Fundamentals chapter 3

To nightingale the knowledge required to provide good nursing was neither unique nor specialized rather

Nightingale viewed nursing as a central human activity grounded in observation reason and commonsense health practices

Theories articulate significant relationships between concepts in order to

Point to something larger such as gravity, the unconscious or the experience of pain

Henderson conceptualizes the nurses role as assisting the sick or healthy patients independence meeting 14 fundamental needs

...bathing normally Eating and drinking adequately Eliminating body wastes Moving and maintaining a desirable position Sleeping and resting Selecting sutable clothes Maintaining body temp Keeping the body clean and well groomed to protect the skin Avoid dangers and avoid injuring others Communicating w others in expressing emotions needs fears or opinions Worshipping according to ones faith Woorking in such a way that one feels a sense of accomplishment Playing or participating in various forms of recreation Learning discovering or satisfying the curiosity that leads to normal development and health and using available health facilities

Sister callista roys work focuses on the increasing complexity of person and environment self organization and on the relationship between and among persons universe and what can be considered a supreme being or god roy focues on the individual as a

...biopsychosocial adaptive system that employs a feedback cycle of input (stimuli) throughput (control processes) and output (behaviors or adaptive responses) both the pt and environment are sources of stimuli that require modification to promote adaptation an on going purposive response

Orem identifys 3 types of nursing systems (the 5 methods of helping can be used in each)

...wholly compensatory systems are required for individuals who are unable to control and monitor their environment and process information Partly compensatory systems are designed for individuals who are un able to perform some but not all self care activities Supportive education (developmental) systems are for persons who need to learn to perform self care measures and need assistance to do so

Betty neuman viwes the cilent as an open system consisting of a basic structure or central core of energy resources (psychological, psychological, sociocultural, developmental, and spiritual) surrounded by

2 concentric boundaries or rings refered to as lines of resistance whick represent internal factors that help the cilent defend against stressor

A philosophy is

A belief system, often an early effort to define nursing phenomenon and serves as the basis for later theoretical formulations

A group of related ideas or statements best defines

A conceptual framework

A set of shared understanding and assumptions about reality and the world is a definition for

A paradigm

A theroy may be defined as

A system of ideas that is presumed to explain a givien phenomenon.

A supposition or system of ideas that is proposed to explain a given phenomenon best defines

A theory

Self care agency is the

Ability to perform self care activities it consists of two agents a self care agent and a dependent care agent

Orems therapeutic self care demand refers to

All self care activities required to meet existing self care requisites aka actions to maintain health and wellbeing

An example of the lines of resistance is

An increase in the body's leukocyte count to combat infection

In 1966 Virginia Henderson described nursing in relation to the client and their environment but unlike nightingale Henderson sees the nurse as concerned with

Both healthy and ill individuals, acknowledges that nurses interact with clients even when recovery may not be feasible and mentions the teaching and advocacy roles of the nurse

Nightingale is often considered the first theorists describing nursing 150 years ago as

Establishing an environment that allows persons to recover from illness

Person environment health and nursing constitute the metaparadigm for nursing because they

Can be utilized in any setting when caring for a client

Nursing theories vary considerably in their level of abstraction;

Conceptualization of clients,health/illness, environment and nursing Ability to describe, explain or predict phenomena some theories are broad in scope others are limited

Madeleine leininger produced the sunrise model to depict her theory of

Cultural diversity and universality. It emphasizes that health and care are influenced by elements of the social structure such as technology religious and philosophical factors kinship and social systems cultural values political and legal factors economic and educational factors

In order for nurses to assist people of diverse cultures leininger presents 3 intervention modes

Culture care preservation and maintenance Culture care accommodation negotiation or both Culture care restructuring and repatterning She examines what is universal among cultures and what varies

The 4th phase of the nurse client relationship is

In the final phase old needs and goals are put aside and new ones adopted. I once older needs are resolved newer and more mature ones emerge

During the latter half of the 20th century disciplines seeking to establish themselves in universities had to

Demonstrate somthing that nightingale had not envisioned for nursing- a unique body of theoretical knowledge

Critical theory is used in academia to

Describe theories that help elucidate how social structures affect a wide variety of human experiences from art to social practices

Theroys are used to

Describe, predict, and control phenomena

In 1970 Martha Rogers presented her theory of unitary human beings she views the person as an irreducible whole the whole being greater than the sum of its parts she states humans are

