DEVELOPMENTAL THEORY

SISTER CALLISTA ROY

Adaptation Model The changing environment stimulates the person to make adaptive responses. For human beings, life is never the same

BIOGRAPHY
Date of Birth: October 14, 1939

EDUCATION
1963: BSN Mount St. Marys College, Los Angeles 1966: Masters Degree in Pediatric Nursing University of California 1973: Masters Degree in Sociology 1977: PhD in Sociology

WORK HISTORY
Entered the Sisters of Saint Joseph Carondelet Professor and Nurse Theorist at Boston College of Nursing Fellow American Academy of Nursing Member
Sigma Theta Tau North American Nursing Diagnosis Association (NANDA)

INFLUENCING FACTORS
Family Education Religious background Mentors Clinical Experience

METAPARADIGM IN NURSING
Person
A biopsychosocial being in constant interaction with a changing environment Is an open, adaptive system who uses coping skills to deal with stressors

METAPARADIGM IN NURSING
Environment
Conditions, circumstances and influences that surround and affect the development and behavior of the person

METAPARADIGM IN NURSING
Health
Is the process of being and becoming an integrated and whole person Represented by a health-illness continuum

METAPARADIGM IN NURSING
Nursing
To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions

METAPARADIGM IN NURSING
Person
Adaptive system has:
Cognator subsystems Regulator subsystems

Adaptive system act to maintain adaptation to four (4) adaptive modes:

Physiologic-physical Self-concept-group identity Role function Interdependence

ROYS ADAPTATION MODEL

Person is an adaptive system in constant interaction with an internal and external environment

ROYS ADAPTATION MODEL

Environment is the source of a variety of stimuli that either threaten or promote the persons unique wholeness

ROYS ADAPTATION MODEL

Categories of environmental stimuli:
Focal Is the internal or external stimulus most immediately challenging the persons adaptation Is the phenomenon that attracts the most of ones attentions Contextual All other stimuli existing in a situation that strengthen the effect of the focal stimulus Residual Any other phenomena arising from a persons internal or external environment that may affect the focal stimulus but whose effects are unclear

ROYS ADAPTATION MODEL

Persons Adaptation Level
Integrated Compensatory Compromised

ROYS ADAPTATION MODEL

Categories of Coping Mechanisms:
Regulator subsystem
Occurs through neural, chemical, endocrine processes Automatic response to stimuli

Cognator subsytem
Occurs through cognitive-emotive processes-perceptual and information processing, learning, judgment, and emotion

ROYS ADAPTATION MODEL

Two Control Processes the Coincide With the Subsystems:
Stabilizer subsystems
The established structures, values, and daily activities whereby participants accomplish the primary purpose of the group and contribute to common purpose of society

Innovator subsystems
Refers to cognitive and emotional strategies that allow a person to change to higher levels of potential

ROYS ADAPTATION MODEL

Four Adaptive Modes:
Physiological Self-concept Role function Interdependence

ROYS ADAPTATION MODEL

Physiological Adaptive Mode
Refers to the way a person responds as a physical being to stimuli from the environment Goal: physiological integrity 5 physiological needs: 4 complex processes:
Oxygenation Nutrition Elimination Activity and rest Protection Senses Fluids and electrolytes Acid-base balance Neurologic function Endocrine function

ROYS ADAPTATION MODEL

Self-Concept Adaptive Mode
Refers to psychological and spiritual characteristics of the person Goal: psychic integrity Two components:
Physical self
Incorporates body sensation and body image

Personal self
Incorporates self-consistency, self-ideal, and moral-ethicalspiritual self

ROYS ADAPTATION MODEL

Role Function Adaptive Mode
Refers to the primary, secondary or tertiary roles the person performs in society Goal: social integrity

ROYS ADAPTATION MODEL

Interdependence Adaptive Mode
Refers to the coping mechanisms arising from close relationship that result in the giving and receiving of love, respect, and value Goal: affectional adequacy

ROYS ADAPTATION MODEL

Results of Coping Mechanisms:
Adaptive responses
Promotes integrity of the person and goals of adaptation

Ineffective responses
Neither promote integrity nor contribute to the goals of adaptation

ROYS ADAPTATION MODEL

Adaptation
Responding positively to environmental changes

NURSING PROCESS
Six Steps:
Assessment of behavior Assessment of stimuli Nursing Diagnosis Goal Setting Intervention Evaluation

NURSING PROCESS
ASSESSMENT OF BEHAVIOR
Adaptive Modes Types:
Observable
Vital signs

Non-observable
Feelings experienced by the person (anxiety)

NURSING PROCESS
ASSESSMENT OF STIMULI
Focal
Most immediately confronting the person

Contextual
All other stimuli present that are affecting the situation

Residual
Stimuli whose effect on the situation is unclear

NURSING PROCESS
NURSING DIAGNOSIS
Formulation of statements that interpret the data about the adaptation status of the person The diagnostic statement indicates:
Actual Potential problems

NURSING PROCESS
GOAL SETTING
Involves the establishment of clear statements of the behavioral outcomes for nursing care Done together with the client Includes:
Behavior Change expected Time frame

