Caring Relationship (Nurture)** - **Example:** Building trust by showing reliability, confidentiality, and emotional presence. - **Application in Practice:** In a mental health setting, a nurse creates a trusting relationship with a patient suffering from depression by consistently being present, actively listening, and maintaining confidentiality in their conversations. 5. **Promotion and Acceptance of the Expression of Positive and Negative Feelings (Forgive) --** and Accept Positive and Negative Feelings -- Authentically Listen to Another's Story - **Example:** Allowing patients to express their emotions, whether they are optimistic or struggling with anger, fear, or sadness. - **Application in Practice:** A hospice nurse encourages a terminally ill patient to express feelings of anger and grief about their situation without judgment, providing a safe space for emotional release and helping the patient cope. 5. **Systematic Use of the Scientific Problem-Solving Method for Decision-Making (Deepen)** - **Example:** Utilizing evidence-based nursing practices to solve problems while considering the unique needs of the patient. - **Application in Practice:** A nurse in a critical care unit uses clinical data, evidence-based guidelines, and patient preferences to develop a plan for managing a patient\'s acute respiratory distress while involving the patient and family in decision-making. 7. **Promotion of Interpersonal Teaching-Learning (Balance)-** Teaching and Learning to Address the Individual Needs, Readiness and Learning Styles - **Example:** Involving patients in their own care by teaching them how to manage their health conditions. - **Application in Practice:** A diabetes nurse educator teaches a newly diagnosed diabetic patient how to monitor blood glucose levels, administer insulin, and adjust their diet. The nurse empowers the patient through education to self-manage their condition. 7. **Supportive, Protective, and/or Corrective Mental, Physical, Societal, and Spiritual Environment (Co- create)-** a Healing Environment for the Physical and Spiritual Self which Respects Human Dignity - **Example:** Creating a healing environment by addressing the patient\'s physical, emotional, and spiritual needs. - **Application in Practice:** In an ICU, the nurse ensures a quiet, peaceful environment for recovery by controlling noise levels and creating a soothing atmosphere, while also offering spiritual support by arranging a visit from a chaplain when requested by the patient\'s family. 7. **Assistance with Gratification of Human Needs (Minister)-** To Basic Physical, Emotional and Spiritual Human Needs - **Example:** Attending to the patient\'s fundamental physical, psychological, and spiritual needs as part of holistic care. - **Application in Practice:** A nurse in a rehabilitation center helps a patient with basic hygiene needs, ensures adequate pain control, and provides emotional support as the patient deals with frustration over their physical limitations. 10. **Allowance for Existential-Phenomenological Forces (Open)-** Open to Mystery and Allow Miracles to Enter - **Example:** Recognizing and addressing a patient\'s existential concerns about life, suffering, and death. - **Application in Practice:** A nurse in palliative care listens as a patient shares their thoughts about the meaning of life and their fears about dying, validating the patient\'s feelings and offering support without trying to \"fix\" the situation. **Patricia Benner\'s** definition of the nursing metaparadigm focuses on how nursing knowledge and skills are developed through experience and how nurses understand and relate to their patients. The metaparadigm includes four central concepts: person, health, environment, and nursing. Here\'s how Benner integrates these elements into her theory: 1. **Person (Human Being)** 2. **Health** 3. **Environment (Situation)** 4. **Nursing** **Novice** Benner suggested that nurses at a higher level of skills in one area of practice could be classified at the novice level if placed in an area of situation completely foreign to them such as moving from the general medical - surgical adult care to neonatal intensive care units. **Description:** Novices have little to no experience in the situations they are facing. They rely on rules and guidelines to perform tasks, often rigidly following procedures. **Example:** A newly graduated nurse on their first day in a surgical unit is assigned to take vital signs. They rely heavily on written protocols and step-by-step instructions to ensure accuracy. The nurse takes each patient\'s vital signs by following the procedure exactly, without considering the individual patient\'s context, such as adjusting for a patient\'s anxiety or a known history of hypertension. **Application in Practice:** Novice nurses focus on mastering basic skills like measuring vital signs, administering medications, or documenting care by strictly adhering to protocols without understanding the nuances of each patient\'s condition. **Advance beginner:** In Dreyfus\' model, develops when the person can demonstrate marginally acceptable performance, having coped with enough real situations to more, or to have pointed out by a mentor, the recurring meaningful components of the situation. To Benner, advanced beginner has enough experience to grasp aspects of the situation. Advanced beginners feel highly responsible for managing patient care, yet they