Conceptual Model & Nursing Theory
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CONCEPTUAL MODEL AND NURSING THEORY PRESENTED BY: 3th GROUP AMIR SYAM EDY HAPSAH NIA ROSAMEY WARDIYAH
The Holarchy of Contemporary Nursing Knowledge: Five Components
Metaparadigm
Philosophies
Conceptual Models
Theories
Methodologies for inquiry and practice Jacqueline Fawcett, PhD, RN, FAAN Professor, 2006
CONCEPTUAL MODEL & NURSING THEORY
Concept Definition:
– an abstraction – creates an image of an idea we want to share – representations of particular aspects of human behavior and characteristics Pain Coping Grief Resilience
Alexis Morgan, WWF Canada, Oct 2005
Conceptual Model A visual method (diagram) of representing a set of causal relationships between factors that believed to impact one or more biodiversity targets.
Alexis Morgan, WWF Canada, Oct 2005
Theory “…is a general statement that summarizes and organizes knowledge by proposing a general relationship between events - if it is a good one it will cover a large number of events and predict events that have not yet occurred or been observed” Robson C.
The Holarchy of Contemporary Nursing Knowledge: Theories One or more relatively concrete and specific concepts that are derived from a conceptual model, the propositions that narrowly describe those concepts, and the propositions that state relatively concrete and specific relations between two or more of the concepts
Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
NURSING THEORY
Creates a conceptual framework for nursing assessment and intervention
Means of interpreting nurses observations
Comprises the core content of Nursing
Nursing Theories Conceptual
structure that organizes practice and research into ideas central to the discipline
“Nursing
theories are reservoirs in which findings related to nursing concepts, such as comfort, healing, recovering, mobility, rest, caring, enabling, fatigue, and family care, are stored.” Meleis, 1997
“an internally consistent group of relational statements (concepts, definitions & propositions) that present a systematic view about phenomenon and that is useful for description, explanation, prediction and control. A theory ….is the primary means of meeting the goals of the nursing profession concerned with a clearly defined body of knowledge” Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))
Conceptual model
≠
Theory
How may it be different ?
Conceptual Model
abstract impressions organized into symbols of reality Can be tested, changed, or used to guide research An early of development theory process
Theory group of concepts that describe a pattern of reality Research questions, study variables Derived of conceptual models
The Holarchy of Contemporary Nursing Knowledge Metaparadigm
Most abstract Philosophies
Conceptual Models Theories
Methodologies Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
Most concrete
The Holarchy of Contemporary Nursing Knowledge Translated for Empirical Nursing Research Study participants Settings Health conditions Research process
Metaparadigm Philosophies
Ethical conduct of research Approaches to knowledge development
Conceptual Models
Research guidelines
Theories
Research questions Study variables
Empirical Research Methods
Research designs Samples Instruments Data analysis techniques
Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
The Holarchy of Contemporary Nursing Knowledge Translated for Nursing Practice Nursing participants Significant others Practice settings Health conditions Nursing process
Metaparadigm
Philosophies Conceptual Models
Code of ethics Patient’s Rights Philosophy of nursing practice Professional nursing perspective Practice guidelines
Theories
Evidence
Practice Methodologies
Standards for Practice Practice Tools Intervention protocols
Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
Theory development
Starts with defining concepts, Next suggests relationships bxn concepts Tests and evaluates the relationships Modifies theory based on research findings Theories develop and mature Various stages with increasing complexity
SISTER CALLISTA ROY 6 Step Nursing Process : 1.Assesses the behaviours manifested from the four adaptive modes 2.Assess the stimuli, and categorize them into Assess the stimuli, and categorize them into type of stimuli type of stimuli 3.Create a nursing diagnosis of the person’s s adaptive state adaptive state 4.Set goals to improve adaptation 5.Implement interventions to achieve goals Implement interventions to achieve goals 6.Evaluate if goals have been met
Hildegard Peplau Interpersonal Relations Model • Person An individual; a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium • Environment- Not defined
Hildegard Peplau Interpersonal Relations Model
Health
Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
Hildegard Peplau Interpersonal Relations Model
Nursing – A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible – Involves problemsolving
Virginia Henderson The Nature of Nursing The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge.
