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Concepts
are basically vehicles of
thought that involve
images.
are words that describe
objects, properties, or
events and are basic
components of theory.
Types of Concepts:
Empirical concepts
Empirical Concepts
Easily understood and measured.
Inferential Concepts
Indirectly observable. Cannot be physically
measured as easily.
Abstract Concepts
Non-observable, not easily understood, hard to
accurately measure.
Models
Propositions
NURSING
CHARACTERISTICS OF THEORIES
Theories:
Interrelate concepts in such a
way as to create a different way
of looking at a particular
phenomenon.
Are logical in nature.
Are generalizable.
Are the bases for hypotheses
that can be tested.
Purposes of Theories
A. Practice
-- Serves to guide assessment,
intervention and evaluation of nursing
care
-- Provide a rationale for collecting reliable
and valid data about the health status of
clients, which are essential for effective
decision making and implementation
-- Help build a common terminology to use
in communicating with other health
B. Research
- Offers a framework for generating knowledge
and new ideas
- Assist in discovering knowledge gaps in
specific field of study
C. Education
- Provide a general focus for curriculum design
- Guide curricular decision making
B. Adaptation
Theory
C. Developmental Theory
D. Change Theory
People change throughout their lives. This
growth and change are evident in the dynamic
nature of basic human needs and how they are
met
Change happens daily
Change involves modification or alteration. It
may be planned or unplanned
"Interaction" theories
These theories revolve around the
relationships nurses form with patients.
"Outcome" theories
These portray the nurse as the changing force, who
enables individuals to adapt to or cope with ill
health (Roy 1980).
"Humanistic" Theories:
Humanistic theories developed in response to
the psychoanalytic thought that a persons
destiny was determined early in life.
Interacti
on
Theorist
King
Orlando
Peplau
Travelbee
Wiedenba
ch
Outcome
Theorist Humanisti
c Theorists
Johnson
Levine
Rogers
Roy
Paterson
Zderad
CONCLUSION
Theory and practice are related.
To develop nursing as a profession the concept of
theory must be addressed.
If nursing theory does not drive the development
of nursing, it will continue to develop in the
footsteps of other disciplines such as medicine.
A. ENVIRONMENTAL THEORY
ENVIRONMENTALPHILOSOPHY
Nursing ought to signify the proper use of fresh air,
light, warmth, cleanliness, quiet, and the proper
selection and administration of diet all at the
least expense of vital power to the patient
1. Health of houses
2. Ventilation and warming
3. Light
4. Noise
5. Variety
6. Bed and bedding
7. Cleanliness of rooms and walls
8. Personal cleanliness
9. Nutrition and taking food
10. Chattering hopes and advices
11. Observation of the sick
12. Petty management
1. Health of Houses
Is closely related to the presence of pure air, pure
water, efficient drainage, cleanliness and light
According to Nightingale, badly constructed
houses do for the healthy what badly constructed
hospitals do for the sick.
Once a stagnant air is stagnant, sickness is certain
to follow
3. Light
Nightingale advocated that the sick needs both fresh air
and light direct sunlight was what clients wanted
She noted that the light has quite real and tangible effects
upon the body
4. Noise
Nightingale believed that patients should never be waked
intentionally or accidentally during the first part of sleep
She averred that whisper or long conversation about
patients are thoughtless and cruel especially when held so
that the patient knows (or assumes) the conversation is
about him
5. Variety
Nightingale stressed that variety in environment was a
critical aspect affecting the patients recovery
She believed in the need for changes in color, form,
including bringing patient brightly colored flowers or plants
8. Personal Cleanliness
Nightingale viewed that function of the skin is important
and she believed that unwashed skin poisoned the patient
and noted that bathing and drying the skin provide great
relief to the patient
She also advocated that personal cleanliness extended to
the nurse and that every nurse ought to wash her hands
very frequently during the day
The Environmental
Adaptation Concepts:
Florence Nightingales original
theory for nursing practice was
holistic.
Her concepts included
human/individual,
society/environment,
health/disease and nursing.
She focused more on physical
factors than on psychological
needs of patients because of the
nature of nursing practice during
her time.
Six Ds of Dysease:
Dirt
Drink (need clean
drinking water)
Diet
Damp
Draughts (Drafts)
Drains (need proper
drainage and sewer
systems)
Faye Abdellah
Patient Centered Approaches to Nursing Model
The focus of care pendulum
Defined nursing as service to individuals and
families.
