Nursing Theories

INTRODUCTION TO NURSING THEORIES
INTRODUCTION Nursing has made phenomenal achievement in the last century that has lead to the recognition of nursing as an academic discipline and a profession. A move towards theory-based practice has made contemporary nursing more meaningful and significant by shifting nursing’s focus from vocation to an organised profession. The need for knowledge-base to guide professional nursing practice had been realised in the first half of the twentieth century and many theoretical works have been contributed by nurses ever since, first with the goal of making nursing a recognised profession and later with the goal of delivering care to patients as professionals.

A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific interrelationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.. Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings: • • • • Metaparadigm (Person, Environment, Health & Nursing) – (Most abstract) Nursing philosophies. Conceptual models and Grand theories. Nursing theories and Middle range theories (Least abstract) NURSING PHILOSOPHIES Theory Key emphasis

Florence Nightingale’s Legacy of caring

Focuses on nursing and the patient environment relationship. Helping process meets needs through the art of individualizing care. Nurses should identify patients ‘need-for – help’ by: Observation Understanding client behaviour Identifying cause of discomfort Determining if clients can resolve problems or have a need for help

Ernestine Wiedenbach: The helping art of clinical nursing

Virginia Henderson’s Definition of Nursing

Patients require help towards achieving independence. Derived a definition of nursing Identified 14 basic human needs on which nursing care is based.

Faye G.Abedellah’s Typology of twenty one Nursing problems Lydia E. Hall :Care, Cure, Core model Jean Watson’s Philosophy and Science of caring

Patient’s problems determine nursing care

Nursing care is person directed towards self love. Caring is moral ideal: mind -body – soul engagement with one and other. Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring.

Patricia Benner’s Primacy of caring

Caring is central to the essence of nursing. It sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness. Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice – novice, advanced beginner, competent, proficient and

expert.

CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orem’s Self care deficit theory in nursing Self–care maintains wholeness. Three Theories: Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing Systems Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself) Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses’ role Myra Estrin Levine’s: The conservation model Holism is maintained by conserving integrity Proposed that the nurses use the principles of conservation of: Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing theories – Conservation Redundancy Therapeutic intention Martha E.Roger’s: Science of unitary human beings Person environment are energy fields that evolve negentropically Martha proposed that nursing was a basic scientific discipline Nursing is using knowledge for human betterment. The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather

than health and illness

Dorothy E.Johnson’s Behavioural system model

Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Individual as a behavioural system is composed of seven subsystems. Attachment, or the affiliative subsystems – is the corner stone of social organisations. Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems.

Sister Callista: Roy‘s Adaptation model

Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual. Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions

Betty Neuman’s : Health care systems model

Reconstitution is a status of adaptation to stressors A conceptual model with two theories “Optimal patient stability and prevention as intervention” Neuman’s model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person. Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the client’s response to

stressors.

Imogene King’s Goal attainment theory

Transactions provide a frame of reference toward goal setting. A conceptual model of nursing from which theory of goal attainment is derived. From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory. · Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing).

Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living

Individuality in living. A conceptual model of nursing from which theory of goal attainment is derived. Living is an amalgam of activities of living (ALs). Most individuals experience significant life events which can affect ALs causing actual and potential problems. This affects dependence – independence continuum which is bi-directional. Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope.

Resource person 3. Orientation 2. Elements of nursing situation: 1. Counselor Ida Jean Orlando’s Nursing Process Theory Interpersonal process alleviates distress. Nurses must stay connected to patients and assure that patients get what they need. Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of Emerging identities Developing feelings of empathy and sympathy. The four phases of nurse-patient relationships are: 1. Leader 5. Teacher 4. until the nurse and patient attained rapport in the final stage. Identification 3. Nurse reactions 3. Nursing actions Joyce Travelbee’s Human To Human Relationship Model Therapeutic human relationships. Patient 2. Surrogate 6.Hildegard E. Stranger 2. Resolution The six nursing roles are: 1. Exploitations 4. Peplau: Psychodynamic Nursing Theory Interpersonal process is maturing force for personality. focused on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s behaviour to alleviate distress. Stressed the importance of nurses’ ability to understand own behaviour to help others identify perceived difficulties. .

caring. Madeleine Leininger’s Transcultural nursing. social and environmental needs. Comfort measures include those nursing interventions designed to address the specific comfort needs. Major concepts include care. psycho spiritual. arising from stressful health care situations that cannot be met by recipients’ traditional support system. Barnard’s Parent Child Interaction Model Growth and development of children and mother–infant relationships Individual characteristics of each member influence the parent–infant system and adaptive behaviour modifies those characteristics to meet the needs of the system. Clients are open. Care is the essence and the dominant. Ramona T. A theory of nursing derived from Roger’s conceptual model. culture-care theory Caring is universal and varies transculturally. mutual and in constant interaction with environment. The nurse assists the client in interaction with the environment and co creating health . Health care needs are needs for comfort. These needs include physical. distinctive and unifying feature of nursing Rosemarie Rizzo Parse’s :Theory of human becoming Indivisible beings and environment co-create health.Kathryn E. Parenting and maternal role attainment in diverse populations A complex theory to explain the factors impacting the development of maternal role over time.Mercer’s :Maternal Role Attainment Katharine Kolcaba’s Theory of comfort Comfort is desirable holistic outcome of care. cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. culture.

Evelyn. London Mosby Year Book. Using the internet the nurses of the world can share ideas and knowledge. Meleis Ibrahim Afaf (1997) . Theoretical Basis for Nursing Philadelphia. Philadelphia. model Promoting optimum health supersedes disease prevention. Philadelphia. Appleton & Lange. Norwalk. Mosby. Taylor Carol. The state of art and science of nursing theory is one of continuing growth. 3rd ed. Alligood.Nola J. Nursing theorists and their work. Lippincott. Nursing Theories. 2002 Alligood M. used. Wills M. A.The base for professional Nursing Practice. 2002. interpersonal influences.M.R. Theoretical Nursing : Development & Progress 3rd ed. Identifies cognitive.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. situational and behavioural factors that help predict in health promoting behaviour CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice.). and applied in the theory based practice for the profession and the continued development of nursing and academic discipline REFERENCES • • • • • • • George B. Philadelphia. Mosby. McEwen Melanie (2002).Pender’s :The Health promotion. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. . Lippincott Williams& wilkins. Nursing theory utilization and application. Tomey. Tomey AM. perceptual factors in clients which are modified by demographical and biological characteristics. 2nd Ed. Potter A Patricia. guide research and curriculum and identify the goals of nursing practice. MR. Julia . Philadelphia. Lippincott. It is important the nursing knowledge is learnt. (5th ed. carrying on the work begun by nursing theorists and continue the growth and development of new nursing knowledge.

Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice. and systematic view of phenomena”. the environment. changes or functions intended to bring about a desired result. Process it is a series of actions. properties. for example. • • • • . propositions & are based on assumptions. predict.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. models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). or events & are basic components of theory. purposeful. They are derived through two principal methods. health & nursing. A particular theory or conceptual frame work directs how these actions are carried out. A theory makes it possible to “organize the relationship among the concepts to describe. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient). Concepts are words that describe objects. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal. models. which further confounds matters. Nursing theorists use both of these methods. The terms ‘model’ and ‘theory’ are often wrongly used interchangeably. Theory is “a creative and rigorous structuring of ideas that projects a tentative. deductive reasoning and inductive reasoning. and control practice” Definition • • Concepts are basically vehicles of thought that involve images. through specific methods of assessment. Types: Empirical concepts Inferential concepts Abstract concepts • • • • Models are representations of the interaction among and between the concepts showing patterns. definitions. Theories are composed of concepts. In nursing. explain. Propositions are statements that explain the relationship between the concepts.

and principles but will leave open unanswered questions that need to be investigated. logical in nature. it is vital to have the theory to analyze and explain what nurses do. 8. This can be seen as an attempt by the nursing profession to maintain its professional boundaries. 7. bases for hypotheses that can be tested. Nursing theory aims to describe. help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964). As medicine tries to make a move towards adopting a more multidisciplinary approach to health care.• Their main limitation is that they are only as accurate or useful as the underlying theory. Importance of nursing theories 1. In addition. Basic processes in the development of nursing theories Nursing theories are often based on & influenced by broadly applicable processes & theories. The benefits of having a defined body of theory in nursing include better patient care. It helps to distinguish what should form the basis of practice by explicitly describing nursing. General System Theory It describes how to break whole things into parts & then to learn how the parts work together in “systems”. used by the practitioners to guide and improve their practice. enhanced professional status for nurses. 3. increasing the general body of knowledge within the discipline through the research implemented to validate them. These concepts may be applied to different kinds of systems. predict and explain the phenomenon of nursing (Chinn and Jacobs1978). laws. 4. It should provide the foundations of nursing practice. 2. The main exponent of nursing – caring – cannot be measured. 5. Following theories are basic to many nursing concepts. and guidance for research and education (Nolan 1996). improved communication between nurses. generalizable. Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). consistent with other validated theories. The characteristics of theories Theories are • • • • • • • interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. . because 6. nursing continues to strive to establish a unique body of knowledge.

3. Human adaptation occurs on three levels : The internal (self) The social (others) & the physical (biochemical reactions) • · 1. often uniquely. functions) Each of these concepts is usually defined & described by a nursing theorist. It outlines the process of growth & development of humans as orderly & predictable. • Adaptation is a continuously occurring process that effects change & involves interaction & response. although these concepts are common to all nursing theories. and organs in Anatomy & Health in Nursing. emotional. the most important is that of the person. 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. beginning with conception & ending with death. is the person. social. emotional. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things & to environmental conditions. The growth & development of an individual are influenced by heredity. Common concepts in nursing theories Four concepts common in nursing theory that influence & determine nursing practice are: • • • • The person (patient). The focus of nursing. & physical environment. Of the four concepts. cultures in sociology. Developmental Theory 1. .e. temperament. life experiences & health status. regardless of definition or theory. 3. the client is an individual. Molecules in chemistry. that. Historical perspectives and key concepts • • • • • Nightingale (1860): To facilitate “the body’s reparative processes” by manipulating client’s environment Peplau 1952: Nursing is. diminishes distress. 2. The progress & behaviors of an individual within each stage are unique. intellectual. when met. 2. or enhances wellbeing. roles. with a need.g. therapeutic interpersonal process. Orlando 1962: To Ida Orlando (1960). and spiritual needs of the client and family. The environment Health Nursing (goals. increases adequacy.

Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the. Practice theory: explores one particular situation found in nursing.• • • • • • • 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. developmental. • Grand theory: provides a conceptual framework under which the key concepts and • Principles of the discipline can be identified. psychological. or social needs. ■ “Outcome “theories. The goal of nursing to reduce stress so that. Classification of nursing theories Depending On Function (Polit et al 2001) 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 To identify under which conditions relationships occur Prescriptive Depending on the Generalisability of their principles • Metatheory: the theory of theory. Rogers 1970: to maintain and promote health. psychological. Nursing care becomes necessary when client is unable to fulfill biological. sociological and dependence-independence adaptive modes. Roy 1979: This adaptation model is based on the physiological. and care for and rehabilitate ill and disabled client through “humanistic science of nursing” Orem1971: This is self-care deficit theory. the client can move more easily through recovery. Identifies specific phenomena through abstract concepts. humanistic aspects of life. Based on the philosophical underpinnings of the theories ■ “Needs “theories. prevent illness. It identifies explicit goals and details how these goals will be achieved. King 1971: To use communication to help client reestablish positive adaptation to environment. Neuman 1972: Stress reduction is goal of system model of nursing practice. ■ “Interaction” theories. • Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. • .

an increasing number of nursing theorists have developed models of nursing that provide bases for the development of nursing theories and nursing knowledge. Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual.■ Humanistic theories. Humanistic theories emphasize a person’s capacity for self-actualization. “Humanistic” Theories • • • • • Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life. “Needs” theories • • These theories are based around helping individuals to fulfill their physical and mental needs. . The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual. Logan and Tierney’s Model of Nursing (1980). Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. biologic. provides a way to visualize reality to simplify thinking. so. Models of nursing • • • • • Until fairly recently. “Interaction” theories • • As described by Peplau (1988). “Outcome” theories • • These portray the nurse as the changing force. According to Fawcett (2000). A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions. Humanists believe that the person contains within himself the potential for healthy & creative growth. who enables individuals to adapt to or cope with ill health (Roy 1980). and medical science theories. Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988). nursing science was derived principally from social. However. from the 1950s to the present. The basis of these theories is well-illustrated in Roper. these theories revolve around the relationships nurses form with patients. as an abstraction of reality. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. A model. person-centered approach now practice in nursing.

and realization of one’s potential is emphasized” (Fawcett). and the persistence view focuses on stability” (Fawcett. nursing (goals. caring. “progress is valued. “The world view of change uses the growth metaphor. and generalizations are formulated (MerriamWebster’s Collegiate Dictionary. and • the major theoretical conceptual classification with which the model seems most consistent (systems. 1989. in which the parts have a function and the system as a totality has a function” (Auger. or growth/development). as a total human being. the environment (society). stress/adaptation.). 1976. An example of systems interaction . and the word Greek word “paradigm. Persistence is endurance in time Persistence world view emphasizes equilibrium and balance. and health. roles. 1977). Growth and Stability Models of Change • • • • • There are two major differences in philosophical beliefs. or world views. functions).” which means a philosophical or theoretical framework of a discipline upon which all theories. about the nature of change. Within the change world view. A general systems approach allows for consideration of the subsystems levels of the human being. Systems Theory as a Framework • • • • Systems theory is concerned with changes caused by interactions among all the factors (variables) General systems theory is emphasized A system is defined as “a whole with interrelated parts. can be conceptualized as the client and becomes the target system for nursing intervention (Sills & Hall. change and growth are continual and desirable. from the level of the individual to the level of society. The term metaparadigm comes from the Greek prefix “meta. and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity.” which means more comprehensive or transcending. Categories of Conceptual Models • Ten conceptual models of nursing have been classified according to two criteria: • the world view of change reflected by the model (growth or stability). 1994). These four concepts form a metaparadigm of nursing.• • • 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). Thus the human being. laws.

1. or a conflict in a person’s social relationships” (King.” As the person interacts with the environment.). 1981. Society is composed of “social systems. develop. 1981).• • • • • Input (Diet teaching) Throughput (Assimilation of information) Output (Food intake) Feedback (Weight record.” 2. Health assumes achievement of maximum potential for daily living and an ability to function in social roles. maintain. or restore health.) Two nursing models based on systems theory: • Imogene King’s systems interaction model. Groups (two or more persons) form “interpersonal systems. and performance” • • • • • Betty Neuman’s Health Care Systems Model • Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability. 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. “Illness is a deviation from normal. and perform daily activities” Health dynamic life experiences of a human being. It is the “dynamic life experiences of a human being.” 3. “The goal of nursing is to help individuals and groups attain. development. . 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” Nursing A process of human interaction Imogene King’s Systems Interaction Model • In interaction model. King’s model conceptualizes three levels of dynamic interacting systems. that is. the purpose of nursing is to help people attain. an imbalance in a person’s biological structure or in his psychological makeup. and • Betty Neuman’s health care systems model. Hb estimation etc. Individuals are called “personal systems. and restore health” Stress: “a dynamic state whereby a human being interacts with the environment to maintain balance for growth. 1989). Major Concepts as Defined in King’s Model Person (human being) A personal system that interacts with interpersonal and social systems Environment A context “within which human beings grow. maintain. he or she must continuously adjust to stressors in the internal and external environment (King.

organized around stress reduction. where stressors are successfully overcome or avoided by the flexible line of defense. the stressor breaks through. The person is a composite of physiologic. or maintain optimal system stability” (Neuman. . The person must adjust to environmental changes to avoid disturbing a balanced existence. stress and adaptation theories view change caused by person–environment interaction in terms of cause and effect. 2002). and spiritual variables considered simultaneously. A person is constantly affected by stressors from the internal. psychological. and triggers a reaction. • • • • Stress/Adaptation Theory as a Framework • • • In contrast to systems theory. sociocultural. Stressors are tension-producing stimuli that have the potential to disturb a person’s equilibrium or normal line of defense. Adaptation theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. This normal line of defense is the person’s “usual steady state. attain. “Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences” (Neuman. predict. disturbs the person’s equilibrium. 2002). Neuman intends for the nurse to “assist clients to retain. This theory has been widely applied to explain. and control biologic (physiologic and psychological) phenomenon. 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. Stressors may be of three types: Intrapersonal: forces arising from within the person Interpersonal: forces arising between persons Extrapersonal: forces arising from outside the person • • Resistance to stressors is provided by a flexible line of defense.• • • • • • • • • • 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 Neuman’s model. Neuman defines illness as “a state of insufficiency with disrupting needs unsatisfied” (Neuman. external. 1996). developmental. or created environment. If the flexible line of defense is no longer able to protect the person against a stressor.” It is the way in which an individual usually deals with stressors. health (wellness) seems to be related to dynamic equilibrium of the normal line of defense. Thus. The reaction may lead toward restoration of balance or toward death. 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. is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health.

However. 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 . nurse education is based on theory borrowed from other disciplines. 6. It has been recognised that traditionally nurses are used to ‘speaking with their hands’ (Levine 1995). such as sociology and psychology. 2. as the occupation is focused on humans. This makes it difficult for the majority of nurses to understand and apply theory to practice (Miller 1985). 7. 4. Use of language • Scott (1994) states that the crucial ingredients of nursing theory should be accessibility and clarity. one of the main criticisms of nursing theory is its use of overtly complex language (Kenny 1993).A unique body of knowledge • • • • • The drive for a unique body of knowledge is based on the assumption that ‘borrowed’ knowledge is less worthy. many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. a theorypractice gap still exists in nursing (Upton 1999). nursing theory still means very little to most practicing nurses. Perhaps this is because the majority of nursing theory is developed by and for nursing academics (Lathlean 1994). and because of nursing’s diverse nature it is impossible for it to have a unique body of knowledge and one unified body of theory (Castledine 1994. perhaps it is inevitable that nursing uses knowledge from other social sciences. Nevertheless. 8. It has been argued that no knowledge is exclusive. 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. Summarization 1. It is important that the language used in the development of nursing theory be used consistently. 3. It has been argued that applying knowledge from different disciplines only serves to dilute nursing practice. However. 9. Yet despite the availability of a vast amount of literature on the subject. Not part of everyday practice • Despite theory and practice being viewed as inseparable concepts. 5. Levine 1995). Therefore.

10. Lippincott. However. it will continue to develop in the footsteps of other disciplines such as medicine Reference • • • • • • • George B.practice. 2006 Jul. Models Of Nursing 11.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. A unique body of knowledge 15. Nurs Sci Q. London Mosby Year Book. Taylor Carol. Norwalk. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. Lippincott.The base for professional Nursing Practice . Meleis Ibrahim Afaf (1997) . Betty Neuman’s Health Care Systems Model 13. Growth and Stability Models of Change 12. McEwen Melanie (2002). 27(6) : 605-15 Reed PG.M.Evelyn. Theoretical Nursing : Development & Progress 3rd ed. If nursing theory does not drive the development of nursing. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Vandemark L. Lippincott Williams& wilkins. perhaps nurses are ‘nursing’ without the knowledge of theories and theory is irrelevant. 3rd ed. If this is true. Julia . Nursing Theories. Stress/Adaptation Theory as a Framework 14. Potter A Patricia. irrespective of nursing theories nurses will continue to exhibit a caring response to the ‘sick and troubled’. theory and practice are related. Criticisms of nursing theories Conclusion Littlejohn (2002) comments that. and if nursing is to continue to develop. Appleton & Lange. the concept of theory must be addressed. Philadelphia. Philadelphia. 2006 Jul. Theoretical Basis for Nursing Philadelphia.19(3):225 . The force of nursing theory guided. Wills M.

or community Environment All internal and external conditions. Jean Watson Rosemary Rizzo Parse Madeleine Leininger .a set of related statements that describes or explains phenomena in a systematic way Concept-a mental idea of a phenomenon Construct.Nursing Theorists Definitions Theory. psychological. and sociocultural components Individual.a phenomena that cannot be observed and must be inferred Proposition. including physical. family. spiritual.a statement of relationship between concepts Conceptual model. Hildegard Peplau Virginia Henderson Fay Abdella Ida Jean Orlando Dorothy Johnson Martha Rogers Dorothea Orem Imogene King Betty Neuman Sister Calista Roy. and influences affecting the person Health Florence Nightingale.made up of concepts and propositions Nursing Theorists • • • • • • • • • • • • • • • Patricia Benner Concepts in the nursing Metaparadigm • • • • • • Person Recipient of care. circumstances.

1859) 5 components of environment ventilation. Included everything. a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium Peplau’s Concepts Environment.Not defined . psychological. physical. personal. effluvia. noise External influences can prevent. suppress or contribute to disease or death Person o o o Patient who is acted on by nurse Affected by environment Has reparative powers Foundation of theory.Environmental Theory Nightingale’s Concepts • Environment o • Health o o • Nursing o Hildegard Peplau -Interpersonal Relations Model • • • • • Based on psychodynamic nursing using an understanding of one’s own behavior to help others identify their difficulties Applies principles of human relations Patient has a felt need Person o o • • Health o Implies forward movement of the personality and human processes toward creative.• • • • • • • • • Degree of wellness or illness experienced by the person Nursing Actions. constructive. warmth. and community living An individual. warmth. good diet. productive. and social Maintaining well-being by using a person’s powers Maintained by control of environment Provided fresh air. light. quiet to facilitate person’s reparative process Florence Nightingale. characteristics and attributes of person giving care First nursing theorist Unsanitary conditions posed health hazard (Notes on Nursing. cleanliness.

social and emotional The nurse must be a good problem solver Nursing o o o o • Health o o • Person o o • o o • • • • One who has physical. And to do this in such a way as to help him gain independence as rapidly as possible. Patient’s behavior can be verbal or non-verbal.Topology of 21 Nursing Problems • • • • • • A list of 21 nursing problems Condition presented or faced by the patient or family. thought. feeling . therapeutic. or knowledge. in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength. She must in a sense. get inside the skin of each of her patients in order to know what he needs". will. or social needs The recipient of nursing care. interpersonal process that functions cooperatively with others to make health possible Involves problem-solving Virginia Henderson -The Nature of Nursing "The unique function of the nurse is to assist the individual. Did not discuss much Includes room. Problems are in 3 categories physical. emotional. The nurse reacts to patient’s behavior and forms basis for determining nurse’s acts. Fay Abdella. and community Excludes illness No unmet needs and no actual or anticipated impairments A helping profession A comprehensive service to meet patient’s needs Increases or restores self-help ability Uses 21 problems to guide nursing care Abdella’s Concepts Environment Ida Jean Orlando.Deliberative Nursing Process The deliberative nursing process is set in motion by the patient’s behavior All behavior may represent a cry for help. sick or well. home. Perception.• Nursing o o A significant.

and sociological factors. psychological. rather than automatic Deliberative actions explore the meaning and relevance of an action. Environment o • • Health o o Nursing Martha Rogers -Unitary Human Beings • Energy fields . interactive. and integrated subsystems Constancy is maintained through biological. External regulatory force that is indicated only when there is instability. The person is a behavioral system comprised of a set of organized. Affiliative subsystem o social bonds helping or nuturing food intake excretion procreation and gratification self-protection and preservation efforts to gain mastery and control Dependency o Ingestive o Eliminative o Sexual o Aggressive o Achievement o Dorothy Johnson-Behavioral Systems Model Johnson’s 7 Subsystems • • • • • • • Johnson’s Concepts • Person o • A behavioral system comprised of subsystems constantly trying to maintain a steady state Not specifically defined but does say there is an internal and external environment Balance and stability.• • • • • Nurses’ actions should be deliberative. interdependent. A steady state is maintained through adjusting and adapting to internal and external forces.

supporting or providing the environment to promote patient’s ability Wholly compensatory nursing system-Patient dependent Partially compensatory. and interactive Characteristic of energy field A wave that changes. infinite. and infinite Unitary man and environmental field Energy fields are open. increasing diversity of the human and envrionmental fields. dynamic. probabilistic. open. becomes complex and diverse A nonlinear domain with out time or space Universe of open systems Pattern Pandimensionality Roger’s Definitions Integrality o o • Helicy o o o • • • • Continuous.o o • • o o o • o • • Fundamental unity of things that are unique. guiding. Characterized by nonrepeating rhymicities Change Continuous and mutual interaction between man and environment Continuous change longer to shorter wave patterns in human and environmental fields Resonancy Dorothea Orem.Self-Care Model Self-care comprises those activities performed independently by an individual to promote and maintain person well-being Self care agency is the individual’s ability to perform self care activities Self. teaching. but needs assistance with decision making or knowledge Open systems framework Human beings are open systems in constant interaction with the environment Personal System • • • Imogene King-Goal Attainment Theory • • • .care deficit occurs when the person cannot carry out self-care The nurse then meets the self-care needs by acting or doing for.Patient can meet some needs but needs nursing assistance Supportive educative-Patient can meet self care requisites.

communication and transaction Family. peers Personal System Interpersonal o o Society The nurse and patient mutually communicate. establish goals and take action to attain goals Each individual brings a different set of values. schools. work. perception.Adapting to change .Adaptation Model • Five Interrelated Essential Elements Patiency. time space. self. time space. interaction. growth.o o o • o • • • • individual. attitudes. ideas. affected by variables Wellness is equilibrium Nursing interventions are activates to: strengthen flexible lines of defense strengthen resistance to stressors maintain adaptation Sister Calista Roy . religious groups. changing. perceptions to exchange The person is a complete system. body image Interpersonal Society Individual.The person receiving care Goal of nursing. development.Health Care Systems Model • • • • • • • • • • Normal line of resistance Normal adaptation state Flexible line of defense Protective barrier. development. growth. body image Socialization. perception. with interrelated parts maintains balance and harmony between internal and external environment by adjusting to stress and defending against tensionproducing stimuli Focuses on stress and stress reduction Primarily concerned with effects of stress on health Stressors are any forces that alter the system’s stability Flexible lines of resistance Surround basic core Internal factors that help defend against stressors Betty Neuman . self.

Human Becoming Theory • Human Becoming Theory includes Totality Paradigm .Health-Being and becoming a whole person Environment Direction of nursing activities. mental and social well-being and functioning Concerned with promoting and restoring health.Facilitating adaptation • • • • • • • • • • • • • • • • • • • • The person is an open adaptive system with input (stimuli). preventing illness Jean Watson .Philosophy and Science of Caring Watson’s 10 Carative Factors Watson’s Concepts Environment o Health o o Nursing Rosemary Parse . cared for. understood and assisted Society Complete physical. nurtured. who adapts by processes or control mechanisms (throughput) The output can be either adaptive responses or ineffective responses Caring can be demonstrated and practiced Caring consists of carative factors Caring promotes growth A caring environment accepts a person as he is and looks to what the person may become A caring environment offers development of potential Caring promotes health better than curing Caring is central to nursing Forming humanistic-altruistic value system Instilling faith-hope Cultivating sensitivity to self and others Developing helping-trust relationship Promoting expression of feelings Using problem-solving for decision making Promoting teaching-learning Promoting supportive environment Assisting with gratification of human needs Allowing for existential-phenomenological forces Person o • • • Human being to be valued. respected.

o • Man is a combination of biological. Involves synthesis of values A human science and art that uses an abstract body of knowledge to serve people Parse’s Three Principles • Rhythmicity o • Cotranscendence o o • Person o • Environment o o • • Health o o Nursing Madeleine Leininger . recover from illness.Culture Care Diversity and Universality • • • • • Based on transcultural nursing. and practices Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care Modes of nursing action Cultural care preservation o o help maintain or preserve health. languaging) in rhythmical patterns Refers to reaching out and beyond the limits that a person sets One constantly transforms Open being who is more than and different from the sum of the parts Everything in the person and his experiences Inseparable. sociological and spiritual factors Simultaneity Paradigm o • • Man is a unitary being in continuous. or face death help adapt to or negotiate for a beneficial health status. mutual interaction with environment Originally Man-Living-Health Theory Meaning o o Man’s reality is given meaning through lived experiences Man and environment cocreate Man and environment cocreate ( imaging. or face death Cultural care accommodation . complimentary to and evolving with Open process of being and becoming. beliefs. psychological. valuing. whose goal is to provide care congruent with cultural values.

Lippincott Williamsand wilkins. Critically analyze theoretical frameworks Reference • • • • • • • Alligood M. Tomey AM.R.• Cultural care re-patterning o help restructure or change lifestyles that are culturally meaningful Patricia Benner . Philadelphia. 3rd ed. 2nd Ed. Mosby. McEwen Melanie (2002). 2002. Wills M.Evelyn. Nursing theorists and their work. Appleton and Lange. Theoretical Basis for Nursing Philadelphia. Theories should be developed in nursing. Meleis Ibrahim Afaf (1997) . not borrow theories form other disciplines 2. Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. Lippincott. Julia . Tomey. Philadelphia.). London Mosby Year Book. Taylor Carol. Norwalk. . Nursing theory utilization and application. A.From Novice to Expert • • Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level Levels reflect: o o movement from reliance on past abstract principles to the use of past concrete experience as paradigms change in perception of situation as a complete whole in which certain parts are relevant      Novice Advanced beginner Competent Proficient Expert Importance of Theoretical Frameworks 1. Responsibility of nurses to know and understand theorists 3. Philadelphia. Mosby. (5th ed. MR. Lippincott. Theoretical Nursing : Development and Progress 3rd ed. George B.M. Alligood. Foundation of any profession is the development of a specialized body of knowledge. Potter A Patricia. 2002. Philadelphia.The base for professional Nursing Practice .Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Nursing Theories.

the environment . They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice. They are derived through two principal methods: 1) Deductive reasoning 2) Inductive reasoning. definitions. health and nursing. Nursing theorists use both of these methods. propositions and are based on assumptions." attempts to describe or explain the phenomenon (process. Types : Empirical concepts Inferential concepts Abstract concepts.NURSING THEORIES: AN OVERVIEW Theory Kerlinger ---views theories as a set of interrelated concepts that give a systematic view of a phenomenon ( an observable fact or event ) that is explanatory and predictive in nature. and control practice" Concepts--. through specific methods of assessment. Process ---. occurrence and event) called nursing" Theories for Professional Nursing • • Theory is "a creative and rigorous structuring of ideas that projects a tentative.are representations of the interaction among and between the concepts showing patterns. or events and are basic components of theory . The terms ‘model’ and ‘theory’ are often wrongly used interchangeably. and systematic view of phenomena" A theory makes it possible to "organize the relationship among the concepts to describe. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks and theories define the person (patient). • • • Models ----. Their main limitation is that they are only as accurate or useful as the underlying theory. purposeful.it is a series of actions . In nursing. properties. A particular theory or conceptual frame work directs how these actions are carried out .are statements that explain the relationship between the concepts.are basically vehicles of thought that involve images. Nursing Theory: Barnum(1998)---. explain. Concepts are words that describe objects . During a process one takes systemic and continuous steps to meet a goal and uses both assessments and feedback to direct actions to the goal. predict. changes or functions intended to bring about a desired result . Definition • • • • • • • . for example. Theories are composed of concepts. Propositions---. which further confounds matters. Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). models .

are consistent with other validated theories. nursing continues to strive to establish a unique body of knowledge. Theories: • • • • • • • interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. General System Theory: It describes how to break whole things into parts and then to learn how the parts work together in " systems". cultures in sociology. These concepts may be applied to different kinds of systems. Following theories are basic to many nursing concepts. organs in Anatomy and health in Nursing. laws. improved communication between nurses. and guidance for research and education (Nolan 1996). Molecules in chemistry . and principles but will leave open unanswered questions that need to be investigated Nursing theories are often based on and influenced by broadly applicable processes and theories. enhanced professional status for nurses. because the main exponent of nursing – caring – cannot be measured. It should provide the foundations of nursing practice. help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964). increase the general body of knowledge within the discipline through the research implemented to validate them..Importance of Nursing Theories • • Nursing theory aims to describe. are the bases for hypotheses that can be tested. are used by the practitioners to guide and improve their practice. e. it is vital to have the theory to analyze and explain what nurses do. It helps to distinguish what should form the basis of practice by explicitly describing nursing. are logical in nature. As medicine tries to make a move towards adopting a more multidisciplinary approach to health care. Adaptation Theory • • • • • The characteristics of theories Basic Processes in the Development Of Nursing Theories: . This can be seen as an attempt by the nursing profession to maintain its professional boundaries.g. In addition. are generalizable. The benefits of having a defined body of theory in nursing include better patient care. Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). predict and explain the phenomenon of nursing (Chinn and Jacobs1978).

although these concepts are common to all nursing theories. emotional. the client is an individual. and care for and rehabilitate ill and disabled client through "humanistic science of nursing" Orem1971: This is self-care deficit theory. social.the internal ( self ) --. and spiritual needs of the client and family. when met. is the person. Adaptation is a continuously occurring process that effects change and involves interaction and response . the most important is that of the person. temperament . regardless of definition or theory . increases adequacy. with a need.Nursing (goals. or enhances well-being. Orlando 1962: To Ida Orlando (1960). Often uniquely. --. emotional. and physical environment .The person( patient) . Human adaptation occurs on three levels: --. life experiences and health status.It defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Nursing care becomes Historical Perspectives and Key Concepts . therapeutic interpersonal process. 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. intellectual. The focus of nursing . The progress and behaviors of an individual within each stage are unique.and the physical ( biochemical reactions ) Developmental Theory It outlines the process of growth and development of humans as orderly and predictable . Of the four concepts . Nightingale (1860): To facilitate "the body’s reparative processes" by manipulating client’s environment Paplau 1952: Nursing is. that. functions) • • Each of these concepts is usually defined and described by a nursing theorist . prevent illness. Common concepts in Nursing Theories: Four concepts common in nursing theory that influence and determine nursing practice are -. 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. Rogers 1970: to maintain and promote health. beginning with conception and ending with death. roles. the client can move more easily through recovery.the social (others) --. diminishes distress.The environment -. The goal of nursing to reduce stress so that.Health --. The growth and development of an individual are influenced by heredity .