the theory is useful in :
Dorothe a Orem SelfCare Model
1. developing and guiding practice and research. 2. gives directions to nursing-specific outcomes 3. related to knowing and meeting the therapeutic self-care demands, regulating the development and exercise of self-care agency, establishing self-care and self-management systems, and others. 4. the design of curriculums for preservice, Graduate, and continuing nursing education. 5. gives direction to nursing administration. The development of theory-based computer systems, assessment forms, and the overall structuring of the delivery of care attests to the usefulness of the theory (Tomey & Alligood,2002).
Jean Watson Philosophy and Science of Caring The nurse’s role is to: 1. Establish a caring relationship with patients 2. Treat patients as holistic beings (body, mind and spirit) 3. Display unconditional acceptance 4. Treat patients with a positive regard 5. Display unconditional acceptance 6. Treat patients with a positive regard 7. Promote health through knowledge and intervention 8. Spend uninterrupted time with patients: “caring moments”
Recently Nursing Care Phenomenon
X Hospital Nurses m syte nal ctio Fun
Client Y
with
Holistic need
Case:
Tn. Y, 67 thn. MRS X dengan KU: tidak bisa menggerakkan bagian kiri tubuhnya. Bibir mencong ke kanan. Dialami sejak 2 jam SMRS. Riwayat penyakit hipertensi sejak usia 30 tahun. Riwayat merokok satu bungkus per hari sejak usia 12 tahun. Tn. Y adalah seorang pensiunan ABRI. TTV : TD : 200/140 mmHg, P : 36 x/menit, N : 115 x/menit, S: 37,4°C. Pertolongan pertama pada Tn. Y diberikan di unit gawat darurat RS X. Klien ditangani dengan pemberian dan pemberian cairan infus sebagai jalur masuknya obat intravena serta pengawasan terhadap tanda-tanda vitalnya. Sebagian besar tindakan ini dilakukan oleh perawat sesuai dengan instruksi dokter.
In case :
assess
Medical order nurses
documentation
Balanced fluid & electrolit Supervise Vital Sign
client
Give Medicine
suffer Not satisfied
Independent
Nothing change
Kondisi
ruang perawatan: 1 perawat menangani 5 – 10 orang pasien tanpa melihat tingkat ketergantungan pasien.
Analysis
Analisis terhadap pelayanan perawat dalam kasus: Askep
tidak diterapkan dengan baik
– Perencanaan tindakan hanya sekedar untuk pendokumentasian. – Implementasi dilakukan tanpa menganalisis masalah klien dan tidak sesuai dengan perencanaan tindakan. – Jarang dilakukan evaluasi tindakan keperawatan.
Lanjutan… Perhatian perawat yang kurang tentang kemandirian & kepuasan klien. Perawat tidak mengerti tentang model keperawatan apa yang sedang dilaksanakannya. Komunikasi terapeutik yang kurang.
Analisis kasus
Masalah keperawatan yang bisa muncul pada klien: – – – – – – – –
Nutrisi kurang dari kebutuhan tubuh Gangguan rasa nyaman Gangguan pola tidur Defisit perawatan diri Hambatan mobilitas fisik Kelemahan Ansietas Kurang pengetahuan
Berdasarkan model Handerson Kebutuhan klien yang terganggu/tdk terpenuhi : Kebutuhan akan nutrisi Kebutuhan isthirahat dan tidur Kebutuhan akan personal hygiene Kebutuhan rasa aman dan nyaman Kebutuhan mobilitas, pengaturan postur Berkomunikasi dengan orang lain dan mengekspresikan emosi, keinginan, rasa takut dan pendapat. Kebutuhan belajar.
