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Life Perspective Rhythm Model Joyce Fitzpatrick Introduction Life Perspective Rhythm Model is a nursing model developed by Joyce J Fitzpatrick. She conceptualized her model from Martha Rogers' Theory of Unitary Human beings. About the Theorist

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"A developing discipline whose central concern is the meaning attached to life (health) Primary purpose of nursing is the promotion and maintenance of an optimal level of wellness.

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The human is unitary, continuously coconstituting patterns of relating. The human is transcending multidimensionally with the possibles

About Becoming

Metaparadigm It refers to the transitions through basic metaparadigm concepts of person, environment, health and nursing. Conclusion Life Perspective Rhythm Model is a complex nursing model which contribute to nursing knowledge by providing taxonomy for identifying and labeling nursing concepts to allow for their universal recognition and communication with others. Human Becoming Theory Rosemarie Rizzo Parse INTRODUCTION The Parse theory of human becoming guides nurses In their practice to focus on quality of life as it is described and lived (Karen & Melnechenko, 1995). The human becoming theory of nursing presents an alternative to both the conventional bio-medical approach and the bio-psycho-social-spiritual (but still normative) approach of most other theories of nursing.(ICPS) The human becoming theory posits quality of life from each person's own perspective as the goal of nursing practice.(ICPS) Rosemarie Rizzo Parse first published the theory in 1981 as the "Man-living-health" theory (ICPS) The name was officially changed to "the human becoming theory" in 1992 to remove the term "man," after the change in the dictionary definition of the word from its former meaning of "humankind." ABOUT THE THEORIST

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Born in 1944 BSN - Georgetown University MS in psychiatric-mental health nursing Ohio State University PhD in nursing - New York University and an MBA from Case Western Reserve University. Fellow in the American Academy of Nursing - 1981 Presently, Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

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Becoming is unitary human-living-health. Becoming is a rhythmically coconstituting human-universe process. Becoming is the human’s patterns of relating value priorities. Becoming is an intersubjective process of transcending with the possibles. Becoming is unitary human’s emerging

Three Major Assumptions of Human Becoming

Meaning

Major Assumptions

Human Becoming is freely choosing personal meaning in situations in the intersubjective process of living value priorities. Man’s reality is given meaning through lived experiences Man and environment cocreate

"The process of human development is characterized by rhythms that occur within the context of continuous personenvironment interaction." Nursing activity focuses on enhancing the developmental process toward health. A central concern of nursing science and the nursing profession is the meaning attributed to life as the basic understanding of human existence. The identification and labeling of concepts allows for recognition and communication with others, and the rules for combining those concepts permits thoughts to be shared through language.

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Rhythmicity

Human Becoming is cocreating rhythmical patterns of relating in mutual process with the universe. Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns

Core Concepts Rhythm Model includes four content concepts and they are:

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Educated at Duquesne University, Pittsburgh MSN and Ph.D. from University of Pittsburgh Published her theory of nursing, ManLiving-Health in 1981 Name changed to Theory of Human Becoming in 1992 Editor and Founder, Nursing Science Quarterly Has published eight books and hundreds of articles about Human Becoming Theory Professor and Niehoff Chair at Loyola University, Chicago

Transcendence

Human Becoming is cotranscending multidimensionally with emerging possibles. Refers to reaching out and beyond the limits that a person sets One constantly transforms SUMMARY OF THE THEORY

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Person

person health wellness-illness and metaparadigm.

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Person includes both self and others. Person is seen as an open system , a unified whole characterized by a basic human rhythm. The model recognizes individuals as having unique biological, psychological, emotional, social, cultural, and spiritual attitudes.

THEORY DEVELOPMENT

Human Becoming Theory includes Totality Paradigm Man is a combination of biological, psychological, sociological and spiritual factors Simultaneity Paradigm Man is a unitary being in continuous, mutual interaction with environment Originally Man-Living-Health Theory

Health

The human becoming theory was developed as a human science nursing theory in the tradition of Dilthey, Heidegger, Sartre, Merleau-Ponty, and Gadamer and Science of Unitary Human Beings by Martha Rogers . The assumptions underpinning the theory were synthesized from works by the European philosophers, Heidegger, Sartre, and Merleau-Ponty, along with works by the pioneer American nurse theorist, Martha Rogers. The theory is structured around three abiding themes: meaning, rhythmicity, and transcendence.

