Nursing Conceptual Models PDF

Nursing Conceptual Models Week 7-8 Martha Roger’s Science of Unitary Human Beings Conceptual Model Rogerian Model Roger’s theory states that the purpose of nurses is to promote health and well-being for all persons wherever they are. The belief of the coexistence of the human an...

Nursing Conceptual Models Week 7-8 Martha Roger’s Science of Unitary Human Beings Conceptual Model Rogerian Model Roger’s theory states that the purpose of nurses is to promote health and well-being for all persons wherever they are. The belief of the coexistence of the human and the environment has greatly influenced the process of change toward better health. In short, a patient cannot be separated from the environment when addressing health and treatment. The model is based on four building block: energy field, universe of open systems, pattern, and four dimensionality. Science of Unitary Human Beings The science comes from knowledge bases of many different sciences such as anthropology, psychology, sociology, astronomy, religion, philosophy, history, biology, physics, mathematics, and literature to create a model of unitary human beings. 8 Concepts of the Theory Energy Field  It is inevitable part of life. Human and environment both have energy field which is open. Energy can freely flow between human and environment. Human Openness  There is no boundary or barrier that can inhibit the flow of energy between humans and environment which leads to the continuous movement or matter of energy. Pattern  Pattern is defined as the distinguishing characteristic of an energy field perceived as single waves.  Pattern is a abstraction and it gives identity to the field. Pan Dimensionality  Is defined as non- linear domain without spatial or temporal attributes.  Human beings are pan dimensional being and have more than three dimensions. Homeodynamic Principles  Refers to the balance between the dynamic life process and environment.  Theses principles help view human as unitary human being. Resonancy  Wave patterns are continuously changing in environmental and human energy fields. Helicy  The nature of change is unpredictable, continuous, and an innovative Integrality  Energy fields of humans and environment are in continuous mutual process. Assumptions of the Theory Wholeness Human being is considered as united whole. Openness A person and his environment are continuously exchanging energy with each other. Unidirectionality The life process of human being evolves irreversibly and unidirectional. Example is birth to death. Pattern & Organization Pattern identifies individuals and reflects their innovative wholeness. Sentence & Thought Humans are the only organisms able to think, imagine, have language and emotions. 6 Domains of Energy Patterning and Corresponding Nursing Interventions:  Connecting- guided imagery, therapeutic touch, Reiki, music/color therapy, Aromatherapy  Conveying- Accupressure, Reflexology  Converting- Herbal therapy, exercise, music/color therapy, Purpose meaning  Conserving-biofeedback, relaxation/meditation, breathing, Herbal therapy, sleep and rest  Clearing- music/color therapy, Accupressure, Aromatherapy, postural movement  Coursing- Yoga, massage, Polarity therapy, exercise 3 Steps in the Theory Process Assessment- includes both the patient and environment. Voluntary Mutual Patterning- includes sharing knowledge, empowering the patient, nutrition, and pain. Evaluation Application in the Clinical Practice  Nursing action is always focused on unitary human being and change the energy field between human and environment.  Nursing action include all non-invasive actions such as guided imagery, humor, therapeutic touch, music, etc. which are used to increase the potential of human field.  The more importance should be on the management of pain, supportive therapy and rehabilitation. Next Topic Dorothea Orem’s Self Care Deficit Theory Self Care Deficit Theory  Developed to improve quality of nursing and patient ability to meet demands of care Purpose of the Theory To help promote patient to perform self- care. Patient can recover faster if they are encouraged to perform self- care tasks to maintaining their health and well- being. Theory can apply to all types of nursing. Example: rehab, primary care settings, nursing home, and elders. Three Components of Theory: Self- care Self- care deficit Nursing system Self- care deficit is core of Orem’s theory because it determines when nursing is needed. Main purpose for theory is for patient and families to maintain control of health by actively performing for self Self- care Activity of person to do on own in maintaining their health and well-being. When there is demand to care for oneself and that individual is capable to meet that demand, self care is possible. Concepts: Self care agency Therapeutic self care demand Self care requisites: universal, developmental and health deviation Self- Care Deficit When individuals is not capable to meet the demand of care for self, self- care deficit occurs. This is the key to Orem’s theory. Nursing is required in self- care deficit to guide in meeting the demand. 