Handerson’s Model Perawat
Manusia yg unik dan holistik 14 KDM
Puas
Sbg central figure
Mandiri Askep
Terganggu
profesional
Klien
sakit
Penurunan kemandirian
Menolong klien mencapai kemampuan memenuhi kebutuhannya secara mandiri
Solusi menurut teori Handerson
Pada saat semua itu terjadi seharusnya, perawat ada di samping pasien, mendengarkan keluhannya, memberikan motivasi dan memberikan penjelasan terkait penyakitnya. Seandainya para ahli-ahli keperawatan kita melihat langsung fenomena tersebut, dia akan sangat besedih. Konsep, teori, dan standar asuhan telah dibuat. Namun, implementasinya di lapangan belum optimal.
Dorothea Orem Menurut
Orem, bila ditemukan seorang pasien dengan defisit perawatan diri, maka seorang perawat seyogyanya bertindak menuntun, membimbing, mendukung atau menyediakan lingkungan yang akan meningkatkan kemampuan pasien tersebut.
KESIMPULAN
Ada beberapa hal yang menjadi kesimpulan dari makalah ini : – Perbedaan yang mendasar antara model konseptual dan teori keperawatan adalah bahwa sebuah konsep bisa berkembang menjadi sebuah teori. Konsep lebih menggambarkan simbol-simbol yang abstrak sedangkan teori lebih menggambarkan tentang polapola realita. – Konsep model dan teori keperawatan yang terkait dengan fenomena dalam makalah ini adalah yang dikemukakan oleh Virginia Henderson dan Dorothy E. Orem. – Virginia Henderson mengembangkan keperawatan berdasarkan 14 kebutuhan dasar manusia.
Lanjutan.. – Menurut Henderson, di sinilah letak peran seorang perawat sebagai penolong pasien dalam memenuhi kebutuhan-kebutuhan tersebut – Menurut Orem, bila perawat menemukan seorang individu mengalami defisit perawatan diri, perawat seharusnya menuntun, membimbing, mendukung atau menyediakan lingkungan yang akan meningkatkan kemampuan pasien tersebut. – konsep dan teori sangat berperan penting dalam perkembangan ilmu keperawatan menuju ke profesi keperawatan yang lebih baik.
The Holarchy of Contemporary Nursing Knowledge: Five Components
Metaparadigm
Philosophies
Conceptual Models
Theories
Methodologies for inquiry and practice Jacqueline Fawcett, PhD, RN, FAAN Professor, 2006
CONCEPTUAL MODEL & NURSING THEORY
Concept Definition:
– an abstraction – creates an image of an idea we want to share – representations of particular aspects of human behavior and characteristics Pain Coping Grief Resilience
Alexis Morgan, WWF Canada, Oct 2005
Conceptual Model A visual method (diagram) of representing a set of causal relationships between factors that believed to impact one or more biodiversity targets.
Alexis Morgan, WWF Canada, Oct 2005
Theory “…is a general statement that summarizes and organizes knowledge by proposing a general relationship between events - if it is a good one it will cover a large number of events and predict events that have not yet occurred or been observed” Robson C.
The Holarchy of Contemporary Nursing Knowledge: Theories One or more relatively concrete and specific concepts that are derived from a conceptual model, the propositions that narrowly describe those concepts, and the propositions that state relatively concrete and specific relations between two or more of the concepts
Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
NURSING THEORY
Creates a conceptual framework for nursing assessment and intervention
Means of interpreting nurses observations
Comprises the core content of Nursing
Nursing Theories Conceptual
structure that organizes practice and research into ideas central to the discipline
“Nursing
theories are reservoirs in which findings related to nursing concepts, such as comfort, healing, recovering, mobility, rest, caring, enabling, fatigue, and family care, are stored.” Meleis, 1997
“an internally consistent group of relational statements (concepts, definitions & propositions) that present a systematic view about phenomenon and that is useful for description, explanation, prediction and control. A theory ….is the primary means of meeting the goals of the nursing profession concerned with a clearly defined body of knowledge” Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))
Conceptual model
≠
Theory
How may it be different ?