The basis of these theories is well-illustrated in Roper. Neuman 1972: Stress reduction is goal of system model of nursing practice. psychological. developmental. "Interaction" theories. "Outcome "theories. who enables individuals to adapt to or cope with ill health (Roy 1980). Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. Watson’s Theory 1979: Watson’s philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the.necessary when client is unable to fulfill biological. Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. these theories revolve around the relationships nurses form with patients. Classification of Nursing Theories Depending On The Generalisability Of Their Principles • • • • • • Metatheory: the theory of theory. Practice theory: explores one particular situation found in nursing. King 1971: To use communication to help client reestablish positive adaptation to environment. Roy 1979: This adaptation model is based on the physiological. humanistic aspects of life. psychological. "Needs "theories. Theories can also be categorised as: • • • • • • "Needs" theories • "Interaction" theories • • "Outcome" theories • . As described by Peplau (1988). "Humanistic theories" These categories indicate the basic philosophical underpinnings of the theories These theories are based around helping individuals to fulfill their physical and mental needs. Grand theory: provides a conceptual framework under which the key concepts and principles of the discipline can be identified. Identifies specific phenomena through abstract concepts. sociological and dependence-independence adaptive modes. Logan and Tierney’s Model of Nursing (1980). Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. or social needs. These portray the nurse as the changing force. It identifies explicit goals and details how these goals will be achieved.

However. the environment (society). an increasing number of nursing theorists have developed models of nursing that provide bases for the development of nursing theories and nursing knowledge. roles. The major contribution that Rogers added to nursing practice is the understanding that each client is a unique individual. These four concepts form a metaparadigm of nursing. A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions. Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual. nursing science was derived principally from social.). or world views. "The world view of change uses the growth metaphor. biologic. and health. Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life. 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" . laws. Humanists believes that the person contains within himself the potential for healthy and creative growth. 1994).• Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988). The term metaparadigm comes from the Greek prefix "meta. provides a way to visualize reality to simplify thinking. and the word Greek word "paradigm. "Humanistic" Theories: • • • • • MODELS OF NURSING • • • • • • • • • • • • Growth and Stability Models of Change • • . nursing (goals. from the 1950s to the present. and generalizations are formulated (MerriamWebster’s Collegiate Dictionary. and medical science theories. Humanistic theories emphasize a person’s capacity for self actualization . about the nature of change. Until fairly recently. so person-centered approach now practice in Nursing." which means a philosophical or theoretical framework of a discipline upon which all theories. According to Fawcett (2000). functions). There are two major differences in philosophical beliefs. as an abstraction of reality." which means more comprehensive or transcending. Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client). and the persistence view focuses on stability" (Fawcett. 1989. A model.

maintain. 1981). Input (Diet teaching) • • • Throughput (Assimilation of information) Output (Food intake) Feedback (Weight record . the purpose of nursing is to help people attain. Imogene King’s Systems Interaction Model • • • • • • interaction model. he or she must continuously adjust to stressors in the internal and external environment (King. and 3. from the level of the individual to the level of society. 1976) A general systems approach allows for consideration of the subsystems levels of the human being. and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity. Ten conceptual models of nursing have been classified according to two criteria: the world view of change reflected by the model (growth or stability). or restore health King’s model conceptualizes three levels of dynamic interacting systems. Society is composed of "social systems. caring. (Sills and Hall. can be conceptualized as the client and becomes the target system for nursing intervention. Systems theory is concerned with changes caused by interactions among all the factors (variables) General systems theory is emphasized A system is defined as "a whole with interrelated parts. Groups (two or more persons) form "interpersonal systems. Individuals are called "personal systems. "progress is valued." 2. in which the parts have a function and the system as a totality has a function" (Auger. and realization of one’s potential is emphasized" (Fawcett)." As the person interacts with the environment. as a total human being. stress/adaptation. . Betty Neuman’s health care systems model. Imogene King’s systems interaction model. change and growth are continual and desirable. Persistence is endurance in time persistence world view emphasizes equilibrium and balance. and the major theoretical conceptual classification with which the model seems most consistent (systems. • • • • • Categories of Conceptual Models Systems Theory as a Framework • • • • An example of systems interaction 1.Hb estimation etc. 1." 3. 1977). Thus the human being.• Within the change world view. or growth/development).) Two nursing models based on systems theory: 2.

or a conflict in a person’s social relationships" (King. Stressors may be of three types: Intrapersonal: forces arising from within the person Interpersonal: forces arising between persons Extrapersonal: forces arising from outside the person Resistance to stressors is provided by a flexible line of defense. "The goal of nursing is to help individuals and groups attain. It is the "dynamic life experiences of a human being. developmental. that is. development. The person is a composite of physiologic. 2002). 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 normalline of defense Neuman’s model. A person is constantly affected by stressors from the internal. If the flexible line of defense is no longer able to protect the person against a stressor. is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. the stressor • • • Betty Neuman’s Health Care Systems Model • • • • • • • • • • • • • • • • . maintain. "Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences" (Neuman. 1989). This normal line of defense is the person’s "usual steady state. external. Stressors are tension-producing stimuli that have the potential to disturb a person’s equilibrium or normal line of defense. and restore health" Stress: "a dynamic state whereby a human being interacts with the environment to maintain balance for growth. and performance" Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability. an imbalance in a person’s biological structure or in his psychological makeup. psychological." It is the way in which an individual usually deals with stressors. "Illness is a deviation from normal. 1981. 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. or created environment. organized around stress reduction.• • • Health assumes achievement of maximum potential for daily living and an ability to function in social roles. 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.). and spiritual variables considered simultaneously. sociocultural.

stress and adaptation theories view change caused by person–environment interaction in terms of cause and effect. 1996). as the occupation is focused on humans. This theory has been widely applied to explain. and because of nursing’s diverse nature it is impossible for it to have a unique body of knowledge and one unified body of theory (Castledine 1994. The person must adjust to environmental changes to avoid disturbing a balanced existence. Adaptation theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. It has been argued that no knowledge is exclusive. one of the main criticisms of nursing theory is its use of overtly complex language (Kenny 1993). attain. nurse education is based on theory borrowed from other disciplines. Neuman intends for the nurse to "assist clients to retain. 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. health (wellness) seems to be related to dynamic equilibrium of the normal line of defense. disturbs the person’s equilibrium. It has been argued that applying knowledge from different disciplines only serves to dilute nursing practice. However. and control biologic (physiologic and psychological) The drive for a unique body of knowledge is based on the assumption that ‘borrowed’ knowledge is less worthy.• • • • breaks through. 2002). Use of language Scott (1994) states that the crucial ingredients of nursing theory should be accessibility and clarity. perhaps it is inevitable that nursing uses knowledge from other social sciences. 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. Nevertheless. and triggers a reaction. In contrast to systems theory. Thus. or maintain optimal system stability" (Neuman. Levine 1995). where stressors are successfully overcome or avoided by the flexible line of defense. However. such as sociology and psychology. The reaction may lead toward restoration of balance or toward death. predict. Neuman defines illness as "a state of insufficiency with disrupting needs unsatisfied" (Neuman. • • Stress/Adaptation Theory as a Framework • • • • A unique body of knowledge • • • • • • • • • Criticisms of nursing theories • • .

Definition Importance of Nursing Theories The characteristics of theories: Basic Processes in the Development Of Nursing Theories: Nursing theories are often based on and influenced ANA definition of Nursing Practice Common concepts in Nursing Theories: Historical Perspectives and Key Concepts Classification 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 Littlejohn (2002) comments that irrespective of nursing theories. Not part of everyday practice Despite theory and practice being viewed as inseparable concepts. However. the concept of theory must be addressed. and if nursing is to continue to develop. perhaps nurses are ‘nursing’ without the knowledge of theories and theory is irrelevant. If nursing theory does not drive the development of nursing. If this is true. Perhaps this is because the majority of nursing theory is developed by and for nursing academics (Lathlean 1994). a theory-practice gap still exists in nursing (Upton 1999). it will continue to develop in the footsteps of other disciplines such as medicine • • • • Summary • • • • • • • • • • • • • • • Conclusion: Reference: .• • • It is important that the language used in the development of nursing theory be used consistently. theory and practice are related. This makes it difficult for the majority of nurses to understand and apply theory to practice (Miller 1985). Therefore. Yet despite the availability of a vast amount of literature on the subject. It has been recognised that traditionally nurses are used to ‘speaking with their hands’ (Levine 1995). many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. nursing theory still means very little to most practicing nurses. nurses will continue to exhibit a caring response to the ‘sick and troubled’.

Norwalk. Julia .Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Meleis Ibrahim Afaf (1997) . prediction and control". Theories are road maps that provide a framework for selecting and organizing information: o What to ask o o o • What to observe What to focus on What to think about • Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing. Potter A Patricia.The base for professional Nursing Practice . 3rd ed. George B. Uses of Theory Theory is used to: • Describe • • • Explain Predict Prescribe a given field of inquiry Uses of Nursing Theory • Define relationships among the variables of • • Guide research. Lippincott. 2. McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williamsand wilkins. Wills M. Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. definitions and propositions) that present a systematic view about a phenomenon and which is useful for description. 5. 3rd ed. Philadelphia.1. London Mosby Year Book. Taylor Carol. UNDERSTANDING THE WORK OF NURSE THEORISTS ……… Creative Beginning Theories of Nursing • Theory is "an internally consistent group of relational statements (concepts. explanation. Theoretical Nursing : Development and Progress 4. Appleton and Lange.Evelyn. 3. Philadelphia. Nursing Theories. practice and communication Allow the prediction of the consequences of care . Lippincott.

We can gain a new perspective of events Basis for challenge of its speculative tenets or propositions Challenges subsequent discovery of new ideas or knowledge that might explain and predict events not yet understood In practice • Assist nurses to describe. interpret findings. • • Assist in discovering knowledge gaps in specific field of study. • Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions. • • Serve to guide assessment. Makes to think differently about a problem or a situation Helps to try new approaches or altering behavior. Ideas are developed and words defined. • Guide curricular decision making In research • Offer a framework for generating knowledge and new ideas. Help to establish criteria to measure the quality of nursing care • • Help build a common nursing terminology to use in communicating with other health professionals.• Allow the prediction of a range of patient responses Levels of Theory There are four levels of theory • Metatheory • • • Grand Theory Middle Range Theory Practice Theory Types of Theory In Nursing there are four types of theories: • Needs • • • Interaction Outcome Humanistic Practice value of theory • Enhances understanding and explanation for events • • • • • • Influence our behavior. intervention. In education • Provide a general focus for curriculum design. An illustration…… The germ theory • Explains the phenomenon of disease transmission . explain. which are essential for effective decision making and implementation. and evaluation of nursing care. and predict everyday experiences. select variables. and validate nursing interventions. Offer a systematic approach to identify questions for study. Provide a rationale for collecting reliable and valid data about the health status of clients.

• • • • Others by the nurse Some may be observed in the environment May be observed in the nurse-client interaction. • How theory contributes to nursing practice… Contribution of practice to theory development • Theory development within nursing occurs in the context of practice. Concept analysis . • • • Two activities contribute significantly to the overall process of developing theory in nursing. In situations of daily work or living. they are considered part of nursing practice. Concept analysis and Practical validation of theory. • Some may be experienced by the client. Example-the communicability of cancer. Viable basis upon which to make decisions about how to prevent certain illnesses. ………….but as long as they are observable during the process of providing direct nursing care. Events….• • • • • Means of speculative explanation and prediction of certain observable events Allows us to effectively function to prevent transmission of communicable disease.. There are phenomena we do not understand that are related to germ transmission.. Approaches to inter relationships between practice and theory • How nursing practice contributes to the process of theory development.. "Nursing Practice." All experiences and events a practicing nurse encounters in the process of providing nursing care.

Environment. and communities). Used as scientific rationale supporting judgments in nursing care plans. the recipient of nursing care (includes individuals. • • Nursing. such as families. ideas such as thermometer. especially direct sunlight Deficiencies in these five factors produced lack Of health or illness. adaptation. and actions of the nurse providing care on behalf of. families. friends. the internal and external surroundings that affect the client. Health. and significant others. ideas such as pain and temperature. or c) non-observable. • Four concepts are considered to be central to nursing : • • Person or client. or in conjunction with. stress. or abstract. groups. rash. the attributes. and lesion.• • • • • Identify and verify abstract concepts "what events in practice can be linked with abstract concept x" Application of theory in practice Nursing process operation of analysis of assessment data. ideas such as equilibrium. characteristics. (b) indirectly observable. Peplau’s interpersonal relations model • Nurses enter into a personal relationship with an individual when a felt need is present Henderson’s definition of nursing • Henderson conceptualized the nurse’s role as assisting sick or well individuals to gain independence in meeting 14 fundamental needs (Henderson) • Breathing normally • • • • • Eating and drinking adequately Eliminating body wastes Moving and maintaining a desirable position Sleeping and resting Selecting suitable clothes . or inferential. This includes people in the physical environment. Concepts • Concepts may be (a) readily observable. the client Nightingale’s environmental theory • "the act of utilizing the environment of the patient to assist him in his recovery" • She linked health with five environmental factors : • • • • • • • Pure or fresh air Pure water Efficient drainage Cleanliness Light. or concrete. the degree of wellness or well-being that the client experiences. and powerlessness • nursing theories address and specify relationships among four major abstract concepts referred to as the metaparadigm of nursing.

c) coordinate the human field with the rhythmicities of the environmental field. Learning. groups. it is the unifying focus for practice.• • • • • • • • Maintaining body temperature within normal range by adjusting clothing and modifying the environment. (b) seek to promote symphonic interaction between the two energy fields (human and environment) to strengthen the coherence and integrity of the person. and communities. supporting. both of which are infinite. and reconstitution factors that are dynamic in nature. guiding. Watson’s human caring theory • Jean Watson (1979) believes the practice of caring is central to nursing. teaching. the reaction to it. Avoiding dangers in the environment and avoiding injuring others Communicating with others in expressing emotions. needs. and providing an environment that promotes the individual’s abilities to meet current and future demands. Neuman’s systems model • The model is based on the individual’s relationship to stress. • Nurses applying Roger's theory in practice (a) focus on the person’s wholeness. Roy’s adaptation model • Roy focuses on the individual as a biopsychosocial adaptive system that employs a feedback cycle of input (stimuli). • Betty Neuman's model of nursing is applicable to a variety of nursing practice settings involving individuals. or opinions Worshipping according to one’s faith Working in such a way that one feels a sense of accomplishment Playing or participating in various forms of recreation. fears. or satisfying the curiosity that leads to normal development and health. It highlights the importance of client’s participation in decision that influence care and focuses on both the process of nurse-client interaction and the outcomes of care. King’s goal attainment theory • King’s theory offers insight into nurses’ interactions with individuals and groups within the environment. and output (behaviors or adaptive responses). throughput (control processes). families. Keeping the body clean and well groomed to protect the integument. and using available health facilities Roger’s science of unitary human beings • She states that humans are dynamic energy fields in continuous exchange with environmental fields. discovering. • Nursing interventions related to human care are referred to as carative factors. . and (d) direct and redirect patterns of interaction between the two energy fields to promote maximum health potential Orem’s general theory of nursing • Orem’s self-care deficit theory explains not only when nursing is needed but also how people can be assisted through five methods of helping: acting or doing for.

Hawks hokanson Jane. Joice. 1996. 2002. it is largely culturally derived.R. and patterns. Philadelphia. (5th ed. Mosby. Medical Surgical Nursing: concepts & clinical practice. Tomey. Phipps J Wilma. Parse’s human becoming theory • Parse’s model of human becoming emphasizes how individuals choose and bear responsibility for patterns of personal health. Missouri. Mosby. • . developmental. 2. and health-deviation selfcare requisites. or a mix) that will help the client achieve an optimal level of self care Implementing • Assisting the client Evaluating 1. Sands K Judith. Mosby publications. 2005. Tomey AM. Leininger’s cultural care diversity and universality theory • She emphasizes that human caring. varies among cultures in its expressions. skills. MR. an appropriate nursing system (wholly compensatory. Determine self-care deficits. partially compensatory. Black M. Nursing theory utilization and application.M. Philadelphia. St Lois.6th edition. with the client’s participation. supportive-educative. Alligood M.Watson’s theory of human caring has receiving worldwide recognition and is a major force in redefining nursing as a caring-healing health model. Nursing theorists and their work.). Orem’s general theory of nursing Assessing • Involves collecting data about the client’s capacities (knowledge. 2nd Ed. A. processes. 3. Alligood. Philadelphia. although a universal phenomenon. Medical Surgical Nursing: Clinical Management for positive outcomes. and motivation) to perform universal. 2002 4. Determining the client’s level of achievement References 1. Diagnosing • Stated in terms of the client’s limitations for maintaining self care (a deficit in self-care agency) Planning • Involves considering and designing.

Relationship between theory and research in nursing is not well understood. aids in design. It enables the scientist to weave the facts together. constructivism. analysis and interpretation. Theories from Nursing or Other Disciplines? . etc…) Need to Link Theory and Research • • • Research without theory results in discreet information or data which does not add to the accumulated knowledge of the discipline. (Empiricism. It may be give to the relative youth of the discipline and debates over philosophical world views. forms the research questions.THEORIES & NURSING RESEARCH Introduction • • • • • RESEARCH – Process of inquiry THEORY – Product of knowledge SCIENCE – Result of the relationship between research & theory To effectively build knowledge to research process should be developed within some theoretical structure that facilities analysis and interpretation of findings. Theory guides the research process.

To interpret research findings To develop clinical practice protocols. Now the focus of research and theory have moved more towards middle range theories Purpose of Theory in Research • • • • • • • To identify meaningful and relevant areas for study. To develop or refine theories Define the concepts and proposed relationships between concepts. Research and theory developed separately in nursing. Between 1928 and 1959 only 2 out of 152 studies reported a theoretical basis for the research design. Afterwards. To propose plausible approaches to health problems. Historical Overview of Research and Theory in Nursing • • • • • • • Florence Nightingale supported her theoretical propositions through research. Types of theory and corresponding research Type of theory • • • Descriptive Explanatory Predictive • How Theory is used in Research Experimental Type of research • Descriptive or explanatory • Co relational . as statistical data and prepared graphs were used to depict the impact of nursing care on the health of British soldiers.• • • Nursing science is blend of knowledge that is unique to nursing and knowledge that is borrowed from other disciplines. It has contributed to problems connecting research and theory in nursing. Generate nursing diagnosis. Debate is whether the use of borrowed theory has hindered the development of the discipline. In 1970’s growing number of nurse theorists were seeking researchers to test their models in research and clinical application Grand nursing theories are still not widely used. In 1990’s borrowed theories were used more. for almost century reports of nursing research were rare.

During the theory generating process. Grounded Theory Research • • Inductive research technique developed by Glazer and Strauss (1967) Grounded theory provides a way to describe what is happening and understanding the process of why it happens. It is inductive and includes field observations and phenomenology. the researcher moves by logical thought from fact to theory by means of a proposition stated as an empirical generalization.Causal theory of planned behaviour Theory Generating Research • • • It is designed to develop and describe relationships between and among phenomena without imposing preconceived notations. .

It requires a deductive reasoning process. A Typology of Research • • • • • • • Testing Analyzing Experimentation Deducting Deductive research Quantitative research The scientific method . which guides the study and enriches the value of its findings. Data may be collected by interview. theoretical statements are translated into questions and hypothesis. Findings are interpreted in light of explanations provided by the framework. Category development – Categories are identified and named Category saturation – Comparison of similar characteristics in each of the categories Concept development – Defines the categories Search for additional categories – Continues to examine the data for additional categories Category reduction – Higher order categories are selected Linking of categories – The researcher seeks to understand relationships among categories Selective sampling of the literature Emergence of the core variable – Central theme are focus of the theory Concept modification and integration – Explaining the phenomenal Theory testing research • In theory testing research.• • • • • • • • • • • • Methodology – The researcher observes. observation. Implications are based on the explanatory power of a framework. The conceptual definitions are drawn from the framework The data collection instrument is congruent with the framework. • • • Theory as a conceptual framework • • • • • Problem being investigated is fit into an existing theoretical framework. Data are coded in preparation for analysis. organizes data and forms theory from the data at the same time. The interpretation determines whether the study supports are contradicts the propositional statement. records or a combination of these techniques. Theory testing requires detailed examination of theoretical relationships. If a conceptual model is used as a theoretical framework for research it is not theory testing. collects data.

4. Philadelphia: WB Saunders Publications. Norwalk. Julia . 9. Appleton and Lange. 4th Ed. ‘heuristic’ research Guidelines for writing about a research study’s theoretical framework In the study’s problem statement 1. 3rd ed. 8. In the study’s discussion section 10. 2001. Describe how study findings are consistent (or inconsistent) with the framework. 5. So interface theory and research by generating theories. testing the theories and by using it as a conceptual framework that drives the study. 11. Burns N. Explain how data collection methods (such as questionnaire items) reflect the concepts in the framework. Conclusion The relationship between research and theory is undeniable. . Reference • • • George B.The base for professional Nursing Practice . Grove SK. Offer suggestions for practice and further research that are congruent with the framework’s concepts and propositions. Philadelphia: JB Lippincott Company. Introduce the framework Briefly explain why it is a good fit for the research problem area At the end of the literature review Thoroughly describe the framework and explain its application to the present study. In the study’s methodology section 7. and it is important to recognize the impact of this relationships on the development of nursing knowledge. Nursing Theories. Describe how the framework has been used in studies about similar problems 6. 2. Hungler BP.• • • • • • • • • • • Theory / hypothesis testing Assaying Refining Interpreting Reflecting Inducing Inductive research Qualitative research Phenomenological research Theory generation ‘Divining’. 3. 1998. Explain how the framework is being operationalized in the study’s design. The practice of Nursing Research. Nursing Research: Principles and Methods. Polit DF.

Washington. Elements of Research in Nursing (3rded. Henderson determined that she needed more education and entered Teachers College at Columbia University where she earned her." "little Miss 3x5" Born in Kansas City. Louis: Mosby. they reflected the interests of nurses of that time.” Introduction • • • • • • • • • “The Nightingale of Modern Nursing” “Modern-Day Mother of Nursing. Bachelor’s Degree in 1932. 1982. Missouri. Subsequently. Treece EW. St.” "The 20th century Florence Nightingale. VIRGINIA HENDERSON’S NEED THEORY “Nursing theories mirror different realities.1998) • . throughout their development. in 1897 and is the 5th child of a family of 8th children but spent her formative years in Virginia Received a Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital. in 1921. Master’s Degree in 1934.C. In 1923. where she remained until 1948(Herrmann. she accepted a position teaching nursing at the Norfolk Protestant Hospital in Virginia. D.• Treece JW. she joined Columbia as a member of the faculty.). where she remained for several years In 1929. Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.

incorporating her personal definition of nursing (Henderson. edition. In 1937 Henderson and others created a basic nursing curriculum for the National League for Nursing in which education was “patient centered and organized around nursing problems rather than medical diagnoses” (Henderson.• • • • • Since 1953. 1966-The Nature of Nursing. and consumer health advocate warranted an obituary in the New York Times. Research and Education 1991. 1996. she has been a research associate at Yale University School of Nursing. Is the recipient of numerous recognitions for her outstanding contributions to nursing? VH was a well known nursing educator and a prolific author. University of Western Ontario. 1956 (with B. she was a frequent visitor to nursing schools well into her nineties. researcher. Her work influenced the nursing profession in America and throughout the world The founding members of ICIRN (Interagency Council on Information Resources for Nursing) and a passionate advocate for the use and sharing of health information resources. Friday March 22. In 1985. University of Rochester. A definition and its implication for practice. O’Malley (1996) states that Henderson is known as the modern-day mother of nursing.1991) In 1939. She argued that nurses needed to be prepared for their role by receiving the broadest understanding of humanity and the world in which they lived. teacher.The Nature of Nursing Reflections after 20 years • Contribution • • • • • • Publications • • • . Harmer)-Textbook for the principles and practices of Nursing. and later wrote the 5th. Died: March 19. 1996.1991) Although she was retired. author. Miss Henderson was honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. She has received honorary doctoral degrees from the o o o o o Catholic University of America Pace University. Yale University Achievements • Her stature as a nurse. she revised: Harmer’s classic textbook of nursing for its 4th edition. In 1978 the fundamental concept of nursing was revisited by Virginia Henderson from Yale University School of Nursing ( USA ).

Patient Orientation Role of nurse Need Deficit Illness.Analysis of Nursing Theory • • • Images of Nursing. 1950-1970 The First School of Thought: Needs This school of thought includes theories that reflect an image of nursing as meeting the needs of clients and were developed in response to such questions as What do nurses do? What are their functions? What roles do nurses play? Answers to these questions focused on a number of theorist describing functions and roles of nurses. Beginnings of independent functions Fulfill needs requisites Decision making Primarily health care professional Outcome theorists Johnson Levine Rogers Roy • • • • • • Henderson’s Theory Background . School of thought in Nursing Theories-1950-1970 Need theorists Abdellah Henderson Orem Interaction theorists King Orlando Peterson and Zderad Paplau Travelbee Wiedenbach Analysis of nursing theories according to 1st School Focus Human being Problems A set of needs or problems. When any of these needs are unmet and when a person is unable to fulfill his own needs. A developmental being. Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy of needs. Nurses then provide the necessary functions and play those roles that could help patients meet their needs. the care provided by nurses is required. disease Dependent on medical practice.