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Health is a dynamic state of being that results from the interaction of person and the environment. 'a human dimension under continuous development, a heightened awareness of the meaningfullness of life. Optimum health is the actualization of both innate and obtained human potential gathered from rewarding relationships with others, goal directed behavior, and expert personal care.

NURSING PARADIGMS AND PARSE'S THEORY

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 Person Open being who is more than and different from the sum of the parts  Environment Everything in the person and his experiences Inseparable, complimentary to and evolving with  Health Open process of being and becoming. Involves synthesis of values  Nursing A human science and art that uses an abstract body of knowledge to serve people SYMBOL OF HUMAN BECOMING THEORY

ASSUMPTIONS About man

Wellness-llness

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Nursing

Professional nursing is rooted in the promotion of wellness practices.

The human is coexisting while coconstituting rhythmical patterns with the universe. The human is open, freely choosing meaning in situation, bearing responsibility for decisions.

STRENGTH AND WEAKNESSES Strengths 6.University of Tennessee in 1962 Master’s degree . its recovery and prevention. Newman also redefines nursing according to her nursing is the process of recognizing the individual in relation to environment and it is the process of understanding of consciousness. pathology Nursing is “caring in the human health experience”. (Newman. health.University of California in 1964 Doctorate . 2. laughter. no matter how disordered and hopeless it may seem. 1983 INTRODUCTION 4. Health encompasses conditions heretofore described as illness. According to Newman understanding the pattern is essential. Does not utilized the nursing process/diagnoses Negates the idea that each person engages in a unique lived experience Not accessible to the novice nurse Not applicable to acute. is part of the universal process of expanding consciousness – a process of becoming more of oneself. Nurses often relate to such people: people facing the uncertainty. Humans are open to the whole energy system of the universe and constantly interacting with the energy. RESEARCH ON PARSE'S THEORY 1. Nursing practice in human becoming: the "Parse nurse" in French Switzerland The lived experience of suffering: a parse research method study On joy-sorrow: a paradoxical pattern of human becoming Human becoming criticism--a critique of Florczak's study on the lived experience of sacrificing something important A Human Becoming perspective on quality of life Feeling respected: a Parse method study Health As Expanding Consciousness Margaret Newman “Health is the expansion of consciousness. no control group. 5. debilitation.   Research considered to be in a “closed circle” Rarely quantifiable results . particularly in that it does not seek to “fix” problems Ability to see patients perspective allows nurse to “be with” patient and guide them toward desired health outcomes Nurse-person relationship cocreates changing health patterns BACHGROUND OF THE THEORIST      Born on October 10. etc. quality of life and quality of nursing practice Expands the theory of human becoming Builds new nursing knowledge about universal lived experiences which may ultimately contribute to health and quality of life  THEORY DEVELOPMENT She was influenced by following theorists: CRITIQUE  Congruence with personal values o Nurse must subscribe to this world view to truly use it Congruence with other professional values o Complements and competes with other health care professionals’ values o Exoteric foundations o Esoteric utility Congruence with social values o Fulfills society’s expectations of nursing role Social Significance   Martha Rogers o Martha Roger’s theory of Unitary Human Beings was the main basis of the development of her theory. Pennsylvania State University. then that is health for that person Health is an expansion of consciousness. Nursing is seen as a partnership between the nurse and client.” Newman. Bachelor’s degree . The theory asserts that every person in every situation. hope. and of reaching new dimensions of connectedness with other people and the world” (Newman. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. standardized questions. 2010). The theory asserts that every person in every situation. of finding greater meaning in life. The nurse helps to understand people to use the power within to develop the higher level of consciousness. is part of the universal process of expanding consciousness – a process of becoming more of oneself. The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible. 4.) 6. New York University. in medical terms. loss and eventual death associated with chronic illness.New York University in 1971 She has worked in . with both grow in the “sense of higher levels of consciousness” . no matter how disordered and hopeless it may seem. etc. University of Minnesotat. Newman also explains the interrelatedness of time. 3. or. emergent care   The theory of health as expanding consciousness stems from Rogers' theory of unitary human beings. University of Minnesota Link to her Biography    Enhances understanding of human lived experience. 2010).Difficult to compare to other research studies. NURSING PARADIGMS Health      Weaknesses 5. Time and space are the temporal pattern of the individual. Differentiates nursing from other disciplines Practice . space and movement. With this process of interaction humans are evolving their individual pattern of whole. The expanding consciousness is the pattern recognition.    Nursing     ASSUMPTIONS 1. DESCRIPTION OF THE THEORY “The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. both have complementary relationship.       APPLICATION OF THE THEORY Nursing Practice     Research A transformative approach to all levels of nursing Differs from the traditional nursing process. Health as Expanding Consciousness Itzhak Bentov – The concept of evolution of consciousness Arthur Young – The Theory of Process David Bohm – The Theory of Implicate  “Health and illness are synthesized as health . The manifestation of disease depends on the pattern of individual so the pathology of the diseases exists before the symptoms appear so removal of disease symptoms does not change the individual structure.Provides guidelines of care and useful administration Useful in Education Provides research methodologies Provides framework to guide inquiry of other theories (grief. Humans are constantly changing through time and space and it shows unique pattern of reality. 2010). The theory has progressed to include the health of all persons regardless of the presence or absence of disease. of finding greater meaning in life.2    Black and white = opposite paradox significant to ontology of human becoming and green is hope Center joined =co created mutual human universe process at the ontological level & nurse-person process Green and black swirls intertwining = human-universe co creation as an ongoing process of becoming o Makes a substantial difference in the lives of clients and nurses 2. 2010).University of Tennessee. 1933. These pathological conditions can be considered a manifestation of the total pattern of the individual The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes Removal of the pathology in itself will not change the pattern of the indivdual If becoming ill is the only way an individual's pattern can manifest itself. (Newman. (Newman.the fusion on one state of being (disease) with its opposite (non-disease) results in what can be regarded as health”. Thus it helps to realize the disease process. and of reaching new dimensions of connectedness with other people and the world. 3.