NURSING PROCESS
INTERVENTION
Management of stimuli
Alter Increase Decrease Remove Maintain

NURSING PROCESS
EVALUATION
Observation of behaviors after interventions have been completed to see if goals have been MET

APPLICATION OF ROYS THEORY

Pages 147-151

MADELEINE LEININGER
Transcultural Theory in Nursing
Cultural Care Diversity and Universality Theory
The purpose of transcultural nursing is to discover and establish a body of knowledge and skills focused on transcultural care, health, and illness in order to assist nurses giving culturally competent, safe, and congruent care to people of diverse culture worldwide

BIOGRAPHY

EDUCATION
1948: Diploma in Nursing St. Anthonys School of Nursing, Denver 1950: BS Biological Science Benedictine College, Atchinson, Kansas 1953: MSN Catholic University, Washington, D.C. 1965: PhD in Anthropology University of Seattle

ACHIEVEMENTS
Offered 1st course in Transcultural Nursing at University of Colorado Major contributor to other schools in transcultural nursing curriculum

DEFINITION
Culture
Set of values, beliefs and traditions that are held by a specific group of people and handed down from generation to generation Beliefs, habits, likes, dislikes, customs, and rituals learned from ones family

DEFINITION
Religion
Set of belief in a divine or super human power to be obeyed and worshipped as the creator and ruler of the universe

DEFINITION
Ethnic
Group of people who share a common and distinctive culture

DEFINITION
Ethnicity
A consciousness of belonging to a group

DEFINITION
Race
Classification of people according to shared biologic characteristics, genetic markers, or features

DEFINITION
Cultural identity
The sense of being part of an ethnic group or culture

DEFINITION
Culture-universals
Commonalities of values, norms of behavior, and life patterns that are similar among different cultures

DEFINITION
Culture-specifics
Values, beliefs and patterns of behavior that tend to be unique to designate a culture

DEFINITION
Material culture
Refers to objects (dress, art, religious artifacts)

DEFINITION
Non-material culture
Refers to beliefs, customs, languages, social institutions

DEFINITION
Diversity
Fact or state of being different Can occur between cultures and within a cultural group

DEFINITION
Cultural shock
State of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness, unfamiliarity and incompatibility to the strangers culture

TRADITIONAL CONCEPTS OF HEALTH AND DISEASE

Explanations for health and disease are characterized by many traditional beliefs about disease causation, treatment, and general health practices

METAPARADIGM IN NURSING
Person
Is caring and capable of being concerned about others

METAPARADIGM IN NURSING
Environment
Closely related to the concept of culture

METAPARADIGM IN NURSING
Health Is culturally defined, valued and practiced Is universal across all cultures yet defined differently by each to reflect its specific values and beliefs It is BOTH universal and diverse Components Health systems Health care practices Changing health patterns Health promotions Health maintenance

METAPARADIGM IN NURSING
Nursing
Has physical, psychocultural, and social significance for those being assisted Uses 3 modes of action to deliver care:
Cultural care preservation or maintenance Cultural care accommodation or negotiation Cultural care repatterning/restructuring

APPLICATION OF LEININGERS THEORY

Refer to page 159-161

MARGARET JEAN WATSON

Philosophy and Science of Caring Caring in nursing conveys physical acts, but embraces the mindbody-spirit as it reclaims the embodied spirit as its focus of attention

EDUCATION
1964: BSN Boulder Campus, Univ. of Colorado 1966: MS in Psychiatric-Mental Health Nursing Health Sciences Campus, Univ. of Colorado 1973: PhD in Educational Psychology and Counseling - Boulder Campus, University of Colorado

METAPARADIGM IN NURSING
Person
Is a valued person in and of him to be cared for, respected, nurtured, understood, and assisted

METAPARADIGM IN NURSING
Environment
Provides values that determine how one should believe and what goals one should strive toward

METAPARADIGM IN NURSING
Health
Unity and harmony within the mind, body, and soul Three elements:
High level of over-all physical, mental, and social functioning A general adaptive-maintenance level of daily functioning Absence of illness (or presence of efforts that lead to its absence)

METAPARADIGM IN NURSING
Nursing
Human science of people and human healthillness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions

MAJOR ELEMENTS
1. The carative factors
Care with love Originated from the word caritas which means to cherish, appreciate and give special attention

MAJOR ELEMENTS
Ten Carative Factors
1. Formation of humanistic-altruistic system of values 2. Instillation of faith-hope 3. Cultivation of sensitivity to ones self and to others 4. Development of a helping-trusting, human caring relationship (pls refer to the next slide) 5. Promotion and acceptance of the expression of positive and negative feelings

MAJOR ELEMENTS
Characteristics needed in the helping-trust relationship
Congruence Empathy Warmth

MAJOR ELEMENTS
Ten Carative Factors
6. Systematic use of a creative problem-solving caring process 7. Promotion of transpersonal teaching-learning 8. Provision of a supportive, protective, and corrective mental, physical, societal, and spiritual environment 9. Assistance with gratification of human needs (please refer to the next slide) 10. Allowance for existential-phenomenological-spiritual forces