5 Methods of Helping Acting for or doing for patient. Teaching patient. Directing patient. Supporting patient. Providing environment for patient. Nursing System in the Theory  Addresses and plans how needs of the patient can be met by the nurse, patient or both. Three Types: Wholly Compensatory System- patients not capable to perform self-care. Partly Compensatory System- limited mobility due to illness. Supportive Educative System- patient is capable learning to perform. Encourage Patient to Perform Self- Care Geriatric patients- restorative programs Physical, occupational and speech therapy Active ROM can facilitate building strength Walking- to maintain physical health ADLs Staying active Nurse can meet needs of patients with setting goals and interventions Relevance of the Theory Allows the nurse to utilize patient’s own self- care abilities. Nurse can maximize the skills for the needs of the patient from an individualized plan of care. Promotes patient autonomy and independence. Nurses focuses on self- care much more than any other discipline in healthcare. It has been used in research. It helps the nurse on what intervention are used based on the needs of the patient. Questions? Next Topic Imogene King’s Goal Attainment Theory Theory of Goal Attainment Describes the importance of the participation of all individuals in decision making as well as choices, alternatives, and outcomes of nursing care. It pertains to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time and personal space. The practice of nursing is differentiated from other healthcare professions by what nurses do with and what they do for individuals. The nurse and patient/client communicates information in order to set goals mutually and then acts to attain those goals. According to King humans have three fundamental needs: Information on health that can be accessed and utilized. Care that aims to prevent illness. Care in times of need or illness. 3 Interacting Systems Framework  Personal System- the individual.  Interpersonal System- individuals interacting with one another.  Social System- groups of people in a community or society sharing common goals, interests and values. Systems Framework Concepts  Personal System- coping, spirituality, perception, self, body image, growth and development.  Interpersonal System- interaction, communication, transaction, role, stress and coping.  Social System- organization, authority, power, status, and decision making. Proposition of King’s Theory  If perceptual interaction accuracy is present in nurse- client interactions, transaction will occur.  If nurse and client make transaction, goal will be attained.  If goal are attained, satisfaction will occur.  If transactions are made in nurse- client interactions, growth and development will be enhanced.  If role expectations and role performance as perceived by nurse and client are congruent, transaction will occur.  If role conflict is experienced by nurse or client or both, stress in nurse- client interaction will occur.  If nurse with special knowledge skill communicate appropriate information to client, mutual goal setting and goal attainment will occur. Goal Attainment Diagram ADPIE Nursing Assessment Planning Implementation Evaluation Diagnosis Assessment Assessment occur during interaction. The nurse brings special knowledge and skills whereas client brings knowledge of self and perception of problems of concern, to this interaction. During assessment nurse collects data regarding client (his/her growth and development, perception of self and current health status, roles, etc.). Perception is the base for collection and interpretation of data. Communication is required to verify accuracy of perception, for interaction and transaction. Nursing Diagnosis The data collected by assessment are used to make nursing diagnosis in nursing process. In process of attaining goal the nurse identifies the problems, concerns and disturbances about which person seek help. Planning After diagnosis, planning for interventions to solve these problems is done. In goal attainment planning is represented by setting goals and making decisions about and being agreed on the means to achieve goals. This part of transaction and client’s participation is encouraged in making decision on the means to achieve the goals. Implementation In nursing process implementation involves the actual activities to achieve the goals. In goal attainment it is the continuation of transaction. Evaluation It involves to finding out whether goals are achieved or not. The described evaluation speaks about attainment of goal and effectiveness of nursing care. Application in Practice  Used for curriculum design in nursing programs and used as frameworks for books.  Relies on the participation of both nurse and patient for effectiveness.  It can be used in most any practice.  Reviewing the patient’s plan of care and providing the patient with information as well as education each day.  Providing the patient options for their plan of care.  Keeping the patient during the process of care.  Making decisions with the patient rather for the patient.  