models. implement the change.eagan under the Creative Commons Attribution license. and is inseparable from the larger unitary field” “Persons as individuals.. The first two have seven stages. and dimensions of the concepts of the theory. Many nursing theorists have drwan from the works of von Bertalanffy on systems theory. The driving forces are the change agents who push employees in the direction of change.    Empirical Precision  Quantitative methods are inadequate in capturing the dynamic. The change agent may be a nurse leader. select the change. while the resistant forces were a fear of accountability. or events & are basic components of theory. while planned change is a sequence of events implemented to achieve established goals. Unplanned changes bring about unpredictable outcomes. explain. moving stage. Derivable Consequences   Newman's theory provides an evolving guide for all health-related disciplines. Change may be planned or unplanned. W eaknesses     CRITIQUE Clarity Abstract Multi-dimensional Qualitative Little discussion on environment     Systems theory and Nursing  Semantic clarity is evident in the definitions. the driving force must dominate the resistant force. 1. 2. The driving force in this case was dissatisfaction with the traditional handover method. Spradley's Change Theory This is an eight-step process for planned change based on Lewin's theory of change. Evaluation of the implemented change showed that the new process was successfully implemented. This theory is applied to long-term change projects.3 Human developing awareness of self and the environment” “The human is unitary.   Reddin's. It makes provision for constant evaluation of the change process to ensure its success. Systems are self-correcting through feedback. deductive reasoning and inductive reasoning. plan the change. Every living organism is essentially an open system. propositions & are based on assumptions. Change theories are used to bring about planned change in nursing. predict. They are derived through two principal methods. implementation and adoption.. definitions. Croyle (2005)]. and systematic view of phenomena”. properties. and control practice”   Generality Change Theories in Nursing Change means making something different from the way it was originally. that is cannot be divided into parts. Persons are “centers of consciousness” within an overall pattern of expanding consciousness” Introduction successful. For this theory to be Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects. Real Life Application An article titled "Managing change in the nursing handover from traditional to bedside handover---a case study from Mauritius" details the use of Lewin's and Spradley's theories to implement a change in the process of handover reports between nurses. The five stages are awareness. Types: 1. Nursing theorists use both of these methods. General systems theory is a general science of 'wholeness'. First proposed by Ludwig von Bertalanffy (1901-1972) as General Systems theory. Systems tend to function in the same way. A theory makes it possible to “organize the relationship among the concepts to describe. Environment  Environment is described as a “universe of open systems” STRENGTHS AND WEAKNESSES Characteristics of systems Strengths    Can be applied in any setting “Generates caring interventions” "Systems" refer specifically to selfregulating systems. Lippitt's and Havelock's theories are based on Lewin's theory and can be used to implement planned change. Theory is “a creative and rigorous structuring of ideas that projects a tentative.[Robert T. Theories are composed of concepts. The various parts of a system have functional as well as structural relationships between each other. while the third has six. descriptions. The steps are: recognize the symptoms. Lewin's theory depends on the presence of driving and resistant forces. analyze alternative solutions. and refreezing stage. interest.   The theory has been applied in several different cultures It is applicable across the spectrum of nursing care situations. Systems theory has been applied in developing nursing theories and conducting nursing research. o Neuman's Systems Theory o Rogers 's Theory of Unitary Huamn Beings o Roy's Adaptation Model o Imogene King's Theory of Goal Attainement o Orem Self-care Deficit Theory o Johnson's Behaviour Systems Model Development of Nursing Theories Introduction  Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. In nursing a change agent is a person who brings about changes that impact nursing services. Other Theories      “Consciousness is a manifestation of an evolving pattern of person-environment interaction” Systems Theory in Nursing     Systems theory may be considered as a specialization of systems thinking and a generalization of systems science. The resistant forces are employees or nurses who do not want the proposed change. Systems have a structure that is defined by its parts and processes. and human beings as a species are identified by their patterns of consciousness”… “The person does not possess consciousness-the person is consciousness”. lack of confidence and fear that this change would lead to more work. changing nature of this theory. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Rogers' Change Theory Everette Rogers modified Lewin's change theory and created a five-stage theory of his own. purposeful. diagnose the problem. Systems are generalizations of reality. evaluate the change and stabilize the change. Theory gives planners tools for moving beyond intuition to design and evaluate health behavior and health promotion interventions based on understanding of behavior. evaluation. Nurses and nurse leaders must have knowledge of change theories and select the right change theory as all the available change theories in nursing do not fit all nursing change situations. Definition CONCLUSION Newman's theory can be conceptualized as Lewin's Change Theory Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage. Empirical concepts Inferential concepts    A grand theory of nursing Humans can not be divided into parts Health is central to the theory and is seen “and is seen as a process of . staff nurse or someone who works with nurses. nut just the isolated concepts. "Dosimeter" is Copyrighted by Flickr user: . The theory as a whole must be understood.  Simplicity   The deeper meaning of the theory of health as expending consciousness is complex.

