Ncm 100 Lecture Notes

April 14, 2005 NURSING THEORY  Why the interest in theory? 1. The no. 1 requisite if we have to be on the level of being a professional. 2. To guide us in how to go about the different nursing actions. 3. It becomes a framework for organizing data. Theory – speculative in nature Nursing Theory – mental conceptualization where the perspective is a nursing aspect - explain & describe a particular nursing action - can also predict its effects on clients’ outcome - primary purpose is to generate scientific knowledge - serve several essential purposes 1. Description – clarifying ideas, phenomena, experience or circumstances that are not well understood. E.g. meaning of pain to patient 2. Exploration – how ideas are related. E.g. relationship of pain to patient’s physiological & psychological conditions 3. Explanation – the whys of events & occurrences 4. Prediction & Control – knowing & foretelling correctly what will happen & also how to make it happen. E.g. how to control the severity of the client’s pain Components of a Theory a. Concepts – basic unit in the language of theoretical thinking - can be empirical or concrete (can be observed through the senses) or abstract (not observable) b. Definitions – statements of the meaning of a word c. Assumptions – accepted facts d. Phenomena – reality Types of Theories a. Grand Theories – does not prescribe actions - provide structural framework b. Middle Range Theories – more helpful to nursing practice - narrower focus than grand theory, more precise than grand theories & focus on developing theoretical statements to answer questions about nursing c. Descriptive Theory – speculative; predictive d. Prescriptive – can anticipate what might be the consequences of nursing actions What are included in the nursing paradigm? a. Client/Patient/Person/Individual – control to all nursing models because it is the client who is the primary recipient of nursing care b. Health – a continuum ranging from a completely healthy state where there is no disease to a completely unhealthy state which results to a multifactorial phenomena. - always ask client what is their definition of health to guide you to make decisions regarding their care c. Environment – from simple physical environment to include elements such as living conditions, public sanitation, air & water quality to factors such as IPR & social interactions, internal environment & factors that affect health (psychological, religious beliefs, etc.) d. Nursing – nurse-client relationship, the client is no longer the passive recipient of nursing care

NCM 100 - LECTURE

Page 1 of 9

Summer 2005

CONCEPTS ON PERSON I.

Judeo-Christian View a. Genesis 1:26-28 – “man is made in the image of God; man is to increase in number, fill the earth and subdue it” b. Colossians 3:12-17 – “We are Gods’ chosen people; we have to clothe ourselves with compassion, kindness, humility, gentleness & patience; be forgiving & over all these virtues put on love…Whatever we do whether in word or in deed, we do it all in the name of the Lord.” c. Spiritual Virtues of man/person c.1. Faith – the unquestioning belief in someone or something or the complete trust & confidence or reliance on places in a person or thing. Example, faith in doctors, hospitals… c.2. Hope – nourishes faith, its presence or absence often plays a part in determining the patient’s prognosis, illness, state of well-being & acceptance of dying process c.3. Charity – love for one’s fellowman. It allows one to give up his own pleasures while serving another without even thinking of the sacrifices it entails.

II.

The Scientific Perspective (HC1 Handouts) a. Biological Being – a living organism, who from birth is destined to die, until he does he has to contend continually with forces in his environment. Man responds to the environmental stimuli as a particular unit – be it a solitary cell, a component organism or a member of conglomerate of individuals a.1. Organismic Behavior a.2. Man as a System a.3. The energy-matter exchange of man

III.

The Atomistic Approach Man is viewed as an organism composed of different organ systems & each system is composed of organs & each organ is made up of tissue cells. The cell is the basic unit of the human body.

IV.

Holistic Approach (Total) The study of the total behavior of man in relation to society. Stimuli in the environment provide the necessary forces to enable man to demonstrate consciously or unconsciously the nature of his responses & the subsequent quality & relationship with his environment. Address questions like – How does he cope with stresses? What makes one fail or succeed?

V.

Human Needs Model Maslow’s framework of basic needs is based on the theory that something is a basic need if its absence results in illness, its presence prevents illness or signals health, & meeting an unmet need restores health

VI.

Man as a Rational Being – The Psychosocial Perspective Man, the psychosocial being is capable of rational, logical thinking most of the time but can become irrational & illogical when provoked. His rational side makes him merciful, kind & compassionate, while his irrational nature may make him commit criminal acts against another man. According to Travelbee, Man is “a unique, irreplaceable (cannot be exchanged for another, even with transplants), a one-time being in this world, when he dies he ceases to exist.