MAJOR ELEMENTS
Watsons Ordering of Needs
Lower order needs (Biophysical Needs)
The need for ventilation The need for food and fluid The need for elimination

Lower order needs (Psychosocial Needs)

The need for activity-inactivity The need for sexuality

MAJOR ELEMENTS
Watsons Ordering of Needs
Higher order needs (Psychosocial Needs)
The need for achievement The need for affiliation

Higher order needs (Intrapersonal-interpersonal Needs)

The need for self-actualization

MAJOR ELEMENTS
2. Transpersonal Caring Relationship
Describes how the nurse goes beyond an objective assessment, showing concerns toward the persons subjective and deeper meaning regarding their own health care situation

MAJOR ELEMENTS
3. Caring occasion / caring moment
The nurse and another person come together in a such a way that an occasion for human caring is created Not simply a goal for the cared-for, the nurse, also needs to be aware of her own consciousness and authentic presence of being in caring moment with her patient

APPLICATION OF WATSONS THEORY

Refer to page 166

PATRICIA BENNER
From Novice to Expert Nursing is a science that studies the relationships between mind, body, and human worlds

EDUCATION
1964: BSN Pasadena College 1970: MSN Univ. of California 1982: PhD Univ. of California

ACHIEVEMENTS
Author of nine books Internationally noted researcher and lecturer on health, stress, and coping, skill acquisition and ethics

METAPARADIGM IN NURSING
Nursing
Enabling condition of connection and concern

METAPARADIGM IN NURSING
Person
Self-interpreting being Major aspects of understanding that the person must deal with as:
The role of the situation The role of the body The role of personal concerns The role of temporality

METAPARADIGM IN NURSING
Health
What can be assessed Not just the absence of disease and illness

METAPARADIGM IN NURSING
Environment
situation social environment

SKILLS ACQUISITION IN NURSING

Novice
Stage where nursing students belong

Advance beginner
Newly graduated nurses

Competent Proficient Expert

SEVEN DOMAINS OF NURSING PRACTICE

Helping role Teaching-coaching function Diagnostic and patient-monitoring function Effective management of rapidly changing situations Administering and monitoring therapeutic interventions and regimens Monitoring and ensuring the quality of health care practices

PHILIPPINE CONCEPTUAL MODELS

Dr. LETTY G. KUAN

Has two MA Degree
Nursing Education, major in Guidance and Counseling

Professor Emeritus UP College of Nursing Former member of Board of Nursing

Dr. LETTY G. KUAN

Dissertation: Retirement and Role Discontinuities

Dr. LETTY G. KUAN

Concepts
Physiological age Role Change of life Retiree Coping approaches

Dr. LETTY G. KUAN

Determinants of positive perceptions in retirement:
Health status Income Work status Family constellation Self-preparation

CARMENCITA ABAQUIN
MAN and PhD UPCN Expertise: MS (Oncologic Nursing) Chairman of the BON

CARMENCITA ABAQUIN
Dissertation:
PREPARE ME Intervention and the Quality of Life of Advance Progressive Cancer Patients

CARMENCITA ABAQUIN
Concepts
Presence Reminisce therapy Prayer Relaxation-breathing Meditation Values clarification

CMO. NO. 14 S. 2009

POLICIES AND STANDARDS FOR BSN PROGRAM

Art. 1
Sec. 1. A person is a unique bio-psycho-sociocultural and spiritual being who is always in constant interaction with the environment. These interactions affects individuals, family, population groups and societal health status

POLICIES AND STANDARDS FOR BSN PROGRAM

Art. 1
Sec. 1. Within the context of Philippine society, nursing education, with caring as its foundation, 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:

POLICIES AND STANDARDS FOR BSN PROGRAM

Core Values
Love of God Caring as the Core of Nursing
Compassion Competence Confidence Conscience Commitment (to a culture of excellence, discipline, integrity, and professionalism)

POLICIES AND STANDARDS FOR BSN PROGRAM

Core Values
Love of People
Respect for the dignity of each person regardless of creed, color, gender, and political affiliation)

Love of Country
Patriotism (civic duty, social responsibility, and good governance) Preservation and enrichment of the environment and culture heritage

POLICIES AND STANDARDS FOR BSN PROGRAM

The BSN Program aims to prepare a nurse who, upon completion of the program, demonstrates beginning professional competencies and shall continue to assume responsibility for professional development and utilizes research findings in the practice of the profession.

POLICIES AND STANDARDS FOR BSN PROGRAM

The following are the 11 Key Areas of Responsibility for which the nurse should demonstrate competence:
1. 2. 3. 4. 5. Safe and quality nursing care Management of resources and environment Health education Legal responsibility Ethico-moral responsibility

POLICIES AND STANDARDS FOR BSN PROGRAM

6. Personal and professional development 7. Quality improvement 8. Research 9. Record management 10. Communication 11. Collaboration and teamwork

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END GOODLUCK AND GOD BLESS