Conceptualized nursing as an art and a
science that molds the attitudes, intellectual
competencies and technical skills of the
individual nurse into the desire and ability to
help people, sick or well and cope with their
health needs.
21 Nursing Problems
BASIC TO ALL PATIENTS
To maintain good hygiene.
11 Nursing Skills
NURSING PROBLEMS
Nursing problem presented by a patient is a
condition faced by the patient or patients family
that the nurse through the performance of
professional functions can assist to meet them.
These problems can either be:
a. Overt
b. Covert
PROBLEM SOLVING
Involves:
- Identifying the problem
- Selecting pertinent data
- Formulating hypothesis
- Testing hypothesis
- Revising hypothesis on the basis of
conclusions obtained from the data
2. Health
3. Person
One who has physical, emotional, or social
needs
The recipient of nursing care.
4. Environment
Strengths
As a logical and simple statement, Abdellahs
problem-solving approach can easily be used
by practitioners to guide various activities
within their nursing practice.
The problem-solving approach is readily
generalizable to client with specific health
needs and specific nursing problems
Weaknesses
Little emphasis on what the client is to achieve was
given in terms of client care.
Abdellahs framework is inconsistent with the
concept of holism. The nature of the 21 nursing
problems attests to this. As a result, the client may
be diagnosed as having numerous problems that
would lead to fractionalized care efforts, and
potential problems might be overlooked because
the client is not deemed to be in a particular stage
of illness.
Dorothy Johnson
Behavioral System Model
Purpose of Systems Theory
Johnsons 7 Subsystems
1. Attachment or affiliative subsystem serves the
need for security through social inclusion or intimacy
2. Dependency subsystem behaviors designed to
get attention, recognition, and physical assistance
3. Ingestive subsystem fulfills the need to supply
the biologic requirements for food and fluids
4. Eliminative subsystem functions to excrete
wastes
Assumptions
A system tends to achieve a balance among the various
forces operating within and upon it and that man strives
continually to maintain a behavioral system balance and
steady states by more or less automatic adjustments and
adaptations to the natural forces impinging upon him.
The system balance reflects adjustments and adaptations
that are successful in some way and to some degree and
may or will vary from individual to individual.
Strengths:
1. She provided a frame of reference for nurses concerned with
specific client behaviors.
2. Johnsons behavioral model can be generalized across the lifespan
and across cultures.
Weaknesses:
1. does not clearly interrelate her concepts of subsystems.
2. Lack of clear definitions for the interrelationships among and
between the subsystems makes it difficult to view the entire
behavioral system as an entity.
3. The lack of clear interrelationships among the concepts creates
difficulty in following the logic of Johnsons work.
Imogene King
Perception
Self
Growth and development
Body image
Space
Time
B. Interpersonal Systems
- Two or more individuals in interaction form interpersonal
systems. As the member of individuals increases, so
does the complexity of the interaction.
- Concepts critical to understanding interactions between
individuals are as follows:
1.
2.
3.
4.
5.
6.
Communication
Interaction
Role
Stress
Stressors
Transaction
C. Social System
- Are composed of large groups with common interests
or goals. Interactions with social systems influence
individuals throughout the lifespan
- Concepts that are useful to understand interactions
within social systems and between social and personal
systems are as follows:
1.
2.
3.
4.
5.
Organization
Authority
Power
Status
Decision making
Strengths:
Kings theory of goal attainment does describe a logical
sequence of events.
For the most part, concepts are clearly defined.
Although the presentation appears to be complex, Kings theory
of goal attainment is relatively simple.
King formulated assumptions that are testable hypotheses for
research.
Weaknesses:
Kings theory contains major inconsistencies:
(1) She indicates that nurses are concerned about the health care of
groups but concentrates her discussion on nursing as occurring in a
dyadic relationship.
(2) King says that the nurse and client are strangers, yet she speaks
of their working together for goal attainment and of the importance of
health maintenance.
Madeleine Leininger
Strengths:
Leiningers theory is essentially parsimonious in
that the necessary concepts are incorporated in
such a manner that the theory and its model can
be applied in many different settings.
Weakness:
The theory and model are not simple in terms.
Overview
Levines Conservation model is based on 3 major
concepts and assumptions:
1. Conservation
2. Adaptation
3. Wholeness
Conservation
4 Conservation Principles
1.
2.
3.
4.
