Nursing (theories & models)

Nursing

***The role of the nurse and the relationship with the client is also an important aspect in nursing models •Basic physical care •Psychological support •Relief of discomfort

8 factors that contribute to a holistic approach to nursing:

1. An open system that freely interacts with, influences and is influenced by internal and external forces 2. The provision of health care services that focus on assisting people in maintaining health, avoiding or minimizing disease and disability, restoring wellness, or achieving a peaceful death 3. Involves collaborating with patients and their families to help them cope and adapt to situations of disequilibrium in an effort to regain homeostasis 4. Integrally involved with people at points along the health illness continuum 5. Care is provided regardless of diagnosis, individual differences, age, beliefs, gender, sexual preference or other factors. Nursing supports the value, dignity, and uniqueness of every person and takes their culture and belief system into consideration 6. Requires advanced knowledge and skills: they also must care about their patients 7. Requires concern, compassion, respect & warmth, as well as comprehensive, individualized planning of care, to facilitate patients' growth toward wellness 8. Links theory & research in an effort to answer difficult questions generalized during nursing practice.

Values are determined by "valuing"

1. Choosing- the cognitive (intellectual) aspect of valuing. Ideally values are chosen freely from all alternatives after considering the possible consequences. 2. Prizing- the affective (emotional) aspect of valuing. People usually feel good about their chosen values and cherish the choices they make. 3. Acting- the kinesthetic (behavioral) aspect of valuing. The individual affirms his values by acting on them publicly. A real value is acted on consistently.

3 main categories of beliefs:

1. Descriptive or existential beliefs are those that can be shown to be true or false 2. Evaluative beliefs are those in which there is a judgement about good or bad 3. Prescriptive (encouraged) and proscriptive (prohibited) beliefs are those in which certain actions are judged to be desirable or undesirable

Theory guides the professional nurse in

1. Organizing patient data 2. Analyzing patient data 3. Understanding connections between pieces of data 4. Discriminating between important and less pertinent data 5. Making sound clinical judgements based on evidence 6. Planning effective nursing interventions 7. Predicting outcomes of interventions

What are the four key concepts involved in nursing theories?

Client, Environment, Health, & Nursing

The system may be

Closed or open

PhD in Nursing

Conducts theory testing and theory development research for nursing science development; frames practice, administration or research in nursing works

Theory based education

Through the use of nursing theory in education, nursing has evolved from an applied vocation with knowledge from other disciplines, to a profession with its own based of knowledge

Master's prepared nurses use theoretical perspectives

Focused on the patient for specific nursing outcomes. (Research at this level may be focused on nursing practice and testing nursing interventions with specific patient groups)

Master of science in Nursing

Frames advanced practice with a nursing model or theory; uses theory to guide research with practice questions

Open system

Free movement of information, matter & energy

Values

Freely chosen principles, ideas, or standards held by an individual, class, or group that gives meaning and direction to life

Doctorally prepared nurses used theory to

Generate Nursing knowledge, theory testing and the development of new theory through research

Baccalaureate nurses are introduced to the research process and the use of theory to

Guide research. (The ability to critique and become an informed consumer is important at this level)

Input

How the system interacts with the elements in an environment

The 4 key concepts are defined

in a different way by individual theorists

Virginia Henderson

•"Definition of Nursing" •Person- Recipient of nursing care who is composed of biological, psychological, sociological, and spiritual components •Health- based upon the patients ability to function independently •Environment- External (temp. in dangers in environment) and some discussion of impact of community on the individual and family •Nursing- Assist the person, sick or well, in performance or activities and help the person gain independence as rapidly as possible

Florence Nightingale

•"Legacy of Caring" •Person- Recipient of Nursing care •Health is "not only to be well, but to be able to use well every power we have to use" •Environment- External (temp., bedding, ventilation) Internal (food, water, medications) •Nursing- Alter or manage the environment to implement the natural laws of health

Jean Watson

•"Model of Human Caring" •Person- A "unity of mind-body-spirit-nature" •Health- Harmony, wholeness, and comfort •Environment- A "field of connectedness" at all levels •Nursing- Reciprocal transpersonal relationship in caring moments guided by carative factors

Systems theory is

A method of analysis where larger concepts are divided into smaller parts

Throughput

A process that allows the input to be changed so that it is useful to the system

Values Clarification

Assists the individual in understanding their own values

Theory based research

Enables nurses to improve the quality of care and understand how evidence based practice nursing actions influence patient outcomes

Nursing theory is a useful tool in

Decision making

Theory is used in

Nursing education, nursing research, and nursing practice

Positive feedback

Leads to change within the system with the goal of improving the system

Bachelor of Science in Nursing

Learns the nursing perspective in a nursing model or theory-based curriculum or courses; uses models, theories, and middle-range theories to guide nursing practice