2. The focus of nursing. Nursing care becomes necessary when client is unable to fulfill biological. improved communication between nurses. for example. predict and explain the phenomenon of nursing (Chinn and Jacobs1978). 4. Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the. & physical environment. when met.4 3. and guidance for research and education (Nolan 1996). “Interaction” theories. help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).  6. logical in nature. Following theories are basic to many nursing concepts. Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts. developmental. which further confounds matters. 12. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal. Of the four concepts. the most important is that of the person. Practice theory: explores one particular situation found in nursing.    Models are representations of the interaction among and between the concepts showing patterns. is the person. Based on the philosophical underpinnings of the theories 1. Henderson 1955: The needs often called Henderson’s 14 basic needs Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical. e. that. . the client is an individual. The goal of nursing to reduce stress so that. 3. life experiences & health status. Principles of the discipline can be identified. social. The growth & development of an individual are influenced by heredity. Roy 1979: This adaptation model is based on the physiological. used by the practitioners to guide and improve their practice.       The person (patient). Adaptation is a continuously occurring process that effects change & involves interaction & response. and spiritual needs of the client and family.  emotional. “Needs” theories These theories are based around helping individuals to fulfill their physical and mental needs. the environment. The main exponent of nursing – caring – cannot be measured. humanistic aspects of life. 3. Molecules in chemistry. Human adaptation occurs on three levels : 7. 11. B. Historical perspectives and key concepts 1. emotional. changes or functions intended to bring about a desired result.“Interaction” theories As described by Peplau (1988). 3. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient).  Each of these concepts is usually defined & described by a nursing theorist. This can be seen as an attempt by the nursing profession to maintain its professional boundaries. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position.     interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. Their main limitation is that they are only as accurate or useful as the underlying theory. beginning with conception & ending with death. although these concepts are common to all nursing theories. Depending On Function (Polit et al 2001) 1. It should provide the foundations of nursing practice. 9. Common concepts in nursing theories Four concepts common in nursing theory that influence & determine nursing practice are: 2. intellectual. 4. The social (others) & 3. Orlando 1962: To Ida Orlando (1960). “Needs “theories. 5. Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. Rogers 1970: to maintain and promote health. Neuman 1972: Stress reduction is goal of system model of nursing practice. temperament. bases for hypotheses that can be tested. and organs in Anatomy & Health in Nursing. C. “Outcome “theories. psychological. Descriptive-to identify the properties and workings of a discipline Explanatory-to examine how properties relate and thus affect the discipline Predictive-to calculate relationships between properties and how they occur Prescriptive -to identify under which conditions relationships occur  Importance of nursing theories    1. often uniquely. sociological and dependenceindependence adaptive modes. Developmental Theory  It outlines the process of growth & development of humans as orderly & predictable. Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). The terms ‘model’ and ‘theory’ are often wrongly used interchangeably. It identifies explicit goals and details how these goals will be achieved. These concepts may be applied to different kinds of systems. with a need. The internal (self) 2. 2. functions) D. Process it is a series of actions. The characteristics of theories Theories are: 1. They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice. In nursing. models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). Basic processes in the development of nursing theories Nursing theories are often based on & influenced by broadly applicable processes & theories. Classification of nursing theories A. The benefits of having a defined body of theory in nursing include better patient care. diminishes distress. the client can move more easily through recovery. nursing continues to strive to establish a unique body of knowledge.  8. and principles but will leave open unanswered questions that need to be investigated. As medicine tries to make a move towards adopting a more multidisciplinary approach to health care.   10. The environment Health Nursing (goals. health & nursing. Definitions Abstract concepts   increasing the general body of knowledge within the discipline through the research implemented to validate them. 2. laws.g. consistent with other validated theories. 1. General System Theory It describes how to break whole things into parts & then to learn how the parts work together in “systems”. King 1971: To use communication to help client reestablish positive adaptation to environment. 2. or enhances well-being. increases adequacy. 4. roles. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things & to environmental conditions. prevent illness. Johnson’s Theory 1968: Dorothy Johnson’s theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. therapeutic interpersonal process. psychological. generalizable. Humanistic theories. enhanced professional status for nurses. the physical (biochemical reactions)   Nursing theory aims to describe. Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). through specific methods of assessment. it is vital to have the theory to analyze and explain what nurses do. Depending on the Generalisability of their principles 1. Grand theory: provides a conceptual framework under which the key concepts and      2. It helps to distinguish what should form the basis of practice by explicitly describing nursing. The progress & behaviors of an individual within each stage are unique. these theories revolve around the relationships nurses form with patients. regardless of definition or theory. and care for and rehabilitate ill and disabled client through “humanistic science of nursing” Orem1971: This is self-care deficit theory. Nightingale (1860): To facilitate “the body’s reparative processes” by manipulating client’s environment Peplau 1952: Nursing is. cultures in sociology. or social needs. Propositions are statements that explain the relationship between the concepts. A particular theory or conceptual frame work directs how these actions are carried out.