Conservation of energy
Conservation of structural integrity
Conservation of personal integrity
Conservation of social integrity
(1)Conservation of Energy
- The human body functions by using energy. The
human body needs energy producing input(food,
oxygen, fluids) to allow energy utilization as an
output.
(2) Conservation of Structural Integrity.
-The human body has physical boundaries (skin and
mucous membrane)that must be maintained to
facilitate health and prevent harmful agents from
entering the body.
Adaptation
Is achieved through the frugal, economic,
contained, and controlled use of environmental
resources by the individual in his or her best
interest
Wholeness
Exists when the interactions or constant
adaptations to the environment permit the
assurance of integrity
Strengths:
- Levine has interrelated the concepts of adaptation,
conservation and integrity in a way that provides a nursing
view different from that of the adjunctive disciplines with
which nursing shares these concepts.
- Levines work is logical. One thought or idea flows from the
previous one and into the next.
Weakness:
- There are many concepts with comparatively unspecified
relationships and unstated assumptions.
Major Concepts
1. Person Variables
1.1 Physiological variable refers to physiochemical structure and
function of the body
1.2. Psychological variable refers to mental processes and
emotions
Ex. Self esteem
1.3. Developmental Variable refers to those processes related to
development over the lifespan
2. Central Core
5. Lines of Resistance
- Protect the basic structure and become activated when environmental
stressors invade the normal line of defense
Ex. Activation of the immune response after invasion of microorganisms
6. Reconstruction
- Is the increase in energy that occurs in relation t the degree of reaction to
the stressor.
7. Stressors
-focuses on the impact of stressors on health and addresses stress and the
reduction of stress.
A stressor is any environmental force which can potentially affect the stability
of the system:
- Intrapersonal
- Interpersonal
- Extrapersonal
8. Prevention
- The primary nursing intervention focuses on keeping the
stressors and the stress response from having a
detrimental effect on the body
Modalities:
Primary prevention occurs before the system reacts to
a stressor
Secondary prevention occurs after the system reacts to
a stressor and is provided in terms of existing systems
Tertiary prevention occurs after the system has been
treated through secondary prevention strategies
Strengths:
The major strength of the model is its flexibility for use in all areas of
nursing administration, education, and practice.
Neuman has presented a view of the client that is equally applicable
to an individual, a family, a group, a community, or any other
aggregate.
The emphasis on primary prevention, including health promotion is
specific to this model.
Weakness:
The major weakness of the model is the need for further clarification
of terms used. Interpersonal and extrapersonal stressors need to be
more clearly differentiated.
Major Concepts
Self-care is the performance or practice of activities that
individuals initiate and perform on their own behalf to
maintain life, health and well-being.
Self-care agency is the humans ability or power to engage
in self-care and is affected by basic conditioning factors.
Basic conditioning factors are age, gender, developmental
state, health state, sociocultural orientation, health care
system factors, family system factors, patterns of living,
environmental factors, and resource adequacy and
availability.
Subconcepts
Self-care Requisites or requirements can be defined as actions
directed toward the provision of self-care. It is presented in three
categories:
A. Universal self-care requisites are associated with life
processes and the maintenance of the integrity of human
structure and functioning.
1. The maintenance of a sufficient intake of air
2. The maintenance of a sufficient intake of water
3. The maintenance of a sufficient intake of food
STRENGTHS:
- It is applicable for nursing by the beginning practitioner as well as
the advanced clinicians
- The term self care, nursing system and self care deficit are easily
understood by the beginning student nurse and can be explored
in greater depth as the nurse gains more knowledge and
experience
- She specifically defines when nursing is needed: Nursing is
needed when the individual cannot maintain continuously that
amount and quality of self-care necessary to sustain life and
health, recover from disease or injury or cope with their effects.
WEAKNESS:
- Orems theory is simple yet complex. The use of
self care in multitude terms can be confusing to
the reader
4 LEVELS OF ANXIETY
1. Mildanxiety is a positive state of heightened
awareness and sharpened senses, allowing the
person to learn new behaviors and solve
problems. The person can take in all available
stimuli (perceptual field).
Assumptions
Nurse and patient can interact.
Peplau stresses that both the patient and nurse mature as the
result of the therapeutic interaction.
Communication and interviewing skills remain fundamental
nursing tools.
Peplau believed that nurses must clearly understand themselves
to promote their clients growth and to avoid limiting clients
choices to those that nurses value.
Strengths:
The phases provide simplicity regarding the natural
progression of the nurse-patient relationship.