Conceptual Model
abstract impressions organized into symbols of reality Can be tested, changed, or used to guide research An early of development theory process
Theory group of concepts that describe a pattern of reality Research questions, study variables Derived of conceptual models
The Holarchy of Contemporary Nursing Knowledge Metaparadigm
Most abstract Philosophies
Conceptual Models Theories
Methodologies Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
Most concrete
The Holarchy of Contemporary Nursing Knowledge Translated for Empirical Nursing Research Study participants Settings Health conditions Research process
Metaparadigm Philosophies
Ethical conduct of research Approaches to knowledge development
Conceptual Models
Research guidelines
Theories
Research questions Study variables
Empirical Research Methods
Research designs Samples Instruments Data analysis techniques
Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
The Holarchy of Contemporary Nursing Knowledge Translated for Nursing Practice Nursing participants Significant others Practice settings Health conditions Nursing process
Metaparadigm
Philosophies Conceptual Models
Code of ethics Patient’s Rights Philosophy of nursing practice Professional nursing perspective Practice guidelines
Theories
Evidence
Practice Methodologies
Standards for Practice Practice Tools Intervention protocols
Jacqueline Fawcett, PhD, RN, FAAN Professor, May, 2006.
Theory development
Starts with defining concepts, Next suggests relationships bxn concepts Tests and evaluates the relationships Modifies theory based on research findings Theories develop and mature Various stages with increasing complexity
SISTER CALLISTA ROY 6 Step Nursing Process : 1.Assesses the behaviours manifested from the four adaptive modes 2.Assess the stimuli, and categorize them into Assess the stimuli, and categorize them into type of stimuli type of stimuli 3.Create a nursing diagnosis of the person’s s adaptive state adaptive state 4.Set goals to improve adaptation 5.Implement interventions to achieve goals Implement interventions to achieve goals 6.Evaluate if goals have been met
Hildegard Peplau Interpersonal Relations Model • Person An individual; a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium • Environment- Not defined
Hildegard Peplau Interpersonal Relations Model
Health
Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
Hildegard Peplau Interpersonal Relations Model
Nursing – A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible – Involves problemsolving
Virginia Henderson The Nature of Nursing The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge.
the theory is useful in :
Dorothe a Orem SelfCare Model
1. developing and guiding practice and research. 2. gives directions to nursing-specific outcomes 3. related to knowing and meeting the therapeutic self-care demands, regulating the development and exercise of self-care agency, establishing self-care and self-management systems, and others. 4. the design of curriculums for preservice, Graduate, and continuing nursing education. 5. gives direction to nursing administration. The development of theory-based computer systems, assessment forms, and the overall structuring of the delivery of care attests to the usefulness of the theory (Tomey & Alligood,2002).
Jean Watson Philosophy and Science of Caring The nurse’s role is to: 1. Establish a caring relationship with patients 2. Treat patients as holistic beings (body, mind and spirit) 3. Display unconditional acceptance 4. Treat patients with a positive regard 5. Display unconditional acceptance 6. Treat patients with a positive regard 7. Promote health through knowledge and intervention 8. Spend uninterrupted time with patients: “caring moments”
Recently Nursing Care Phenomenon
X Hospital Nurses m syte nal ctio Fun
Client Y
with
Holistic need
Case:
Tn. Y, 67 thn. MRS X dengan KU: tidak bisa menggerakkan bagian kiri tubuhnya. Bibir mencong ke kanan. Dialami sejak 2 jam SMRS. Riwayat penyakit hipertensi sejak usia 30 tahun. Riwayat merokok satu bungkus per hari sejak usia 12 tahun. Tn. Y adalah seorang pensiunan ABRI. TTV : TD : 200/140 mmHg, P : 36 x/menit, N : 115 x/menit, S: 37,4°C. Pertolongan pertama pada Tn. Y diberikan di unit gawat darurat RS X. Klien ditangani dengan pemberian dan pemberian cairan infus sebagai jalur masuknya obat intravena serta pengawasan terhadap tanda-tanda vitalnya. Sebagian besar tindakan ini dilakukan oleh perawat sesuai dengan instruksi dokter.