5  Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. Humanists believe that the person contains within himself the potential for healthy & creative growth.” 3. 2. “Humanistic” Theories An example of systems interaction Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life. “Outcome” theories" A system is defined as “a whole with interrelated parts. and health. Groups (two or more persons) form “interpersonal systems. The term metaparadigm comes from the Greek prefix “meta. 3. Two nursing models based on systems theory: 1.Systems Theory as a Framework  Systems theory is concerned with changes caused by interactions among all the factors (variables)  . 2002). person-centered approach now practice in nursing. or maintain optimal system stability” (Neuman. Intrapersonal: forces arising from within the person Interpersonal: forces arising between persons Extrapersonal: forces arising from outside the person Health According to Fawcett (2000). The reaction may lead toward restoration of balance or toward death. Categories of Conceptual Models Ten conceptual models of nursing have been classified according to two criteria: Nursing Imogene King’s Systems Interaction Model In interaction model. in which the parts have a function and the system as a totality has a function”. and generalizations are formulated (Merriam-Webster’s Collegiate Dictionary. The person is a composite of physiologic. laws. 1989). Stressors are tension-producing stimuli that have the potential to disturb a person’s equilibrium or normal line of defense.    Humanistic theories emphasize a person’s capacity for self-actualization. or created environment. Neuman intends for the nurse to “assist clients to retain. attain. “The goal of nursing is to help individuals and groups attain. a dynamic protective buffer made up of all variables affecting a person at any given moment the person’s resistance to any given stressor or stressors. A general systems approach allows for consideration of the subsystems levels of the human being. 1996). These four concepts form a metaparadigm of nursing. 1. 2002). Neuman defines illness as “a state of insufficiency with disrupting needs unsatisfied” (Neuman. develop. the purpose of nursing is to help people attain. 1981). “Illness is a deviation from normal. health (wellness) seems to be related to dynamic equilibrium of the normal line of defense. developmental. maintain.     Input (Diet teaching) Throughput (Assimilation of information) Output (Food intake) Feedback (Weight record. The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual. who enables individuals to adapt to or cope with ill health. roles. 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” A process of human interaction  A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions. and Betty Neuman’s health care systems model. or growth/development). external. as a total human being. so. If the flexible line of defense is no longer able to protect the person against a stressor. 2. Stress: “a dynamic state whereby a human being interacts with the environment to maintain balance for growth. Individuals are called “personal systems.” which means a philosophical or theoretical framework of a discipline upon which all theories. and triggers a reaction. can be conceptualized as the client and becomes the target system for nursing intervention (Sills & Hall. 1994). Thus. stress/adaptation. Stress/Adaptation Theory as a Framework In contrast to systems theory. that is.” Resistance to stressors is provided by a flexible line of defense. disturbs the person’s equilibrium. This normal line of defense is the person’s “usual steady state. and the word Greek word “paradigm. the environment (society). and restore health”    the world view of change reflected by the model (growth or stability). Carl Rogers developed a person – centered model of psychotherapy that emphasizes the uniqueness of the individual. Imogene King’s systems interaction model. functions). 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” (King.  1.” which means more comprehensive or transcending. The person must adjust to environmental changes to avoid disturbing a balanced existence. 1981.    A person is constantly affected by stressors from the internal. sociocultural. Society is composed of “social systems. Illness appears to be a separate state when a stressor breaks through the normal line of defense and causes a reaction with the person’s lines of resistance.” 2. caring. stress and adaptation theories view change caused by person–environment interaction in terms of cause and effect.). maintain. or a conflict in a person’s social relationships” (King. he or she must continuously adjust to stressors in the internal and external environment (King. and performance” Betty Neuman’s Health Care Systems Model Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability. psychological. Person (Human Being) A personal system that interacts with interpersonal and social systems   A context “within which human beings Environment grow. Normal line of defense: an adaptational level of health considered normal for an individual Lines of resistance: protection factors activated when stressors have penetrated the normal line of defense 4. and spiritual variables considered simultaneously. Stressors may be of three types: 1. the stressor breaks through. from the level of the individual to the level of society.) Neuman’s model. Hb estimation etc. and the major theoretical conceptual classification with which the model seems most consistent (systems. as an abstraction of reality. and perform daily activities” dynamic life experiences of a human being. General systems theory states   3. Health assumes achievement of maximum potential for daily living and an ability to function in social roles. where stressors are successfully overcome or avoided by the flexible line of defense. “Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences” (Neuman.” It is the way in which an individual usually deals with stressors. development. A conceptual model “gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems” Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client).    Outcome theories have been criticized as too abstract and difficult to implement in practice. Adaptation  As the person interacts with the environment. It is the “dynamic life experiences of a human being. provides a way to visualize reality to simplify thinking. King’s model conceptualizes three levels of dynamic interacting systems. Major Concepts as Defined in King’s Model Models of nursing A model. 1977). Thus the human being.   Oucome theories portray the nurse as the changing force. an imbalance in a person’s biological structure or in his psychological makeup. organized around stress reduction. nursing (goals. or restore health. is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity.