15). She was one of the first nurses to point out that nursing does not consist of merely following physician's orders. the principles and practice or nursing must be built upon and derived from the definition of the profession. First. This experience enlarges Henderson’s view to recognize the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed (Henderson. Then in 1955. 1966. Henderson's focus on individual care is evident in that she stressed assisting individuals with essential activities to maintain health. She called her definition of nursing her “concept” (Henderson1991) Although her major clinical experiences were in medical-surgical hospitals. will or knowledge. she was concerned that many states had no provision for nursing licensure to ensure safe and competent care for the consumer. And to do this in such a way as to help him gain independence as rapidly as possible" (Henderson.• • • Henderson’s concept of nursing was derived form her practice and education therefore. she participated in the revision of a nursing textbook. to recover. complementary (working with the person). in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength. p. Her famous definition of nursing was one of the first statements clearly delineating nursing from medicine: "The unique function of the nurse is to assist the individual. She described the nurse's role as substitutive (doing for the person). based on human needs. supplementary (helping the person). In the revision she recognized the need to be clear about the functions of the nurse and she believed that this textbook serves as a main learning source for nursing practice should present a sound and definitive description of nursing. with the goal of helping the person become as independent as possible. she worked as a visiting nurse in New York City. • • . • • Furthermore. 15). sick or well.1991) Virginia Henderson defined nursing as "assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery" (Henderson. She categorized nursing activities into 14 components. 1966. Second. Although official statements on the nursing function were published by the ANA in 1932 and 1937. • • • • • The development of Henderson’s definition of nursing • • • • Two events are the basis for Henderson’s development of a definition of nursing. or to achieve peaceful death. Henderson viewed these statements as nonspecific and unsatisfactory definitions of nursing practice. p. the earlier ANA definition was modified. her work is inductive.

or opinions. Eat and drink adequately. fears. Select suitable clothes-dress and undress. In 1955. The first 9 components are physiological. • • • Patients desire to return to health. Play or participate in various forms of recreation. but this assumption is not explicitly stated. Henderson’s first definition of nursing was published in Bertha Harmer’s revised nursing textbook. Maintain body temperature within normal range by adjusting clothing and modifying environment Keep the body clean and well groomed and protect the integument Avoid dangers in the environment and avoid injuring others. Henderson’s theory and the four major concepts Individual • • • Have basic needs that are component of health. Nurses are willing to serve and that “nurses will devote themselves to the patient day and night” A final assumption is that nurses should be educated at the university level in both arts and sciences. Communicate with others in expressing emotions.• • She proposed 14 components of basic nursing care to augment her definition. Sleep and rest. Learn. Worship according to one’s faith. Breathe normally. Work in such a way that there is a sense of accomplishment. . The tenth and fourteenth are psychological aspects of communicating and learning The eleventh component is spiritual and moral The twelfth and thirteenth components are sociologically oriented to occupation and recreation The 14 components • • • • • • • • • • • • • • • • • • Assumption The major assumption of the theory is that: • Nurses care for patients until patient can care for themselves once again. Mind and body are inseparable and interrelated. or satisfy the curiosity that leads to normal development and health and use the available health facilities. discover. Requiring assistance to achieve health and independence or a peaceful death. needs. Move and maintain desirable postures. Eliminate body wastes.

and the knowledge. physical. and spiritual components. The theory presents the patient as a sum of parts with biopsychosocial needs. Use nursing research Categorized Environment • • • • • • • • Health • • • • • Nursing • • • • • • • • .• • Considers the biological. In return she expects society to contribute to nursing education. Supports tasks of private and public agencies Society wants and expects nurses to act for individuals who are unable to function independently. sociological. the will. Individuals in relation to families Minimally discusses the impact of the community on the individual and family. Assists and supports the individual in life activities and the attainment of independence. All external conditions and influences that affect life and development. or "independent. Nurse serves to make patient “complete” “whole"." Henderson's classic definition of nursing: "I say that the nurse does for others what they would do for themselves if they had the strength. and emotional balance Is the individual’s ability to meet these needs independently? Temporarily assisting an individual who lacks the necessary strength. psychological. But I go on to say that the nurse makes the patient independent of him or her as soon as possible." The nurse is expected to carry out physician’s therapeutic plan Individualized care is the result of the nurse’s creativity in planning for care. Affected by age. and intellectual capacities. and the patient is neither client nor consumer. Nurses need to stress promotion of health and prevention and cure of disease. Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided Definition based on individual’s ability to function independently as outlined in the 14 components. Good health is a challenge. Settings in which an individual learns unique pattern for living. will and knowledge to satisfy 1 or more of 14 basic needs. cultural background.

an independent practitioner and able to make independent judgments as long as s/he is not diagnosing. cleanliness and serving food. sick or well. Nursing Process Henderson’s 14 components and definition of nursing Henderson’s 14 components Analysis: Compare data to knowledge base of health and disease. In the Nature of Nursing “ that the nurse is and should be legally.” o And nurse has responsibility to assess the needs of the individual patient.” In the Nature of Nursing o Nurse role is. for these are the physicians function. taking into consideration strength. Document how the nurse can assist the individual. will or knowledge.” to get inside the patient’s skin and supplement his strength will or knowledge according to his needs. prescribing treatment for disease.” “Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.” “Nursing process stresses the science of nursing rather than the mixture of science and art on which it seems effective health care service of any kind is based. The steps are those of the scientific method. Nursing Diagnosis Identify individual’s ability to meet own needs with or without assistance. or making a prognosis. • • Henderson's classic definition of nursing "I say that the nurse does for others what they would do for themselves if they had the strength." Henderson’s and Nursing Process • Henderson views the nursing process as “really the application of the logical approach to the solution of a problem. But I go on to say that the nurse makes the patient independent of him or her as soon as possible. Nursing Assessment Nursing plan . help individual meet their health need.” • Summarization of the stages of the nursing process as applied to Henderson’s definition of nursing and to the 14 components of basic nursing care.o o • Nursing : nursing care Non nursing: ordering supplies. and the knowledge. the will. and or provide an environment in which the individual can perform activity unaided.

recover from illness.Nursing implementation Assist the sick or well individual in to performance of activities in meeting human needs to maintain health. The quality of care is drastically affected by the preparation and native ability of the nursing personnel rather that the amount of hours of care. and physical and intellectual capacities. age. Nursing evaluation Comparison with Maslow's Hierarchy of Need MASLOW'S Physiological needs HENDERSON Breathe normally Eat and drink adequately Eliminate by all avenues of elimination Move and maintain desirable posture Sleep and rest Select suitable clothing Maintain body temperature Keep body clean and well groomed and protect the integument Safety needs Avoid environmental dangers and avoid injuring others . Implementation based on the physiological principles. cultural background. Successful outcomes of nursing care are based on the speed with which or degree to which the patient performs independently the activities of daily living. or to aid in peaceful death. emotional balance.nursing and appropriate laws related to the practice of nursing. Carry out treatment prescribed by the physician. Nursing implementation Nursing process Henderson’s 14 components and definition of nursing Use the acceptable definition of .

it is impossible to generate testable hypotheses. culture. Her ideas of nursing practice are well accepted throughout the world as a basis for nursing care. Concepts of fundamental human needs. Theories can be the bases for hypotheses that can be tested.Belongingness and love needs Esteem needs Communicate with others Worship according to faith Work at something providing a sense of accomplishment Play or participate in various forms of recreation Learn. Ideally the nurse would improve nursing practice by using her definition and 14 components to improve the health of individuals and thus reduce illness. nurse-patient relationship Theories must be logical in nature. Maslow’s Hierarchy of human needs. Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal. and interaction. or satisfy curiosity Self actualization needs Characteristic of Henderson’s theory • • Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. Her definition of nursing cannot be viewed as theory. However some questions to investigate the definition of nursing and the 14 components may be useful. Her work can be applied to the health of individuals of all ages. the impact of the definition and components has not been established through research.E.g. communication and is borrowed from other discipline. concept of interactioncommunication i. Is the sequence of the 14 components followed by nurses in the USA and the other countries? What priorities are evident in the use of the basic nursing functions? Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. discover..e. therefore. • • • • • • • • • • • • • • . Theories should be relatively simple yet generalizable. Theories can be utilized by practitioners to guide and improve their practice. However. biophysiology.

and the principles embodied by the 14 activities are still important in evaluating nursing care in thee21st centaury. rather than on. the psychological from the physical and the theory from clinical care. and principles but will leave open unanswered questions that need to be investigated. the leg of the amputee. She strongly believed in "getting inside the skin" of her patients in order to know what he or she needs. Philosophical claims The philosophy reflected in Henderson's theory is an integrated approach to scientific study that would capitalize on nursing's richness and complexity.• Theories must be consistent with other validated theories.. the "doing" of nursing from the "knowing". but believed that it should be clinical research (O’Malley.. Others concepts that Henderson (1966) proposed have been used in nursing education from the 1930s until the present O'Malley. the eyes of the newly blind. and she worked to change that. Like she said. p. the love of life for the suicidal. • • Value in extending nursing science • • Usefulness • • • Testability • . From an historical standpoint. and not to separate the art from the science. Her contributions to nursing literature extended from the 1930s through the 1990s and has had an impact on nursing research by strengthening the focus on nursing practice and confirming the value of tested interventions in assisting individuals to regain health. her concept of nursing enhanced nursing science this has been particularly important in the area of nursing education..." Henderson stated that “Thorndike’s fundamental needs of man” (Henderson. Much of the research before her time had been on educational processes and on the profession of nursing itself. laws. Values and Beliefs • Henderson believed nursing as primarily complementing the patient by supplying what he needs in knowledge. 1996) Henderson supported nursing research. The principles of Henderson’s theory were published in the major nursing textbooks used from the 1930s through the 1960s. the practice and outcomes of nursing . Nursing education has been deeply affected by Henderson’s clear vision of the functions of nurses. "The nurse is temporarily the consciousness of the unconscious. 1991. helper to the patient and partner with the patient. will or strength to perform his daily activities and to carry out the treatment prescribed for him by the physician. 1996).16) had an influence on her beliefs. a means of locomotion for the infant and the knowledge and confidence for the young mother. The nurse should be the substitute for the patient.

Assist in discovering knowledge gaps in the specific field of study. the theory can guide research in any aspect of the individual’s care needs. but there is little explanation of what the nurse does. and predict everyday experiences. and evaluation of nursing care. No concept of the holistic nature of human being. Lack of conceptual linkage between physiological and other human characteristics. Offer a systematic approach to identify questions for study. interventions. explain. and validate nursing interventions. • • • • In Education: • • • • • In Research: Approaches to developing nursing theory • • . interpret findings. Further. select variables. “Peaceful death” is curious and significant nursing role.• • Each of the 14 activities can be the basis for research. they may be reformulated into researchable questions. Lacks inter-relate of factors and the influence of nursing care. Written in testable terms. Inductively looking at nursing practice to discover theories/concepts to explain phenomena. the relationship among the components is unclear. Serve to guide assessment. Provide a general focus for curriculum design Guide curricular decision making. Offer a framework for generating knowledge and new ideas. Ideas are developed and words are defined. If the assumption is made that the 14 components prioritized. which are essential for effective decision making and implementation. Limitations • • • • • • Purposes of nursing theories In Practice: • • • Assist nurses to describe. Although the statements are not. Help to describe criteria to measure the quality of nursing care. Borrowing conceptual frameworks from other disciplines. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. Provide a rationale for collecting reliable and valid data about the health status of clients. Assisting the individual in the dying process she contends that the nurse helps. Help build a common nursing terminology to use in communicating with other health professionals.

Evelyn.The base for professional Nursing Practice . Major four concepts 8. Fundamental skills and concepts in Patient Care. 14 components 7. imitation Conclusion In conclusion. Henderson provides the essence of what she believes is a definition of nursing. Characteristics 14. Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs. She didn’t intend to develop a theory of nursing but rather she attempted to define the unique focus of nursing. Her definition of nursing and the 14 components of basic nursing care are uncomplicated and self-explanatory. Nursing Theories. Development of Henderson’s definition of nursing 6. Julia . 7th edition. Comparison with Maslow's Hierarchy need 10. Publications 4. Usefulness 12. Testability 13. Analysis of Nursing theories 5. Questions from practicing Nurse about using Nursing theory Practice • • • Does this theory reflect nursing practice as I know it? Will it support what I believe to be excellent nursing practice? Can this theory be considered in relation to a wide range of nursing situation? What will it be like to think about nursing theory in nursing practice? Will my work with nursing theory be worth the effort? Personal Interests. LWW. Assumptions 11. N George B. McEwen Melanie (2002). Achievements 3. Wills M. Theoretical Basis for Nursing . Reference • • • Timber BK. Norwalk. Nursing process with Henderson’s theory 9. Background 2. 3rd ed. Appleton & Lange. Abilities and Experiences • • Summary 1.• Deductively looking for the compatibility of a general nursing theory with nursing practice.

Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. • • • • Meleis Ibrahim Afaf (1997) .19(3):225 Delaune SC. Nurs Sci Q. Ladner PK. Potter A Patricia. standard and practice. Philadelphia. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. Thomson. Philadelphia.E. Fundamental of nursing.Philadelphia. The force of nursing theory guided. London Mosby Year Book. Pennsylvania [1909] .. Vandemark L. 2nd edition. Peplau Introduction • Born in Reading. 2006 Jul. Lippincott Williams& wilkins. Taylor Carol. 2002 • • Theory of interpersonal relations Hildegard .Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.practice.M. 2006 Jul. Theoretical Nursing : Development & Progress 3rd ed. Lippincott. 27(6) : 605-15 Reed PG. NY. Lippincott.

It functions cooperatively with other human process that make health possible for individuals in communities . NIMH and nurse corps. personal and community living. Worked with W. In her book she discussed the phases of interpersonal process. Health : A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative. nursing is therapeutic in that it is a healing art. Died in 1999.• • • • • • • • • • • Graduated from a diploma program in Pottstown. Person :A developing organism that tries to reduce anxiety caused by needs 2. Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. 5. assisting an individual who is sick or in need of health care. MA in psychiatric nursing from Colombia University New York in 1947. Definitions 1. The attainment of goal is achieved through the use of a series of steps following a series of pattern. Professor emeritus from Rutgers university Started first post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952 1968 :interpersonal techniques-the crux of psychiatric nursing Worked as executive director and president of ANA. EdD in curriculum development in 1953. The nurse and patient work together so both become mature and knowledgeable in the process. To apply principles of human relations to the problems that arise at all levels of experience 4.O. Environment : Existing forces outside the organism and in the context of culture 3. productive. To help others identify felt difficulties 3. roles in nursing situations and methods for studying nursing as an interpersonal process. Done BA in interpersonal psychology from Bennington College in 1943. Psychodynamic nursing 1. 6. 4. Understanding of ones own behavior 2. According to Peplau.H. 7. 8. Nursing: A significant therapeutic interpersonal process. constructive. Pennsylvania in 1931.

Technical expert Consultant Health teacher Tutor Socializing agent Safety agent Manager of environment Mediator Administrator Recorder observer Researcher Additional Roles include: Theory of interpersonal relations • • • • Middle range descriptive classification theory Influenced by Harry Stack Sullivan's theory of inter personal relations (1953) Also influenced by Percival Symonds . 5. Teacher: who imparts knowledge in reference to a need or interest Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation Counselors : helps to understand and integrate the meaning of current life circumstances . 11. 2. Resolution Orientation phase • • • • Problem defining phase Starts when client meets nurse as stranger Defining problem and deciding type of service needed Client seeks assistance . Exploitation 4.conveys needs .asks questions. Abraham Maslow's and Neal Elger Miller Identified four sequential phases in the interpersonal relationship: 1.provides guidance and encouragement to make changes Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. 3. Identification 3. 8. 9. 10.Roles of nurse • • • • • • Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way 1. 6. Orientation 2. 7. 4. shares preconceptions and expectations of past experiences .

understand and adequately deal with the underlying problem Patient may fluctuates on independence Nurse must be aware about the various phases of communication Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step Resolution phase • • • • • Termination of professional relationship The patients needs have already been met by the collaborative effect of patient and nurse Now they need to terminate their therapeutic relationship and dissolve the links between them. Sometimes may be difficult for both as psychological dependence persists Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals Interpersonal theory and nursing process . explains roles to client. helps to identify problems and to use available resources and services Factors influencing orientation phase Identification phase • • Selection of appropriate professional assistance Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness Exploitation phase • • • • • • • • Use of professional assistance for problem solving alternatives Advantages of services are used is based on the needs and interests of the patients Individual feels as an integral part of the helping environment They may make minor requests or attention getting techniques The principles of interview techniques must be used in order to explore .• Nurse responds.

• • • Both are sequential and focus on therapeutic relationship Both use problem solving techniques for the nurse and patient to collaborate on. Leads to adaptability in any nurse patient relationship. goals. The nurse patient interaction can apply to the concepts of human being . Four phases interrelate the different components of each phase. with the end purpose of meeting the patients needs Both use observation communication and recording as basic tools utilized by nursing Assessment Data collection and analysis [continuous] May not be a felt need Nursing diagnosis Planning Mutually set goals Implementation Plans initiated towards achievement of mutually set goals May be accomplished by patient . environment and nursing. . Theories must be logical in nature Provides a logical systematic way of viewing nursing situations Key concepts such as anxiety. nurse or family Evaluation Based on mutually expected behaviors May led to termination and initiation of new plans Orientation Non continuous data collection Felt need Define needs Identification Interdependent goal setting Exploitation Patient actively seeking and drawing help Patient initiated Resolution Occurs after other phases are completed successfully Leads to termination Peplau’s work and characteristics of a theory Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.health. tension. and frustration are indicated with explicit relationships among them and progressive phases Theories should be relatively simple yet generalizable It provides simplicity in regard to the natural progression of the NP relationship.

Norwalk. (1961). Nursing Theories. unconscious patients some areas are not specific enough to generate hypothesis Research Based on Peplau’s Theory 1.F. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. the patients were able to apply the concept of anxiety after the group was terminated. With drawn patients. Peplau’s anxiety continuum is still used in anxiety patients Theories must be consistent with other validated theories. personal space considerations and community social service resources are considered less Health promotion and maintenance were less emphasized Cannot be used in a patient who doesn’t have a felt need eg.The basic nature of nursing still considered an interpersonal process Theories can be the bases for hypothesis that can be tested. 2.D. In 1950’s two third of the nursing research concentrated on N-P relation ship. N George B. Fundamental skills and concepts in Patient Care. and principles but will leave open unanswered questions that need to be investigated. Consistent with various theories Limitations • • • • Intra family dynamics.S. Appleton & Lange.The base for professional Nursing Practice . Develop and test a nursing intervention framework for working with anxious patients: Students developed competency in beginning interpersonal relationship References • • Timber BK. LWW. Hays . Theories can be utilized by practitioners to guide and improve their practice. Julia . .Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method. 3rd ed. 7th edition. Has generated testable hypotheses. laws. Burd .

2006 Jul. standard and practice. Lippincott Williams& wilkins. 27(6) : 605-15 Reed PG.. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Vandemark L. Philadelphia.M. Taylor Carol.19(3):225 Delaune SC. NY. Thomson.• • • • • Wills M.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Theoretical Nursing : Development & Progress 3rd ed. London Mosby Year Book. 2002 • • . Theoretical Basis for Nursing Philadelphia. Nurs Sci Q. Meleis Ibrahim Afaf (1997) . Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. Potter A Patricia. Philadelphia. Lippincott. Ladner PK. 2nd edition. McEwen Melanie (2002).practice.Evelyn. Fundamental of nursing. The force of nursing theory guided. Lippincott. 2006 Jul.

helped transform nursing theory.FAYE GLENN ABDELLAH'S THEORY TWENTY ONE NURSING PROBLEMS INTRODUCTION • • • • • Faye Glenn Abdellah. She has been a leader in nursing research and has over one hundred publications related to nursing care. sick or well. nursing is based on an art and science that mould the attitudes. nursing care and nursing education Birth:1919 Dr Abdellah worked as Deputy Surgeon General Former Chief Nurse Officer for the U.S Public Health Service . education for advanced practice in nursing and nursing research. • • • Recognizing the nursing problems of the patient Deciding the appropriate course of action to take in terms of relevant nursing principles Providing continuous care of the individuals total needs • • • . According to her. and technical skills of the individual nurse into the desire and ability to help people . cope with their health needs. As a comprehensive service . to families. therefore to. to society.C . Abdellah described nursing as a service to individuals. pioneer nursing researcher. and. Department of Health and human services. intellectual competencies. influenced by the desire to promote client-centred comprehensive nursing care. In 1960. D.nursing includes. Washington.

She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses’ prerogative. ‘he’ for doctors and patients. continuing education for professional nurses 6. Abdellah’s theory was derived. pollution. and refers to the object of nursing as ‘patient’ rather than client or consumer. the impact of problems such as poverty. and so forth on health care delivery. . 3. change and anticipated changes that affect nursing. MAJOR ASSUMPTIONS. 2. CONCEPTS & RELATIONSHIPS 1. Consistent with the decade in which she was writing. she uses the term ‘she’ for nurses. • • • • • PHILOSOPHICAL UNDERPINNINGS OF THE THEORY Abdellah’s patient-centred approach to nursing was developed inductively from her practice and is considered a human needs theory. changing nursing education 5. The need to appreciate the interconnectedness of social enterprises and social problems. The theory was created to assist with nursing education and is most applicable to the education of nurses. national and international levels 10) Carrying out continuous evaluation and research to improve nursing techniques and to develop new techniques to meet the health needs of people These original premises have undergone an evolutionary process. the item 3. 4. education. From these premises.• • • • • • • Providing continuous care to relieve pain and discomfort and provide immediate security for the individual Adjusting the total nursing care plan to meet the patient’s individual needs Helping the individual to become more self directing in attaining or maintaining a healthy state of mind & body Instructing nursing personnel and family to help the individual do for himself that which he can within his limitations 8)Helping the individual to adjust to his limitations and emotional problems 9) Working with allied health professions in planning for optimum health on local. Although it was intended to guide care of those in the hospital. racism. in 1973. 4. state. Assumptions were related to 1. it also has relevance for nursing care in community settings. Abdellah and colleagues developed a list of 21 nursing problems. development of nursing leaders from under reserved groups 5. .“providing continuous care of the individual’s total health needs” was eliminated. The language of Abdellah’s framework is readable and clear. As result. 2. 3.

Teaching of patients and families 5. Use of personnel resources 8. rest and sleep To promote safety through the prevention of accidents. Validate the patient’s conclusions about his nursing problems 7. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan 9. injury. Problem-solving 9.6. Nursing procedures The twenty one nursing problems Three major categories • • • Physical. 11 nursing skills to be used in developing a treatment typology 10 steps to identify the client’s problems 1. Use of resource materials 7. and emotional needs of clients Types of interpersonal relationships between the nurse and patient Common elements of client care 21 NURSING PROBLEMS BASIC TO ALL PATIENTS • • • To maintain good hygiene and physical comfort To promote optimal activity: exercise. They also identified 10 steps to identify the client’s problems 7. Direction of work of others 10. or other trauma and through the prevention of the spread of infection . Sort out relevant and significant data 3. Skills of communication 3. Test generalizations with the patient and make additional generalizations 6. Planning and organization of work 6. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior 8. sociological. Application of knowledge 4. Identify how the nurses feels about the patient’s nursing problems 10. Observation of health status 2. Therapeutic use of the self 11. Learn to know the patient 2. Discuss and develop a comprehensive nursing care plan 11 nursing skills 1. Make generalizations about available data in relation to similar nursing problems presented by other patients 4. Identify the therapeutic plan 5.

In this way. emotional. nursing problems. feelings. physical and emotional To use community resources as an aid in resolving problems arising from illness To understand the role of social problems as influencing factors in the case of illness SUSTENAL CARE NEEDS REMEDIAL CARE NEEDS RESTORATIVE CARE NEEDS • • • Abdellah's 21 problems are actually a model describing the "arenas" or concerns of nursing. with a focus on disease and cure. and problem solving. from the practice of medicine. the theory distinguished the practice of nursing.• • • • • • • • • • • • • • • To maintain good body mechanics and prevent and correct deformities To facilitate the maintenance of a supply of oxygen to all body cells To facilitate the maintenance of nutrition of all body cells To facilitate the maintenance of elimination To facilitate the maintenance of fluid and electrolyte balance To recognize the physiological responses of the body to disease conditions To facilitate the maintenance of regulatory mechanisms and functions To facilitate the maintenance of sensory function To identify and accept positive and negative expressions. Such a statement maintains problem solving as the vehicle for the nursing problems as the client is moved toward health – the outcome NURSING . and developmental needs To accept the optimum possible goals in the light of limitations. with a focus on the 21 nursing problems. and reactions To identify and accept the interrelatedness of emotions and organic illness To facilitate the maintenance of effective verbal and non verbal communication To promote the development of productive interpersonal relationships To facilitate progress toward achievement of personal spiritual goals To create and / or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical . rather than a theory describing relationships among phenomena. Abdellah’s theory would state that nursing is the use of the problem solving approach with key nursing problems related to health needs of people. such a statement can be derived by using her three major concepts of health. ABDELLAH’S THEORY AND NURSING • Although Abdellah’s writings are not specific as to a theoretical statement.

she seems to swing the pendulum to the opposite pole. and revising hypothesis where necessary on the basis of conclusions obtained from the data. nursing is based on an art and science that mould the attitudes. cope with their health needs. which the nurse can assist him or them to meet through the performance of her professional functions In her attempt to bring nursing practice into its proper relationship with restorative and preventive measures for meeting total client needs. which the nurse can assist him or them to meet through the performance of her professional functions. selecting pertinent data. from the disease orientation to nursing orientation. Health is a dynamic pattern of functioning whereby there is a continued interaction with internal and external forces that results in the optimum use of necessary resources that serve to minimize vulnerabilities Nursing problem presented by a client is a condition faced by the client or client’s family that the nurse through the performance of professional functions can assist them to meet . HEALTH • NURSING PROBLEMS • • • • PROBLEM SOLVING • COMPARISON WITH OTHER THEORIES MASLOW HENDERSON ABDELLAH . by the patient or family.• Acc to her. The problem solving process involves identifying the problem. sick or well. formulating hypothesis. while leaving the client somewhere in the middle. and technical skills of the individual nurse into the desire and ability to help people. An overt nursing problem is an apparent condition faced by the patient or family. The problem can be either an overt or covert nursing problem. testing hypothesis through the collection of data. The covert nursing problem is a concealed or hidden condition faced. intellectual competencies.

To promote safety through the prevention of accidents. rest and sleep 8. To facilitate the maintenance well groomed & of regulatory mechanisms protect the and functions integument 8. To maintain good hygiene and physical comfort 9. Worship according to faith 12. Sleep & rest 6. To facilitate the maintenance of elimination 5. Select suitable clothing 7. Eat and drink adequately Physiological needs 3. Safety needs Avoid environmental dangers & avoid injuring others 9. To promote the development of productive interpersonal relationships 13. or other trauma and through the prevention of the spread of infection 10.1. To facilitate the maintenance of nutrition of all body cells 3. To facilitate the maintenance of sensory function Belongingness10. Move & maintain desirable posture 5. Communicate with 11. To promote optimal activity: exercise . Keep body clean and7. Eliminate by all avenues of elimination 4.To facilitate the maintenance & love needs others of effective verbal and non verbal communication 11. Breathe normally 2. To facilitate progress toward achievement of personal spiritual goals . To facilitate the maintenance of a supply of oxygen to all body cells 2. injury. To facilitate the maintenance of fluid and electrolyte balance 4. To maintain good body mechanics and prevent and correct deformities 6. Maintain body temperature 1.

Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. emotional. To identify and accept positive and negative expressions. and reactions To identify and accept the interrelatedness of emotions and organic illness To create and / or maintain a therapeutic environment To facilitate awareness of self as an individual with varying physical. 21. Play or participate in various forms of 15. nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs. In Abdellah’s model. or alleviating impairment. 19. cope with their health needs. 18. sick or well. increasing or restoring self-help ability. feelings.Esteem needs 12. discover. Work at something14. She considers nursing to be comprehensive service that is based on art and science and aims to help people. • • Person . To accept the optimum providing a sense of possible goals in the light of accomplishment limitations. or conditions satisfy curiosity 16. 20. physical and emotional 13. Self actualization needs ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS Nursing • Nursing is a helping profession. To recognize the recreation physiological responses of the body to disease 14. Learn. and developmental needs To use community resources as an aid in resolving problems arising from illness To understand the role of social problems as influencing factors in the case of illness 17.

consisting of largely physical needs. and sociological needs. These needs may overt. the focus of nursing service is clearly the individual. and international levels”. This is true when considering • Characteristic2 • • Characteristic 3 Characteristic4 • Characteristic5 • Characteristic6 • . Although Abdellah does not give a definition of health. or achieving of it. emotional. she speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing as a comprehensive service. This question could generate hypothesis for testing and thus demonstrates the ability of Abdellah’s work to generate hypothesis for testing The results of testing such hypothesis would contribute to the general body of nursing knowledge Abdellah’s problem solving approach can easily be used by practitioners to guide various activities within their practice. • • • • • Health Society/Environment • • ABDELLAH’S WORK AND CHARACTERISTICS OF A THEORY Characteristic1 • Abdellah’s theory has interrelated the concepts of health. However. The environment is the home or community from which patient comes. Problem solving is an activity that is inherently logical in nature Framework seems to focus quite heavily on nursing practice and individuals. Society is included in “planning for optimum health on local. is the purpose of nursing services. Individuals (and families) are the recipients of nursing Health. state. nursing problems. and problem solving as she attempts to create a different way of viewing nursing phenomenon The result was the statement that nursing is the use of problem solving approach with key nursing problems related to health needs of people. or covert. such as emotional and social needs.• Abdellah describes people as having physical. In Patient –Centered Approaches to Nursing. This somewhat limit the ability to generalize although the problem solving approach is readily generalizable to clients with specific health needs and specific nursing problems One of the most important questions that arise when considering her work is the role of client within the framework. as she further delineated her ideas. Abdellah describes health as a state mutually exclusive of illness. national. Patient is described as the only justification for the existence of nursing.

These specific problems would be grouped under one or more of the broader nursing problems. then it becomes reasonable to conclude that these goals are basically nursing goals. the plan is evaluated in terms of the client’s progress or lack of progress toward the achievement of the stated goals. a plan is developed and appropriate nursing interventions are determined. Using the goals as the framework. Thus. respectively. This would be extremely difficult if not impossible to do for Abdellah’s nursing problem approach since it has been determined that the goals are nursing goals. tachycardia and profuse diaphoresis • • Stage of illness is basic to care Selected Abdellah nursing problem . Therefore. A principle underlying the problem solving approach is that for each identified problem. once the problem has been diagnosed. According to the American Nurses’ Association Standards of Nursing Practice. The overt or covert nature of the problems necessitates a direct or indirect approach. the goals have been established. Given that these problems are called nursing problems. many questions remain unanswered USE OF 21 PROBLEMS IN THE NURSING PROCESS ASSESSMENT PHASE • • • Nursing problems provide guidelines for the collection of data.nursing practice that deals with clients who have specific needs and specific nursing problems Characteristic7 • Although consistency with other theories exist. NURSING DIAGNOSIS • • • • PLANNING PHASE • IMPLEMENTATION • EVALUATION • • • AN illustration of the implementation of Abdellah’s framework in Ryan’s care Consider a case of Ryan who experienced severe crushing chest pain ‘shortness of breath. not the client goals. the most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals. pertinent data are collected. The results of data collection would determine the client’s specific overt or covert problems. This step is consistent with that involved in nursing diagnosis The statements of nursing problems most closely resemble goal statements.

or in their own homes and who would benefit by care in a hospital environment to achieve its maximum potential This programme makes it possible to extend needed services to the patient after he leaves the hospital and returns to his home in the community • Intermediate care o • Self care o • Long term care unit o • Home care o Benefits of PPC PATIENT . nursing observation are assigned to the ICU.Amount of pain CONCEPT OF PROGRESSIVE PATIENT CARE 1. close and frequent if not constant.• • • • • • • • • • To maintain good hygiene and personal comfort Classification and approach Overt problem of pain. Direct and indirect method Selected Nursing Interventions administer oxygen elevate headrest reposition client administer prescribed analgesic remain with client Criterion measure. PPC is tailoring of hospital services to meet patients needs 3. PPC is defined as better patient care through the organization of hospital facilities. One patient in an ICU requires at least three nurses to observe him in 24 hrs Patients assigned to this unit are both the moderately ill and those for whom the treatment can only be palliative Ambulatory patients who are convalescencing or require diagnosis or therapy may be cared for in this unit This unit will provide services to certain patients now cared for in the general hospital. services and staff around the changing medical and nursing needs of the patient 2. in nursing homes. PPC is systematic classification of patients based on their medical needs Elements of PPC • Intensive care o Critically and seriously ill patients requiring highly skilled nursing care. PPC is caring for the right patient in the right bed with the right services at the right time 4.

who are ambulatory for short periods. the critically ill patients are concentrated regardless of diagnosis.• • • • • • • • • • • • • • • • • • • better attention better adjustment minimized problems life saving care constant medical and nursing care assuring best nursing care drugs and equipments at hand orders carried out effectively better clinical an team service effective and efficient use of staff improved public image individual skills can be used more time with patient helping pt. and family to solve problems job satisfaction in-service education continuity with hospital services minimize the need of hospitalization Many nurse educators feel that the PPC hospital where all five phases of care are available can provide clinical experience in which the nurse can learn to solve basic nursing problems in meeting patients’ needs. with life saving techniques and equipment immediately available In the intermediate care unit are concentrated patients requiring a moderate amount of nursing care. and who are beginning to participate in he planning of their own care The self-care unit provides for patients who are physically self-sufficient and require diagnostic and convalescent care in hotel-type PHYSICIAN HOSPITAL NURSING PERSONNEL COMMUNITY Implications of PPC for nursing education • Organization of hospital and community services based on patients needs • • • • . These patients are under the constant audio-visual observation of the nurse. not of an emergency nature. In the intensive care unit. The three month assignment of professional nurses may no longer be realistic in such a setting.