Dynamic energy feilds in continous exchange with environmental feilds both are infinite

Debates about the role of theory in nursing practice provide

Evidence that nursing is maturing as both an academic discipline and a clinical profession

The third phase of the nurse client relationship is

Exploration the client derives full value from what the nurse offers through the relationship. The client uses available services based on self intrest and needs. Power shifts from the nurse to the client

The term practice discipline is used for

Fields of study in which the central focus is performance of a professional role

Nursing research is more often informed by midlevel theories that

Focus on the exploration of concepts such as pain, self-esteem, learning and hardness

Nurses applying rodgers theory in practice

Focus on the persons wholeness Seek to promote symphonic interaction between the two energy fields to strengthen the cogerence and integrity of the person Coordinate the human field with the rhythmicities of the environmental field Direct patterns of interaction between the two energy fields to promote maximum health potential

Imogene kings transaction process model was designed to describe the nature of and standard for nurse-client interactions that lead to

Goal attainment that nurses purposefully interact and mutually set explore and agree to means to achieve goals which represents outcomes. When nurses record this in a clients records nurses have data that represents evidence based nursing practice

In the natural sciences the main function of theory is to

Guide research In practice disciplines the main function of theory is to provide new possibilities for understanding the disciplines focus

The purpose of theory in science is to

Help scientists interpret phenomena

Orems self care deficit theory explains not only when nursing care is needed but also

How people can be assisted through 5 methods of helping acting or doing for Guiding Teaching Supporting And providing an environment that promots the pts abilities to meet current and future demands

Parse's human becoming theory proposes 3 assumptions about human becoming

Human becoming is freely choosing personal meaning in situations in the intersubjective process of relating value priorities Human becoming is cocreating rhymatic patterns or relating in mutual process with the universe Human becoming is cotranscending multidimensionally with the emerging possibles

Jean watson belives caring is central to nursing her major asumptions

Human caring in nursing is not just an emotion concern or attitued or benevolent desire caring connotes a person's response Caring is an intersubjective human process and is the moral idea of nursing Caring can b effectively demonstrated only interpersonally Effective caring promotes health and individual or family growth Caring promotes health more than does curing Caring responses accept a person not only as they are now but what they might become A caring environment offers the development of potential while allowing the person to choose the best action for the srlf at any given time Caring occasions involve action and choice by nurse and client if the caring occasion is transpersonal the limitsof openess expand as do human compacities The most abstract characteristics of a caring person is that the person is somehow responsive to another Human caring involves values a will and commitment to care knowledge caring actions and consequences The idea of caring is a starting point a stance an attitude that has to become a will an intention a commitment and a conscious judgment that manifest its selfin concrete acts

The second phase of the nurse client relationship is

Identification the client assumes a posture of dependance, interdependence or independence in a relation to the nurse (relatedness) the nurses focus is to assure the person that the nurse understands the interpersonal meaning of the clients situation

Neuman categorizes stressors as

Intrapersonal stressors which occor within the patient like an infection Interpersonal strossors between individuals like unrealistic role expations and extrapersonal stressors like those that occur outside the person like finacial concerns

The human field image perspective surpasses that of the physical body according to rodgers unitary man:

Is an irreducible four dimensional energy field identified by pattern Manifests characteristics different from the sum of the parts Interacts continously and creatively with the environment Behaves as a totality As a sentient being participates creatively in change

Four influential theories from the 2oth century were

Marxs theroy of alienation, freuds theory of the unconscious, darwins theory of evolution, and Einsteins theory of relativity

Parse's 3 assumptions focuse on

Meaning arises from a person's interrelationship with the world and refers to happenings to which the person attaches varying degrees of significance Rhythmicity is the movement toward greater diversity Cotranscendence is the process of reaching out beyond the self

Which provides the best explanation for describing nursing as a practice discipline

Nursing focuses on performing the professional role

Nightingale viewed nursing as a central human activity grounded in

Observation, reason, and commonsense health practices

The nurse - client relationship evolves in 4 phases the first is

Orientation the client seeks help and the nurse assists the client to understand the problem and the extent of the need for help

Paradigm refers to a

Pattern of shared understandings and assumptions about reality and the world

In the late 20th century much of the theoretical work in nursing focused on articulating relationships between 4 major concepts