NCM 100 - LECTURE

Page 2 of 9

Summer 2005

Theorist’s Concept on Person 1. Rosemarie Rizzo Parse – HUMAN BECOMING – influenced by constant interaction of human and ones environment – Human being is an open being in mutual process with the universe, co-creating patterns of relating with others, “lives at multidimensional realms of the universe all at once, freely choosing ways of becoming, as meaning is given to situations. The human being and the universe are inseparable in the creation of the living experience – Co-creating – man and universe are affecting each other – Rhythmical pattern happens when man interacts with another man – Behavior of a person is influenced by one’s ancestors – Man has a passive relationship with the environment 2. Florence Nightingale – ENVIRONMENTAL THEORY - considers the environment as an important factor - referred to the person as the patient - man inherently has the capacity to heal itself, given the right environment - for most part, the descriptions describe a passive patient 3. Virginia Henderson - DEFINITION OF NURISNG THEORY - 1st theorist to attempt to define what is nursing - “A person is a whole, is complete, & independent being who has 14 fundamental needs.” 1. breathe normally 5. sleep & rest 2. eat & drink adequately 6. select suitable clothes 3. eliminate body waste 7. maintain body temp. 4. move & maintain desirable position 8. keep the body clean & well-groomed 4. Martha Rogers – UNITARY HUMAN BEINGS AS ENERGY FIELD - psychic, physical or molecular energy - energy field – fundamental unit of both living & non-living. - Field is a unifying concept & energy signifies the dynamic nature of the field - A person is irreducible - The person is in continuous exchange with energy (matter & energy) - Pattern – identifies the energy field. It is the distinguishing characteristic of an energy field & is perceived as a single wave - In the unitary being, the whole is greater than the individual parts 5. Sister Callista Roy – ADAPTATION MODEL - person is a biopsychosocial being who is in constant interaction with the environment & that has four models of adaptation based on physiologic needs - man copes with stressors Coping mechanisms to stressors 1. Regulator – coping subsystem that responds automatically through the neural & endocrine system inherently responds 2. Cognator – control processes related to higher brain functions of perception or information processing, judgment & emotion. Adaptive Mode 1. Physiologic – physical response to environmental stimuli & primarily involves the regular subsystems. The basic needs met in this mode are physiologic integrity & is composed of needs associated with oxygenation, nutrition, elimination, etc. 2. Self-Concept – basic need for psychic integrity, its focus is on the psychological & spiritual aspects of the person. 3. Role-Function Mode – defines how the person relates with another as a coping mechanism

NCM 100 - LECTURE

Page 3 of 9

Summer 2005

4. Interdependence – affectional needs are met. Identifies patterns of human values, affection, love & affirmation Coping can be: 1. Adaptive response (Effective Coping) – goal is achieved; those that promote the integrity of a person 2. Ineffective response – goal is not achieved 6. Dorothea B. Orem – SELF-CARE DEFICIT THEORY - man is a unity of several systems & can be able to do self-care activities - self-care activities – those which are performed by the person for himself that contribute to health. Self care must be learned & deliberately performed continuously according to the stages of development - Universal Self-Care Requisites – Activities of Daily Living (ADLs) - Normalcy – that which is essentially human and that which is in accordance with genetics & constitutional characteristics and talents of individuals 7. Imogene King – GOAL ATTAINMENT THEORY - believes that there are 3 interacting systems: Individual (Personal System); Group (Interpersonal System); and Society (Social Systems) 8. Betty Neuman – HEALTH CARE SYSTEMS MODEL - human being is an open system consisting of basic structure or central core of survival factors surrounded by concentric rings that are bounded by lines of resistance, a normal line of defense, & a flexible line of defense - person has a core & outside the core are rings of defenses which can be flexible at certain times, when the normal defenses are low, the normal person gets sick The basic structure energy resources contain the following features: 1. Ability to maintain body temperature within the normal range 2. genetic characteristics/structures 3. response pattern 4. organ strength/weaknesses 5. ego structure 6. knowns or commonalities (inter-relationship) April 15, 2005 9. Patterson & Zderad – HUMANISTIC THEORY - man is related to other man in time and space - a person is beholded to other person from birth until he becomes capable (from time of birth until development) 10. Jean Watson – NURSING & HUMAN SCIENCE AND HUMAN CARE - a person as he/she grows up is confronted with different conflicts - conflicts are inherent to the growth process - all these conflicts are stress provoking 11. Ann Boykin & Savina Schoenhofer – NURSING AS CARING - human beings are persons who are caring from moment to moment & are whole and complete in the moment - all persons are caring, although not all actions are caring Seven assumptions underlie the theory 1. Persons are caring by virtue of their humanness 2. Persons are caring from moment to moment 3. Personhood is a process of living, grounded in caring