Bedside report is a good start. Questions? Next Topic Betty Neuman’s System Model Neuman Model The model is dynamic because it is based on the client’s continuous relationship to environmental stress factors, which have a potential for causing a reaction, or obvious symptomatic reaction to stress, or could affect reconstitution following diagnosis of stress. It is a complex systems model with focus on stress reactions and stress reduction. The Neuman model is based on the philosophy that each person is layered multidimensional being. Each layer in the model consists of 5 person variables or subsystems. Physiological Psychological Socio- cultural Spiritual Developmental The 5 Interacting Variables  Psychological- refers to bodily structure and internal function.  Psychological- refers to mental processes and interactive environmental effects, both internally and externally.  Socio- cultural- refers to combined effects of social cultural conditions and influences.  Developmental- refers to age related developmental processes and activities.  Spiritual- refers to spiritual beliefs and influences. Basic Structure of the System  the basic structure of the central core consists of basic survival factors.  The flexible and normal line of defense and the lines of resistance are essential functions as protective mechanisms for the basic structure to preserve client system integrity. Flexible Line of Defense  It forms the outer layer of the defined client system; whether a single client, a group or a social issue.  The flexible line of defense is depicted as the outer, broken circle surrounding the normal line of defense.  It acts as a protective buffer system for the client’s normal stable state.  It prevents stressor invasion of the client system, keeping the system free from stressor reactions.  As it expands away from the normal line of defense, greater protection is provided, as it draws close, less protection is available. When the normal line of defense is rendered ineffective in particular to a stressor impact, a reaction will occur within the client system. Coping patterns, lifestyle factors and beliefs will influence to changes. Normal Line of Defense  The flexible line of defense protects the normal line of defense.  The line represents what the client has become, the state to which the client has evolved over time or the wellness level. It is dynamic in terms of its ability to become and remain stabilized to deal with life stressor over time, thus protecting the basic structure and systems integrity. Line of Resistance  This line is activated following invasion of the normal line of defense by environmental stressors.  The line of resistance contain certain known and unknown internal and external resource factors that support the client’s basic structure and normal defense line. Example of it is body mobilization of white blood cells or activation of immune system mechanisms, its ineffectiveness leads to energy depletion and death.  Lifestyle, coping, client expectations, motivation are all inherent within the lines of defense and resistance, ultimately protecting the basic structure. Stability of Defenses in Health Stability of Defenses from Environment Nursing Intervention in Relation to the Defenses  Nursing interventions can occur before or after stressors at all levels of prevention.  Client is viewed as an open system interacting with the environment through interpersonal and extra personal factors. Nursing Prevention Interventions are made thru:  They are based on  The degree of reaction  Resources  Goals  Anticipated outcomes Levels of Prevention Primary Occurs before the system reacts to a stressor. It can strengthen a person. Health promotion and injury prevention. Secondary Occurs after the stressor has effected the environment. Focuses on preventing damage to internal core. Tertiary Occurs after the system has been treated through secondary prevention measure. Focus on support. How Stressor Penetrates the Lines Effects of the Stressor and How Nursing Prevention Works Once an individual is exposed to stress, the flexible line of defense will be alarmed to protect the normal line of defense to keep the system free from stressor reactions. However, if this individual is continuously exposed to stress and if the flexible line of defense is unable to cope, the normal line of defense will be altered. If this happens, the basic structure of the individual will enter instability and illness develops. Questions? Next Topic Sister Callista Roy’s Adaptation Model Goal of the Nursing Model  The promotion of adaptation for individuals and groups in each of the 4 adaptive modes, thus contributing to health, quality of life, and dying with dignity.  The model is a conceptual deductive theory based on causality. Model Concept: People as Adoptive Systems  People, individually and in groups are holistic adaptive systems, complete with coping processes acting to maintain adaptation and to promote person and environment as transformations. Model Concept: People as Adoptive Systems Individuals  Regulator Subsystem- uses physiologic processes such as chemical, neurologic, and endocrine response to cope with the changing environment  Cognator Subsystem- involves the cognitive and emotional processes that involves the cognitive and emotional process that interact with the environment. Example: a person sees an incoming car after stepping off a curb. The person’s body pumps adrenaline that provides energy to move out of the way (regulator), while emotion of fear is experienced helping to escape (cognator). Model Concept: People as Adoptive Systems Groups  Stabilizer Subsystem- structures, values and daily activities work together to accomplish the primary purpose of the group. Example: the family’s purpose is to earn a living and provide nurturance and education for the children. Family values influence how members respond to its environment in order to fulfill responsibilities to maintain the family.  