The problems also provide a basis for organizing appropriate nursing strategies. nursing problems. the fifth element of progressive patient care. It is anticipated that by solving the nursing problems. Cont… Abdellah has also published on nursing. education for advanced practice in nursing and nursing research. with impetus for it being nursing education. the theoretical statement of nursing that can be derived is the use of the problem solving approach with key nursing problems related to health needs of people. She has been a strong advocate for improving nursing practice through nursing research It helped to bring structure and organization to what was often a disorganized collection of lectures and experiences. nursing research. and problem solving. She categorized nursing problems based on the individual’s needs and developed developed a typology of nursing treatment and nursing skills. and public policy related to nursing in several international publications. • In the long-term care unit are concentrated patients requiring prolonged care. Abdellah’s publications on nursing education began with her dissertation. From this framework. She has been a leader in nursing research and has over one hundred publications related to nursing care. her interest in education for nurses continues into the present. extends hospital services into the home to assist the physician in the care of his patients The patient centered approach was constructed to be useful to nursing practice. This unit serves as a link between the hospital and the home.. The grouping of such patients will permit staffing patterns that are less costly Home care. Very strong nursing centered orientation • USEFULNESS • • • • VALUE IN EXTENDING NURSING SCIENCE • • NURSING RESEARCH • LIMITATIONS • • • • • Little emphasis on what the client is to achieve Her framework is inconsistent with the concept of holism Potential problems might be overlooked Using Abdellah’s concepts of health. the client would be moved toward health. 21 nursing problems were developed Abdellah’s theory provides a basis for determining and organizing nursing care.accommodations. The nurse’s philosophical frame of reference would SUMMARY • • CONCLUSIONS • .

L. Abdellah. International Nursing Review. Preparing nursing research for the 21st century. Beland. perspectives on nursing theory. New York: Springer. CA: Sage publications. Boston: Little. George Julia B. A. Public policy impacting on nursing care of older adults .). Patient-centered approaches to nursing (2nd ed.M. Nursing theories: The base of professional nursing practice 3rd edition. F. 1968. 35(5). The federal role in nursing education. 1991. 6. MS. Norwalk.). 1990. perspectives on gerontological nursing. University of Colorado.). F.G.. In L.G. University of Colorado. 2. Abdellah. 4.. 1973 . & Matheney. The nature of nursing science. PhD. 19.. Abdellah. Abdellah. E. Nicholl (Ed. I. 1994. 1964. 1987. Evolution of nursing as a profession: perspective on manpower development.G. Baines (Ed.G. JEAN WATSON'S PHILOSOPHY OF NURSING Introduction • • Born: West Virginia Educated: BSN.determine whether this theory and the 21 nursing problems could be implemented in practice. 5. F. R. 3. Martin.G.H. University of Colorado.).In E. 1972).224-225. REFERENCES 1. New York: Mac Millan. CN: Appleton and Lange. 1986. Nursing outlook. Abdellah.. F.. F. & Levine. 7. 1966. Newbury. F.G. Brown.V. Abdellah. 3.

Caring consists of carative factors that result in the satisfaction of certain human needs. her theory was published in “nursing: human science and human care”. 5. The basic assumptions are: 1. a Fulbright Research Award in Sweden and six (6) Honorary Doctoral Degrees. The ten primary carative factors The structure for the science of caring is built upon ten carative factors. She previously served as Dean of Nursing at the University Health Sciences Center and is a Past President of the National League for Nursing Dr. 3. Watson has earned undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and holds her PhD in educational psychology and counseling. United Kingdom. The practice of caring is central to nursing. These are: . She is founder of the original Center for Human Caring in Colorado and is a Fellow of the American Academy of Nursing. Caring can be effectively demonstrated and practiced only interpersonally. She believes that for nurses to develop humanistic philosophies and value system. Watson believes that the main focus in nursing is on carative factors. including 3 International Honorary Doctorates (Sweden. Canada). 2. Caring responses accept person not only as he or she is now but as what he or she may become. • • • • • • • • The seven assumptions Watson proposes even assumptions about the science of caring. She asserts that the caring stance that nursing has always held is being threatened by the tasks and technology demands of the curative factors. A humanistic value system thus under grids her construction of the science of caring. 6. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. Her research has been in the area of human caring and loss. a strong liberal arts background is necessary. The foundation of Jean Watson’s theory of nursing was published in 1979 in nursing: “The philosophy and science of caring” In 1988. She is a widely published author and recipient of several awards and honors. Caring is more “ healthogenic” than is curing. Effective caring promotes health and individual or family growth. including an international Kellogg Fellowship in Australia. This philosophy and value system provide a solid foundation for the science of caring. A science of caring is complementary to the science of curing. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado Health Sciences Center.• • Dr. Quebec. 7. 4.

makes the nurse more authentic. Faith-hope • • 3. The allowance for existential-phenomenological forces. in both the nurse and those with whom the nurse interacts. the learning one gains and exposure to the humanities. protective and /or corrective mental. which establishes rapport and caring. 1. Mediated through ones own life experiences. Strongest tool is the mode of communication. The installation of faith-hope. Explores the need of the nurse to begin to feel an emotion as it presents itself.altruistic system of values. Establishing a helping-trust relationship • • .altruistic system of values • • • Begins developmentally at an early age with values shared with the parents. Is essential to both the carative and the curative processes.• • • • • • • • • • The formation of a humanistic. These are: 2. Development of one’s own feeling is needed to interact genuinely and sensitively with others. When modern science has nothing further to offer the person. The cultivation of sensitivity to one’s self and to others. which encourages self-growth and self-actualization. The nurses promote health and higher level functioning only when they form person to person relationship. the nurse can continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual. physical. Striving to become sensitive. socio-cultural and spiritual environment. She has defined the characteristics needed to in the helping-trust relationship. Cultivation of sensitivity to one’s self and to others • • • • 4. The provision for a supportive. Assistance with the gratification of human needs. The first three carative factors form the “philosophical foundation” for the science of caring. The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings. The formation of a humanistic. The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning. Is perceived as necessary to the nurse’s own maturation which then promotes altruistic behavior towards others. The remaining seven carative factors spring from the foundation laid by these first three.

privacy and safety as a part of this carative factor.solving method is the only method that allows for control and prediction. She also values the relative nature of nursing and supports the need to examine and develop the other methods of knowing to provide an holistic perspective. The expression of feelings. It is grounded in a hierarchy of need similar to that of the Maslow’s. protective and /or corrective mental. Provision for a supportive. Promotion of interpersonal teaching-learning 8. Lower order needs (biophysical needs) o The need for food and fluid • • 9. nonverbal and listening in a manner which connotes empathetic understanding. which the nurse manipulates in order to provide support and protection for the person’s mental and physical well-being. According to her such expression improves one’s level of awareness. and they need to be considered and allowed for in a caring relationship”. and that permits selfcorrection. Assistance with the gratification of human needs • • • Watson’s ordering of needs • . She has created a hierarchy which she believes is relevant to the science of caring in nursing. the scientific problem.Congruence Empathy Warmth • Communication includes verbal. “feelings alter thoughts and behavior. The caring nurse must focus on the learning process as much as the teaching process. Watson suggests that the nurse also must provide comfort. All the needs deserve to be attended to and valued. Awareness of the feelings helps to understand the behavior it engenders. The external and internal environments are interdependent. Understanding the person’s perception of the situation assist the nurse to prepare a cognitive plan. both positive and negative • • • 6. • • • • 7. The systematic use of the scientific problem-solving method for decision making • According to Watson. physical. According to Watson. 5. According to her each need is equally important for quality nursing care and the promotion of optimal health. socio-cultural and spiritual environment • Watson divides these into eternal and internal variables. The science of caring should not be always neutral and objective.

Allowance for existential-phenomenological forces • Phenomenology is a way of understanding people from the way things appear to them. in general a philosophical view of a person as a fully functional integrated self. from their frame of reference. She adds the following three elements: • A high level of overall physical. 2. mental and social functioning • • 3. human is viewed as greater than and different from. Health • Watson believes that there are other factors that are needed to be included in the WHO definition of health. a valued person in and of him or herself to be cared for. He. 10. anorexia and gastro-intestinal ulcers are a just few of the disorders that indicate a complex interaction between the physiological and psychological. understood and assisted. According to Watson.. the sum of his or her parts”. • This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. the current thinking of holistic care emphasizes that: o Factors of the etiological component interact and produce change through complex neuro-physiological and neuro-chemical pathways o Each psychological function has a physiological correlate o Each physiological component has a psychological correlate Example: Bulemia. • Thus the nurse assists the person to find the strength or courage to confront life or death. Watson’s theory and the four major concepts 1. Human being • She adopts a view of the human being as: “….o o • o o • o o o o o • The need for elimination The need for ventilation The need for activity-inactivity The need for sexuality Higher order needs (psychosocial needs) The need for achievement The need for affiliation Higher order need (intrapersonal-interpersonal need) The need for self-actualization Lower order needs (psychophysical needs) Watson’s ordering of needs Research findings have established a correlation between emotional distress and illness. nurtured. A general adaptive-maintenance level of daily functioning The absence of illness (or the presence of efforts that leads its absence) Environment/society . respected. • Existential psychology is the study of human existence using phenomenological analysis.

• Also includes conceptual knowledge for the formulation and conceptualization of framework. ideas and experiences that are represented symbolically and seek to illuminate a given phenomenon” • She views nursing as. 3. caring for the sick and restoring health”. It determines what data would be collected and how on whom.According to Watson caring (and nursing) has existed in every society. Plan • It helps to determine how variables would be examined or measured. • . • Includes the formulation of hypothesis. “…. preventing illness. “a theory is an imaginative grouping of knowledge. Intervention • It is the direct action and implementation of the plan. • It focuses on health promotion and treatment of disease. reductionistic. It is transmitted by the culture of the profession as a unique way of coping with its environment. A caring attitude is not transmitted from generation to generation. They both try to solve a problem. defining variables that will be examined in solving the problem. Assessment • Involves observation. esthetic and ethical human transactions”. She believes that holistic health care is central to the practice of caring in nursing.. Watson’s theory and nursing process • Watson points out that nursing process contains the same steps as the scientific research process. use of applicable knowledge in literature. Watson’s work and the characteristic of a theory • According to Watson. Evaluation Analysis of the data as well as the examination of the effects of interventions based on the data. scientific methodology”. • She defines nursing as…. identification and review of the problem. 4. Nursing • According to Watson “ nursing is concerned with promoting health.both a human science and an art and as such it cannot be considered qualitatively continuous with traditional. Includes the interpretation of the results. • It includes the collection of the data. Watson elaborates the two processes as: 1. • It may also generate additional hypothesis or may even lead to the generation of a nursing theory. scientific. personal. 2. the degree to which positive outcome has occurred and whether the result can be generalized. • 4. Both provide a framework for decision making. includes a conceptual approach or design for problem solving. “A human science of persons and human health-illness experiences that are mediated by professional.

Western Australia and involved a tribe of aborigines. Theories can be the basis for hypotheses that can be tested • Watson’s theory is based on phenomenological studies that generally ask questions rather than state hypotheses. She describes caring in both philosophical and scientific terms. Its purpose is to describe the phenomena.• • • • • • She suggests that nursing might want to develop its own science that would not be related to the traditional sciences but rather would develop its own concepts. The core of the nursing is that which is intrinsic to the nurse-client interaction that produces a therapeutic result. Theories must be consistent with other validated theories. Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon The basic assumptions for the science of caring in nursing and the ten carative factors that form the structure for that concept is unique in Watson’s theory. The science of caring suggests that the nurse recognize and assist with each of the interrelated needs in order to reach the highest order need of selfactualization. the procedure and the techniques. laws and principles but will leave open unanswered questions that need to be investigated • • • . • She defines trim as the clinical focus. Watson also indicates that needs are interrelated. • Theories contribute to and assist in increasing the general body within the discipline through research implemented to validate them • According to Watson the best method to test this theory is through field study. • She discusses this in the preface of her book when she speaks of the “trim” and the “core” of nursing. Theories must be logical in nature • Watson’s work is logical in that the factors are based on broad assumptions which provide a supportive framework. • An example is her work in the area of loss and caring that took place in Cundeelee. Core mechanisms are the carative factors. Theories can be utilized by practitioners to guide and improve their practice • Watson’s work can be used to guide and improve practice. to analyze and to gain an understanding. Theories should be relatively simple yet generalizable • The theory is relatively simple as it does not use theories from other disciplines that are familiar to nursing. relationships and methodology. • The theory is simple relatively but the fact that it de-emphasizes the pathophysiological for the psychosocial diminishes its ability to be generalizable. • With these carative factors she delineates nursing from other professions These carative factors are logically derived from the assumptions and related to he hierarchy of needs. • It can provide the nurse with the most satisfying aspects of practice and can provide the client with the holistic care so necessary for human growth and development.

. Further. Strengths • Besides assisting in providing the quality of care that client ought to receive. communication. Limitations • Given the acuity of illness that leads to hospitalization. J Adv Nurs. they need further research in nursing to demonstrate their application to practice. • While Watson acknowledges the need for biophysical base to nursing. humanistic psychology and existential phenomenology which provide the foundation for the science of caring. this area receives little attention in her writings. there was a relationship between the Caring model and a decrease in patient's blood pressure. California has selected Jean Watson’s theory of human caring as the framework base for nursing practice.Watson’s work is supported by the theoretical work of numerous humanists. • She clearly designates the theories of stress. it also provides the soul satisfying care for which many nurses enter the profession. the short length stay .41(2):130-9. • While the carative factors have a sound foundation based on other disciplines. • This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. and the increasing complex technology. in those patients for whom the caring model was practised. development. • The ten caratiive factors primarily delineate the psychosocial needs of the person. • The client is placed in the context of the family. philosophers. such quality of care may be deemed impossible to give in the hospital. The Watson Caring Model is recommended as a guide to nursing patients with hypertension. teaching-learning. 2003 Jan. each nurse becomes an active coparticipant in the client’s struggle towards self-actualization. As the science of caring ranges from the biophysical through the intrapersonal. • It places the client as the focus of practice rather than the technology. developmentalists and psychologists. • The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension. as one means of decreasing blood pressure and increase in quality of life. the community and the culture. Summary • Watson’s theory • • • • • • • Its seven assumptions The ten carative factors Watson’s theory and the four major concepts Watson’s theory and the nursing process Watson’s work and the characteristic’s of the theory Strengths Limitations • Research related to Watson’s theory • Saint Joseph Hospital in Orange.

Philadelphia. Using Watson’s theory to explore the dimensions of adult polycystic kidney disease . ANNA Journal. Norwalk. Julia . LWW. Nurs Sci Q.19(3):225 • Cheng MY. Using her theory can add a dimension to practice that is both satisfying and challenging. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 3rd ed.The base for professional Nursing Practice . • Meleis Ibrahim Afaf (1997) . Hu Li Za Zhi. The force of nursing theory guided. (2000). A. Philadelphia. NY. Fundamental skills and concepts in Patient Care. Thomson. The detailed descriptions of the carative factors can give guidance to those who wish to employ them in practice or research. London Mosby Year Book. Reference • Timber BK. 2006 Jul. Fundamental of nursing. • .M. 2006 Jul. 4.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Ladner PK. • Potter A Patricia. Using King's Goal Attainment Theory to facilitate drug compliance in a psychiatric patient.Evelyn.53(3):90-7. 2nd edition. Nursing Theories. Theoretical Basis for Nursing Philadelphia. 3. ANNA Journal. The lived experience of using Watson’s actual caring occasions to treat depressed women .practice. L. N • George B. Journal of Holistic Nursing. • Taylor Carol. 2. 18(2). Lippincott. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. B. 18. 27(6) : 605-15 • Reed PG. Lippincott Williams& wilkins. (1991). S..Martin. (1991). standard and practice. 403-406 Conclusion 1. • Delaune SC. Using Watson’s theory to explore the dimensions of adult polycystic kidney disease . 7th edition. McEwen Melanie (2002). She ties together many theories commonly used in nursing education and does so in a manner helpful to practioners of the art and science of nursing. 2002. L. J. 2006 Jun. Watson provides many useful concepts for the practice of nursing. Appleton & Lange. Theoretical Nursing : Development & Progress 3rd ed. 18. 403-406 . 129-142 • Martin. • Wills M. Lippincott. • Vandemark L. S. • Mullaney.

Georgia. from Harvard University in Boston in 1948. in 1942.JOHNSON’S BEHAVIOUR SYSTEM MODEL Introduction • Dorothy E. • From 1949 until her retirement in 1978 she was an assistant professor of pediatric nursing. and her M. • Dorothy Johnson has had an influence on nursing through her publications since the 1950s. B. • She also stated that nursing was “concerned with man as an integrated whole and this is the specific knowledge of order we require”. or in which illness is found” Based on this definition there are four goals of nursing are to assist the patient: • Whose behavior commensurate with social demands. • Whose behavior does not give evidence of unnecessary trauma as a consequence of illness Assumptions of behavioral system model There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model (Johnson was influenced by Buckley . Johnson has stressed the importance of research-based knowledge about the effect of nursing care on clients. Throughout her career.P. N. Who is able to modify his behavior in ways that it supports biological imperatives • Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill. 1919. from Vanderbilt University in Nashville.H. an associate professor of nursing.Chin and Rapport) there are 4 assumptions of system: • • . Johnson was born August 21. • In 1980 Johnson published her conceptualization of “behavioral system of model for nursing” this is the first work of Dorothy that explicates her definitions of the behavioral system model. Definition of nursing She defined nursing as “an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health. S. in Savannah. Johnson’s behavior system model • In 1968 Dorothy first proposed her model of nursing care as fostering of “the efficient and effective behavioral functioning in the patient to prevent illness". and a professor of nursing at the University of California in Los Angeles. Tennessee.

Each subsystem must be “nurtured” through the input of appropriate supplies from the environment. 4.” 3.1. 1. events and situations in his environment. These actions and behaviors form an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relationship of the person to the objects event situations in the environment. The integration of these assumptions provides the behavioral system with the pattern of action to form “an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects. purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation” Johnson’s Behavioral Subsystem . 4. 3. in certain ways rather than the other ways”. Each subsystem has three functional requirements 2. both in social life and for the individual.” Assumptions about structure and function of each subsystem 2. “from the form the behavior takes and the consequences it achieves can be inferred what “drive” has been stimulated or what “goal” is being sought” 3. The fourth assumption is that it produce “observable outcome” that is the individual’s behavior. repetitive ways of acting that comprise a behavioral system specific to that individual. These behaviors are “orderly. The final assumption states “system balance reflects adjustments and adaptations that are successful in some way and to some degree. The integration of these assumptions provides the behavioral system with the pattern of action to form “an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects. and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him. interdependency and integration of the parts and elements of behaviors that go to make up The system ” 2. purposeful.” 1. A behavioral system. 2. This predisposition is called as “set”. First assumption states that there is “organization. Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation Johnson believes each individual has patterned. which both requires and results in some degree of regularity and constancy in behavior. is essential to man that is to say. it is functionally significant in that it serves a useful purpose. A system “tends to achieve a balance among the various forces operating within and upon it'. System must be “protected" from noxious influences with which system cannot cope”. Each individual has a “predisposition to act with reference to the goal. Each subsystem has a repertoire of choices or “scope of action” 1. interaction. events and situations in his environment.

2. Johnson views “human being” as having two major systems. 3. Representation of Johnson's Model Goal ----Set --Choice of Behavior --Behavior Affiliation Dependency Sexuality Aggression Elimination Ingestion Achievement The four major concepts 1. attention or recognition and physical assistance” 4. “Society” relates to the environment on which the individual exists. 4.but the existence of such a pattern remains different from culture to Culture.” 3. Ingestive subsystem: “the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten” 5. “Health” is a purposeful adaptive response.An assessment based on behavioral model does not easily permit the nurse to gather detailed information about the biological systems: 1. physically mentally.” 6.she stated that nursing is concerned with the organized and integrated whole. Attachment or affiliative subsystem: “social inclusion intimacy and the formation and attachment of a strong social bond. creative. but that the major focus is on maintaining a balance in the Behavior system when illness occurs in an individual. Dependency subsystem: “approval. the biological system and the behavioral system. Achievement subsystem:” provokes behavior that attempt to control 2. Aggressive subsystem:" it relates to the behaviors concerned with protection and self preservation Johnson views aggressive subsystem as one that generates defensive response from the individual when life or territory is being threatened” the environment intellectual. physical. mechanical and social skills achievement are some of the areas that Johnson recognizes". and socially to internal and external stimuli in order to maintain stability and comfort. Nursing process Assessment Grubbs developed an assessment tool based on Johnson’s seven subsystems plus a subsystem she labeled as restorative which focused on activities of daily living . It is role of the medicine to focus on biological system where as Nursling's focus is the behavioral system. “Nursing” has a primary goal that is to foster equilibrium within the . According to Johnson an individual’s behavior is influenced by the events in the environment individual . emotionally. Eliminative subsystem: “human cultures have defined different socially acceptable behaviors for excretion of waste . Sexual subsystem:" both biological and social factor affect the behavior in the sexual subsystem” 7.

She says. with the nurse determining the clients needs and state behavior appropriate for that need. her mother told her she was not a good mother because John is not gaining weight like he should. 4. 2. Affiliative subsystem between mother and John. She states she had not called the nurse when she knew John was not gaining weight because she thought nurse would think she was a bad mother just like her own mother thought she was a bad mother. Discrepancy 3. based on nursing assessment of the individuals drive. Affiliative subsystem between Mrs. Insufficiency ingesion subsystem. Insufficiency 2. Restorative Diagnosis Diagnosis tends to be general to the system than specific to the problem. If the alterations in the behavior that are planned do occur. . the plan will focus on nurses actions to modify clients behavior. She stated he was a planned baby but that she never realized how much work a baby could be. Ingestion 7.1. Affiliation 2. He sleeps 4to 5 hour between the feedings. Dominance Planning and implementation Implementation of the nursing care related to the diagnosis may be difficult because of lack of clients input in to the plan. Sexuality 4. Dependency subsystem between mother and John 3. If the baseline data are available for an individual. Johnson's behavioral model with the nursing process is a nurse centered activity.His mother stated she feeds him but he does not seem to eat much. Incompatibility 4. Smith never looks at Johnny and never speaks to him. the nurse should be able to observe the return to the previous behavior patterns. His mother holds him in her arms without trunk to trunk contact. The plan may include protection. Evaluation Evaluation is based on the attainment of a goal of balance in the identified subsystems. Dependency 3. As the assessment is made the nurse notes that Mrs. Aggression 5. and observable behavior. Situation John Smith. Grubb has proposed 4 categories of nursing diagnosis derived from Johnson's behavioral system model: 1. these plan than have a goal . set behavior. Achievement 8. Elimination 6.Smith and her mother. He presents with no weight gain since his check up at the age of 2 weeks . 6 weeks brought into the clinic for a routine check-up. Assessment 1.to bring about homeostasis in a subsystem. repertoire. the nurse may have goal for the individual to return to the baseline behavior. nurturance or stimulation of the identified subsystem.

The model is very individual oriented so the family of the client is only considered as an environment. drives. Theories can be utilized by practitioners to guide and improve their practice. 2. 2. Evaluation 1. Limitation • Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model. Johnny's weight gain or weight loss will be carefully assessed. Smith with her mother. set. Theories must be consistent with other validated theories. Johnson does not define the expected outcomes when one of the system is affected by the nursing implementation an implicit expectation is made that all human in all cultures will attain same outcome –homeostasis. 3. Each subsystem composed of four structural characteristics i. The model is very individual oriented so the nurses working with the group have difficulty in its implementation. 2. Theories can be bases of hypothesis that can be tested. Theories must be logical in nature. Johnson’s and Characteristics of a theory 1. The focus on the behavioral system makes it difficult for nurses to work with physically impaired individual to use this theory. Interrelate concepts to create a different way of viewing a phenomenon. The interaction of Mrs. Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them 6. Increasing mother’s awareness of the baby’s clues. 5.e. laws and principles but will leave unanswered questions that need to be investigated. 7. Johnson’s behavioral system model is not flexible. Insufficient development of the affiliative subsystem.Diagnosis 1. • • • • • It is difficult to test Johnson's model by development of hypothesis. choices and observable behavior. The patient is defined as behavioral system composed of 7 behavioral subsystems. • Summary Johnson’s Behavioral system model is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. Assisting her to talk with the baby. Theories must be simple yet generalizable 4. Insufficient development of the dependency subsystem Planning and implementation 1. using the nursing child assessment feeding scale. • The definition of concept is so abstract that they are difficult to use. pat and cuddles etc. The –infant interaction could be reassessed. (2) Provision for the . 2. Teach her to bring a bond between her and the baby by touch. 3. Three functional requirement of each subsystem includes (1) Protection from noxious influences. 3.

Louis: Mosby. Burns N. St.The base for professional Nursing Practice . 1998. Appleton and Lange.).it is nursing role to assist the client to return to the state of equilibrium. Julia . Norwalk. Any imbalance in each system results in disequilibrium . Philadelphia: WB Saunders Publications. The practice of Nursing Research. Hungler BP. Philadelphia: JB Lippincott Company. 3rd ed. and (3) stimulation for growth. Nursing Theories. Grove SK. 2001. 1982. Nursing Research: Principles and Methods. Polit DF. Reference • • • • George B. 4th Ed.nurturing environment. Treece EW. Treece JW. Elements of Research in Nursing (3rded. IMOGENE KING: THEORY OF GOAL ATTAINMENT .

Louis University in 1957 Completed her Doctorate from Teacher’s college. Columbia University King’s Conceptual Framework It includes: • • • • • • • Several basic assumptions Three interacting systems Several concepts relevant for each system Nursing focus is the care of human being Nursing goal is the health care of individuals & groups Human beings: are open systems interacting constantly with their environment Interacting systems: personal system Interpersonal system Social system • • • • • • • • • • • • • • • Concepts are given for each system Perception Self Growth & development Body image Space Time Interaction Communication Transaction Role Stress Organization Authority Power Concepts for Personal System Basic assumptions Concepts for Interpersonal System Concepts for Social System . Louis University in 1948 Completed her Master of science in nursing from St.Introduction of Theorist • • • • Born in 1923 Completed her Bachelor in science of nursing from St.

human being has three fundamental needs: . stress. Major concepts of king’s theory 1. Human being /person: is social being who are rational and sentient. stress in nurse-client interaction will occur If nurse with special knowledge skill communicate appropriate information to client. transaction will occur If nurse and client make transaction. satisfaction will occur Proposition cont… If transactions are made in nurse-client interactions. goal will be attained If goal are attained. space & time Major Theses of King’s conceptual framework King’s Theory of Goal Attainment • • • Propositions of King’s Theory From the theory of goal attainment king developed predictive propositions.• • • • Status Decision making “Each human being perceives the world as a total person in making transactions with individuals and things in environment” “Transaction represents a life situation in which perceiver & thing perceived are encountered and in which person enters the situation as an active participant and each is changed in the process of these experiences” Theory of goal attainment was first introduced by Imogene King in the early 1960’s. which includes: • • • • • • • • If perceptual interaction accuracy is present in nurse-client interactions. Person has ability to : -perceive -think -feel -choose -set goals -select means to achieve goals -and to make decision According to King. Theory describes a dynamic. mutual goal setting and goal attainment will occur. interpersonal relationship in which a person grows and develops to attain certain life goals. Factors which affects the attainment of goal are: roles. transaction will occur If role conflict is experienced by nurse or client or both. growth & development will be enhanced If role expectations and role performance as perceived by nurse & client are congruent.

with knowledge of self and perception of personal problems. It involves: Goal of nurse: “To help individuals to maintain their health so they can function in their roles. with special knowledge and skills.” and “ a process of human interactions between nurse and client whereby each perceives the other and the situation. 6.” Domain of nurse: “includes promoting. Reaction: not specified. 2. and agree on means to achieve goals. identify problems.(a) The need for the health information that is unable at the time when it is needed and can be used (b) The need for care that seek to prevent illness. Action: is defined as a sequence of behaviors involving mental and physical action. meet as strangers in natural environment. In addition king discussed: (a) (b) (c) 4. 4. 3. and through communication.” 1. Environment (a) Internal environment: transforms energy to enable person to adjust to continuous external environmental changes. They interact mutually. establish and achieve goals. but might be considered as included in the sequence of behaviors described in action. explore means. and a client in need of nursing. (b) External environment: involves formal and informal organizations. and caring for the sick. 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 3. injured and dying. 5. reaction and interaction by which nurse and client share information about their perception in nursing situation. Nurse is a part of the patient’s environment. King said in her theory. Function of professional nurse: “To interpret information in nursing process to plan. they set goals. maintaining. Theory of Goal Attainment and Nursing Process Assumptions . Health: According to King. 2. goal domain and functions of professional nurse Environment is the background for human interactions. and (c) The need for care when human beings are unable to help themselves. implement and evaluate nursing care. “A professional nurse. and restoring health. health involves dynamic life experiences of a human being. Nursing Nursing: is defined as “A process of action.

to this interaction. During assessment nurse collects data regarding client (his/her growth & development. This part of transaction and client’s participation is encouraged in making decision on the means to achieve the goals. Acc. to king in process of attaining goaI the nurse identifies the problems. Communication is required to verify accuracy of perception.) Perception is the base for collection and interpretation of data. concerns and disturbances about which person seek help. is also the basic assumption of nursing process. planning for interventions to solve those problems is done. Nursing Process and Theory of Goal Attainment Nursing process method Nursing process theory A system of oriented actions A system of oriented concepts Assessment Planning Perception. It involves to finding out weather goals are achieved or not. In goal attainment it is the continuation of transaction. roles etc. The data collected by assessment are used to make nursing diagnosis in nursing process. In nursing process implementation involves the actual activities to achieve the goals. The nurse brings special knowledge and skills whereas client brings knowledge of self and perception of problems of concern.Basic assumption of goal attainment theory is that nurse and client communicate information. communication and interaction of nurse and client Decision making about the goals Be agree on the means to attain the goals Implementation Evaluation Transaction made Goal attained . In goal attainment planning is represented by setting goals and making decisions about and being agreed on the means to achieve goals. In king description evaluation speaks about attainment of goal and effectiveness of nursing care. • • • Nursing diagnosis • Planning • • • Implementations • • Evaluation 1. Assessment • King indicates that assessment occur during interaction. perception of self and current health status. After diagnosis. 2. set goal mutually and then act to attain those goals. for interaction and transaction.