NCM 100 - LECTURE

Page 4 of 9

Summer 2005

4. Personhood is enhanced through participating in nurturing relationship with caring others 5. nursing is both a discipline and a profession 6. Personhood are viewed as already complete & continuously grow in completeness, fully caring & unfolding caring possibilities moment to moment CONCEPTS ON ENVIRONMENT Virginia Henderson – everything that is outside of the patient but is connected to the patient is considered the environment & the environment should support the 14 fundamental needs. Dorothea Orem – environment is linked to the individual, forming an integrated & interactive system. It is any setting in which a patient has unmet self-care needs. - A healthy person is one who can do self-care activities - The nurse/caregiver would have to provide for any deficit in the person’s self-care deficits Rosemarie Parse – the environment is viewed as inseparable from the human being, each element participates in the co-creation of a lived experienced; nurse is part of the environment. - the universe is inseparable but complementary & evolves - the nurse is important because the nurse co-creates Florence Nightingale – cleanliness & good drainage system is also important - started to do professional nursing April 16, 2005 Theories on Environment According to Different Theorists 1. Florence Nightingale – ENVIRONMENTAL Theory - The major concepts of health are ventilation, warmth, light, diet, cleanliness & absence of noise. It is external to the person but affecting health of both sick & well persons. The environment is one of the chief resources of infection & must include fresh air, fresh water, efficient drainage, cleanliness & light. Little emphasis was given to social & emotional aspects. -

Addressed psychological aspects on her writings on “Chattering Hopes and Advises” and “Variety” but stressed the physical environment more

Different Aspects in the Environment 1. Health of Houses – presence of pure air (eliminate the source of offensive smells rather than fumigate), pure water, pure drainage, cleanliness & light. 2. Ventilation & Warming – consider the source of air in the patient’s room… “Keep the air he breathes as pure as external air without chilling him”; not to warm, not too cold Effluvia – refers to noxious or foul odors that come from excrements and equipment used to discard excrements (bedpan, urinals) - At present, people experience “building sickness” due to absence of fresh air 3. Light – used for direct sunlight Implication during the present times- Intensive care psychosis or confusion related to the lack of the accustomed cycling of day & night. 2. Sister Callista Roy – all the conditions, circumstances & influences surrounding the person 3. Betty Neuman – environment is viewed as stressors

NCM 100 - LECTURE

Page 5 of 9

Summer 2005

4. Imogene King – environment is constantly changing; focus on what really is the desire of the person; if the person’s goal is not attained, illness comes in. CONCEPTS ON HEALTH Definitions: HEALTH – “State of complete physical, mental & social well-being, and not merely the absence of disease or infirmity” (WHO, 1947) Health is a state of being that people define in relation to their own values, personality & lifestyle. Each person has a personal concept of health. Individual’s view of health can vary among different age groups, gender, race, and culture. Pender (1996) explains that “all people free of disease are not equally healthy”. ILLNESS – is a process in which the functioning of a person is diminished or impaired in one or more dimensions when compared with the person’s previous condition. It is not synonymous with disease; although nurses must be familiar with different kinds of diseases and treatments, they are concerned more with illness, which may include disease, but also the effects on functioning and well-being in all dimensions. Human experience of disease; and may be perceived as loss, challenge, threat, punishment or gain. RISK FACTORS – any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increase the vulnerability of an individual or groups to an illness or accident. The presence of risk factors does not mean that a disease will develop, but risk factors increase the chances that the individual will experience a particular disease or dysfunction Risk factors can be placed in the following categories: genetic & physiologic factors, age, physical environment & lifestyle WELLNESS – an integrated method of functioning which is oriented toward maximizing the potential of which the individual perceives or views the experience of health HEALTH BELIEFS – are a person’s ideas, convictions, and attitudes about health & illness They may be based on factual information or misinformation, common sense or myths, or reality or false expectations HEALTH BEHAVIORS – client’s attitudes towards health HEALTH PROMOTION – anticipating guidance Health promotion activities such as routine exercise and good nutrition, helps clients maintain or enhance their present levels of health; motivate people to act positively to reach more stable levels of health. Models of Health and Illness

NCM 100 - LECTURE

Page 6 of 9

Summer 2005

I.

Health – Illness Continuum Model -

II.