Innovative Subsystem- response to environmental change. Example: organizations plan activities and team building sessions. During this time, the group creates new goals and growth resulting in progression. Model Concept: People as Adoptive Systems Four Adaptive Modes: 1. Physiologic-Physical: people as individuals interact as physical beings with environment.  Senses; fluid electrolyte, acid- base balance; neurologic function; endocrine function 2. Self concept: composite beliefs and feelings that a person holds about him or herself at a given time; sense or purpose.  Involves developing self, perceiving self, and focusing self. 3. Role Function- roles on people in society filing their needs for social integrity, relating self to others.  Individual needs to know who one is in relation to others to act. 4. Interdependence modes: close relationship of people and their purpose, structure and development Model Concept: Environment Defined environment as all the conditions, circumstances and influences surrounding and affecting the development and behavior or individuals and groups. Model Concept: Environment Three categorized factors of environment stimuli:  Focal- factors immediately affecting the person.  Contextual- all other stimuli affecting situation.  Residual- factors whose effect are unclear. Model Concept: Environment Three levels of Adaptation:  Integrated Adaptation- structures and functions of the adaptive modes are working together and meet human needs.  Compensatory Adaptation- occurs when the cognator and regulator or stabilizer and innovator are activated by a challenge.  Compromised Adaptation- occurs when integrated and compensatory processes are inadequate, creating an adaptation Model Concept: Health  Defined as the reflection of personal and environmental interactions that are adoptive.  A process  A state of being.  Becoming whole and integrated in a way that reflects individual and environment mutuality Nursing Process in Relation to Adaptive Model  Gathering of data about certain behavior of the person or group.  Identifying the internal and external stimuli that influence behavior.  Collaboration with the person or group to set goals or behavioral outcomes.  Interventions are based on the best way to assist the person in reaching the goal.  Evaluation judges the effectiveness of the intervention. Questions? Next Topic Dorothy Johnson’s Behavior System Model Definition of Nursing thru the Model  An external regulatory force which acts to preserve the organization and integration of the patient’s behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health, or in which illness is found. Goal of the Model  It advocates the fostering of the patient and effective behavioral functioning of the patient to prevent illness.  The patient is defined as a behavior system composed of 7 behavioral subsystems.  Assist the patient whose behavior is proportional to social demands.  To assist the patient who is able to modify his behavior in ways that it supports biological imperatives.  To assist the patient who is able to benefit to the fullest extent during illness from the physician knowledge and skills.  Whose behavior does not give evidence of unnecessary trauma as a consequence of illness. Purpose of the Model  Nurse creates a balance between client and environment.  Protection from noxious stimuli that threaten the survival of the behavioral system.  Nurturance, which provides adequate input to sustain behavior.  Stimulation to continue growth of the behavior. Assumptions of the Model  Form of the behavior can infer what drive or what goal.  Predisposition of act.  Different choices/ scope of choices.  Outcomes are produced. Goal Set Choice behavior Behavioral Subsystem  Attachment- goal attainment, form relationships and social bonds.  Aggressive- protect oneself to respond to threats.  Dependency- attention, recognition, physical assistance.  Ingestion- intake of nutrients to obtain knowledge.  Elimination- eliminate waste and to express feelings.  Sexual- to procreate, to have sexual relationships, to develop gender- based identity.  Achievement- mastery or control of some aspect of the environment. System is out of Balance When:  Insufficiency- does not get enough of something.  Discrepancy- not optimally working.  Incompatibility- subsystems conflict.  Dominance- one subsystem is always used. Functional Requirements Needed by Each Subsystem to Fulfill its Function Nurturance Simulation Protection Nurse Goals Contribute to patient welfare as that of fostering efficient and effective behavioral functioning in the person both to prevent illness and during and following illness. How?  Reduce stressful stimuli.  Support natural adaptive process.  Makes changes to environment.  Focus is the patient not illness. Questions? End of Week 7-8