still rely on the help of those who are more experienced. **Description:** At this stage, nurses begin to gain experience and recognize recurring patterns. They still need guidance and are often focused on task completion, but they are starting to see the big picture. **Example:** After a few months in the surgical unit, a nurse begins to notice that some postoperative patients tend to exhibit certain signs of infection (e.g., fever, redness at the incision site). Although the nurse is able to identify these patterns, they still rely on colleagues or mentors to confirm their observations and take appropriate action. **Application in Practice:** The nurse can handle simple clinical tasks like wound care or administering medications and recognizes when a patient\'s condition might be deteriorating, but they still seek advice before making decisions or taking actions independently. **Competent** Consistency, predictability, and time management are important in competent performance. A sense of mastery is acquired through planning and predictability. A competent nurse may display hyper responsibility for the patient, often more than is realistic, and may exhibit an ever-present and critical view of the self. **Description:** After about 2-3 years of practice, nurses reach the competent stage. They have more confidence in their clinical abilities, are able to prioritize tasks, and can manage patient care. **Example:** A nurse working on a medical-surgical floor has been caring for post-operative patients for two years. They can manage several patients at once, prioritize interventions based on individual needs. For example, they anticipate potential complications like dehydration or infection, and make independent decisions about when to alert the physician or adjust the care plan. **Application in Practice:** At this stage, nurses take charge of patient care. They prioritize nursing interventions, coordinate with the healthcare team, and manage patient assignments while becoming more proactive in recognizing potential issues. **Proficient** Nurses at this level demonstrate a new ability to see changing relevance in a situation, including recognition and implementation of skilled responses to the situation as it evolves. They no longer rely on preset goals of organization, and they demonstrate increased confidence in their knowledge and abilities. **Description:** Proficient nurses have a deep understanding of clinical situations and are able to see the whole picture. They can anticipate outcomes based on experience and act accordingly without needing as much deliberate decision-making. **Example:** A nurse in a neonatal intensive care unit (NICU) has been working there for several years. When caring for a premature infant showing early signs of respiratory distress, the nurse immediately takes steps to address the issue without waiting for orders, adjusting oxygen levels and monitoring closely. They are also able to predict how changes in the infant\'s condition will affect other aspects of care and communicate this to the medical team. **Application in Practice:** Proficient nurses handle complex patient care situations efficiently, using their experience to anticipate complications and proactively make decisions. They offer guidance to less experienced nurses and make decisions based on long-term care goals. **Expert:** Benner described the expert nurse as having an intuitive grasp of the situation and as being able to identify the region of the problem without losing time considering a range of alternative diagnoses and solutions. The expert nurse has the ability to recognize patterns on the basis of a deep experiential background. For the expert nurse, 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. **Description:** Nurses at the expert level no longer rely on set rules or guidelines. Their intuition and deep experience allow them to act fluidly, making decisions quickly and accurately without consciously thinking through each step. **Example:** An expert nurse in the emergency department (ED) sees a patient presenting with chest pain. Based on subtle cues from the patient\'s demeanor and their clinical history, the nurse immediately suspects a life-threatening cardiac condition even before diagnostic results confirm it. They begin life-saving interventions, alert the team, and coordinate care with speed and precision, relying on their intuition developed over years of practice. **Application in Practice:** Expert nurses handle critical situations swiftly, relying on their extensive experience to make life-saving decisions. They can mentor others, teach, and lead by example, offering valuable insights into complex cases. **Summary of Stage Applications** - **Novice nurses** focus on mastering basic tasks using strict guidelines. - **Advanced beginners** begin recognizing patterns but still rely on guidance. - **Competent nurses** plan, prioritize, and make independent clinical decisions. - **Proficient nurses** see the whole picture, anticipate outcomes, and manage care proactively. - **Expert nurses** use their deep knowledge and intuition to handle complex situations with speed and accuracy, often without needing to refer to formal guidelines. This model illustrates how nurses develop clinical expertise over time, progressing from basic task completion to highly intuitive, autonomous practice. **Martha Rogers**\' **Theory of Unitary Human Beings** is a well-known