Person environment health and nursing because these can be superimposed on almost anywork in nursing they are sometimes collectively known as a metaparadigm for nursing

Which is an accurate statement about the role of the nursing theory

Practice theories assist nurses to reflect on the effectiveness of what they do

Nursing interventions for neumans theory focus on retaining or maintaing systems stability these interventions are carried out in 3 ways

Primary-protecting the normal line of defense and strengthening the flexibility of the line of defense Secondary focuses on strengthening internal lines of reststance reducing the reaction and increasing resistance factors Tertiary prevention focuses on stability and proects reconstitution or return to wellness following treatment

Nightingale linked health with five environmental factors

Pure or fresh air, pure water, efficient drainage, cleanliness and light especially direct sun light

A conceptual framework is a group of

Related ideas, statements or concepts example freuds structure of the mind id ego and superego aka conceptual model or grand theories

Betty neuman developed a model based onthe individuals

Relationship to stress the reaction to it and reconstitution factors that are dynamic in nature reconstitution is the state of adaptation to stressors

In qualitative research theory can be used to help

Select the phenomenon frame the philosophical underpinnings of the study and guide data analysis and interpation

Dorothea Orems theory was first published in 1971 includes 3 related concepts

Self care Self care deficit and nursing systems

Self care theory is based on 4 concepts

Self care Self care agency Self care requisites Therapeutic self care demand

Imogene king slected 15 concepts from the nursing literature as essential knowledge for use by nurses they are

Self, role, perception, communication, interaction, transaction, growth, and development, stress, time, personal space, organization, status, power, authority, and decision making

Paradigms include our notations of reality that are largely unconscious or taken for granted most theories relfect

The dominant paradigm of a culture although some may grow out of developing rival paradigm

Disciplines without a strong theory and research base were refered to as

Soft a negative comparison with the hard natural sciences

To help clients fulfill their needs nurses assume many roles

Stranger teacher resource person surrogate leader and counselor peplaus model continues to be used w psych patients

According to betty neumans theory outside the lines of resistance are 2 lines of defense

The inner or normal line of defense depicted as a solid line represents the persons state of equilibrium or adaptation developed and maintained over time and considered normal for them. The flexible line of defense depicted as a broken line is dynamic and can be rapidly altered over a short period of time it is a proective buffer to prevent stressors from penetrating the normal line. Sleep deprivation can create rappid changes

In the late 20th century much of the theoretical work in nursing focused on articulating relationships among 4 major concepts

The person or client is the recipient of nursing care The environment is the internal and external surroundings that affect the client this includes family and friends Health is the degree of wellness or wellbeing that the client experiences Nursing is the attributes, characteristics, and actions of the nurse providing care on behalf of, or in conjunction with the client

The goal of roys model is to enhance life processes through adaptation in 4 modes

The physiological mode involves the body's basic physiological needs and ways of adapting with regard to fluid electrolytes activity and rest circulation and o2 nutrition and elimination protection the senses and neurologic and endocrine function The self-concept mode has 2 components the physical self which involves sensation and body image and the personal self which involves self idea self consistency and the moral ethical self The role function mode is determinedby the need for social integrity and refers to the performance of duties based on given positions with in society The interdependence mode involves ones relations w significant others and support systems that provide help affection and attention

Sister callista roy defines adaptation as

The process and outcome whereby thinking and feeling person uses conscious awareness and choice to create human and environmental integration

Adaptive response contribute to health which roy defines as

The process of being and becoming intergrated ineffective or maladaptive response do not contribute to health each pts adaptive level is unique and constantly changing

Imogene kings theory of goal attainment in 1981 was derived from her conceptual framework which shows

The relationship of personal systems (individuals) interpersonal systems (groups such as nurse client) and social systems (health care or education systems)

Hildegard peplau was a psychiatric nurse her interpersonal concepts in 1952 central to pleplaus theroy is the existence of a

Therapeutic relationship between the nurse and the client

Self care refers to

Those activities an individual performs independently throughout life to promote and maintain personal wellbeing

Self care requisites or self care needs are measures or actions taken to provide self care there are 3 categorys

Universal are common to all people like maintaining intake and elimination of air, water, and food, balancing rest solitude and social interaction preventing hazards to life and wellbeing The second is developmental requisites from maturation or associated conditions or events like change in body image or loss of spouse Third health deviation requisites result from illness injury or disease or its treatment like seeking health care taking meds living w effects of both