Alligood. Theoretical Nursing : Development & Progress 3rd ed. Tomey AM. Wills M. Nursing theory utilization and application. Mosby. McEwen Melanie (2002).Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. A. Meleis Ibrahim Afaf (1997) . 2nd Ed.Evelyn. Philadelphia. Lippincott.References • • • • • • • Alligood M. Theoretical Basis for Nursing Philadelphia. Philadelphia.R. Lippincott Williams& wilkins. London Mosby Year Book. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Potter A Patricia. (5th ed.M. Philadelphia. MR. Philadelphia. Tomey.). Mosby. 2002. Taylor Carol. 3rd ed. Nursing Theories. 2002 . George B. Norwalk.The base for professional Nursing Practice . Lippincott. Appleton & Lange. Julia . Nursing theorists and their work.

and in the second edition in 1980. in Lowel. It was refined and subsequently published in the first edition of Conceptual Models for Nursing Practice. secondary and tertiary nursing prevention intervention for retention. The model was published in 1972 as “A Model for Teaching Total Person Approach to Patient Problems” in Nursing Research. in clinical psychology She was a pioneer in the community mental health movement in the late 1960s. She completed BS in nursing in 1957 and MS in Mental Health Public health consultation. She holds a Ph. And the use of primary. Ohio. HISTORY AND BACKGROUND OF THE THEORIST • • • • • • • DEVELOPMENT OF THE MODEL • . attainment. 1974. The models was initially developed in response to graduate nursing students expression of a need for course content that would expose them to breadth of nursing problems prior to focusing on specific nursing problem areas. Betty Neumann began developing her health system model while a lecturer in community health nursing at University of California. and maintenance of optimal client system wellness. Neumann’s model was influenced by a variety of sources. Betty Neumann was born in 1924.D. from UCLA in 1966. It focuses attention on the response of the client system to actual or potential environmental stressors.BETTY NEUMANN’S SYSTEM MODEL INTRODUCTION • • • Betty Neumann’s system model provides a comprehensive flexible holistic and system based perspective for nursing. Los Angeles.

is a dynamic composite of the inter-relationships of the variables. Secondary prevention relates to symptomatology following a reaction to stressor. Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the back in circular manner toward primary prevention. The normal LOD can be used as a standard from which to measure health deviation. Primary prevention relates to G.common client survival factors in unique individual characteristics representing basic system energy resources. appropriate ranking of intervention priorities and treatment to reduce their noxious effects. Von Bertalanfy.the variables of the person in interaction with the internal and external environment comprise the whole client system Basic structure/Central core: . a composite of factors and characteristics within a given range of responses contained within a basic structure. constant energy exchange with the environment. Wellness is on a continuum of available energy to support the system in an optimal state of system stability. and universal stressors exist. in identification and reduction of possible or actual risk factors. Content: . Each client/ client system has evolved a normal range of responses to the environment that is referred to as a normal LOD. the stressor breaks through the normal LOD The client whether in a state of wellness or illness. which function to stabilize and realign the client to the usual wellness state. Selye on stress theory. Each differ in it’s potential for disturbing a client’s usual stability level or normal LOD The particular inter-relationships of client variables at any point in time can affect the degree to which a client is protected by the flexible LOD against possible reaction to stressors.2002). that is applied in client assessment and intervention. Each client system is unique. Many known. unknown. and Lazlo on general system theory. BASIC ASSUMPTIONS • • • • • • • • CONCEPTS • • • . When the flexible LOD is no longer capable of protecting the client/ client system against an environmental stressor. The basis structure. or central core.K. The client as a system is in dynamic. is made up of the basic survival factors that are common to the species (Neumann. Lararus on stress and coping.• • • • • • • The philosophy writers deChardin and cornu (on wholeness in system). Implicit within each client system are internal resistance factors known as LOR.

output. Flexible LOD: .The series of concentric circles that surrounds the basic structure. Wellness/Illness: . which leads to a state of balance.A system in which there is continuous flow of input and process. or maintain an optimal level of health thus preserving system integrity. inter (role expectation). Prevention as intervention: . accordion like mechanism that surrounds and protects the normal LOD from invasion by stressors. output and feedback. It is considered dynamic because it can expand or contract over time. causing a reaction symptomatology. It is a system of organized complexity where all elements are in interaction.environmental factors.Response pattern. Reconstitution: . Negentropy: . Genetic structure. following treatment for stressor reaction..• • • • • • • These factors include:. that have potential for disrupting system stability.A process of energy conservation that increase organization and complexity. LOR: . or homeostasis.. and compensation. Stability: . range. or the usual state of wellness.output: .the amount of system instability resulting from stressor invasion of the normal LOD. A homeostatic body system is constantly in a dynamic process of input. energy. attain. feedback. Open system:.The return and maintenance of system stability. Entropy: .The matter. Stressors: . Organ strength or weakness. resulting either a positive or negative outcome.Wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client. A stressor is any phenomenon that might penetrate both the F and N LOD. moving the system toward stability or a higher degree of wellness. E. occurs when the amount of energy that is available exceeds that being used by the system.a protective. Normal LOD: .Normal temp.Interventions modes for nursing action and determinants for entry of both client and nurse in to health care system. intra (emotion.g. and extra personal (job or finance pressure) in nature.It represents what the client has become over time. and information exchanged between client and environment that is entering or leaving the system at any point in time. Ego structure Stability. • • • • • • • • • • • . mobilization of WBC and activation of immune system mechanism Input. feeling). Protection factors activated when stressors have penetrated the normal LOD. Degree to reaction: . which may result in a higher or lower level of wellness.a process of energy depletion and disorganization moving the system toward illness or possible death.A state of balance of harmony requiring energy exchanges as the client adequately copes with stressors to retain.

prevention is the primary nursing intervention. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor.o o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman. Socio-cultural.Refers to mental processes and emotions. Developmental. Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing system. Primary prevention includes health promotion and maintenance of wellness. PREVENTION • According to Neumann’s model. On the one hand. Tertiary prevention occurs after the system has been treated through secondary prevention strategies. 2002).Refer of the physicochemical structure and function of the body. Primary prevention occurs before the system reacts to a stressor. Spiritual. Psychological.Refers to those processes related to development over the lifespan. Illness is an excessive expenditure of energy… when more energy is used by the system in its state of disorganization than is built and stored.Refers to relationships. the outcome may be death (Neuman. • ENVIRONMENT . PRIMARY PREVENTION • • • SECONDARY PREVENTION • • TERTIARY PREVENTION • • FOUR MAJOR CONCEPTS PERSON • The focus of the Neumann model is based on the philosophy that each human being is a total person as a client system and the person is a layered multidimensional being. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.Refers to the influence of spiritual beliefs. 2002). and social/cultural expectations and activities. it strengthens the person (primary the flexible LOD) to enable him to better deal with stressors On the other hand manipulates the environment to reduce or weaken stressors. Each layer consists of five person variable or subsystems: o o o o o Physiological.

The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. These forces include the intrapersonal, interpersonal and extra-personal stressors which can affect the person’s normal line of defense and so can affect the stability of the system. • • • The internal environment exists within the client system. The external environment exists outside the client system. Neumann also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.

HEALTH • Neumann sees health as being equated with wellness. She defines health/wellness as “the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neumann, 1995)”. The client system moves toward illness and death when more energy is needed than is available. The client system moved toward wellness when more energy is available than is needed Neumann sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor. The person is seen as a whole, and it is the task of nursing to address the whole person. Neuman defines nursing as “action which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors.’’ Neuman states that, because the nurse’s perception will influence the care given, then not only must the patient/client’s perception be assessed, but so must those of the caregiver (nurse). The role of the nurse is seen in terms of degree of reaction to stressors, and the use of primary, secondary and tertiary interventions

NURSING •

• •

STAGES OF NURSING PROCESS (BY NEUMAN) NURSING DIAGNOSIS • It depends on acquisition of appropriate database; the diagnosis identifies, assesses, classifies, and evaluates the dynamic interaction of the five variables. Variances from wellness (needs and problems) are determined by correlations and constraints through synthesis of theory and data base. Broad hypothetical interventions are determined, i.e. maintain flexible line of defense.

• •

NURSING GOALS

These must be negotiated with the patient, and take account of patient’s and nurse’s perceptions of variance from wellness. Nursing intervention using one or more preventive modes. Confirmation of prescriptive change or reformulation of nursing goals. Short term goal outcomes influence determination of intermediate and long – term goals. A client outcome validates nursing process.

NURSING OUTCOMES • • • •

NEUMANN’S SYSTEM MODEL FORMAT Neumann’s nursing process format designates the following categories of data about the client system as the major areas of assessment. ASSESSMENT • • • • • • • • • • • GOAL • • In Neumann’s systems model the goal is to keep the client system stable. Planning is focused on strengthening the lines of defense and resistance. PLANNING IMPLEMENTATION The goal of stabilizing the client system is achieved through three modes of prevention • • • • Primary prevention : actions taken to retain stability Secondary prevention : actions taken to attain stability Tertiary prevention : actions taken to maintain stability The nursing process is evaluated to determine whether equilibrium is restored and a steady state maintained. Potential and actual stressors. Condition and strength of basic structure factors and energy sources. Characteristics of flexible and normal line of defenses, lines of resistance, degree of reaction and potential for reconstitution. Interaction between client and environment. Life process and coping factors (past, present and future) actual and potential stressors (internal and external) for optimal wellness external. Perceptual difference between care giver and the client. The data collected are then interpreted to condition and formulate the Nursing diagnosis. Health seeking behaviors. Activity intolerance. Ineffective coping. Ineffective thermoregulation.

NURSING DIAGNOSIS

EVALUATION

ACCEPTANCE BY THE NURSING COMMUNITY • • Neumann’s model has been described as a grand nursing theory by walker and Avant. Grand theories can provide a comprehensive perspective for nursing practice, education, and research and Neuman’s model does. The Neumann systems model has been applied and adapted to various specialties include family therapy, public health, rehabilitation, and hospital nursing. The sub specialties include pulmonary, renal, critical care, and hospital medical units. One of the model’s strengths is that it can be used in a variety of settings Using this conceptual model permits comparison of a nurse’s interpretation of a problem with that of the patient, so the patient and nurse do not work on two separate problems. The role of the nurse in the model is to work with the patient to move him as far as possible along a continuum toward wellness. Because this model requires individual interaction with the total health care system, it is indicative of the futuristic direction the nursing profession is taking. The patient is being relabeled as a consumer with individual needs and wants. The model has also been widely accepted in academic circles. It has often been selected as a curriculum guide for a conceptual framework oriented more toward wellness than toward a medical model and has been used at various levels of nursing education. In the associate degree program at Indiana University. One of the objectives for nursing graduate is to demonstrate ability to use the Neumann health care system in nursing practice. This helps prepare the students for developing a frame of reference centered on holistic care. At northwestern State University in Shreveport, Louisiana, the faculty determined that a systems model approach was preferred for their master’s program because of the universality framework. Acceptance by the nursing community for education therefore is evident. A study was published by Riehl and Roy to test the usefulness of the Neumann model in nursing practice. There were two major objectives of the study. o To test the model/assessment’ tool for its usefulness as a unifying method of collecting and analyzing data for identifying client problems.

PRACTICE •

• •

EDUCATION • •

• •

• • •

RESEARCH

o

To test the assessment tool for its usefulness in the identification of congruence between the client’s perception of stressors and the care giver’s perception of client stressors.

• • •

Results indicated that the model can help categorize data for assessing and planning care and for guiding decision making. Neumann’s model can easily generate nursing research. It does this by providing a framework to develop goals for desired outcomes. Acceptance by the nursing community for research applying this model is in the beginning stages and positive. Theories connects the interrelated concepts in such a way as to create a different way of looking at a particular phenomenon. o o The Neumann model represents a focus on nursing interest in the total person approach to the interaction of environment and health. The interrelationships between the concepts of person, health, nursing and society/environment are repeatedly mentioned throughout the Neumann model and are considered to be basically adequate according to the criteria. Neumann’s model in general presents itself as logically consistent. There is a logical sequence in the process of nursing wherein emphasis on the importance of accurate data assessment is basic to the sequential steps of the nursing process. Neumann’s model is fairly simple and straightforward in approach. The terms used are easily identifiable and for the most part have definitions that are broadly accepted. The multiple use of the model in varied nursing situations (practice, curriculum, and administration) is testimony in itself to its broad applicability. The potential use of this model by other health care disciplines also attests to its generalizability for use ion practice. One drawback in relation to simplicity is the diagrammed model since it presents over 35 variables and tends to be awesome to the viewer. Neumann’s model, due to its high level and breadth of abstraction, lends itself to theory development. One are for future consideration as a beginning testable theory might be the concept of prevention as intervention, subsequent to basis concept refinement in the Neuman model.

NEUMANN’S AND THE CHARACTERISTICS OF A THEORY •

Theories must be logical in nature o o

Theories should be relatively simple yet generalizable. o o o

o o

Theories can be the bases for hypotheses that can be tested. o o

Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.

o

The model has provided clear, comprehensive guidelines for nursing education and practice in a variety of settings; this is its primary contribution to nursing knowledge. The concept within the guidelines is clearly explicated and many applications of the theory have been published, little research explicitly derived from this model has been published to date.

o

Theories can be utilized by the practitioner to guide and improve their practice. o One of the most significant attributes of the Neumann model is the assessment/intervention instrument together with comprehensive guidelines for its use with the nursing process. These guidelines have provided a practical resource for many nursing practitioners and have been used extensively in a variety of setting in nursing practice, education and administration.

o

Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated. o In general, there is no direct conflict with other theories. There is, however, a lack of specificity in systems concepts such as “boundaries” which are indirectly addressed throughout the model.

Research Articles

1. “Using the Neuman Systems Model for Best Practices’’--Sharon A.

DeWan, Pearl N. Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006). 1. The purpose of this study was to present two case studies based upon Neuman systems model; one case is directed toward family care, and the other demonstrates care with an individual. Theorybased exemplars serve as teaching tools for students and practicing nurses. 2. These case studies illustrate how nurses' actions, directed by Neuman's wholistic principles, integrate evidence-based practice and generate high quality care

2. Melton L, Secrest J, Chien A, Andersen B.

“A community needs assessment for a SANE program using Neuman's model” J Am Acad Nurse Pract. 2001 Apr;13(4):178-86. 1. The purpose of the study was to present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. 2. Sexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a community's needs. 3. Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature

Reference

Philadelphia. 1969. The force of nursing theory guided. 3rd ed.1949 MSN:-Wayne state University. Nurs Sci Q. standard and practice. Wills M. 7th edition. Meleis Ibrahim Afaf (1997) . Lippincott Williams& wilkins. Appleton and Lange. Lippincott. Theoretical Basis for Nursing Philadelphia. McEwen Melanie (2002). Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. This was the reason of choosing nursing as a career Also called as renaissance women-highly principled. Detroit. Lippincott. LWW. 2002 • • • LEVINE’S FOUR CONSERVATION PRINCIPLES Myra Estrine Levine Introduction • • • • • • • • Born in Chicago. 2006 Jul. 1944 BSN:-University of Chicago. Nursing Theories.practice.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Thomson. Theoretical Nursing : Development & Progress 3rd ed. NY.M. N George B. Delaune SC.• • • • • • • Timber BK. Julia . Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 1962 Publication:-An Introduction to Clinical Nursing. 2nd edition. London Mosby Year Book. 27(6) : 605-15 Reed PG. Fundamental of nursing. Using King's Goal Attainment Theory to facilitate drug compliance in a psychiatric patient. Philadelphia. 2006 Jul. Chicago. raised with a sister and a brother with whom she shared a close loving relationship Also very fond of her father who was often ill and frequently hospitalized with GI problem. Hu Li Za Zhi. 2006 Jun. remarkable and committed to patient’s quality of care Died in 1996 Diploma in nursing:-Cook county SON. Norwalk.The base for professional Nursing Practice . Fundamental skills and concepts in Patient Care.1973 & 1989 Educational Achievement . Vandemark L.53(3):90-7. Potter A Patricia.. Taylor Carol.Evelyn. Ladner PK.19(3):225 Cheng MY.

Nebraska Administrative supervisor at university of Chicago Chairperson of clinical nursing at cook country SON Visiting professor at Tel Aviv university in Israel Goal: To promote adaptation and maintain wholeness using the principles of conservation Model guides the nurse to focus on the influences and responses at the organismic level Nurse accomplishes the goal of model through the conservation of energy. age. dilation of ventricle and thickening of myocardial muscle While the responses are same. contained and controlled use of environmental resources by individual in his or her best interest" Exist when the interaction or constant adaptations to the environment permits the assurance of integrity Promoted by use of conservation principle The product of adaptation "Keeping together "of the life systems or the wholeness of the individual Achieving a balance of energy supply and demand that is with in the unique biological realities of the individual Achievements Conservational model Adaptation • • • • • • Wholeness • • • • • Conservation Nursing’s paradigm Person • A holistic being who constantly strives to preserve wholeness and integrity . economic. the timing and manifestation of organismic responses will be unique for each individual pulse rate) An ongoing process of change in which patient maintains his integrity within the realities of environment Achieved through the "frugal.• • • • • • • • • • • Received honorary doctorate from Loyola University in 1992 Clinical experience in OT technique and oncology nursing Civilian nurse at the Gardiner general hospital Director of nursing at Drexel home in Chicago Clinical instructor at Bryan memorial hospital in Lincoln. structure and personal and social integrity Every individual has a unique range of adaptive responses The responses will vary by heredity. gender or challenges of illness experiences Example: The response to weakness of cardiac muscle is an increased heart rate.

• A unique individual in unity and integrity. beliefs and tradition Adaptation Organismic response Conservation Characteristics Historicity: Adaptations are grounded in history and await the challenges to which they respond Specificity: Individual responses and their adaptive pattern varies on the base of specific genetic structure Redundancy: Safe and fail options available to the individual to ensure continued adaptation Environment • • • • • • • • • Internal Environment • • • • External Environment • • • Person and environment • • • Adaptation Organismic response . believing. feeling. micro-organism and pollution Conceptual: Part of person's environment including cultural patterns characterized by spiritual existence. which permit the individual’s body to sustain its well being with the vast changes which encroach upon it from the environment Preconceptual: Aspect of the world that individual are able to intercept Operational: Elements that may physically affects individuals but not perceived by hem: radiation. ideas. values. thinking and whole system of system Competes the wholeness of person Internal Homeostasis Homeorrhesis External Preconceptual Operational Conceptual Homeostasis: A state of energy sparing that also provide the necessary baselines for a multitude of synchronized physiological and psychological factors A state of conservation Homeorrhesis: A stabilized flow rather than a static state Emphasis the fluidity of change within a space-time continuum Describe the pattern of adaptation.

Inflammatory: response intended to provide for structural integrity and the promotion of healing 3. Perceptual: Involves gathering information from the environment and converting it in to a meaning experience Nine models of guided assessment • • • • • • • • • • • • • • • • • • • • • • Vital’s signs Body movement and positioning Ministration of personal hygiene needs Pressure gradient system in nursing interventions Nursing determination in provision of nutritional needs Pressure gradient system in nursing Local application of heat and cold Administration of medicine Establishing an aseptic environment The nurse creates an environment in which healing could occur A human being is more than the sum of the part Human being respond in a predictable way Human being are unique in their responses Human being know and appraise objects . condition and situation Human being are agents who act deliberately to attain goal Adaptive changes involve the whole individual A human being has unity in his response to the environment Assumption . reason and understand human being action are self determined even when emotional Human being are capable of prolonging reflection through such strategists raising questions Human being make decision through prioritizing course of action Human being must be aware and able to contemplate objects.• • • • A change in behavior of an individual during an attempt to adapt to the environment Help individual to protect and maintain their integrity They co-exist They are four types 1.condition and situation Human being sense . most primitive response 2. Flight or fight: An instantaneous response to real or imagined threat.reflects. Stress: Response developed over time and influenced by each stressful experience encountered by person 4.

Levine’s idea can be tested Hypothesis can be derived from them .• • • • Every person possesses a unique adaptive ability based on one’s life experience which creates a unique message There is an order and continuity to life change is not random A human being respond organismically in an ever changing manner A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient A human being is a social animal A human being is an constant interaction with an ever changing society Change is inevitable in life Nursing needs existing and emerging demands of self care and dependant care Nursing is associated with condition of regulation of exercise or development of capabilities of providing care Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon The concept of illness adaptation. using interventions. they can be used to explain the consequences of nursing action Theories should be relatively simple yet generalizable.it is hard o determine the contribution to the general body of knowledge with in the discipline • • • • • Levine’s work & Characteristics of theory • • • • • • • • • • • • • • • .they are combined to look at nursing care in a different way (more comprehensive view incorporating total patient care) form previous time. Theories must be logical in nature. Since Levine’s idea have not yet been widely researched . and the evaluation of nursing interventions are interrelated . The principle of conservation are specific enough to be testable Levine’s work & Characteristics of theory Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.e. Levine’s theory is easy to use . those related to the conservational principles Theories can be the bases for hypotheses that can be tested. It’s major elements are easily comprehensible and the relation ship have the potential for being complex but are easily manageable Certain isolated aspect of the theory are the generalizable i. Levine’s idea about nursing care are organized in such a way as to b sequential and logical.

laws and principles particularly those from the humanities and sciences Conservation of energy Conservation of structural integrity Conservation of personal integrity Conservation of social integrity Refers to balancing energy input and output to avoid excessive fatigue includes adequate rest. Levine’s ideas seem to be consistent with other theories.Crawford-gamble :-successfully applied Levine’s theory to the female patient undergoing surgery for the traumatic amputation of the fingers These ideas lend themselves to use in practice particularly in acute care setting Theories must be consistent with other validated theories. Conservation of structural integrity • Refers to maintaining or restoring the structure of body preventing physical breakdown And promoting healing Example: Assist patient in ROM exercise Maintenance of patient’s personal hygiene 3. a political system and a nation Example: • • Position patient in bed to foster social interaction with other patients Avoid sensory deprivation . Conservation of personal integrity • Recognizes the individual as one who strives for recognition. respect. nutrition and exercise • • • Conservational Principle • • • • • • 1. a community . selfhood and self determination Example: Recognize and protect patient’s space needs 4. Conservation of social integrity • An individual is recognized as some one who resides with in a family.a religious group. Conservation of energy Example: availability of adequate rest Maintenance of adequate nutrition 2. an ethnic group. Paula E.• • Theories can be utilized by the practitioner to guide and improve their practice. self awareness. laws and principles but will leave open unanswered questions that need to be investigated .

reads medical reports.• • • • Promote patient’s use of news paper. always practiced and studied in concert with all of the disciplines that together from the health sciences" The human interaction relying on communication . radio. realizing that every individual requires a unique and separate cluster of activities The individual integrity is his abiding concern and it is the nurse’s responsibility to assist him to defend and to seek its realization Assessment Trophicognosis Hypothesis Interventions Evaluation Assessment Health • Nursing • • • • • Goal of Nursing Nursing Process • • • • • Nursing Process • Collection of provocative facts through observation and interview of challenges to the internal and external environment using four conservation principles Nurses observes patient for organismic responses to illness. TV Provide support and assistance to family Health is a wholeness and successful adaptation It is not merely healing of an afflicted part .it is return to daily activities. magazines.rooted in the organic dependency of the individual human being in his relationships with other human beings Nursing involves engaging in "human interactions" To promote wholeness. selfhood and the ability of the individual to pursue once more his or her own interest without constraints Disease: It is unregulated and undisciplined change and must be stopped or death will ensue "nursing is a profession as well as an academic discipline. talks to patient and family Assesses factors which challenges the individual Trophicognosis • • • Nursing diagnosis-gives provocative facts meaning A nursing care judgment arrived at through the use of the scientific process Judgment is made about patient’s needs for assistance • • .

acute or long term care unit Theory of therapeutic intention • • • • • • • • • Uses • Theory of therapeutic intention .Hypothesis • • • • • • • • • • • Planning Nurse proposes hypothesis about the problems and the solutions which becomes the plan of care Goal is to maintain wholeness and promoting adaptation Interventions Testing the hypothesis Interventions are designed based on the conservation principles Mutually acceptable Goal is to maintain wholeness and promoting adaptation Evaluation Observation of organismic response to interventions It is assesses whether hypothesis is supported or not supported If not supported. plan is revised.speculative theory that redefined aging and everything else that has to do with human life Aging is diminished availability of redundant system necessary for effective maintenance of physical and social well being Goal: To seek a way of organizing nursing interventions out of the biological realities which the nurse has to confront Therapeutic regimens should support the following goals: Facilitate healing through natural response to disease Provide support for a failing auto regulatory portion of the integrated system Restore individual integrity and well being Provide supportive measure to ensures comfort Balance a toxic risk against the threat of disease Manipulate diet and activity to correct metabolic imbalance and stimulate physiological process Reinforce usual response to create a therapeutic changes Critical. new hypothesis is proposed Conservational model provides the basis for development of two theories o o • • Theory of redundancy Theory of therapeutic intention Conservational models Theory of redundancy Untested .

Francis de sales. pregnant young adult and elderly care unit Primary health care OT Community setting Nursing research Nursing education Nursing administration Nursing practice Nursing research Principles of conservation have been used for data collection in various researches Conservational model was used by Hanson et al. Pennsylvania Used in nursing education program sponsored by Kapat Holim in Israel Nursing administration Taylor described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care McCall developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients Family assessment tool was designed by Lynn-Mchale and Smith for families of patient in critical care setting Nursing practice Conservational model has been used for nursing practice in different settings Bayley discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patient’s perceptual. infant and young children. shelters or streets Utility of Theory • • • • • • • • • Nursing process according to Levine’s model .in their study of incidence and prevalence of pressure ulcers in hospice patient Newport used principle of conservation of energy and social integrity for comparing the body temperature of infant’s who had been placed on mother’s chest immediately after birth with those who were placed in warmer Nursing education Conservational model was used as guidelines for curriculum development It was used to develop nursing undergraduate program at Allentown college of St.• • • • • • • • • • • Neonates. operational and conceptual environment Pond used conservation model for guiding the nursing care of homeless at a clinic.

inability to pass urine Personal integrity:-not able to give birth to more children Social integrity:-Strained relationship with husband Inadequate nutritional status Pain Potential for wound and bladder infection Need to learn self catheterization Decreased self worth Potential for abuse Nutritional consultation Teaching and return demonstration of urinary self catheterization Care of surgical wound Exploring concern regarding hysterectomy Energy conservation • • • • • • • Provide medication for pain and nausea Allowing rest period Structural integrity Administrating antibiotic for wound. nausea . Mona. a wife of an abusive husband. insanitary condition in home Energy conservation:-weight loss. Teaching self catheterization Personal integrity Exploring her feeling about uterus removal while respecting her privacy Social integrity Assess potential abuse form husband Support to the family Trophicognosis Hypothesis Interventions Organismic response . underwent a radical hysterectomy.Mrs.weight loss. loss of reproductive ability Challenges to the external env:-abusive husband.Patient has history of smoking and stays in house which is less than sanitary Assessment • • • • • • • • • • • • • • • • Challenges to the internal env:-weight loss. nausea and inability to empty bladder . nausea. Post operatively has pain .pain Structural integrity:-threatened by surgical procedure.

Trophicogosis . Nursing process 1.• • • • • • • • • • • Controlled pain Abdominal wound healing Improved appetite . A theory of health promotion for preterm infants based on conservational model of nursing.weight gain Clean urinary self catheterization Assistance from husband She values the holistic approach to all individual.17 (3) The article describes a new middle range theory of health promotion for preterm infants based on Levine’s conservational model that can be used to guide neonatal nursing practice. this mismatch will be an area of conflict. Nurse has the responsibility for determining the patient ability to participate in the care . well or sick Values patient’s participation in nursing care Comprehensive content in depth Provides direction of nursing research .and if the perception of nurse and patient about the patient ability to participate in care don’t match. Nursing science quarterly. education.2004 Jul. Assessment 2. The major limitation is the focus on individual in an illness state and on the dependency of patient. Conservation principles 2. Critiquing the theory Limitation • • • Research Highlights • Summary • • • • • • Introduction to the theorist Conservational model Concept of the model Adaptation Wholeness Conservation 1. administration and practice Logically congruent Shows high regard to adjunctive disciplines to develop theoretical basis for nursing Limited attention can be focused on health promotion and illness prevention.

Appleton & Lange. Thomson. Potter A Patricia. Nursing research 2. Nursing Theories. • • • . standard and practice. Julia . Theoretical Basis for Nursing Philadelphia. Nurs Sci Q. McEwen Melanie (2002). Nursing administration 4. Delaune SC. Norwalk. Taylor Carol. Philadelphia. Hypothesis 4. 27(6) : 605-15 Reed PG.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Using King's Goal Attainment Theory to facilitate drug compliance in a psychiatric patient. LWW. Theoretical Nursing : Development & Progress 3rd ed. 3rd ed.M. Vandemark L. Philadelphia. 2006 Jul. Evaluation 3. 2006 Jun. Interventions 5. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 7th edition.53(3):90-7. Hu Li Za Zhi. Utility of theory 1.The base for professional Nursing Practice . Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed.3. Fundamental of nursing. London Mosby Year Book. Wills M. The force of nursing theory guided. 2002. NY. 2nd edition.. Theory of redundancy 4. Fundamental skills and concepts in Patient Care. Lippincott. 2006 Jul. Nursing education 3. Ladner PK. Meleis Ibrahim Afaf (1997) . Theory of therapeutic intention 5.Evelyn.practice. Lippincott Williams& wilkins. Nursing practices References • • • • • • • Timber BK.19(3):225 Cheng MY. George B. Lippincott.

TN. MD. 1952 . 1945 MPH :Johns Hopkins University. Dallas. Columbia university. New York. George Peabody College. Texas Diploma :Knoxville General Hospital School of Nursing(1936) Graduation in Public Health Nursing. 1937 MA :Teachers college.MARTHA ROGER’S SCIENCE OF UNITARY HUMAN BEINGS Introduction • • • • • Born :May 12. 1914. Baltimore.