conceptual model in nursing that views patients as **whole, dynamic energy fields**, constantly interacting with the universe. Her theory, developed in the 1970s, focuses on the **holistic nature of human beings** and their continuous evolution in an ever-changing environment. The key idea is that humans and their environment are **irreducible, whole systems** that cannot be divided into parts. **Key Principles of Rogers\' Theory of Unitary Human Beings** Rogers\' theory presents the idea that human beings are **unitary**---that is, they are **integrated, open systems** connected with the environment and the universe. Her theory is grounded in the idea that **energy fields** define both humans and their environment, which interact continuously in a dynamic process. Slide 3 **Nursing:** The purpose of nursing is to promote health and well-being for all persons. The art of nursing is the creative use of the science of nursing for human betterment. Nursing exists for the care of people and the life process of humans. Rogers believed that nursing should be viewed as a science, similar to other scientific disciplines. She argued that nursing should be based on a sound theoretical foundation and that nurses should engage in research to continually refine their understanding of human beings and their energy fields. **Definition:** Rogers defines nursing as a **science and an art** that aims to promote interaction between human beings and their environment to foster health and well-being. Nursing is a **therapeutic process** that aims to help people achieve maximum health potential by working with their energy fields. **How it\'s applied in her theory:** The nurse\'s role is to assist in balancing and aligning the human energy field with the environmental energy field. This can be achieved through non-invasive techniques, such as therapeutic touch, guided imagery, and other holistic practices, to promote healing and well-being. **Health:** In Rogers\' science, the phenomenon central to nursing\'s conceptual system is the human life process. The life process has its own dynamic and creative unity that is inseparable from the environment and is characterized by the whole. **Definition:** Rogers does not define health in terms of the absence of disease but rather as a state of well-being in harmony with the **continuous change of the individual\'s energy field**. Health is seen as a reflection of the **interaction between human and environmental fields**. **How it\'s applied in her theory:** Health is the **dynamic interaction** between the patient and their environment, and it is constantly evolving. Nurses promote health by fostering harmony and balance within the person\'s energy field. Slide 4 **Person:** Man is unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts. **Definition:** According to Rogers, a **person is viewed as an irreducible energy field**, unique and continuously evolving. The person is more than just a physical body or biological system: they are a unified whole, connected to their environment and capable of change and growth. **How it\'s applied in her theory:** The human being is an **open system**, constantly exchanging energy with their environment. Nurses must focus on the **whole person**, considering their physical, emotional, intellectual, and spiritual dimensions, rather than just treating symptoms or disease. Rogers believed that individuals are not just a collection of separate parts or systems but are unified, holistic beings. This means that the physical, mental, emotional, and spiritual aspects of a person are interconnected and cannot be fully understood in isolation. **Environment:** environmental fields are infinite, and change is continuously innovative, unpredictable, and characterized by increasing diversity. environmental and human fields are identified by wave patterns manifesting continuous mutual change. **Definition:** The environment is also viewed as an **energy field**, in constant interaction with the human energy field. Rogers describes it as an **irreducible, pan-dimensional energy field** that surrounds and influences the human system. **How it\'s applied in her theory:** The environment and the person are **inseparable**, and both are continuously influencing each other. Nurses must consider not only the physical surroundings but also the **social, psychological, and spiritual environment** of patients. Slide 5 Rogers\' theory introduces **five key concepts** that help explain the dynamic relationship between humans and their environment: 1. **Energy Fields** - **Definition:** Energy fields are the **fundamental units** of the living and non-living. They are **invisible** but provide the basic structure of everything in the universe, including human beings and the environment. - **Application:** Both humans and their environment consist of **energy fields** that are in constant interaction. In nursing, this concept highlights the importance of considering the patient as an **integral part of their environment**, with continuous exchanges of energy between them. 2. **Openness** - **Definition:** Human beings are **open systems**, meaning that there are no **boundaries or barriers** between themselves and the environment. The exchange of energy between the two is constant and dynamic. - **Application:** The concept of openness implies that nurses need to work with the patient\'s **environment** as much as with the patient themselves. For example, environmental modifications like sound therapy or changing lighting may help balance energy and promote healing. 