. definitions. everyone should take part in working for its fulfillment. E.6 theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. C. 5 million tons of garbage is disposed daily. most of them are in the urban areas.the condition of being free from harm. Political will . deficiency . and problems. Safety . Like empty coffee cups.                Definition Importance of Nursing Theories The characteristics of theories: Basic Processes in the Development Of Nursing Theories: Nursing theories are often based on & influenced ANA definition of Nursing Practice Common concepts in Nursing Theories: Historical Perspectives & Key Concepts Clasification of Nursing Theories Models Of Nursing Growth and Stability Models of Change Betty Neuman’s Health Care Systems Model Stress/Adaptation Theory as a Framework A unique body of knowledge Criticisms of nursing theories As a result of mainly poverty.a customary action usually done to maintain or promote health like use of anting-anting and lucky charms. Practices .The Philippines is the leading exporter of nurses abroad. 5.It is a set of concepts. A theory presents a systematic way of understanding events or situations. .a state or habit of mind wherein a group of people place into something or a person.The leading causes of death and illness are predeceases and other socially related problems such as AIDS and drug abuse. Pneumonia and tuberculosis are leading cause of death 1. HEREDITY . injury or loss of authority or power The National Health Situation is intimately linked to the economic. ENVIRONMENT .For every 10 deaths.1 Love of God 1.the ability of a person to do something . attitudes and customs shared by a group of people and passed from the generation to the next. diphtheria and rabies. 11 of whom are children. 639 are government owned. 8. Oppression .616. 1. manages and other people in decision making. SOCIO-ECONOMIC . . A VISION OF HEALTHY TOMORROW: Preventive . Croyle (2005)] HEALTH AS A MULTIFACTORIAL PHENOMENON FACTORS AFFECTING HEALTH A. poor sanitation and lack of a safe water supply make an individual susceptible to disease. clothing and shelter Available basic health services Accessible health care facilities Clean environment Danger Signs: To attain the dream of healthy tomorrow.number 1 in the Western Pacific region for tuberculosis. and don’t have a specified content or topic area. integrity and professionalism) . but nothing inside. 6 were not seen by a doctor. genetically determined. with caring as its foundation. monitoring and evaluation of the community’s program COMPETENCY BASED APPROACH TO THE BSN CURRICULUM Within the context of Philippine society. . Conclusion Theory and practice are related.creating the circumstances where people can use their faculties and abilities at the maximum level in the pursuit of common goals 16 Filipinos .536 million Filipinos (millions) in the urban and 35 million in the rural areas) cannot avail of adequate health care because of misdistribution of health personnel and facilities. 6. and control biologic (physiologic and psychological) phenomenon. implementation. and high cost of medicines and services. malnutrition is also a major health problem. [Robert T. Competence c. Confidence d. 2.relating to the representation of non-physical traits. beliefs. die everyday from diarrhea 2 babies die every hour from pneumonia.16 million Filipinos have no access to a sanitary toilet. promotive health care Community participation Traditional medicine Affordable medicine Adequate food. 2. goals. Compassion b. 1. but most stay in the cities 1.the sum of all the conditions and elements that make up the surroundings and influence the development of the individuals. POLITICAL Involves one’s leadership how/she rules. iron and iodine deficiencies. more than 50% pregnant or breastfeeding mothers are anemic. Criticisms of nursing theories To understand why nursing theory is generally neglected on the wards it is necessary to take a closer look at the main criticisms of nursing theory and the role that nurses play in contributing to its lack of prevalence in practice. 2 million of Filipino pre-school children are malnourished. They become useful when filled with practical topics. They are. 7. nursing education. The Philippines: . B.2 Caring as the core of nursing a.Sixty eight percent (68%) of the Filipino doctors go abroad.6 million Filipinos have Vitamin a. Summarization .385 poorly equipped Health Centers. measles and malnutrition. schistosomiasis and polio. Commitment (commitment to a culture of excellence. Empowerment . 1103 are privately owned. 13 million Filipinos have no access to safe water . 4. Of this number. 1.742 hospitals in the country. Beliefs . subscribes to the following core values which are vital components in the development of a professional nurse and are therefore emphasized in the BSN program: 2.number 3 in the world for blindness due to vitamin A.the genetic transmission of traits from parents to offspring. in addition to poor nutrition.Theories must be applicable to a broad variety of situations. political and sociocultural system of the society. 4. distribution of and consumption of goods of an individual. D. 32% of them remain the country. 3. This theory has been widely applied to explain. predict.determination to pursue something which is for the interest of the majority. . Everybody must participate in the planning. There are 1. theories have shapes and boundaries.number I in the world for whooping cough. abstract.refers to the production activities. THE NATIONAL HEALTH SITUATION Majority of the 68.in Manila alone. such as values. discipline.unjust or cruel exercise of authority or power 3. Conscience e. CULTURAL . by nature. There are 2. and propositions that explain or predict these events or situations by illustrating the relationships between variables. diarrhea.