Consultant. Evolution of abstract system The development of the abstract system was strongly influenced by an early grounding in arts and background of science and her keen interest in space The science of unitary human beings originated as a synthesis of facts and ideas from multiple sources of knowledge The uniqueness is in the central phenomena : people and environment The Rogerian view of a causality emerges from an infinite universe of open system Overview of Rogerian model • • • • • • Rogers model provides the way of viewing the unitary human being Humans are viewed as integral with the universe The unitary human being and the environment are one . New York University. 1954 Fellowship: American academy of nursing Position: Professor Emerita. lies in the phenomenon central to its focus. 1994 Theoretical basis of nursing (Rogers 1970) Nursing science and art :a prospective (Rogers 1988) Nursing :science of unitary. The purpose of nurses is to promote health and well-being for all persons wherever they are. Speaker Died : March 13 . irreducible.• • • • Doctorate in nursing :Johns Hopkins University.not dichotomous Nursing focus on people and the manifestations that emerge from the mutual human /environmental field process Change of pattern and organization of the human field and the environmental field is propagated by waves The manifestations of the field patterning that emerge are observable events . the uniqueness of nursing. Nurses long established concern with the people and the world they live is in a natural forerunner of an organized abstract system encompassing people and the environments. The irreducible nature of individuals is different from the sum of the parts. Division of Nursing. human beings update (Rogers 1990) Vision of space based nursing (Rogers 1990) Publications of Martha Rogers Rogers nursing theory Nursing is both a science and art. Baltimore. like that of any other science. The integral ness of people and the environment that coordinate with a multidimensional universe of open systems points to a new paradigm :the identity of nursing as a science.

pan dimensional energy field identified by pattern and integral with the human field" The field coexist and are integral. indivisible. pan dimensional (fourdimensional) energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts" and "a unified whole having its own distinctive characteristics which cannot be perceived by looking at . describing. and homeodynamic principles Energy field Concepts of Rogers model • • • • • • • • • • • The energy field is the fundamental unit of both the living and nonliving This energy field "provide a way to perceive people and environment as irreducible wholes" The energy fields continuously varies in intensity. openness. Manifestation emerge from this field and are perceived.there is no temporal ordering of lives. and pan dimensionality Basic concepts include unitary human being . density.environment. Health • . Unitary Human Being (person) A unitary human being is an "irreducible. pattern. and extent Openness The human field and the environmental field are constantly exchanging their energy There are no boundaries or barrier that inhibit energy flow between fields Pattern Pattern is defined as the distinguishing characteristic of an energy field perceived as a single waves "pattern is an abstraction and it gives identity to the field" Pan dimensionality Pan dimensionality is defined as "non linear domain without spatial or temporal attributes" The parameters that human use in language to describe events are arbitrary. The present is relative .• • • The identification of the pattern provide knowledge and understanding of human experience Basic characteristics which describes the life process of human :energy field. or summarizing the parts" The people has the capacity to participate knowingly and probabilistically in the process of change Environment • • The environment is an "irreducible .

they are the "characteristics and behavior emerging out of the mutual. but continuous. simultaneous interaction of the human and environmental fields" Health and illness are the part of the sane continuum. intellectual judgment with which such knowledge is made in service to the man kind People needs knowledgeable nursing The principles of homeodynamic postulates the way of perceiving unitary human beings The fundamental unit of the living system is an energy field Three principle of homeodynamic • • • Resonance • • • • Helicy • Helicy describes the unpredictable.• Rogers defined health as an expression of the life process. The multiple events taking place along life's axis denote the extent to which man is achieving his maximum health potential and very in their expressions from greatest health to those conditions which are incompatible with the maintaining life process Nursing The concept Nursing encompasses two dimensions Independent science of nursing An organized body of knowledge which is specific to nursing is arrived at by scientific research and logical analysis • • • • • Art of nursing practice The creative use of science for the betterment of the human The creative use of its knowledge is the art of its practice Assumptions about people and nursing • • Nursing exists to serve people………. nonlinear evolution of energy fields as evidenced by non repeating rhythmicties Resonance is an ordered arrangement of rhythm characterizing both human field and environmental field that undergoes continuous dynamic metamorphosis in the human environmental process Resonancy Helicy integrality • • • • Homeodynamic principles ..the imaginative.it is the direct and overriding responsibility to the society The safe practice of nursing depends on the nature and amount of scientific nursing knowledge the individual brings to practice…….

perception of time passing. there is no linear time nor any separation of human and the environmental fields Theory postulates that evolutionary change is speeding up and that the range of diversity of life process is widening. déjàvu. Changes occur by by the continuous repatterning of the human and environmental fields by resonance waves The fields are one and integrated but unique to each other Rogerian theories-Grand theories Integrality • • • Rogerian theories • • • • • The theory of accelerating evolution The theory of paranormal phenomena The theory of rhythmicities This theory focus on the explanations for precognition. Irreducible. 1986) Theory of creativity.psychological rhythm) Theory deals with the manifestations of the whole unitary man as changes in human sleep wake patterns. clairvoyance. and other rhythmic development The perspective rhythm model (Patrick 1983) Theory of health as expanding consciousness (Neumann. and therapeutic touch Clairvoyance is rational in a four dimensional human field in continuous mutual. actualization and empathy (Alligood 1991) Theory of self transcendence (Reed1997) Power as knowing participation in change (Barrett 1998) Nursing is a learned profession-it is a science and art Nursing is the study of unitary. simultaneous interaction with a four dimensional world. Rogers explained that higher wave frequencies are associated with accelerating human development Focus on the human field rhythms (these rhythms are different from the biological . telepathy.• The principle of Helicy postulates an ordering of the humans evolutionary emergence Integrality cover the mutual. indices of human field motion. indivisible human and environmental energy fields The art of nursing involves the imaginative and creative use of nursing knowledge Theory of paranormal phenomena The theory of accelerating evolution • Theory of Rhythmicity • • • Theories derived from the science of unitary human beings • • • • • • • • Rogers concepts of nursing . continuous relationship of the human energy field and the environmental field .

and to direct and redirect patterning of the human and environmental fields for realization of maximum health potential Nursing intervention seeks to coordinate environmental field and human field rhythmicities.including future generation of space kind . research. meditation focusing on health potential of the person.as life continuous to evolve from earth to space and beyond. music. supportive psychotherapy motivation for rehabilitation. to strengthen the coherence and integrity of the human field. and rehabilitation encompasses the scope of nursing Rogers was one of the first nurse scholars to explicitly identify the person (unitary man) as the central phenomena of nursing concern Nursing abstract system is a matrix of concepts relevant to the life process in man Rogers conceptual system provides a body of knowledge in nursing that will have relevance for all workers concerned with people. to help people move toward better health Nursing aims to assist people in achieving their maximum potential. participates in the process of change . Professional practice in nursing seeks to promote symphonic interaction between man and environment. but with special relevance for nurses. guided imagery. and in the direct patient care practice • • • • • • • Roger’s contribution to nursing knowledge • • • • • Rules for nursing research guided by the Rogerian theory Rules for research • • The Rogerian research require both basic and applied research The phenomena to be studied are unitary human beings and their environmental interaction . Nursing practice should be emphasized on pain management. consequently to nurses In the evolution it is properly subjected to reformulation and change as the knowledge grows. Maintenance and promotion of health. the the conceptual data will be more clearer and it will take new dimensions The utilization of Rogerian model is used as a guide for theory development. such as therapeutic touch. nursing education.• • • The purpose of nurses is to promote health and well-being for all person and groups wherever they are using the art and science of nursing The health services should be community based Rogers challenges nurses to consider nursing needs of all people . prevention of disease. nursing diagnosis. humor. light. use of color. Her view provides a different world view that encompasses a practice of nursing for the present time and for the imagined and for the yet to be imagined future Rogers envisions a nursing practice of noninvasive modalities. intervention. because it matters to human beings.

technical nursing The focus is the transmission of the body of knowledge Teaching and practicing therapeutic touch Conducting regular in-service education Baccalaureate degree program Masters program Doctoral program The major concepts are – principal of Resonancy.learning strategies .• Study participants may be any person or group. Helicy. Integrality The faculty in the nursing education must be prepared at doctoral level Research methodology • • • • • • • • • • • • • • • Research tools derived from science of unitary human beings Rules for nursing education guided by Rogerian theory Nursing programs Teaching. with the provision that both person and environment are taken into account Qualitative and quantitative methods can be applied Experimental researches are questionable because she rejects the notion of causality Case study and longitudinal research are better than cross sectional study Research instruments that are directly derived from science of unitary human beings should be used Data analysis – multivariate analysis (canonical correlation studies) Perceived field motion scale Human field rhythm scale Temporal experience scale Assessment of dream experience scale Person environment participation scale Leddy healthiness scale Mutual exploration of the healing human-environment field scale Garon assessment of pain scale Family assessment tool Community health assessment tool Focus of the curriculum • • • • • • • • • Nursing education can be for professional nursing .

hospitals. community. other places where people lives Importance of use of media in education • • Rules for nursing administration guided by Rogerian theory Purpose of nursing services • • • • • Nursing services is the center of any health care system The purpose of nursing services is health promotion The administrators should hold higher degrees in nursing and licensed Leaders must be visionary and willing to embrace innovative and creative change Leaders should be able to identify the patterning to ensure the integrated behaviors for client and employees Administrative policies foster an open and supportive administrative climate that enhances staff members self esteem . industry. schools. community across the life span .the lab setting include homes. family. industry.at risk for developing dissonance/illness Areas of Rogerian model application • SETTINGS • All spheres of life • • • • • School Industry Family Community Space Rules for nursing practice guided by Rogerian theory .• Emphasis should be on developing self awareness as an aspect of the clients environmental energy field and the dynamic role of nurse pattern manifestation on the client Emphasis on laboratory study. clinics. space (by 2050AD) Independent practitioner is an advanced practice registered registered nurse who focus on well-being or mutual patterning of individual. actualization. and freedom of choice and provide opportunity for staff development and continuing education The ultimate goal is the clients well-being Characteristics of nursing personnel Management strategies and administrative policies • • • • • • Rules for independent practitioner guided by Rogerian model Nursing is an independent science Nurse assumes the role of potentiater of care She proposes the independent role in various setting like school.

Health patterning practice method • • • • • For the nurse .• SPECIALITIES • • • • • • • • Pediatrics Psychiatry Oncology Burns Geriatrics Neurology Cardiology Rehabilitative medicine • SPECIALIZED AREAS OF PRACTICE o o o o o o o o o o o o Neonatal ICU Pediatric ICU Post operative unit Pre operative unit Palliative care unit Rehabilitation center Burns unit Adult ICU’s Old age homes Neuropsychiatric units AREA WHERE ROGERIAN MODEL IS NOT APPLICABLE Operation theaters • • To promote well-being for all persons. wherever they are To assist both the client and nurse to increase their awareness of their own rhythm From community to hospital to outer space People of all ages both as individual human energy fields and group energy fields Assessment Voluntary mutual patterning Evaluation Pattern appraisal Mutual patterning of human and environmental fields Purpose of nursing practice Setting for practice • • Legitimate participants Nursing process.

dissonance Environmental fields pattern of communication. exchange. dissonance. rhythms. rhythms.• • • • Evaluation Self reflection Patterning activities Personal appraisal For the patient Nursing process Assessment • Areas of assessment • • • • • • • Simultaneous states of the individual and the environment Total pattern of events at any given point in space –time Rhythms of life process Categorical disease entities Subsystem pathology Supplementary data Pattern appraisal It is a comprehensive assessment of: • • Human field patterns of communication. harmony Intuitive reflection of self Validation of the appraisal • • o o o o o • • • • • Validate with self Validate with the client Mutual patterning of human and environmental field Sharing knowledge Offering choices Empowering the client Fostering patterning Evaluation Repeat pattern appraisal Identify dissonance and harmony Validate appraisal with the client Self reflection for the client Pattern appraisal include appraisal of multiple lifestyle rhythms such as: • • • Nutrition Work/leisure activities Exercise .

…………. clinging to her husband .depression with suicidal ideation. muttering to self. decreased ADL..ill-kempt.cries inconsolably …on repeated asking expressed sadness of mood Nursing care of Radha with Rogers model • • • • • • With rogerian model. and evaluation Pattern appraisal This visible rhythmical pattern is a manifestation of evolution towards dissonance Radha has pattern manifestation of dissonance……. From past 3 weeks Radha started sitting lonely. ovarian malignancy. Current assessment findings ……. not talking….poor nutritional intake. when asked about her illness…. neglecting her child care.• • • • Meditation Imagery Journaling Sleep / wake cycles Relationships Discomfort or pain Fear /hopes Patterning activities for the client Modifying the surroundings Clinical case study of Radha using Rogerian conceptual Model Radha is a 22years old female admitted in a psychiatry unit with severe depression secondary to diagnosis of ovarian malignancy She becomes tearful during history taking Radha is accompanied with her husband and 1year old child Her husband appeared anxious but supportive and attentive …………he is working as an accountant in their native place Radha was diagnosed with ovarian cancer 2 months back and underwent bilateral salphingio oopherectomy and hysterectomy……… 30days ago She is undergoing chemotherapy due to its Metastatic pattern……. complaints of severe pain in the body.looking perplexed.3 days back attempted suicide by consuming rat poison. decreased sleep . decreased talks. the process of caring Radha begins with pattern appraisal Nursing care involve pattern appraisal. mutual patterning. pain Radha has a low educational background A pattern activity of healing is noted through reports of a positive operative course .. repeated crying spells. neglects hygiene.her general appearance is a teary eyed young woman . appetite.

medication she is receiving are patterning modalities Patterning activities planned by the nurse for Radha ……. nutrition and her perception of self Appraisal can be grouped into exchanging patterns.her self knowledge links her illness to her personal belief of being punished for her past sins Appraisal is needed in her sleep patterns. communication patterns. pain.• • • • • • • • • • • • • • • • • • • • • • • • Patterning has to be directed towards reduction in perceived dissonance with her personal and environmental field Pain is a manifestation of perceived dissonance Decreased environmental energy transfer is visible by decreased talking and crying Radha has manifestation of fear……. helps in energy transmission for healing and …….helps in developing trust in the nurse Teach her how to center the energy and channel her energy to the area of pain Use humor for increasing socialization and developing self confidence and developing worthiness Human environmental patterning needs to involve the other individual who share her environment including husband and son Options are introduced relating to increase communication and hygiene patterns The entire family is involved in power as knowing participation in change Evaluation The evaluation process centers on the perceptions of dissonance that exist after the mutual pattern activities The appraisal process is repeated Manifestation of worry. humor . meditation. sadness of moos has to be appraised with family members A summary of the dissonance and/or harmony that is perceived is then shared with Radha. fear. imagery Radha needs to be assessed fully regarding her ability to understand and agree with different patterning modalities Therapeutic touch can be introduced to Radha Touch is introduced and incorporated into the management of pain.therapeutic touch.. and relating patterns Time between nurse and Radha is needed to foster her healing During the process nurse must rely on personal intuition and insight regarding the emerging pattern All this pattern forms the unitary pattern of Radha Mutual patterning The process is mutual between the nurse and Radha The surgery performed. and mutual patterning is modified or instituted ad indicated based on the evaluation .

2. Wills M.The base for professional Nursing Practice . 4.Summary • • • • • • • • Biographical sketch of Martha Rogers Overview of Rogerian concepts Rogerian terminologies Rogerian theories Nursing concepts. Appleton & Lange. McEwen Melanie (2002). Lippincott. 5. Julia . London Mosby Year Book. Philadelphia. Philadelphia.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. nursing process Perspectives of nursing education. Nursing Theories.Evelyn. nursing practice Contribution to nursing knowledge Clinical example References 1. 3. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) . Theoretical Nursing : Development & Progress 3rd ed. . Theoretical Basis for Nursing Philadelphia. Norwalk. 3rd ed. administration. Lippincott. Potter A Patricia. George B. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Taylor Carol.

past experiences and perceptions. needs.THEORIES BASED ON INTERACTIVE PROCESS IMOGENE KING: THEORY OF GOAL ATTAINMENT Major Concepts and Definitions Interaction · A process of perception and communication · Between person and environment · Between person and person · Represented by verbal and nonverbal behaviors · Goal-directed · Each individual brings different knowledge . molecular and behavioural levels of activities · Helps individuals move towards maturity Time · Sequence of events · Moving onwards to the future Space · Existing in all directions · Same everywhere · Immediate environment (nurse and client interaction) . which influence interaction Communication · Information from person to person · Directly or indirectly · Information component of interaction Perception · Each person’s representation of reality Transaction · Purposeful interaction leading to goal attainment Role · A set of behaviours expected of person’s occupying a position in a social system · Rules that define rights and obligations in a position Stress · Dynamic state · Human being interacts with the environment Growth and development · Continuous changes in individuals · At cellular. goals.

family and other interactions Environment · Open system · Constantly changing · Influences adjustment to life and health Personal system Concepts • Perception • • • • • Self Body image Growth and development Time Space Interpersonal system Concepts • Interaction • • • • Transaction Communication Role Stress Social system Concepts • Organization • • Authority Power . physicians. patient. interaction and transaction Person · Social beings · Sentient beings · Rational beings · Perceiving beings · Controlling beings · Purposeful beings · Action – oriented beings · Time – oriented beings Health · Dynamic state in the life cycle · Continuous adaptation to stress · To achieve maximum potential for daily living · Function of nurse. reaction.MAJOR ASSUMPTIONS Nursing · Observable behaviour · In health care system in society · Goal – to help individuals maintain health · Interpersonal process of action.

• • Status Decision making ASSUMPTIONS • Perceptions. SISTER CALLISTA ROY: ADAPTATION MODEL Introduction · Begins with man · Man as a biopsychosocial being · In constant interaction with his environment Focus of nursing · Man’s position on the health – illness continuum · Influenced by ability to adapt to confronted stimuli MAJOR CONCEPTS AND DEFINITIONS System · a set of units so related or connected as to form a unit · characterised by inputs. out puts. contextual and residual stimuli · represent the persons own standard of the range of stimuli. needs and values of the nurses and client influence interaction process • Individuals have the right to knowledge about themselves and to participate in decisions that influence their life. health and community services • Health professionals have the responsibility that helps individuals to make informed decisions about their health care • Individuals have the right to accept or reject health care • Goals of health professionals and recipients of health care may not be congruent II. made up of focal. to which one can respond with the ordinary adaptive response Adaptation problems: · the occurrence of situations of inadequate responses to need deficits or excesses Focal stimulus: · stimulus most immediately confronting the person · must make an adaptive response · factor that precipitates behaviour Contextual stimuli · all other stimuli present · contribute to behaviour caused by the focal stimuli Residual stimuli · · factors that may be affecting behaviour effect not validated . control and feedback process. Adaptational level · a constantly changing point. goals.

information · processing. reproduction and mastery. self concept. Ineffective responses: · Does not contribute to adaptive goals Physiological mode · involves body’s basic needs and ways of dealing with adaptation in relation to Fluid and electrolytes Exercise and rest Elimination Nutrition Circulation Oxygen · regulation includes: The senses Temperature Endocrine regulation Self – concept mode: · composite of belief and feeling · formed from perceptions · directs one’s behaviour · components are : · the physical self · the personal self Role performance mode: * performance of duties * based on given positions in society Interdependence mode: * one’s relation with significant others .Regulator · subsystem coping mechanism · responds automatically through neural-chemical-endocrine processes Cognator · subsystem coping mechanism · cognitive – emotive process · responds through · perception. role function and interdependence Adaptive responses · Promote integrity of the person in terms of the goals of survival. learning · judgment and emotion Adaptive (effector) modes · classification of ways of coping · manifests regulator and cognator activity · physiologic. growth.

ASSUMPTIONS FROM HELSON’S THEORY • human behaviour represents adaptation to environmental and organismic forces • adaptive behaviour is a function of the stimulus and adaptation level. the pooled effect of the focal.* support system * maintains psychic integrity * meets needs for nurturance and affection MAJOR ASSUMPTIONS • from system theory • • from Helson’s theory from humanism ASSUMPTIONS FROM SYSTEMS THEORY • a system is a set of units so related or connected as to form a unit or whole • • • • a system is a whole that functions as a whole by virtue of the interdependence of its parts systems have inputs. ASSUMPTIONS FROM HUMANISM • Persons have their own creative power • • • • A persons behaviour is purposeful and not merely a chain of cause and effect Person is holistic A person’s opinions and view points are of value The interpersonal relationship is significant. complex. in the form of a standard or feedback (information) living systems are more complex than mechanical systems and have standards and feedback to direct their functioning as a whole. adaptive system With internal processes (the cognator and regulator) Acting to maintain adaptation to the four modes Health • A state and a process of being and becoming an integrated and whole person . that is. • ELEMENTS Nursing • A science and practice discipline • • • A theoretical system of knowledge Prescribes a process of analysis and action Related to the care of the ill or potentially ill person Person • A biopsychosocial being • • • A living. outputs and control and feedback processes input. contextual and residual stimuli • adaptation is a process of responding positively to environmental changes responses reflect the state of the organism as well as the properties of stimuli and hence are regarded as active processes.

George B. Julia . Philadelphia.R. (5th ed.Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Dorothea Orem earned her Bachelor of science in nursing education in 1939 and Master of science in nursing in 1945 During her professional career . 1991. Nursing theorists and their work. . A. Orem’s Theory Introduction One of America’s foremost nursing theorists. Potter A Patricia.private duty nurse . circumstances and influences surrounding and affecting the development and behaviour of persons or groups References • • • • • • Alligood M.she worked as a staff nurse . Alligood. Mosby. Mosby. During this time she developed her definition of nursing practice. McEwen Melanie (2002). 1995. Philadelphia. Theoretical Nursing : Development and Progress 3rd ed.Evelyn.1985. 3rd ed. Lippincott. 2002. and 2001. Her goal was to upgrade the quality of nursing in general hospitals throughout the state. Taylor Carol. Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. Appleton and Lange. MR. Wills M. 2002.M. Nursing Theories. Meleis Ibrahim Afaf (1997) . Tomey. Philadelphia. Lippincott Williamsand wilkins. Norwalk.The base for professional Nursing Practice . All the conditions. Nursing theory utilization and application. Education and Welfare where she help publish "Guidelines for Developing Curricula for the Education of Practical Nurses" in 1959. Tomey AM. She continued to develop her concept of nursing and self care during this time. London Mosby Year Book. Philadelphia. 1958-1960 US Department of Health. Theoretical Basis for Nursing Philadelphia. Published first formal articulation of her ideas in Nursing: Concepts of Practice in 1971.nurse educator and administrator and nurse consultant Received honorary Doctor of Science degree in 1976 Dorothea Orem as a member of a curriculum subcommittee at Catholic University.Environment 1.and finally in 1995 Development of Theory 1949-1957 Orem worked for the Division of Hospital and Institutional Services of the Indiana State Board of Health. Orem’s Nursing: Concept of Practice was first published in 1971 and subsequently in 1980.). 2nd Ed. 1959 Orem subsequently served as acting dean of the school of Nursing and as an assistant professor of nursing education at CUA.second in 1980. Lippincott. recognized the need to continue in developing a conceptualization of nursing.

conditions . a helping service. developmental.Continues to develop her theory after her retirement in 1984 Definitions of domain concepts Nursing – is art. and a technology Actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments Encompasses the patient’s perspective of health condition .the physician’s perspective .includes that which makes a person human.developmental needs and capable of continuous self care A unity that can function biologically. and health derived or health related conditions Nursing process.symbolize and use symbols Conceptualized as a total being with universal .environmental elements. and the nursing perspective Goal of nursing – to render the patient or members of his family capable of meeting the patient’s self care needs To maintain a state of health To regain normal or near normal state of health in the event of disease or injury To stabilize .control .a human being who has "health related /health derived limitations that render him incapable of continuous self care or dependent care or limitations that result in ineffective / incomplete care. symbolically and socially Nursing client. .or minimize the effects of chronic poor health or disability Health – health and healthy are terms used to describe living things … it is when they are structurally and functionally whole or sound … wholeness or integrity.and developmental environment Human being – has the capacity to reflect .systematic and purposeful action Orem’s General Theory of Nursing Orem’s general theory of nursing in three related parts:Theory of self care Theory of self care deficit Theory of nursing systems Theory of Self Care Includes :-- .a system to determine (1)why a person is under care (2)a plan for care .(3)the implementation of care Nursing therapeutics– deliberate . A human being is the focus of nursing only when a self –care requisites exceeds self care capabilities Nursing problem – deficits in universal.…operating in conjunction with physiological and psychophysiological mechanisms and a material structure and in relation to and interacting with other human beings Environment – environment components are environmental factors .

or disease . life experience sociocultural orientation health and available resources Therapeutic self care demand – "totality of self care actions to be performed for some duration in order to meet self care requisites by using valid methods and related sets of operations and actions" Self care requisites-action directed towards provision of self care 3 categories of self care requisites are:-Universal Developmental Health deviation Universal self care requisites Associated with life processes and the maintenance of the integrity of human structure and functioning Common to all . Or associated with an event E.injury. food Provision of care assoc with elimination process Balance between activity and rest.Conditioned by age developmental state.water.health and well being Self care agency – is a human ability which is "the ability for engaging in self care" -.Self care – practice of activities that individual initiates and perform on their own behalf in maintaining life . ADL Identifies these requisites as: Maintenance of sufficient intake of air .g. between solitude and social interaction Prevention of hazards to human life well being and Promotion of human functioning Developmental self care requisites Associated with developmental processes/ derived from a condition…. adjusting to a new job adjusting to body changes Health deviation self care Required in conditions of illness .these include:-o o o o o Seeking and securing appropriate medical assistance Being aware of and attending to the effects and results of pathologic conditions Effectively carrying out medically prescribed measures Modifying self concepts in accepting oneself as being in a particular state of health and in specific forms of health care Learning to live with effects of pathologic conditions Theory of self care deficit Specifies when nursing is needed .

the patient. health status Maintaining interpersonal .the parent) is incapable or limited in the provision of continuous effective self care Orem identifies 5 methods of helping:-Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in relation to meet future demands Teaching another Theory of Nursing Systems Describes how the patient’s self care needs will be met by the nurse . or both Identifies 3 classifications of nursing system to meet the self care requisites of the patient:Wholly compensatory system Partly compensatory system Supportive – educative system Design and elements of nursing system define Scope of nursing responsibility in health care situations General and specific roles of nurses and patients Reasons for nurses’ relationship with patients and The kinds of actions to be performed and the performance patterns and nurses’ and patients’ actions in regulating patients’ self care agency and in meeting their self care demand Orem recognized that specialized technologies are usually developed by members of the health profession A technology is systematized information about a process or a method for affecting some desired result through deliberate practical endeavor .Nursing is required when an adult (or in the case of a dependent .action abilities and limitations Regulatory technologies Maintaining and promoting life processes Regulating psycho physiological modes of functioning in health and disease .with or without use of materials or instruments Categories of technologies Social or interpersonal Communication adjusted to age.intragroup or intergroup relations for coordination of efforts Maintaining therapeutic relationship in light of psychosocial modes of functioning in health and disease Giving human assistance adapted to human needs .

analyze and interpret –make judgment regarding care Design of a nursing system and plan for delivery of care Production and management of nursing systems Step 1-collect data in six areas:The person’s health status The physician’s perspective of the person’s health status The person’s perspective of his or her health The health goals within the context of life history .determine why nursing is needed. The 2 actions are:Bringing out a good organization of the components of patients’ therapeutic self care demands Selection of combination of ways of helping that will be effective and efficient in compensating for/ overcoming patient’s self care deficits Step 3 Nurse assists the patient or family in self care matters to achieve identified and described health and health related results .collecting evidence in evaluating results achieved against results specified in the nursing system design . Orem emphasizes that the technological component "must be coordinated with interpersonal and social processes within nursing situations Comparison of Orem’s Nursing Process and the Nursing Process Nursing Process Assessment Nursing diagnosis Plans with scientific rationale Implementation evaluation Orem’s Nursing. The steps within the approach are considered to be the technical component of the nursing process.. and health status The person’s requirements for self care The person’s capacity to perform self care Step 2 Nurse designs a system that is wholly or partly compensatory or supportive-educative.Promoting human growth and development Regulating position and movement in space Orem’s Theory and Nursing Process Orem’s approach to the nursing process presents a method to determine the self care deficits and then to define the roles of person or nurse to meet the self care demands. Process Diagnosis and prescription .life style.

perform intermittent catheterizatio n Therapeutic self care demand Adequacy of self care agency Nursing diagnosis Methods of helping .Actions are directed by etiology component of nursing diagnosis evaluation Application of Orem’s theory to nursing process Personal factors 29 yr. Female Early adulthood transition Universal self care 32pack /yr Water-no restrictions Food –nil Wt89lb Wt loss-19% nauseated 8th grade Teenage pregnancy No work Married Child-2 Urinary retention Intermittent self catheterizatio n Pain Tearful Husband abusive Dissatisfied with home RT No BSE Infrequent physical examination No HRT Poor health Developmental Health self care deviatio n Teenage pregnancy-2 OC-10 yrs Husband emotionally away Seeks medical attention for overt s/s Aware of disease No evidence ability to manage effects Surgery on reproductive organs Difference between knowledge base & lifestyle Medical problem & plan Self care deficits Lives at mother’s home. Environmen t unclean Limited resources EDU deprivation Oppressive living conditions Will receive RT .

R/T early parenthood Guiding & directing Providing psy support Inadequate Level of education Providing physical.Air Maintain effective respiration Water No problem Food maintain sufficient intake Inadequate Potential for impaired respiratory status P F fluid imbalance Adequate Inadequate Actual nutritional deficit r/t ausea Guiding & directing Teaching Providing physical support Personal development Hazards Prevent spouse abuse Promotion of normalcy Inadequate A/d in environment Shared housing Inadequate P/F injury Guiding & directing Guiding & directing Maintain developmental environment Support ed normalcy in environment Prevent /manage dev threat Inadequate Actual delay in normaldev. psy support Dev deficit r/t loss of reproductive organs .

Maintenance of health status Management of disease process Inadequate Inadequate P/F contd.laws and principles Theory Testing Orem’s theory has been used as the basis for the development of research instruments to assist researchers in using the theory A self care questionnaire was developed and tested by Moore(1995) for the special purpose of measuring the self care practice of children and adolescents . teaching Adherence to med regimen Awareness of potential problems Inadequate Inadequate P/F ¯ adherence in self catheterization & OPD RT Actual deficit in awareness of advisability of HRT & RT effects teaching teaching Adjust to loss of reproductive ability & dev healthy view of illness Adjust life style to cope with change Inadequate Actual threat to self image Actual self deficit in planning for future needs Providing psy support Guiding & directing Inadequate Orem’s work and the characteristics of a theory Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon Theories must be logical in nature Theories must be relatively simple yet generalizable Theories are the basis for hypothesis that can be tested Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them Theories can be used by the practitioners to guide and improve their practice Theories must be consistent with other validated theories . alterations in health status P/F UTI Guiding & directing. teaching Guiding & directing.