3. **Pattern** - **Definition:** The pattern is the **unique energy configuration** of a person. It is the way energy is organized and reflects the whole person\'s characteristics and experiences. - **Application:** Nurses can use the concept of pattern to assess the patient holistically, identifying unique **behavioral, emotional, and physical patterns**. This allows for personalized interventions tailored to the patient\'s needs and life experiences. 4. **Pan-Dimensionality** - **Definition:** Rogers describes the human field as **pan-dimensional**, meaning that it extends beyond the traditional concepts of time and space. Human beings exist within **multiple dimensions** that are beyond the physical. - **Application:** Nursing care can consider the **non-physical aspects** of a patient\'s life, such as spirituality, emotions, and consciousness. This allows for a more holistic approach to healing that moves beyond just treating the physical body. **Pattern:** Pattern is an abstraction. It reveals itself through manifestation. A sense of self is a manifestation, the nature of which is unique to each individual. Pattern is changing continuously and may manifest disease, illness, or well-being. Pattern change is continuous, innovative, and relative. Rogers emphasized the importance of nurses and healthcare professionals in recognizing and understanding the unique patterns of each individual\'s energy field. This involves looking beyond symptoms and considering the person\'s overall well-being and life experience. **Pan dimensionality** is defined as \"non linear domain without spatial or temporal attributes\" The parameters that human use in language to describe events are arbitrary. The present is relative, there is no temporal ordering of lives. This statement seems to suggest that our perception of time and the way we structure our lives in a linear fashion may be subjective or relative. It raises questions about the nature of time, our experiences, and how we organize and understand the events in our lives. It\'s a philosophical idea that encourages thinking about time and existence in a non-linear or non-traditional way. **Summary of Rogers\' Theory of Unitary Human Beings** 1. **Person:** An irreducible energy field, constantly interacting with the environment. 2. **Health:** A dynamic, evolving state of well-being that reflects the balance between the person\'s energy field and their environment. 3. **Environment:** An energy field that is inseparably linked to the human field, influencing and being influenced by the person\'s energy. 4. **Nursing:** A science and art focused on promoting harmony and balance between the patient\'s energy field and the environment to achieve optimal health. Martha Rogers\' theory emphasizes a **holistic, integrative approach to nursing**, where human beings are seen as energy fields connected to the environment, and nurses play a vital role in promoting **healing** by fostering **balance and harmony** between the person and their surroundings. **Dorothea Elizabeth Orem (1914-2007)** was a prominent American nurse and theorist, best known for developing the **Self-Care Deficit Nursing Theory**, which has had a profound influence on nursing practice and education. **Definition:** Orem defines nursing as a **helping service** that provides assistance to individuals who cannot meet their own self-care needs. Nursing involves helping individuals manage their self-care deficits by performing care for them, assisting them in self-care, or teaching them how to care for themselves. **Application in nursing:** Nurses assess the patient\'s self-care deficits and intervene appropriately by providing total care, partial assistance, or education to enable the patient to achieve independence in self-care. **Nursing:** It focuses on each individual\'s ability to perform self-care, defined as \"the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.\" Nursing is an art, a helping service, and a technology. **Goal of nursing** - to render the patient or members of his family capable of meeting the patient\'s self-care needs **Definition:** Health is defined as a **state of physical, mental, and social well-being**. It is the ability to live life to its fullest and perform self-care activities that promote health and well-being. Orem\'s concept of health includes the person\'s ability to maintain structural and functional **integrity**. **Application in nursing:** Nurses support patients in maintaining health or managing illness by helping them meet their self-care needs. **Health** - health and healthy are terms used to describe living things **Integrity:** They are structurally and functionally whole or sound\... wholeness or integrity includes that which makes a person human\... operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings Slide 5 **Definition:** Orem views the person as a **self-care agent** capable of engaging in self-care. Each person has the potential to care for themselves, but there are times when a person might be unable to meet their own self-care needs due to illness, injury, or developmental limitations. **Application in nursing:** Nurses assess patients\' ability to perform self-care and determine when nursing interventions are required to help the patient achieve self-care. Humans are