Health is a dynamic state that fluctuates as a person adapts to changes in the internal & external environment to maintain a state of physical, emotional, social development & spiritual well-being. Illness is a process in which the functioning of a person is diminished or impaired in one or more dimensions when compared to the person’s previous condition According to Neuman, “health on a continuum is the degree of client wellness that exists at any point in time, ranging from optimal wellness condition, with available energy at its maximum, to death, which represents total energy depletion.” Central to the health-illness continuum model are risk factors, which are important in identifying the level of health The way clients view their levels of health depends on their attitudes toward health, values, beliefs & perceptions of their physical, emotional, intellectual, social, developmental & spiritual well-being. Most effective when used to compare a client’s present health with the client’s own previous level of health Useful as the nurse helps the client set goals to attain a future level of health Health Belief Model

-

III.

addresses the relationship between a person’s belief & behaviors it provides a way of understanding & predicting how a client will behave in relation to their health & how they will comply with health care therapies. First component on this model involves the individual’s perception of susceptibility to an illness. Second component is the individual’s perception of the seriousness of the illness Third component, which is also called “cue to action”, is the likelihood that a person will take preventive action – results from the person’s perception of the benefits & barriers of taking action. This model helps nurses to understand factors influencing client’s perceptions, beliefs & behaviors in order to plan care that will most effectively assist clients in maintaining or restoring health & preventing illness. Basic Human Needs Model

IV.

basic human needs are elements that are necessary for human survival & death – the extent to which basic needs are met in a major factor in determining a person’s level of health this model can provide a basis for nursing clients of all ages in all health settings Maslow’s hierarchy of needs is a model that nurses can use to understand the interrelationships of basic human needs. According to this model, certain human needs are more basic than others; that is, some needs must be met before other needs. This model is useful for designating priorities of care & for planning individualized care for a client. Role Performance Model

-

Health is the ability to perform all those roles which one has been socialized. Health is defined in terms of the individual’s ability to fulfill societal roles, that is, to perform work. People who can fulfill their roles are healthy even if they appear clinically ill. Example, a man who works all day at his job as expected is healthy even though an x-ray of his lung indicates tumor.

Levels of Preventive Care

NCM 100 - LECTURE

Page 7 of 9

Summer 2005

I.

Primary Prevention - “true prevention”, it precedes disease or dysfunction & is applied to clients considered physically & emotionally healthy - aimed at health promotion includes health education programs, immunization, & physical & nutritional fitness activities

II.

Secondary Prevention - focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions - activities are directed at diagnosis & prompt intervention, thereby reducing severity & enabling the client to return to a normal level of health as easy as possible

III.

Tertiary Prevention - occurs when a defect or disability is permanent & irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications & deteriorations. - Activities are directed at rehabilitation rather than diagnosis & treatment; care at this level aims to keep clients achieve as high a level of functioning as possible despite the limitations caused by illness or impairments.

Impact of Illness on the Client & Family: Changes that take place on the patients when there is illness: 1. BEHAVIORAL & EMOTIONAL CHANGES - people react differently to illness or the threat of illness; reactions depend on the nature of the illness; the client’s attitude toward it; the reaction of others to it, & the variables of illness behavior - short term, non-life threatening illnesses evoke few behavioral changes in the functioning of the client or family - severe illness, particularly one that is life threatening, can lead to more extensive emotional & behavioral changes such as anxiety, shock, denial, anger & withdrawal 2. IMPACT ON BODY IMAGE - Body image is the subjective concept of physical appearance; some illnesses result in changes in physical appearance, & clients & families react differently to these changes. - These reactions of clients & families to change in body image depend on the following: a. the types of changes (e.g. loss of a limb/organ) b. their adaptive capacity c. the rate at which changes take place d. support service available - When a change in body image occurs, the client generally adjusts in the following phases: shock, withdrawal, acknowledgement, acceptance, & rehabilitation. 3. IMPACT ON SELF-CONCEPT - one’s mental image – projected as personality - self-concept is a mental self-image of strengths & weaknesses in all aspects of personality; depends in part on body image & roles but also includes other aspects of psychology & spirituality. - The impact of illness on the self-concepts of clients & family members may be more complex & less readily observed than role changes. - A client whose self-concept changes because of illness may no longer meet family expectations, leading to tension or conflict

NCM 100 - LECTURE

Page 8 of 9

Summer 2005

4. IMPACT ON FAMILY ROLES - People have many roles in life. When an illness occurs, parents & children try to adapt to major changes resulting from a family member’s illness - Role reversal is common; such as reversal of the usual situation can lead to stress, conflicting responsibilities for the adult child, or direct conflict over decision making. 5. IMPACT ON FAMILY DYNAMICS - Family dynamics is the process by which the family functions, makes decisions, give support to individual members & copes with everyday change & challenges. - If a parent in a family becomes ill, family activities & decision making often come to a halt as the other family members wait for the illness to pass, or they delay action because they are reluctant to assume the ill person’s roles or responsibilities.

NCM 100 - LECTURE

Page 9 of 9

Summer 2005