(2006). (1991). Dorthea E. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Nursing: Concepts of practice (4th ed.she interprets the concepts of human beings. Theoretical Nursing : Development & Progress 3rd ed.).G.Orem’s visual presentation of the boxed nursing systems implies three static conditions of health Appears that the theory is illness oriented rather with no indication of its use in wellness settings Summary Orem’s general theory of nursing is composed of three constructs .Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Lippincott. London Mosby Year Book. In A. Whelan. Potter A Patricia. Significance of theory for nursing as a discipline and profession. & Alligood. Philadelphia. Lippincott Williams& wilkins. St.and has defined 3 steps of nursing process It has a broad scope in clinical practice and to lesser extent in research .thing Health is often viewed as dynamic and ever changing .The theory has been used as a conceptual framework in assoc. S. Louis. degree programs (Fenner 1979) also in many nursing schools Strengths Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of nursing practice nursing curricula . Julia . D. Taylor.M. A. (1984). Lippincott. nursing and society . St. Wills M.education and administration References • • • • • • • • • Orem. Meleis Ibrahim Afaf (1997) . Orem: Self-care deficit theory of nursing.The base for professional Nursing Practice . Philadelphia. George B. Louis.Evelyn. 3rd ed. E. Retrieved October 31.and nursing research Specifies when nursing is needed Also includes continuing education as part of the professional component of nursing education Her self care approach is contemporary with the concepts of health promotion and health maintenance Expanded her focus of individual self care to include multiperson units Limitations In general system theory a system is viewed as a single whole thing while Orem defines a system as a single whole . health. MO: Mosby-Year Book Inc. Tomey. M. McEwen Melanie (2002). Appleton & Lange. . Mosby. 2006. G.nursing education administration . Taylor Carol.Throughout her work . Nursing Theorists and their work. Norwalk.E. Missouri. Theoretical Basis for Nursing Philadelphia. Nursing Theories. United States of America. (2002). Analysis and application of Dorothea Orem’s Self-care Practuce Model.

a prominent nurse theorist. researcher and teacher Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill Born at Los Angeles on October 14. She joined the faculty of Mount St. Callista of the importance of describing the nature of nursing as a service to society and prompted her to begin developing her model with the goal of nursing being to promote adaptation. Los Angeles in 1963.she was made chair of the nursing department at the college.Callista Roy. She organized course content according to a view of person and family as adaptive systems. Mary’s College 1970-The model was implemented in Mount St. Goal of nursing to direct nursing education. She introduced her ideas about ‘Adaptation Nursing’ as the basis for an integrated nursing curriculum. She also earned a master’s and PhD in Sociology in 1973 and 1977 . practice and research Model as a basis of curriculum impetus for growth--Mount St. Mary’s school 1971. Callista had the significant opportunity of working with Dorothy E.respectively. writer. Mary's College. Johnson Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. teaching both pediatric and maternity nursing.THE ROY'S ADAPTATION MODEL Introduction Sr. a master's degree program in pediatric nursing at the University of California . Influencing Factors • • • • • Family Education Religious Background Mentors Clinical Experience . Fabien Roy she earned a Bachelor of Arts with a major in nursing from Mount St. Sr.Los Angeles in 1966. lecturer. Mary's College in 1966. and Mrs. 1939 as the 2nd child of Mr.

and view points" Interpersonal relations are an integral part of nursing There is a dynamic objective for existence with ultimate goal of achieving dignity and integrity A person can be reduced to parts for study and care. Published these ideas in "Nursing outlook" in 1970 Subsequently different components of her framework crystallized during 1970s. The person is in constant interaction with a changing environment.outcome of adaptation Nursing -. person uses both innate and acquired mechanisms which are biological.promoting adaptation and health Responding positively to environmental changes Explicit assumptions (Roy 1989. The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response. ’80s.Theory description • The central questions of Roy’s theory are: o o o • • • • • • • • • • • • • • Who is the focus of nursing care? What is the target of nursing care? When is nursing care indicated? Roy’s first ideas appeared in a graduate paper written at UCLA in 1964.adaptive system Environment -. self. Health and illness are inevitable dimensions of the person’s life. A state of adaptation frees an individual’s energy to respond to other stimuli.concept. Nursing is based on causality.goal of nursing Person -.stimuli Health -. "Nursing accepts the humanistic approach of valuing other persons’ opinions. and ’90s Over the years she identified assumptions on which her theory is based. The person has 4 modes of adaptation: physiologic needs. To cope with a changing world. To respond positively to environmental changes . The person is a bio-psycho-social being. Adaptation -. role function and inter-dependence. psychological and social in origin.the person must adapt. Roy and Andrews 1991) Implicit assumptions • • • • • • • • • • Roy Adaptation Model Concepts: Early and Revised Concepts-Adaptation . Patient’s values and opinions are to be considered and respected.

and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions Concepts-Subsystems Cognator subsystem — A major coping process involving 4 cognitive-emotive channels: perceptual and information processing. and endocrine coping channels Relationships Derived Four Adaptive Modes 500 Samples of Patient Behavior What was the patient doing? What did the patient look like when needing nursing care? Four Adaptive Modes Physiologic Needs • • • • • • • • • • • • • • • • • • • • • . including focal. learning. self reflection and choice to create human and environmental integration Concepts-Person Bio-psycho-social being in constant interaction with a changing environment Uses innate and acquired mechanisms to adapt An adaptive system described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groups-families. chemical.• The process and outcome of individuals and groups who use conscious awareness. and society as a whole Concepts-Environment Focal .internal or external and immediately confronting the person Contextual.all stimuli present in the situation that contribute to effect of focal stimulus Residual-a factor whose effects in the current situation are unclear All conditions. communities. circumstances. quality of life. contextual and residual stimuli Concepts-Health Inevitable dimension of person's life Represented by a health-illness continuum A state and a process of being and becoming integrated and whole Concepts-Nursing To promote adaptation in the four adaptive modes To promote adaptation for individuals and groups in the four adaptive modes. judgment and emotion. Regulator subsystem — a basic type of adaptive process that responds automatically through neural. thus contributing to health. organizations. and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources.

• • • • • • • Self Concept Role Function Interdependence Four Adaptive Mode Categories Tested in practice for 10 years Criteria of significance. and faith Scientific Assumptions for the 21st Century • • • • • • • • • • • • • Philosophical Assumptions . and fostering of interdependence Persons and the earth have common patterns and integral relations Person and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness. usefulness. enlightenment. protection. Thinking and feeling mediate human action System relationships include acceptance. and completeness were met Sample Proposition and Hypothesis for Practice Self Concept Mode: Increased quality of social experience leads to increased feelings of adequacy Providing support for new mothers can lead to positive parenting Derived Theory Theory Development • • • • • • 91 Propositions Described relationships between and among regulator and cognator and four adaptive modes 12 Generic propositions Questions Raised by 21st Century Changes How can ethics and public policy keep pace with developments in science? How can nurses focus on human needs not machines? How can nurses contribute to creating meaning and purpose in a global society? Systems of matter and energy progress to higher levels of complex self organization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Human decisions are accountable for the integration of creative processes.

and transforming the universe Includes relating persons. organizations. nations. sustaining. communities. growth in a new role Compromised Processes . and society as a whole Persons Adaptation and Groups • Adaptive Modes • • • • • • • • • • • • • • • • • • • • • • • • Physiologic Self Concept Role Function Interdependence Groups Physical Group Identity Role Function Interdependence Role Function Mode Underlying Need of Social integrity The need to know who one is in relation to others so that one can act The need for role clarity of all participants in group Adaptation Level A zone within which stimulation will lead to a positive or adaptive response Adaptive mode processes described on three levels: Integrated Compensatory Compromised Integrated Life Processes Adaptation level where the structures and functions of the life processes work to meet needs Examples of Integrated Adaptation Stable process of breathing and ventilation Effective processes for moral-ethical-spiritual growth Compensatory Processes Adaptation level where the cognator and regulator are activated by a challenge to the life processes Compensatory Adaptation Examples: Grieving as a growth process. partners. higher levels of adaptation and transcendence Role transition.• Persons are accountable for the processes of deriving. families.

The elements : • • • • • • First level assessment Second level assessment Diagnosis Goal setting Intervention evaluation The nursing process Usefulness of Adaptation Model • • • • • • • • • • • • • Scientific knowledge for practice Clinical assessment and intervention Research variables To guide nursing practice To organize nursing education Curricular frame work for various nursing colleges Theories can interrelates concepts in such a way as to present a new view of looking at a particular phenomenon. laws and principles but will leave open unanswered questions that need to be investigated RAM is testable BBARNS (1999) reported that 163 studies have been conducted using this model. Characteristics of the theory Testability • • .• • • • • • • • • Adaptation level resulting from inadequate integrated and compensatory life processes Adaptation problem Compromised Adaptation Examples Hypoxia Unresolved Loss Stigma Abusive Relationships RAM offers guidelines to nurse in developing the nursing process. Theories must be logical in nature Theories should be relatively simple yet generalizable Theories can be the basis for the hypotheses that can be tested Theories contribute to and assist in increasing the general body of knowledge of a discipline through the research implemented to validate them Theories can be utilized by the practitioners to guide and improve their practice Theories must be consistent with other validated theories.

(2000). L. health and environment • • • • • • • • • • Persons are viewed as living adaptive systems whose behaviours may be classified as adaptive responses or ineffective responses. B. 5 elements -person. (1997). The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes. Middle range theories have been derived from RAM 1998-Ducharme et al described a longitudinal model of psychosocial determinants of adaptation 1998-Levesque et al presented a MRT of psychological adaptation 1999-A MRNT .. Norwalk. Nursing Science Quarterly. Zhan. and Ziegler. Kowitski. 12591268. 28(6). Nursing Science Quarterly. Journal of Ophthalmic Nursing and Technology. Theoretical Nursing : Development & Progress 3rd ed. J. Philadelphia. These behaviors are derived from regulator and cognator mechanisms. H. H. using information about person’s adaptation level. Krippendorf. Piacentino. These mechanisms work with in 4 adaptive modes. (1998). G. Appleton & Lange.• • RAM is complete and comprehensive It explains the reality of client. Meleis Ibrahim Afaf (1997) . 6(2). 74-78. The environment consists of person’s internal and external stimuli. reproduction.. C. J. K. Nursing Science Quarterly.C. Julia . 13(2). Nursing Theories. A meta-analysis of the interrelationships between the modes in Roy's adaptation model. (2001). References . and Dunn. Wills M.C. the urine control theory by Jirovec et al Dunn. and various stimuli. E. Health is a process of becoming integrated and able to meet goals of survival. 14. Eliasof. and mastery. (2000). Hughes. D. Adaptation in children with cancer: research with Roy's model.. Nursing activities involve manipulation of these stimuli to promote adaptive responses. The Roy Adaptation Model and its application to clinical nursing practice. Lippincott Williams& wilkins. 252-258 Yeh. Research studies using RAM • • • • • • • • • Summary 1... goal of nursing. Lippincott.. Cognitive adaptation and self-consistency in hearingimpaired older persons: testing Roy's adaptation model. growth. Women's perception of group support and adaptation to breast cancer. Chiou.The base for professional Nursing Practice . Theoretical Basis for Nursing Philadelphia. 13(3). 158-165. Journal of Advanced Nursing. C. Samarel. P.Evelyn. 141-148. so nursing interventions can be specifically targeted. nursing activities. Fawcett.. C. McEwen Melanie (2002). N. George B. 3rd ed.

was a board member of Harvard Community Health Plan. Despite her efforts. Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. her BS in public health nursing from St. Orlando was an Associate Professor at Yale School of Nursing where she was Director of the Graduate Program in Mental Health Psychiatric Nursing. NY. Nurs Sci Q.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. a first-generation American of Italian descent was born in 1926. 2006 Jul. Potter A Patricia.M. and served as both a national and international consultant. and her MA in mental health nursing from Columbia University. Philadelphia. Orlando's theory was developed in the late 1950s from observations she recorded between a nurse and patient. John's University. Lippincott. 27(6) : 605-15 Reed PG. The Dynamic Nurse-Patient Relationship. Vandemark L. The results of this research are contained in her 1972 book titled: The Discipline and Teaching of Nursing Processes Orlando held various positions in the Boston area. The force of nursing theory guided. MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital.19(3):225 • ORLANDO'S NURSING PROCESS THEORY INTRODUCTION Ida Jean Orlando. she was only able to categorize the records as "good" or "bad" nursing.• • • Taylor Carol. She furthered the development of her theory when at McLean Hospital in Belmont.practice. She is a frequent lecturer and conducted numerous seminars on nursing process. . It was from this research that she developed her theory which was published in her 1961 book. 2006 Jul. She received her nursing diploma from New York Medical College. While at Yale she was project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum. London Mosby Year Book. New York.

the help needed may not be what it appears to be. however. This process helps nurse find out the nature of the distress and what help the patient needs.is responsive to individuals who suffer or anticipate a sense of helplessness.internal response Nursing process discipline – investigation Improvement . nurses need to use their perception. MAJOR DIMENSIONS OF THE THEORY Function of professional nursing . it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding. thoughts about the perception. Therefore.problematic situation Immediate reaction . diminishing or curing the individuals sense of helplessness The purpose of nursing is to supply the help a patient requires for his needs to be met Nursing thought .Does the patient have an immediate need for help or not? If the patient has an immediate need for help and the nurse finds out and meets that need . From these observations she formulated the deliberative nursing process Questions What prompts nursing actions? What are the properties of dynamic nurse patient relationships that may lead to effective care? Answer Nurses were prompted in their actions for reasons other than the patients immediate experiences and needs INTRODUCTION TO THEORY The role of the nurse is to find out and meet the patient's immediate need for help. or the feeling engendered from their thoughts to explore with patients the meaning of their behavior. The patient's presenting behavior may be a plea for help.It then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records.the function of professional nursing is achieved PRESENTING BEHAVIOR – PROBLEMATIC SITUATION To find out the immediate need for help the nurse must first recognize the situation as problematic . it is focused on the process of care in an immediate experience.resolution FUNCTIONS OF PROFESSIONAL NURSING – ORGANIZING PRINCIPLE Finding out and meeting the patients immediate needs for help Nursing…. relieving.organizing principle Presenting behavior .

causes an automatic internal response in the nurse. Her own individuality and that of the patient requires that she go through this each time she is called upon to render service to those who need her ASSUMPTIONS When patients cannot cope with their needs without help. they become distressed with feelings of helplessness Nursing . and the nurses behavior causes a response in the patient IMMEDIATE REACTION –INTERNAL RESPONSE Person perceives with any one of his five sense organs an object or objects The perceptions stimulate automatic thought Each thought stimulates an automatic feeling Then the person acts The first three items taken together are defined as the person’s immediate reaction Reflects how the nurse experiences her or his participation in the nurse patient situation NURSING PROCESS DISCIPLINE . helpful or appropriate until she checks the validity of it in exploration with the patient The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does Automatic reactions are not effective because the nurses action is decided upon for reasons other than the meaning of the patients behavior or the patients immediate need for help When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops IMPROVEMENT . may represent a plea for help The presenting behavior of the patient. does add to the distress of the patient Patients are unique and individual in their responses . regardless of the form in which it appears.INVESTIGATION Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time The nurse does not assume that any aspect of her reaction to the patient is correct.RESOLUTION It is not the nurses activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met In each contact the nurse repeats a process of learning how to help the individual patient. the stimulus.The presenting behavior of the patient. in its professional character .

increase in ability. adequacy in better care of self and improvement in patients behavior Health – sense of adequacy or well being . perceptions.Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child Nursing deals with people. individuals have their own subjective perceptions and feelings that may not be observable directly Nursing client – patients who are under medical care and who cannot deal with their needs or who cannot carry out medical treatment alone Nursing problem – distress due to unmet needs due to physical limitations. for avoiding. 2) the reaction of the nurse and 3)the nursing actions which are assigned for the patients benefit Nurse – patient relations – central in theory and not differentiated from nursing therapeutics or nursing process .. 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. relieving. Sense of comfort Environment – not defined directly but implicitly in the immediate context for a patient Human being – developmental beings with needs. adverse reactions to the setting or experiences which prevent the patient from communicating his needs Nursing process – the interaction of 1)the behavior of the patient. Fulfilled needs. diminishing or curing the individuals sense of helplessness Finding out meeting the patients immediate need for help Goal of nursing – increased sense of well being. actions and reactions are influenced by both nurse and patient Human beings attach meanings to situations and actions that are not apparent to others Patients entry into nursing care is through medicine The patient cannot state the nature and meaning of his distress for his need without the nurses help or without her first having established a helpful relationship with him Any observation shared and observed with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time Nurses are concerned with needs that patients cannot meet on their own DOMAIN CONCEPTS Nursing – is responsive to individuals who suffer or anticipate a sense of helplessness Process of care in an immediate experience…. thoughts and feelings The nurse – patient situation is dynamic.

dimensions and goals of interactions Use of field approach Focus on describing psychosocial aspects of nurse . automatic feeling.patient interaction Used a mixture of operational and problematic methods of theory development Focus on how to deliver care not on what care to be given Nursing process theory of low to medium level abstraction STRENGTHS . action THEORY ANALYSIS PARADIGMATIC ORIGINS Paplau’s focus of interpersonal relationships in nursing Paplau acknowledged the influence of Harry Stack Sullivan on the development of her ideas Symbolic interactionism – Chicago school Use of field methodology John Dewey’s theory of inquiry ORLANDO'S WORK AND CHARACTERISTICS OF A THEORY Theories can interrelate concepts in such a way in such a way as to create a different way of looking at a particular phenomenon Theories must be logical in nature Theories should be relatively simple yet generalizable Theories can be the bases for hypotheses that can be tested Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them Theories can be utililized by practitioners to guide and improve their practice Theories must be consistent with other validated theories.Nursing therapeutics – Direct function : initiates a process of helping the patient express the specific meaning of his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the help he requires so that his distress may be relieved. Indirect function – calling for help of others . validation of perceptions. whatever help the patient may require for his need to be met Nursing therapeutics .Disciplined and professional activities – automatic activities plus matching of verbal and nonverbal responses. and principles but will leave open unanswered questions that need to be investigated INTERNAL DIMENSIONS • • • • • • Analyzed 2000 nurse – patient interactions to identify the properties. automatic thoughts. laws. matching of thoughts and feelings with action Automatic activities – perception by five senses.

particularly aware and conscious individuals and on the virtual absence of reference group or family members Highly interactive nature Orlando's theory makes it hard to include the highly technical and physical care that nurses give in certain settings Her theory struggles with the authority derived from the function of profession and that of the employing institution’s commitment to the public Value of nursing shifted from task oriented to patient oriented nursing process Theory is culturally bound Misinterpretation of continuous validation as lack of knowledge and expertise The uniqueness of individuals assumed by the theory could counteract automatic responses of nurses THEORY TESTING THEORY CRITIQUE • • • LIMITATIONS • • EXTERNAL COMPONENTS • • • • COMPARISON WITH NURSING PROCESS • • Validation of perceptions. in understanding patient’s needs.• • • • • • Use of her theory assures that patient will be treated as individuals and that they will have active and constant input into their own care Prevents inaccurate diagnosis or ineffective plans because the nurse has to constantly explore her reactions with the patient Assertion of nursing’s 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 Make evaluation a less time consuming and more deliberate function. in relieving distress to experienced by patients during the process of admission to a hospital Used in describing the responsibilities of nursing students to distressed patients • . thoughts and feelings is essential for enhancing the congruence between patient’s needs and the care given Results indicate unique nursing process is more effective than other approaches in dealing with pain. in reducing stress. the results of which would be documented in patients charts Nursing can pursue Orlando's work for retesting and further developing her work Lack of operational definitions for concepts – limits development of research hypothesis Theory is more congruent in guiding nurse – patient interactions for assessing needs and in providing nursing therapeutics deemed necessary to patient care Focus on short term care.

Potter and Bockenhauer (2000) found positive results after implementing Orlando’s theory. improved decision-making skills among staff nurses. Their research results indicate that there were: higher patient retention. In an Veterans Administration (VA) ambulatory psychiatric practice in Providence. These included: positive. is using Orlando's theory for teaching entering nursing students. Lincoln. SD has been using Haggerty’s (1985) description of the communication based on Orlando’s theory for entering nursing students as well as reenforcing it in their junior year Schmieding successfully used Orlando's theory in two major hospitals for both practice and administration (Lincoln General Hospital. including determining what constituted nursing versus non-nursing functions. and a decrease in patient’s immediate distress. Gavin. and influenced a more positive nursing identity and unity among staff. patient-centered outcomes. a model for staff to use to approach patients. negotiated more effectively in resolving conflict among staff nurses and between staff and physicians. NE and Boston City Hospital. In a pilot study..• • • • • A number of studies focused on explicating the properties and components of nurse – patient interactions Perceptions was used as a frame work to describe needs of grieving spouses Gillis supported Orlando’s differentiation between presenting problems as perceived by the nurse and those as perceived and validated by patients Used as a framework to research nursing administration USES OF THEORY Use in Education • • Midwestern State University in Wichita Falls. RI Shea. Implementation of Orlando’s theory produced substantial benefits. decreased hospital stay. and Bauer (1987) used Orlando’s theoretical model with patients (N = 76) having a bipolar disorder. Its use increased effectiveness in meeting patient needs. reduction of emergency services. McBride. and increased satisfaction. Boston. Nursing care plan Case studies Progressive patient care settings Assessment Diagnosis • Uses in Administration o • Use in Research o • • Use in Clinical Practice o o o • • Nursing process . Texas. MA). South Dakota State University in Brookings.

M. Julia . Nurs Sci Q. Appleton & Lange. McEwen Melanie (2002). Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Taylor Carol. Norwalk. Theoretical Nursing : Development & Progress 3rd ed. Lippincott Williams& wilkins. 4.The base for professional Nursing Practice . 2006 Jul. Lippincott. The strength of the theory is that it is clear. Meleis Ibrahim Afaf (1997) . Philadelphia. Nursing Theories.Evelyn. 2. Orlando's theory remains one the of the most effective practice theories available. 3. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. The use of her theory keeps the nurse's focus on the patient. 3rd ed.• • • SUMMARY • • • • • • • • • • • • Planning Implementation Evaluation Theorist – IDA JEAN ORLANDO Development of theory Dimensions of theory Assumptions Concepts Theory analysis Characteristics of a theory Paradigmatic origins Strengths and limitations Internal and external components Comparison with nursing process Theory testing and uses of theory CONCLUSION TO THEORY 1. Potter A Patricia. 27(6) : 605-15 Reed PG. The force of nursing theory guided. REFERENCES • • • • • • George B. Philadelphia.19(3):225 • . concise. Theoretical Basis for Nursing Philadelphia. Lippincott. While providing the overall framework for nursing. Wills M. 2006 Jul. the use of her theory does not exclude nurses from using other theories while caring for the patient. and easy to use. Vandemark L. London Mosby Year Book.practice.

Major Concepts and Definitions 1. to evaluate the extent to which the process was fruitful. for his left indirect inguinal hernia and was expecting discharge from hospital.Sy (74 years) was admitted in L3 ward of . to assess the patient condition by the various methods explained by the nursing theory 2.. to demonstrate an effective communication and interaction with the patient. Interaction A process of perception and communication Between person and environment .APPLICATION OF IMOGENE KING’S THEORY OF GOAL ATTAINMENT Objectives 1. for a herniorrhaphy on . It highlights the importance of client’s participation in decision that influences care and focuses on both the process of nurse-client interaction and the outcomes of care.. the theory of goal attainment was used in his nursing process. to select a theory for the application according to the need of the patient 5.. 4.. Introduction King’s theory offers insight into nurses’ interactions with individuals and groups within the environment.. to apply the theory to solve the identified problems of the patient 6..Hospital. Mr. to identify the needs of the patient 3.

Transaction Purposeful interaction leading to goal attainment 5. which influence interaction 2. Role A set of behaviours expected of person’s occupying a position in a social system Rules that define rights and obligations in a position 6. Communication Information from person to person Directly or indirectly Information component of interaction 3. interaction and transaction Person 1. Sentient beings 3. Time Sequence of events Moving onwards to the future 9.Between person and person Represented by verbal and nonverbal behaviours Goal-directed Each individual brings different knowledge . past experiences and perceptions. Perception Each person’s representation of reality 4. needs. goals. Purposeful beings 7. Stress Dynamic state Human being interacts with the environment 7. Social beings 2. Space Existing in all directions Same everywhere Immediate environment (nurse and client interaction) MAJOR ASSUMPTIONS Nursing Observable behaviour In health care system in society Goal – to help individuals maintain health Interpersonal process of action. Growth and development Continuous changes in individuals At cellular. Perceiving beings 5. Action – oriented beings . Rational beings 4. reaction. molecular and behavioural levels of activities Helps individuals move towards maturity 8. Controlling beings 6.

which includes: If perceptual interaction accuracy is present in nurse-client interactions. Role 5. family and other interactions Environment Open system Constantly changing Influences adjustment to life and health Dynamic Interacting Systems Personal system Concepts Perception Self Body image Growth and development Time Space Interpersonal system Concepts 1. transaction will occur If nurse and client make transaction. Interaction. satisfaction will occur Proposition cont… If transactions are made in nurse-client interactions. Power 4. 5. Organization 2. Authority 3. growth & development will be enhanced . goal will be attained If goal are attained. Transaction 3. needs and values of the nurses and client influence interaction process Individuals have the right to knowledge about themselves and to participate in decisions that influence their life. Time – oriented beings Health Dynamic state in the life cycle Continuous adaptation to stress To achieve maximum potential for daily living Function of nurse. 2. Stress Social system Concepts 1.8. Communication 4. goals. Decision making ASSUMPTIONS Perceptions. physicians. health and community services Health professionals have the responsibility that helps individuals to make informed decisions about their health care Individuals have the right to accept or reject health care Goals of health professionals and recipients of health care may not be congruent Propositions of King’s Theory From the theory of goal attainment king developed predictive propositions. patient. Status.

The following areas were addressed to for gathering data. Communication is required to verify accuracy of perception.Hospital on 27/03/08 with a diagnosis of indirect inguinal hernia underwent herniorraphy with prolene mesh done on 30/03/08. History Identification details Mr. Patient may develop hypertension related complications in future.. I have no other problem” “I have pain in the area of surgery when moving” “I’m taking medicines for hypertension for the last 7 years from here” “I have vision problem to my left eye. got admitted in L3 ward of . “ The wound is getting healed. stress in nurseclient interaction will occur If nurse with special knowledge skill communicate appropriate information to client. Sy is 74yrs married. Patient has pain related to surgical incision. Assessment is conducted by gathering data about the patient based on relevant concepts. transaction will occur If role conflict is experienced by nurse or client or both. roles etc. Theory of Goal Attainment and Nursing Process Assumptions Basic assumption of goal attainment theory is that nurse and client communicate information. for interaction and transaction. I had undergone a surgery for my right eye about 10 years back”. Assessment King indicates that assessment occur during interaction. What is the patient’s perception of the situation? Patient says ” I have undergone surgery for hernia”. perception of self and current health status. The first process in nursing process is nurse meets the patient and communicates and interacts with him. Sy is 74yrs married. male. studied up to 7th What are my perceptions of the situation? What other information do I need to assist this patient to achieve health? . to this interaction. Patient underwent herniorahaphy operation on 30th March for indirect inguinal hernia which he kept untreated for 35 years.If role expectations and role performance as perceived by nurse & client are congruent. is also the basic assumption of nursing process. The nurse brings special knowledge and skills whereas client brings knowledge of self and perception of problems of concern.) Perception is the base for collection and interpretation of data. Patient is at risk of developing infection. During assessment nurse collects data regarding client (his/her growth & development. Patient has health maintenance related problems.. set goal mutually and then act to attain those goals. mutual goal setting and goal attainment will occur. Mr.

got admitted in L3 ward of .Hospital on 27/03/08 with a diagnosis of indirect inguinal hernia underwent herniorraphy with prolene mesh done on 30/03/08. a practicing Muslim. Present History of Illness Abdominal swelling for 35 years with difficulty in activities and occasional abdominal pain.per month Life Style Non vegetarian No habit of smoking or alcoholism. He has hypertension for seven years. adequate nourishment.. No swelling . No infection. conscious and oriented Moderately built. Subjective problems Pain at the surgical wound site Lack of bowel movement for 2 days Review of relevant systems GI system Inspection: Healing wound. getting increasing size when standing for long and reducible on applying pressure No h/o severe pain but increasing size for the last few years Relived after pressing the swelling back to position and on taking rest and applying pressure Past health history Patient underwent cataract surgery about 10 years back On treatment for hypertension No other significant illness Family History Patient’s next elder brother and next younger brother had inguinal hernia and were operated Elder brother underwent 3 surgeries for hernia Socioeconomic Status High economic status >Rs. with BMI of 22 Vital signs – normal except BP 140/90 mmHg General head-to-foot examination reveals normal finding except for the vision difficulty of the right eye and healing surgical wound on th left inguinal region.20000/. Aware about health care facilities Physical examination Alert. No redness.Std is doing Business. The swelling remained stable with uncomplicated progress..

6-1.91 mg/dl Na(130-143mEq/dl) . Normal abdominal organs Percussion: No dull sound suggesting fluid collection or ascitis Genito-Urinary system Inspection: Testicles in position.134 mEq / dl K+ (3. No swelling or enlargement Palpation No c/o pain.5-5 mg/dl) .3. Patient has risk for infection due to inadequate knowledge and age. Patient is at risk of developing complications of hypertension Patient requires education regarding health maintenance What conclusion (judgement) does this patient make? What conclusions (judgement) do I make? Patient requires management for his pain Patient understands the need taking care of health risks and agrees to work on these aspects Based on the assessment following nursing diagnoses were formulated. Fascicular block Left atrial enlargement Normal axis What does this information means to this situation? years wound Patient has family history of inguinal hernia and risk for recurrence Patient has a risk for recurrence due to constipation.<1 mg/ dl Other investigations Electro cardio gram Ant. i.No prostate enlargement Percussion No fluid collection in scrotum Auscultation Normal Bowel sounds Laboratory Investigations FBS . No infection. the clinical Patient neglected a health problem for 35 Patient has acute pain at the site of surgical .e.Auscultation: Normal bowel sounds Palpation No pain at the site.5 mEq / dl Urea(8-35mg/dl)-29 mg / dl Cr (0.6 mg/ dl).

• Acute pain related to surgical incision • • • • Risk for infection related to surgical incision Risk for constipation related to bed rest. The client will be free of infection as evidenced by normal temperature. In goal attainment planning is represented by setting goals and making decisions about and being agreed on the means to achieve goals.Nursing diagnosis The data collected by assessment are used to make nursing diagnosis in nursing process. 5. concerns and disturbances about which person seek help. The client will experience improved comfort. normal vital signs. The client will have improved bowel elimination. judgement about the patient’s actual and potential problems. This part of transaction and client’s participation is encouraged in making decision on the means to achieve the goals. pain medication and NPO or soft diet Deficient knowledge regarding the treatment and home care Ineffective health maintenance Planning After diagnosis. Identifying the goals and planning to achieve these goals(this step is congruent with planning in the traditional nursing process) What goals do I think will serve the patient’s best interest? 1. 3. the ability to rest and sleep comfortably 2. Client will acquire adequate knowledge regarding the treatment and home care. as evidenced by: Elimination of stool without straining 4. as evidenced by: a decrease in the rating of the pain. the nurse identifies the problems. Acc. Client will attend to health problems promptly Patient’s goals are: Freedom from pain Rapid healing Adequate bowel movement Acquiring adequate knowledge regarding his health problems Yes What are the patient’s goals? Are the patient’s goals and professional goals are congruent? What are the priority goals? Relief of pain Freedom from infection Adequate bowel movement Improvement knowledge aspect of health conditions Prompt attendance to health problems Working with the health professionals Gaining knowledge Disclosing adequate information regarding What does the patient perceives as the best way to achieve goals? . to King in process of attaining goal. planning for interventions to solve those problems is done.

health problems Is the patient willing to work towards the goals? What do I perceive to be the best way to achieve the goals? Yes Goal 1: Assess the characteristics of pain Administration of prescribed medicine Monitor the responses to drug therapy Provide calm. Goal 2: Monitor vital signs Administer antibiotics as advised Use aseptic techniques while changing dressing Kept the surgical wound site clean Report surgeon regarding early signs of infection Goal 3: Ensure that the client has adequate bulk in diet and adequate fluid intake Instruct the client on prevention of straining and avoiding valsalva manoeuvre Consult treating physician regarding medications. Restriction of heavy weight lifting (more than 20kg) for 6 months Further management which may be necessary Diet control for his hypertension Rehabilitation measures to promote better living For regular examination of the site for recurrence of hernia Goals are both short-term and long term Pain is tolerable to the patient and requires no SOS medication Are the goals short-term or long term? What modifications required based on . efficient manner that reassures the client and minimizes anxiety Provide a comfortable position as per client’s requests. Explain demonstrate about the home care. Goal 4: Explain the treatment measures to the patient and their benefits in a simple understandable language. Repeat the information whenever necessary to reinforce learning. Clarify the doubts of the patient as the patient may present with some matters of importance. Goal 5: Health education given about the following.

a few interventions require immediate attention. Am I doing what the patient and I have agreed upon? How am I carrying out the actions? When do I carry out the action? Yes On a mutually acceptable manner in accordance with the goals set. This step results in transactions being made. Transactions occur as a result of perceiving the other person and the situation. Other interventions are carried out during the period of hospitalization till 5th April. because the patient is motivated to continue home care. What actions are not working? What is patient’s response to my actions? Are other factors hindering goal achievement? How should the plan be changed to achieve goals? References . 4. Yes Why am I carrying out the action? Is it reasonable to think that the identified goals will be reached by carrying out the action? Evaluation It involves to finding out weather goals are achieved or not. and taking some actions in response. In King’s description evaluation speaks about attainment of goal and effectiveness of nursing care. Involvement of family member in care of the patient. In nursing process implementation involves the actual activities to achieve the goals.mutuality? Constipation is not that severe enough to take medication Other interventions are mutually acceptable. Implementations 1. making judgments about those perceptions. 3. Patient’s condition demands nursing car. Are my actions helping the patient achieve mutually defined goals? How well are goals being met? Yes Short-term goals are met before discharge from hospital Long-term goals are expected to be met. According to priority. 2. Reactions to action lead to transactions that reflect a shared view and commitment 5. Patient is satisfied with my actions Patient’s age is a hindering factor in goal achievement regarding health maintenance. This step reflects implementation in the traditional nursing process. Health teaching can be modified according to developmental stage.