defined as \"men, women, and children cared for either singly or as social units\" and are the \"**material object**\" of nurses and others who provide direct care. A human being who has \"health-related/health derived limitations that render him incapable of continuous self-care or dependent care or limitations that result in ineffective/incomplete care. A human being is the focus of nursing only when a self-care requisites exceeds self-care capabilities **Environment:** **Definition:** The environment consists of the physical, chemical, biological, and social factors that affect the person\'s ability to engage in self-care. Orem acknowledges the importance of external conditions in influencing health and self-care ability. **Application in nursing:** Nurses assess how environmental factors, such as living conditions, family support, or access to healthcare resources, impact the patient\'s ability to perform self-care. They also modify the environment to support the patient\'s health. Slide 6 Dorothea Orem is primarily known for her Self-Care Deficit Theory of Nursing, but she did not develop a separate theory specifically called the \"Theory of Dependent Care\" as a distinct and widely recognized nursing theory. Instead, her work primarily focuses on self-care and the nurse\'s role in helping individuals meet their self-care needs, as discussed in the previous response. However, it\'s worth noting that Orem\'s Self-Care Deficit Theory encompasses the care of individuals who may have a self-care deficit and are dependent on others for assistance with their activities of daily living. In such cases, nursing care provided by healthcare professionals is designed to bridge the gap between the individual\'s self-care abilities and their self-care requirements. Orem\'s theory acknowledges that some individuals may be unable to perform self-care independently due to various factors, including illness, disability, or injury. In these situations, nurses play a crucial role in providing dependent care, which involves assisting patients with their self-care needs to promote recovery, maintain health, or manage chronic conditions. So, while Orem\'s theory primarily emphasizes self-care and the promotion of independence, it implicitly recognizes the importance of dependent care when individuals are unable to meet their self-care needs on their own. Dependent care is an integral part of nursing practice, but it is not a separate theory developed by Orem. Instead, it is an aspect of nursing theory that is addressed within the broader framework of her Self-Care Deficit Theory. **Theory of Self-Care** This theory focuses on the activities individuals perform on their own behalf to maintain life, health, and well-being. **Self-care** involves learned behaviors that individuals can practice to sustain health or manage illness. - **Example:** Taking medication as prescribed, maintaining personal hygiene, and following a proper diet are examples of self-care activities. **Definition:** Self-care is the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. It includes activities like eating, bathing, taking medications, and exercising. **Application in nursing:** Nurses assess the patient\'s capacity for self-care and provide interventions to promote self-care independence. For example, in a diabetic patient, the nurse teaches self-care skills like blood sugar monitoring and diet management. **Self-Care Agency** - **Definition:** Self-care agency refers to a person\'s ability to engage in self-care activities. It is influenced by factors such as age, health status, and knowledge. - **Application in nursing:** Nurses evaluate a patient\'s ability to care for themselves and determine whether they have a **self-care deficit**. For example, a patient with limited mobility after surgery may have reduced self-care agency and need assistance. **Therapeutic Self-Care Demand** - **Definition:** The total self-care actions required to meet an individual\'s self-care needs. This includes the knowledge and skills needed to meet daily health maintenance activities. - **Application in nursing:** Nurses assess the **therapeutic self-care demand** of the patient (e.g., medication administration, wound care) and provide interventions to meet that demand if the patient cannot do it independently. Self-care requisites - action directed towards the provision of self-care. 3 categories of self-care requisites are: Universal self-care requisites Developmental self-care requisites Health deviation self-care requisites **Universal Self-Care Requisites** These are basic self-care needs that are common to all individuals throughout life. They are necessary for maintaining health and well-being. **Universal self-care requisites include:** - **Air:** Maintaining adequate oxygenation (e.g., breathing exercises for patients with lung conditions). - **Water:** Ensuring proper hydration (e.g., teaching a patient to drink adequate fluids after surgery). - **Food:** Maintaining a balanced diet (e.g., educating a diabetic patient on a low-sugar diet). - **Elimination:** Managing waste elimination (e.g., assisting a post-op patient with bladder or bowel care). - **Activity and Rest:** Balancing physical activity with adequate rest (e.g., encouraging a heart patient to take walks while getting enough rest). - **Solitude and Social Interaction:** Ensuring a balance between time alone and with others (e.g., helping a patient find support groups to manage loneliness). - **Prevention of Hazards:** Avoiding injury and promoting safety (e.g., teaching elderly patients fall-prevention techniques). - **Normality:** Promoting a sense of normalcy in development and functioning (e.g., supporting a child with developmental delays to achieve their growth milestones). **Example:** A nurse caring for a post-operative patient ensures that the patient meets their universal self-care requisites by monitoring fluid intake, helping with ambulation to prevent complications, and providing guidance on proper nutrition for recovery. 