This simplicity leads to adaptability in any nurse-patient
interaction, thus providing generalizability.
Weaknesses:
Health promotion and maintenance were less emphasized.
The theory cannot be used in a patient who doesnt have a
felt need such as with withdrawn patients.
Strengths:
Rogers concepts provide a worldview from which nurses may derive
theories and hypotheses and propose relationships specific to different
situations.
Rogers work is not directly testable due to lack of concrete hypotheses,
but it is testable in principle.
Weaknesses:
It is an abstract, unified, and highly derived framework
and does not define particular hypotheses or theories.
Concepts are not directly measurable thus testing the
concepts validity is questionable.
It is difficult to comprehend because the concepts are
extremely abstract.
Nurses roles were not clearly defined.
No concrete definition of health state
B. Regulator subsystem
A basic type of adaptive process that responds automatically through neural, chemical, and
endocrine coping channels.
Focal stimuli
Those stimuli that are the proximate causes of the situation.
Contextual stimuli
All other stimuli in the internal or external environment, which
may or may not affect the situation.
Residual stimuli
Those immeasurable and unknowable stimuli that also exist
and may affect the situation
Strengths:
A major strength of the model is that it guides nurses to use observation
and interviewing skills in doing an individualized assessment of each
person.
The concepts of Roys model are applicable within many practice settings of
nursing.
Weaknesses:
Painstaking application of the model requires significant input of time and
effort.
Roys model has many elements, systems, structures and multiple
concepts.
Assumptions
The motivation and energy necessary for healing
exist within the patient, rather than in the health care
team.
The three aspects of nursing should not be viewed
as functioning independently but as interrelated.
The three aspects interact, and the circles
representing them change size, depending on the
patients total course of progress.
Strengths:
The use of the terms care, core, and cure are unique to Hall.
Halls work appears to be completely and simply logical.
Weaknesses:
Halls work is simple in its presentation. However, the openness
and flexibility required for its application may not be so simple for
nurses whose personality, educational preparation, and
experience have not prepared them to function with minimal
structure. This and the self-imposed age and illness
requirements limit the generalizability
Subconcepts
Patient Behavior
This sets the nursing process discipline in motion.
All patient behavior, no matter how insignificant, must be
considered an expression of need for help until its meaning to a
particular patient in the immediate situation is understood.
The presenting behavior of the patient, regardless of the form in
which it appears, may represent a plea for help (Orlando, 1990).
Patient behavior may be verbal or nonverbal. Inconsistency
between these two types of behavior may be the factor that alerts
the nurse that the patient needs help.
Distress
The patients behavior reflects distress when the patient
experiences a need that he cannot resolve, a sense of
helplessness occurs.
Some categories of patient distress are: physical limitations,
adverse reactions to the setting and experiences which
prevent the patient from communicating his needs (Orlando,
1990).
Nurse Reaction
The patient behavior stimulated a nurse reaction, which
marks the beginning of the nursing process discipline.
This reaction is comprised of three sequential parts
(Orlando, 1972). First, the nurse perceives the behavior
through any of her senses. Second, the perception leads to
automatic thought. Finally, the thought produces an
automatic feeling.
The nurse does not assume that any aspect of her reaction
to the patient is correct, helpful, or appropriate until she
checks the validity of it in exploration with the patient
(Orlando, 1990).
The nurse must learn to identify each part of her action so
the process becomes logical rather than intuitive and thus,
disciplined rather than automatic
Assumptions
When patients cannot cope with their needs without help, they become distressed
with feelings of helplessness.
Patients are unique and individual in their responses.
Nursing offers mothering and nursing analogous to an adult mothering and nurturing
of a child.
Nursing deals with people, environment and health.
Patient need help in communicating needs, they are uncomfortable and ambivalent
about dependency needs.
Human beings are able to be secretive or explicit about their needs, perceptions,
thoughts and feelings.
The nurse patient situation is dynamic, actions and reactions are influenced by both
nurse and patient.
Strengths:
Use of her theory assures that the patient will be treated as individuals and they
will have an active and constant input into their own care.
Assertion of nursings independence as a profession and her belief that this
independence must be based on a sound theoretical frame work.
Guides the nurse to evaluate her care in terms of objectively observable patient
outcomes.
Weaknesses:
Lack the operational definitions of society or environment which limits the
development of research hypothesis.
The theory focuses on short term care, particularly aware and conscious
individuals and on the virtual absence of reference group or family members.