In case :
assess
Medical order nurses
documentation
Balanced fluid & electrolit Supervise Vital Sign
client
Give Medicine
suffer Not satisfied
Independent
Nothing change
Kondisi
ruang perawatan: 1 perawat menangani 5 – 10 orang pasien tanpa melihat tingkat ketergantungan pasien.
Analysis
Analisis terhadap pelayanan perawat dalam kasus: Askep
tidak diterapkan dengan baik
– Perencanaan tindakan hanya sekedar untuk pendokumentasian. – Implementasi dilakukan tanpa menganalisis masalah klien dan tidak sesuai dengan perencanaan tindakan. – Jarang dilakukan evaluasi tindakan keperawatan.
Lanjutan… Perhatian perawat yang kurang tentang kemandirian & kepuasan klien. Perawat tidak mengerti tentang model keperawatan apa yang sedang dilaksanakannya. Komunikasi terapeutik yang kurang.
Analisis kasus
Masalah keperawatan yang bisa muncul pada klien: – – – – – – – –
Nutrisi kurang dari kebutuhan tubuh Gangguan rasa nyaman Gangguan pola tidur Defisit perawatan diri Hambatan mobilitas fisik Kelemahan Ansietas Kurang pengetahuan
Berdasarkan model Handerson Kebutuhan klien yang terganggu/tdk terpenuhi : Kebutuhan akan nutrisi Kebutuhan isthirahat dan tidur Kebutuhan akan personal hygiene Kebutuhan rasa aman dan nyaman Kebutuhan mobilitas, pengaturan postur Berkomunikasi dengan orang lain dan mengekspresikan emosi, keinginan, rasa takut dan pendapat. Kebutuhan belajar.
Handerson’s Model Perawat
Manusia yg unik dan holistik 14 KDM
Puas
Sbg central figure
Mandiri Askep
Terganggu
profesional
Klien
sakit
Penurunan kemandirian
Menolong klien mencapai kemampuan memenuhi kebutuhannya secara mandiri
Solusi menurut teori Handerson
Pada saat semua itu terjadi seharusnya, perawat ada di samping pasien, mendengarkan keluhannya, memberikan motivasi dan memberikan penjelasan terkait penyakitnya. Seandainya para ahli-ahli keperawatan kita melihat langsung fenomena tersebut, dia akan sangat besedih. Konsep, teori, dan standar asuhan telah dibuat. Namun, implementasinya di lapangan belum optimal.
Dorothea Orem Menurut
Orem, bila ditemukan seorang pasien dengan defisit perawatan diri, maka seorang perawat seyogyanya bertindak menuntun, membimbing, mendukung atau menyediakan lingkungan yang akan meningkatkan kemampuan pasien tersebut.
KESIMPULAN
Ada beberapa hal yang menjadi kesimpulan dari makalah ini : – Perbedaan yang mendasar antara model konseptual dan teori keperawatan adalah bahwa sebuah konsep bisa berkembang menjadi sebuah teori. Konsep lebih menggambarkan simbol-simbol yang abstrak sedangkan teori lebih menggambarkan tentang polapola realita. – Konsep model dan teori keperawatan yang terkait dengan fenomena dalam makalah ini adalah yang dikemukakan oleh Virginia Henderson dan Dorothy E. Orem. – Virginia Henderson mengembangkan keperawatan berdasarkan 14 kebutuhan dasar manusia.
Lanjutan.. – Menurut Henderson, di sinilah letak peran seorang perawat sebagai penolong pasien dalam memenuhi kebutuhan-kebutuhan tersebut – Menurut Orem, bila perawat menemukan seorang individu mengalami defisit perawatan diri, perawat seharusnya menuntun, membimbing, mendukung atau menyediakan lingkungan yang akan meningkatkan kemampuan pasien tersebut. – konsep dan teori sangat berperan penting dalam perkembangan ilmu keperawatan menuju ke profesi keperawatan yang lebih baik.
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