Negative feedback

Maintains stability, does not produce change

Feed back loop

Makes the process circular and links elements together

Associate degree in Nursing

May have a nursing model or theory guided curriculum or courses; may be introduced to middle-range theories for nursing practice

Evaluation

Measuring the success or failure of the output (and the effectiveness of the system)

Closed system

Prevents any movement into & out of the system-generally static & unchanging

Beliefs

Represent the intellectual acceptance of something as true or correct

Advances in nursing practice are only made through the use of

Theory based practice, theory testing research and theory generating research

Hospitals, patients, & families are all

Systems

Client as partner

The client sets goals and take an active part in achieving these goals and help to evaluate these goals

Output

The end result or product of the system

Philosophy

The study of principles underlying conduct, thought and the nature of nursing

Nursing practice is strengthened through

The use of theories and models

Nursing practice is guided by

The work of Nursing theorist

Nursing theory is

used in different ways at each level of nursing education

Understanding systems allows the nurse to

View their patient holistically, understand how hospitals function

Understanding each of these theories

provides a framework for individual nursing practice

Holistic nursing care nourishes

the "whole person", that is the body, mind, & spirit

Client (or person)

• Each individual man, woman, or child • The recipient of nursing care •Generally refers to a single individual, but can refer to a group of individuals such as a community • Complex entities that are affected by various interrelating factors •Mind & body •Individual & the Environment •Person & Person's family ***In many nursing models the "client" does not have to be "sick" but instead is on a continuum of wellness to health

Sister Callista Roy

•"Adaption Model" •Person- "A whole with parts that function as a unity" •Health- "a state and process of being and becoming an integrated and whole human being" •Environment- Internal & external stimuli: "the world within and around humans as adaptive systems" •Nursing- Manipulation of stimuli to foster successful adaption

Imogene King

•"Model of Foal Attainment" •Person- a personal system that interacts with interpersonal and social systems •Health-"Dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one's resources to achieve maximum potential for daily living" •Environment- A context within which human beings grow, develop, and perform daily activities. The internal environment of human beings transforms energy to enable them to adjust to continuous external environment changes •Nursing- A process of human interaction; the goal of nursing is to help patients achieve their goals

Dorothea Orem

•"Self Care Model" •Person- A person under the care of a nurse;a total being with universal developmental needs and capable of self-care •Health- "A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning" •Environment- Physical, chemical, biological, and social contexts within which human beings exist; environmental components include environmental factors, elements, conditions & developmental environments •Nursing- Therapeutic self care designed to supplement self care requisites. Nursing actions fall into 3 categories: wholly compensatory, partly compensatory, and supportive-educational system

Values

•An abstract representation of what is right, worthwhile & desirable •Define ideal modes of conduct and reflect what the individual or group endorse and try to emulate •Relatively stable & resistant to change

Beliefs

•Can also be described as convictions •Groupings of beliefs form codes and creeds •Are opinions that may be, in reality, true or false •Based on attitudes that have been acquired and verified by experience •Generally transmitted from generation to generation, are stable and resistant to change

Philosophy

•Entails a search for meaning in the universe •Philosophies of nursing are statements of beliefs about nursing and expressions of values in nursing •Generally built on a foundation of beliefs about people, environment, health, and nursing

Health beliefs & health behaviors

•Health is relative, ever changing, and affect by genetics, environment, personal beliefs & cultural beliefs •Health affects the entire person-physically, socially, psychologically, & spiritually •Individuals health behaviors are powerful and influence how they respond to efforts to change their health behaviors

Environment

•May be physical environment •Living conditions, public sanitation •Air & water quality •Interpersonal relations Social interactions

Theory based practice

•Occurs when nurses intentionally structure their practice around a particular nursing theory and use it for guidance in the nursing process •Theory provides a systematic way of thinking about nursing that is consistent and guides the decision making process •Empowers nurses to challenge the conventional views of patients, illness, the health care delivery system and traditional nursing interventions.

Health

•Originally thought as an absence of disease •Continuum of completely healthy with no disease to completely unhealthy, resulting in death. •Difficult to define because health may not have the same definition for all. •Young adult with no chronic diseases perceived health differently than older adult with many chronic diseases. •Cultures may define health differently •Definition of "health" changes throughout time

Internal environment

•Personal psychological processes •Religious beliefs •Sexual orientation •Personality •Emotional responses

Theoretical frameworks

•Provide a systematic and knowledgeable approach to nursing practice •Are tools that assist in critical thinking as care is planned for and provided

Nursing theory

•Provides language for explanations of what the nurse does, how it is done and why is it done •Facilitates the transmission of knowledge to students and other health care providers •Contributes to professional autonomy by providing a nursing based guide for practice, education and research •Develops analytical skills, challenges thinking and clarifies values and assumptions