2. **Developmental Self-Care Requisites** - **Developmental milestones:** Supporting physical and cognitive development in children. - **Life transitions:** Helping individuals cope with major life events such as adolescence, pregnancy, or aging. - **Developmental challenges:** Managing chronic conditions, illness, or trauma during different life stages. **Example:** A nurse might help a pregnant teenager manage her pregnancy by offering education and emotional support, addressing both the developmental requisites of adolescence and pregnancy. **Health Deviation Self-Care Requisites** These requisites apply when individuals experience illnesses, injuries, or disabilities. They address specific healthcare needs that arise from medical conditions or treatments. **Health deviation self-care requisites include:** - **Seeking and securing appropriate medical care:** Encouraging patients to attend follow-up appointments after diagnosis. - **Carrying out prescribed medical treatments:** Assisting patients in understanding and adhering to their treatment plans (e.g., taking medications or following dietary restrictions). - **Being aware of and attending to side effects:** Educating patients about recognizing and managing the side effects of medications. - **Learning to adjust to changes in health status:** Helping patients adapt to limitations caused by illness or injury (e.g., providing physical therapy support for stroke recovery). - **Modifying self-concept in light of health problems:** Supporting patients in adjusting their self-image after an illness (e.g., counseling a cancer survivor on body image changes). **Example:** A nurse working with a diabetic patient ensures that the patient understands how to monitor their blood glucose levels, administer insulin, and recognize signs of hypoglycemia, thus addressing the patient\'s **health deviation requisites**. Dorothea Orem\'s theory of nursing systems is a component of her broader Self-Care Deficit Theory of Nursing. This theory, often referred to as the \"Nursing Systems Theory,\" outlines how nurses and healthcare professionals organize themselves to deliver care to care deficits. Orem\'s Nursing Systems Theory is essential in understanding how nurses and other caregivers work together to provide care and support to patients who are unable to meet their self-care needs independently. **Here are the key components of Orem\'s Nursing Systems Theory:** **Wholly Compensatory System:** This nursing system is employed when individuals are entirely incapable of meeting their self-care needs. In such cases, nurses assume full responsibility for all aspects of care. The nurse performs all required self-care activities on behalf of the patient, essentially compensating for the individual\'s inability to care for themselves. This system is typically used for patients who are acutely ill, critically injured, or completely dependent on others due to severe physical or cognitive limitations. **Partially Compensatory System:** In this nursing system, both the patient and the nurse share the responsibility for self-care. The patient is capable of performing some self-care activities but requires assistance with others. Nurses assess the patient's abilities and deficits and then provide assistance and support accordingly, focusing on the aspects of self-care that the patient cannot manage independently. Supportive-Educative System: The supportive-educative nursing system is utilized when individuals can perform most self-care activities but require education, guidance, or emotional support to maintain their health and well-being. Nurses serve as educators, counselors, and facilitators in this system, helping patients learn how to care for themselves effectively. Patients are encouraged to take an active role in their own care and decision-making, with nurses providing the necessary information and emotional support. Orem's theory also includes the concept of basic conditioning factors, which are factors or influences that affect an individual's ability to engage in self-care. Basic Conditioning Factors: These factors include age, developmental stage, gender, environment, health state, and family and sociocultural factors. They can either support or hinder an individual's ability to perform self-care. In summary, Orem's Nursing Systems Theory recognizes that nursing care is not a one-size-fits-all approach. Instead, it outlines different nursing systems based on the degree of self-care deficit exhibited by the patient. The choice of nursing system is determined by the patient's abilities and needs, with the goal of promoting self-care independence whenever possible. This theory provides a structured framework for nurses to tailor their care interventions to the specific requirements of each patient, ultimately aiming to improve their health and well-being.