Quality improvement 8. significant others and members of the health team Core competency 2: identifies verbal and non-verbal cues Core competency 3: utilizes formal and informal channels Core competency 4: responds to needs of individuals. Personal and professional development 7.4 Love of Country . Respect for the dignity of each person regardless of creed. gender and political affiliation. Collaboration and teamwork The BSN is a four-year program consisting of general education and professional courses. unprofessional nursing practice Phases of developing competency standards ○ 1st Phase Competency identification through DACUM ○ 2nd Phase Verification of identified competencies ○ 3rd Phase Pilot testing ( senior student in 8 nursing colleges) ○ 4th Phase Benchmarking with exiting standards from 3 countries + ICN 1. Management of resources and environment 3. Record Management 10. enhances this core values. Communication 11. Safe and quality nursing care 2. who. 14 Series of 2009 ○ Personal & professional development ○ Quality improvement ○ Research ○ Record management ○ Communication ○ Collaboration & teamwork LEGAL BASES Article 3 Sec. ethical and technical. and Community Core competency 5: uses appropriate information technology to facilitate communication Collaboration and teamwork Core competency 1: establishes collaborative relationship with colleagues with colleagues and other members of the health team Core competency 2: collaborative plan of care with other members of the health team Source: CHED Memorandum Order (CMO) No. education. local and national Core competency 3: documents care rendered to patients Ethico-moral Responsibility Core competency 1: respects the rights of individual/ groups Core competency 2: accepts responsibility and accountability for own decision and actions Core competency 3: adheres to the national and international code of ethics for nurses Personal and Professional Development Core competency 1: identifies own learning needs Core competency 2: pursues continuing education Core competency 3: gets involved in professional organizations and civic activities Core competency 4: projects a professional image of the nurse Core competency 5: possesses positive attitude towards change and criticism Core competency 6: performs function according to professional standards Quality Improvement Core competency 1: gathers data for quality improvement Core competency 2: participates in nursing audits and rounds Core competency 3: identifies and reports variances Core competency 4: recommends solutions to identified problems Research Core competency 1: gathers data using different methodologies Core competency 2: recommends actions for implementation Core competency 3: disseminates results of research findings Core competency 4: applies research findings in nursing practice Records Management Core competency 1: maintains accurate and updated documentation of patient care Core competency 2: records outcome of patient care Core competency 3: observes legal imperatives in record keeping Communication Core competency 1: establishes rapport with patients. SIGNIFICANCE OF CORE COMPETENCY STANDARDS Unifying framework for nursing practice.a Patriotism (Civic duty. family.7 Core competency 5: evaluates the outcome of health education Legal Responsibility Core competency 1: adheres to practices in accordance with the nursing law and other relevant legislation including contracts. informed consent Core competency 2: adheres to organizational policies and procedures. group. Legal responsibility 5.3 Love of People a. The BSN program aims to produce a fully functioning nurse who is able to perform the competencies under each of the Key Areas of Responsibility.b Preservation and enrichment of the environment and culture heritage A strong liberal arts and sciences education with a transdisciplinary approach. The BSN program provides an intensive nursing practicum that will refine clinical skills from the first year level to ensure basic clinical competencies required of a beginning nurse practitioner. Professional courses begin in the first year and threads through the development of competencies up to the fourth year level. Safe and Quality Nursing Care Core competency 1: demonstrates knowledge base on the health/illness status of individual / groups Core competency 2: provides sound decision making in the care of individuals / groups considering their beliefs and values Core competency 3: promotes safety and comfort and privacy of patients Core competency 4: sets priorities in nursing care based on patients’ needs Core competency 5: ensures continuity of care Core competency 6: administers medications and other health therapeutics Core competency 7:utilizes the nursing process as framework for nursing Management of Resources and Environment Core competency 1: organizes work load to facilitate patient care Core competency 2: utilizes resources to support patient care Core competency 3: ensures functioning of resources Core competency 4: checks proper functioning of equipment Core competency 5: maintains a safe environment Health Education Core competency 1: assesses the learning needs of the patient Core competency 2: develops health education plan based on assessed and anticipated needs Core competency 3: develops learning materials for health education Core competency 4: implements the health education plan 11 CORE COMPETENCIES KEY AREAS OF RESPONSIBILITY: CORE COMPETENCY STANDARDS FOR NURSING PRACTICE IN THE PHILIPPINES ○ Safe & quality nursing practice ○ Management of resources & environment ○ Health education ○ Legal responsibility ○ Ethico – moral responsibility . moral and professional standards in the practice of nursing taking into account the health needs of the nation. 9173/ “Philippine Nursing Act 2002” Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient. regulation Guide in nursing curriculum development Framework in developing test syllabus for nursing profession entrants Tool for nurses’ performance evaluation Basis for advanced nursing practice.A. Ethico-moral responsibility 6. The BSN program therefore. aims to prepare a nurse. 1. Health education 4. Research 9. upon completion of the program. specialization Framework for developing nursing training curriculum Public protection from incompetent practitioners Yardstick for unethical. The following are the Key Areas of Responsibility for which a nurse should demonstrate competence in: 1. social responsibility and good governance) .9 (c) of R. demonstrates beginning professional competencies and shall continue to assume responsibility for professional development and utilizes research findings in the practice of the profession. color.

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