Mosby. (5th ed. Hawks Hokanson Jane.). Mosby.M. 2002. Tomey.R. Philadelphia. Nursing theory utilization and application. Medical Surgical Nursing: concepts & clinical practice. 2002 Alligood M. Tomey AM. Joice.• • • • Phipps J Wilma. Philadelphia. . 2nd Ed. 2005. Black M. A. Medical Surgical Nursing: Clinical Management for positive outcomes. MR. Sands K Judith.6th edition. Alligood. Nursing theorists and their work. Philadelphia. Missouri. 1996. Mosby publications. St Lois.

Later graduate education and masters education was given much importance.APPLICATION OF OREM'S SELF-CARE DEFICIT THEORY IN NURSING PRACTICE INTRODUCTION • • • The history of professional nursing begins with Florence nightingale. The development of the theory era was a natural outgrowth of the research era. Areas Patient details • • • • • OBJECTIVES       . Within the contemporary phase there is an emphasis on theory use and theory based nursing practice and lead to the continued development of the theories. to select a theory for the application according to the need of the patient to apply the theory to solve the identified problems of the patient to evaluate the extent to which the process was fruitful. there emerged the research era. however research and theory produced the nursing sciences. to assess the patient condition by the various methods explained by the nursing theory to identify the needs of the patient to demonstrate an effective communication and interaction with the patient. As more and more nurses began to pursue higher degrees in nursing. With an increased number of researches it became obvious that the research without theory produced isolated information. Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing. Later in last century nursing began with a strong emphasis on practice.

she explains self care as the activities carried out by the individual to maintain their own health. • • The deficit is identified by the nurse through the thorough assessment of the patient. partly compensatory or supportive and educative system. • • • • • • The self care is carried out to fulfill the self-care requisites. theory of self care. Whenever there is an inadequacy of any of these self care requisite. family system etc. gender. Once the care is provided. OREM’S THEORY OF SELF CARE DEFICIT • The self care deficit theory proposed by Orem is a combination of three theories. 1. 2. theory of self care deficit and the theory of nursing systems. The care will be provided according to the degree of deficit the patient is presenting with. health care system. X…. There are mainly 3 types of self care requisites such as universal. She has these complaints since 5 years and has taken treatment from local hospital. stiffness which is more in the morning and reduces by the activities. .e. The self care agency is the acquired ability to perform the self care and this will be affected by the basic conditioning factors such as age. • • • For Mrs. Thus the theory could be successfully applied into the nursing practice. X 56 years Female No formal education House hold Married Hindu Rheumatoid arthritis Orem’s theory of self care deficit. Therapeutic self-care demand is the totality of the self care measures required. the person will be in need of self care or will have a deficit in self care. the nursing activities and the use of the nursing systems are to be evaluated to get an idea about whether the mutually planned goals are met or not. She came to the hospital with complaints of pain over all the joints.         Name Age Sex Education Occupation Marital status Religion Diagnosis Theory applied • • • • • • • • • Mrs. i. In the theory of self care. the nurse has to select required nursing systems to provide care: wholly compensatory. developmental and health deviation self care requisites. Once the need is identified.

Frequent rest is required due to pain. Voids and eliminates bowel without difficulty. husband working At home with partner Rural area. Deformity of the joint secondary to the disease process and use of the joints. Indian. sister’s son 2. UNIVERSAL SELF-CARE REQUISITES: Air Water Breaths without difficulty. daughter. 5. no pallor cyanosis Fluid intake is sufficient. DATA COLLECTION ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT 1. items for ADL not in easy reach.3. The symptoms were not reducing and came to --MC. therapeutic self care demand Ego integrity vs despair No formal education. She also was malnourished and was not having awareness about the deficiencies and effects. 4. Pain not completely relieved. BASIC CONDITIONING FACTORS Age Gender Health state Development state Sociocultural orientation Health care system Family system Patterns of living Environment resources 56 year Female Disability due to health condition. Edema present over ankles. Activity level ha s come down.6gm%. Hindu Institutional health care Married.Food intake is not adequate or the diet is not nutritious. Hospital for further management. Turgor normal for the age Food Hb – 9. Patient was able to do the ADL by herself but the way she performed and the posture she used was making her prone to develop the complications of the disease. BMI = 14. Elimination Activity/ rest . no special precautions to prevent injuries Husband.

HEALTH DEVIATION SELF CARE REQUISITES Adherence to medical regimen Reports the problems to the physician when in the hospital. Prevention of hazards Promotion of normalcy Need instruction on care of joints and prevention of falls. Pan 40 mg OD T. Prefer to walk bare foot. Adjusted with the deformities. DEVELOPMENTAL SELF-CARE REQUISITES: Maintenance of developmental environment Prevention/management of the conditions threatening the normal development Able to feed self . Tramazac 50 mg OD T. Cooperates with the medication. Valus SR OD T. toileting etc Feels that the problems are due to her own behaviours and discusses the problems with husband and daughter. Pain tolerance not achieved Awareness of potential problem associated with the regimen Modification of self image to incorporates changes in health status Adjustment of lifestyle to accommodate changes in the health status and medical regimen. 5. Not much aware about the use and side effects of medicines Not aware about the actual disease process.Social interaction Communicates well with neighbors and calls the daughter by phone Need for medical care is communicated to the daughter. 4. MEDICAL PROBLEM AND PLAN: Physician’s perspective of the condition: Diagnosed with rheumatoid arthritis and is on the following medications: T. Difficult to perform the dressing. The adoption of new ways for activities leads to deformities and progression of the disease. Not aware about the side effects of the medications Has adapted to limitation in mobility. Has good relation with daughter 3. Not compliant with the diet and prevention of hazards. Need instruction on improvement of nutritional status. Recofix Forte BD .

Water c. Effectiveness of the selected nursing system to meet the needs. . Effectiveness of the nurse patient action to -Promote patient as self care agent Meet self care needs - . 2. a. Nursing goal and objectives 3.Decrease the Decrease the self care self care deficit. Activity/ Rest f. o. Outcome 2. Prevention of hazards h. modify self image p. k. Design of nursing system 4. Promotion of normalcy i. deficit.T. Prevent or manage the developmental threats Awareness and management of the disease process. AREAS AND PRIORITY ACCORDING TO OREM’S THEORY OF SELF-CARE DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS. Elimination e. Solitude/ Interaction g. l. Appropriate method of helping Implementation (control operations) Nurse. j. Food d.patient actions to Promote patient as self care agent Meet self care needs Evaluation (regulatory operations ) 1. Heamup 2tsp TID Medical Diagnosis: Rheumatoid arthritis Medical Treatment: Medication and physical therapy. Awareness of potential problem. Shelcal BD Syp. Maintain a developmental environment. Adjust life style to accommodate health status changes and MR Nursing care plan according to Orem’s theory of self care deficit Nursing diagnosis ( diagnostic operations ) Based on self care deficits Outcome and plan (Prescriptive operations) 1. Adherence to the medical regimen n. Maintenance of health status m. Air b.

X will: . . A NURSING CARE PLAN FOR MRS. that are available in the locality. Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. Method of helping: guidance support Teaching Providing developmental environment . Objectives: Mrs. modify self image Adjust life style to accommodate health status changes and medical regimen APPLYING THE OREM’S THEORY OF SELF-CARE DEFICIT. Nursing Goals and objectives Goal: to achieve optimal levels of nutrition.state the importance of maintaining a balanced diet. Design of the nursing system: supportive educative d. b. c. Adherence to the medical regimen Awareness of potential problem.List the food items rich in iron . X COULD BE PREPARED AS FOLLOWS … Therapeutic self care demand: deficient area: food Adequacy of self care agency: Inadequate NURSING DIAGNOSIS Inability to maintain the ideal nutrition related to inadequate intake and knowledge deficit OUTCOMES AND PLAN a.Thus in the patient Mrs. Outcome: improved nutrition Maintenance of a balanced diet with adequate iron supplementation. X the areas that need assistance were… • • • • • • • • • • • • • • • • Air Water Food Elimination Activity/ Rest(2) Solitude/ Interaction Prevention of hazards(2) Promotion of normalcy Maintain a developmental environment.

OUTCOMES AND PLAN a. EVALUATION Mrs.maintain the ability to perform the toileting and dressing with modification as required. X understood the importance of maintaining an optimum nutrition. b. Initiate the pain relieving measures always before the patient go for any of the activities of daily living . Outcome: .improved self-care . Provide passive exercises and make to perform active exercises so as to promote the mobility of the joint. secondary to the inflammatory process in the joints. Nursing Goals and objectives Goal: to achieve optimal levels of ability for self care. Design of the nursing system: Partly compensatory d. X will: -perform the dressing activities within limitations -utilize the alternative measures available for improving the toileting -perform the other activities of daily living with minimal assistance. Method of helping: Guidance: Assess the various hindering factors for self care and how to tackle them. X -------------------------------------------------------------------------Therapeutic self care demand: deficient area: Activity Adequacy of self care agency: Inadequate NURSING DIAGNOSIS Self-care deficit: dressing. c. Support: Provide all the articles needed for self care. Objectives: Mrs. near to the patient and ask the family members also to give the articles near to her. toileting related to restricted joint movement. The self care deficit in terms of food will be decreased with the initiation of the nutritional intake. The supportive educative system was useful for Mrs.IMPLEMENTATION Mutually planned and identified the objectives and the patient were made to understand about the required changes in the behaviour to have the requisites met. She listed the foods that are rich in iron and that are locally available. She told that she will select the iron rich diet for her food. Make the patient use commodes or stools to perform toileting and insist on avoidance of squatting position Provide assistance whenever needed for the self care activities Provide encouragement and positive reinforcement for minor improvement in the activity level.

Teaching: Teach the family members the limitation in the activity level the patient has and the cooperation required Promoting a developmental environment: Teach the family and help them to practice how to help the patient according to her needs IMPLEMENTATION Mutually planned and identified the objectives and the patient was made to understand about the required changes in the behaviour to have the requisites met. X ---------------------------------------------------------------------Therapeutic self care demand: deficient area: Pain control Adequacy of self care agency: Inadequate NURSING DIAGNOSIS • Ineffective pain control related to lack of utilization of pain relief measures OUTCOMES AND PLAN a.Make the patient to use loose fitting clothes which will be easy to wear and remove. b. X will: describe the total plan of pharmacological and non pharmacological pain relief demonstrate a reduction in the pain behaviours verbalize a reduction in the pain scale score from 7 – 4 c. She performed the dressing activities with minimal assistance Patient verbalized that she will perform the activities as instructed to get her ADL done. Outcome: • • . She verbalized an improved comfort and self care ability. Nursing Goals and objectives Goal: to achieve reduction in the pain. severity. associated and aggravating factors.improved pain self control . The partly compensatory system was useful for Mrs. location. Design of the nursing system: supportive educative d. Ask the client to report the intensity.achieve and maintain a reduction in the pain. Support: Provide rest to the joints and avoid excessive manipulations . Objectives: Mrs. method of helping: Guidance: Explore the past experience of pain and methods used to manage them. EVALUATION Patient was performing some of the activities and she practiced toileting using a commode in the hospital.

Outcome: Absence of falls and injury to the patient b. She demonstrated slight reduction in the pain behaviours. Design of the nursing system: supportive educative d. X -------------------------------------------------------------Therapeutic self care demand: deficient area: prevention of hazards. activities and the mental status for any confusion or disorientation Encourage the patient to use supportive devices as required.provide hot and cold application to have better mobility. Nursing Goals and objectives Goal: prevent the falls and injury and to maintain a good body mechanics. c. Encourage exercises to the joints by immersing in the warm water. Administer T. Providing the developmental environment: Discuss with the patient the necessity to maintain a pain diary with all information regarding episodes of pain and refer to that periodically Enquire from the health team. the need for opioid analgesics or other analgesics and get a prescription for the patient. objectives: Mrs. The pain scale score was 6 after the measures were provided to the patient. The supportive educative system was useful for Mrs. IMPLEMENTATION ----------------------------------------------------------------------------EVALUATION Patient still has pain over the joints and she agreed that she will use the measures for pain relief that is told to her. method of helping: Support Never leave the client alone in the unit Assess the patients gait. Provide diversion and psychological support to the patient Teaching: Teach the non – pharmacological method to the patient once the pain is a little reduced. OUTCOMES AND PLAN a.explaining the methods to prevent the injury. X will: -remain free from injury as evidenced by: -absence of signs and symptoms of fall or injury . Adequacy of self care agency: Inadequate NURSING DIAGNOSIS Potential for fall and fractures related to rheumatoid arthritis. Ultracet and Tab Diclofecac as prescribed. .

identify the measures to relieve edema. nursing Goals and objectives Goal: Maintain the skin integrity and take measures to prevent skin impairment. Assess the edema for its degree. b. Outcome: Maintenance of normal skin integrity. Objectives: Mrs. X -----------------------------------------------------------------Therapeutic self care demand: deficient area: prevention of hazards. The supportive educative system was useful for Mrs. list the measures to prevent the loss of skin integrity 3. Adequacy of self care agency: Inadequate NURSING DIAGNOSIS: Potential for impaired skin integrity related to edema secondary to renal cysts. maintain a normal skin integrity 2. c. Keep the skin clean always Avoid stress or pressure over the area of edema by providing extra cushions or padding Monitor the lab values as well as the patient for any signs and symptoms of renal failure. Encourage the patient to use slippers while walking and that should not be tight fitting. Involve the family members in providing and maintaining a safe environment in the home Involve the family members to provide support to the patient whenever necessary Plan a balanced diet for the patient with a mutual interaction IMPLEMENTATION -----------------------------------------------------------------EVALUATION Patient remained free from injury as evidenced by absence of signs and symptoms. method of helping: Support: Assess the skin regularly for any excoriation or loss of integrity or colour changes.Provide a safe environment in the hospital by avoiding sharp objects or wooden objects on the way and slippery floor. . Design of the nursing system: supportive educative d. X will: 1. pitting or non pitting and continue the assessment daily. OUTCOMES AND PLAN: a. Patient explained the various measures that they will take to prevent the injury.

to the health team IMPLEMENTATION ------------------------------------------------------------------EVALUATION Patient remained free from impaired skin integrity She listed the measures to prevent the loss of skin integrity She identified the measures to relieve edema. increased edema etc. palpitations. Outcome: Absence of complications and improved awareness about the disease process. nursing Goals and objectives Goal: Improve the knowledge of the patient about the disease process and the complications. OUTCOMES AND PLAN a. Explain the patient the need for taking care of the edematous parts Explain the patient to report the symptoms like decreased urine output. Design of the nursing system: supportive educative d. Objectives: Mrs.Provide a leg end elevated position or elevation of the leg on a pillow if no cardiac abnormalities are identified. b. The supportive educative system was useful for Mrs. Methods of helping: • • • Guidance Teaching Promoting a developmental environment IMPLEMENTATION ------------------------------------------------------------EVALUATION Patient got adequate information regarding the disease . x ----------------------------------------------------------------Therapeutic self care demand: deficient area: awareness of the disease process and management Adequacy of self care agency: Inadequate NURSING DIAGNOSIS Potential for complications related to rheumatoid arthritis secondary to knowledge deficit. X will: -verbalize the various complication and their preventions -verbalize the changes occurring with the disease process and the treatment available -describe the actions and side effects of the medications which she is using c.

2002.2002. Nursing theorists and their work. George JB . Nursing Theory: Utilization &Application . (5th ed. revised. Tomey AM. This was helpful to provide care in a comprehensive manner. Missouri: Elsevier Mosby Publications. Mosby. The model focuses on following three areas: Individual characteristics and experiences Behavior-specific cognitions and affect Behavioral outcomes . X from various aspects. Health promotion is directed at increasing a client’s level of wellbeing. 1996) was designed to be a “complementary counterpart to models of health protection.She verbalized what she understood about the disease and its management. New Jersey :Prentice Hall. Patient has cleared her doubts regarding the medication actions and the side effect The supportive educative system was useful for Mrs. HEALTH PROMOTION MODEL INTRODUCTION The health promotion model (HPM) proposed by Nola J Pender (1982. 2. Tomey A M.). REFERENCES 1. Alligood. The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health. 2002 3.Nursing Theories: The Base for Professional Nursing Practice . Alligood M R. X EVALUATION OF THE APPLICATION OF SELF CARE DEFICIT THEORY The theory of self-care deficit when applied could identify the self care requisites of Mrs. Patient was very cooperative.” It defines health as a positive dynamic state not merely the absence of disease. MR.3rd ed.5th ed. Philadelphia. the application of this theory revealed how well the supportive and educative and partly compensatory system could be used for solving the problems in a patient with rheumatoid arthritis.

which reflect both nursing and behavioral science perspectives: 1. 7. 4. 5. Individuals in all their biopsychosocial complexity interact with the environment.The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM. ASSUMPTIONS OF THE HEALTH PROMOTION MODEL The HPM is based on the following assumptions. 3. Persons seek to create conditions of living through which they can express their unique human health potential. The set of variables for behavioral specific knowledge and affect have important motivational significance. THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL . 2. The final behavioral demand is also influenced by the immediate competing demand and preferences. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change. including assessment of their own competencies. which exerts influence on persons throughout their lifespan. Individuals seek to actively regulate their own behavior. Health promoting behaviors should result in improved health. Persons have the capacity for reflective self-awareness. progressively transforming the environment and being transformed over time. 6. These variables can be modified through nursing actions. enhanced functional ability and better quality of life at all stages of development. which can derail an intended health promoting actions. Health professionals constitute a part of the interpersonal environment. Persons value growth in directions viewed as positive and attempts to achieve a personally acceptable balance between change and stability.

Direct and indirect effects on the likelihood of engaging in health promoting behaviors. and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior. result in increased positive affect. Perceived barriers can constrain commitment to action. 5. v PERSONAL FACTORS . 2. 7. Families. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. affect. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior. peers. a mediator of behavior as well as actual behavior. the probability of commitment and action is increased. 13. 11. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior. and the interpersonal and physical environment to create incentives for health actions. and enactment of health-promoting behavior. THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL Individual Characteristics and Experience v PRIOR RELATED BEHAVIOR Frequency of the similar behaviour in the past. The HPM is based on the following theoretical propositions: 1. 4. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention. 6. The greater the commitments to a specific plan of action. 12. Positive affect toward a behavior results in greater perceived self-efficacy. Persons can modify cognitions. and provide assistance and support to enable the behavior. 9. When positive emotions or affect are associated with a behavior. 3. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. 13. expect the behavior to occur.Theoretical statements derived from the model provide a basis for investigative work on health behaviors. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. Prior behavior and inherited and acquired characteristics influence beliefs. 8. 10. affect. the more likely health-promoting behaviors are to be maintained over time. which can in turn.

accuculturation. aerobic capacity. increased feelings of efficacy can generate further positive affect. beliefs. Situational influences may have direct or indirect influences on health behaviour. and healthcare providers. v INTERPERSONAL INFLUENCES Cognition concerning behaviours. Interpersonal influences include: norms (expectations of significant others). Behavioural Outcome v COMMITMENT TO PLAN OF ACTION .Personal factors categorized as biological. Anticipated. Behavioural Specific Cognition and Affect v v PERCEIVED BENEFITS OF ACTION PERCEIVED BARRIERS TO ACTION Anticipated positive out comes that will occur from health behaviour. Primary sources of interpersonal influences are families. during and following behavior based on the stimulus properties of the behaviour itself. Personal socio-cultural factors Include variables such as race ethnicity. the greater the feeling of efficacy. Include perceptions of options available. which means the more positive the subjective feeling. peers. or balance. Personal psychological factors Include variables such as self esteem self motivation personal competence perceived health status and definition of health. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Activity-related affect influences perceived self-efficacy. Personal biological factors Include variable such as age gender body mass index pubertal status. These factors are predictive of a given behavior and shaped by the nature of the target behaviour being considered. In turn. psychological and socio-cultural. v SITUATIONAL INFLUENCES Personal perceptions and cognitions of any given situation or context that can facilitate or impede behaviour. social support (instrumental and emotional encouragement) and modelling (vicarious learning through observing others engaged in a particular behaviour). or attitudes of the others. agility. imagined or real blocks and personal costs of understanding a given behaviour v PERCEIVED SELF EFFICACY Judgment of personal capability to organise and execute a health-promoting behaviour. education and socioeconomic status. strength. v ACTIVITY RELATED AFFECT Subjective positive or negative feeling that occur before.

The concept of intention and identification of a planned strategy leads to implementation of health behaviour. v IMMEDIATE COMPETING DEMANDS AND PREFERENCES Competing demands are those alternative behaviour over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behaviour over which individuals exert relatively high control, such as choice of ice cream or apple for a snack v HEALTH PROMOTING BEHAVIOUR Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being, personal fulfillment, and productive living. REFERENCES

1. Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida
T.Nola J. Pender. The Health Promotion Model. St Louis: Mosby; 2005

2. Polit DF, Beck CT. Nursing research:Principles and methods. 7th ed.
Philadelphia: Lippincott Williams & Wilkins; 2007 3. Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed. Philadelphia: Elsevier Mosby; 2006.

4. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier
Mosby; 2006.

HEALTH BELIEF MODEL (HBM)
INTRODUCTION HBM is a popular model in nursing, especially in issues focusing on patient compliance and preventive health care practices. the model postulates that health-seeking behaviour is influenced by a person’s perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat. HBM addresses the relationship between a person’s beliefs and behaviors. It provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL There are six major concepts in HBM: 1. 2. 3. 4. 5. 6. 1. Perceived Susceptibility Perceived severity Perceived benefits Perceived costs Motivation Enabling or modifying factors

Perceived Susceptibility: refers to a person’s perception that a health problem is personally relevant or that a diagnosis of illness is accurate.

2.

Perceived severity: even when one recognizes personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious organic or social complications.

3.

Perceived benefits: refers to the patient’s belief that a given treatment will cure the illness or help to prevent it.

4.

Perceived Costs: refers to the complexity, duration, and accessibility and accessibility of the treatment

5.

Motivation: includes the desire to comply with a treatment and the belief that people should do what

6.

Modifying factors: include personality variables, patient satisfaction, and socio-demographic factors.

REFERENCES 1. Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida T.Nola J. Pender. The Health Promotion Model. St Louis: Mosby; 2005 2. Polit DF, Beck CT. Nursing research:Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2007 3. Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed. Philadelphia: Elsevier Mosby; 2006. 4. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby; 2006. 5. Rosenstoch I. Historical origin of Health Belief model. Health Educ Monogr 2:334, 1974.

THEORIES USED IN COMMUNITY HEALTH NURSING
Introduction The concept of community is defined as "a group of people who share some important feature of their lives and use some common agencies and institutions." The concept of health is defined as "a balanced state of well-being resulting from harmonious interactions of body, mind, and spirit." The term community health is defined by meeting the needs of a community by identifying problems and managing interactions within the community

Basic Elements The six basic elements of nursing practice incorporated in community health programs and services are (1) promotion of healthful living (2) prevention of health problems (3) treatment of disorders (4) rehabilitation (5) evaluation and (6) research. Major Roles The focus of nursing includes not only the individual, but also the family and the community, meeting these multiple needs requires multiple roles. The seven major roles of a community health nurse are (1) care provider, (2) educator, (3) advocate, (4) manager, (5) collaborator, (6) leader, and (7) researcher. Major Settings Settings for community health nursing can be grouped into six categories: (1) homes, (2) ambulatory care settings, (3) schools, (4) occupational health settings, (5) residential institutions, and (6) the community at large. Community health nursing practice is not limited to a specific area, but can be practiced anywhere. Theories and Models for community health nursing The commonly used theories are: 1. Nightingale’s theory of environment 2. Orem’s Self care model 3. Neumann’s health care system model 4. Roger’s model of the science and unitary man 5. Pender’s health promotion model 6. Roy’s adaptation model 7. Milio’s Framework of prevention 8. Salmon White’s Construct for Public health nursing 9. Block and Josten’s Ethical Theory of population focused nursing 10. Canadian Model Milio’s Framework of prevention Nancy Milio a nurse and leader in public health policy and public health education developed a framework for prevention that includes concepts of community-oriented, population focused care.(1976,1981).The basic treatise is that behavioral patterns of populations and individuals who make up populations are a result of habitual selection from limited choices. She challenged the common notion that a main determinant for unhealthful behavioral choice is lack of knowledge. Governmental and institutional policies, she said set the range of options for personal choice making. It neglected the role of community health nursing, examining the determinants of community health and attempting to influence those determinants through public policy.

Salmon White’s construct for public health nursing Mark Salmon White (1982) describes a public health as an organized societal effort to protect, promote and restore the health of people and public health nursing as focused on achieving and maintaining public health. He gave 3 practice priorities i.e.; prevention of disease and poor health, protection against disease and external agents and promotion of health. For these 3 general categories of nursing intervention have also been put forward, they are: 11. education directed toward voluntary change in the attitude and behaviour of the subjects 12. engineering directed at managing risk-related variables 13. enforcement directed at mandatory regulation to achieve better health. Scope of prevention spans individual, family, community and global care. Intervention target is in 4 categories 1.Human/Biological 2. Environmental 3. Medical/technological/organizational 4. Social Block and Josten’s Ethical Theory of population focused nursing Derryl Block and Lavohn Josten, public health educators proposed this based on intersecting fields of public health and nursing. They have given 3 essential elements of population focused nursing that stem from these 2 fields: 1. an obligation to population 2. the primacy of prevention 3. centrality of relationship- based care the first two are from public health and the third element from nursing. Hence it implies to nursing that relation-based care is very important in population focused care. Canadian Model for community The community health nurse works with individuals, families, groups, communities, populations, systems and/or society, but at all times the health of the person or community is the focus and motivation from which nursing actions flow. The standards of practice are applied to practice in all settings where people live, work, learn, worship and play. The philosophical base and foundational values and beliefs that characterize community health nursing - caring, the principles of primary health care, multiple ways of knowing, individual/community partnerships and empowerment - are embedded in the standards and are reflected in the development and application of the community health nursing process. The community health nursing process involves the traditional nursing process components of assessment, planning, intervention and evaluation but is enhanced by community health nurses in three dimensions: 1) individual/community participation in each component, 2) multiple ways of knowing, each of which is necessary to understand the complexity and diversity of nursing in the

1. Families and individuals. such as policies within their workplace and the legislative framework applicable to their work. Health life style and the avoidance of high-risk behaviour. The values and beliefs (green or shaded) ground practice in the present yet guide the evolution of community health nursing practice over time.N. The standards of practice revolve around both the values and beliefs and the nursing process with the energies of community health nursing always being focused on improving the health of people in the community and facilitating change in systems or society in support of health. Spradely B. the community will be affected by provincial/territorial policies.265-80.Lippincott. Social factors play important role in health. The recognition of the fact that the health of an individual is more than biological phenomena has brought in to the forefront the significance of behavioural dimension of health. The standards of practice are founded on the values and beliefs of community health nurses. Community health nursing practice does not occur in isolation but rather within an environmental context.(4th edn) 2001. Community Health Nursing Promoting health of Aggregates. Social conditions and not only promote the possibility of illness and disability. advance the individual’s potential for a longer and healthier life. . Allender J.g. References 1.342-45. knowledge and utilization of all these ways of knowing forms evidencebased practice consistent with these standards. embracing the present and projecting into the future. Lancaster J.Mosby. The model illustrates the dynamic nature of community health nursing practice. they also enhance prospect for disease prevention and health maintenance. Community Health Nursing Concepts and practice. Application of Suchman’s Stages of illness Model Introduction Man is a social being.W. and 3) the inherent influence of the broader environment on the individual/community that is the focus of care (e. and supports practice that exemplifies the standards of community health nursing. and utilization of the community health nursing process.community. The community health nursing process provides the vehicle through which community health nurses work with people. (8th edn) 2001. its own economic status and by the actions of its individual citizens). Stanhope M.

General information Name Age Gender Marital status Place Hosp. Date of admission Ward/Unit Education Culture & life-style Religion too. a 73 years old. Food habits : Islam.Mr. male patient admitted in ---ward of ---Hospital with a diagnosis of prostate cancer. Data regarding psychosocial aspects of his life and illness were collected through interview. It occurs in 1 in 10 in the men living to the age of 70 years. Muslim. It has been suggested that all men over the age of 50 years should be screened by rectal examination.. As the tumour grows locally it may produce bladder neck obstruction. AS : 73 years : Male : Married : ---/ ---: -----: 1-4-08 : -------: No formal education .prognosis being poorer with poorly differentiated tumours.as he was frequently expressing his financial troubles which could not be helped by anyone related to him. hard and irregular. In late disease rectal examination shows the prostate to be large.. He was cooperative and interactive with me for most part. Early clinical features are indistinguishable from those of BPH and the gland may feel normal on digital examination. The PSA may be elevated (>4 ng/ml). believes in 'Durgas'. Rectal ultrasound may show the spread of the cancer and this should also be used for directing needle or aspiration biopsy. But later he was found to be reluctant to talk . obstruct the ureters and rapidly lead to renal impairment. No. AS. Therapy depends on staging. Cancer Prostate Prostate cancer is the fifth most common type of cancer in men and its incidence rises with advancing years. and has gone : four time in a day : Non-vegetarian once in a day Socioeconomic condition · · · · · Lower socioeconomic status Occupation Fisher man for 12 years He was a beedi worker for 10 years went to gulf and worked there for 4 years : Mr. Muslim. Prostatic biopsy is important in giving prognostic information. Early disease is treated with local radiotherapy and more advanced disease by orchidectomy and hormone therapy with oestrogen. transrectal ultrasound and PSA measurement.

but earns only Rs. and father These role are affected due the illness “ everything is disturbed at home” Patient has poor social support network There is no one to support him financially for treatment of his illness Social Support Network · His daughter visited him twice in the hospital.5000/month His residence is about 80 km away from ----. earning member. observing/ performing activities relating to caring · “I have pain at genital region” · “I have problem of passing urine without control. working most of his life in night time for marriage parties · Currently. he is hospitalised for cancer.50.50/ person Role in the family · · · · Head of the family.000?” · Patient complains that he is not getting adequate sleep during night · He sleeps during daytime Basic physical needs · He is advised not to take bath till the end of radiotherapy to · He says is a practicing Muslim Interpretation and analysis Identification of patient needs Needs arising from present illness and the consequent response to cope with · Patient’s main complaints are pain. irritation at the site of urinary catheter. to and fro journey costs rs. no other person visited him or enquired him about his illness after coming in the hospital Patient complaints (on the first meeting) · · · · · Pain at the genital area (on catheterization) Urine tube needs to be removed No taste for anything he eats No money in hand to pay the hospital bill No sleep at night Collection.· · · Cook for 35 years His son is in Gulf country. and sleep disturbance · He was a cook. that is why tube is inserted” · “I want to get this urine tube removed” · “Who will pay my hospital bill of Rs. prostate and is receiving radiotherapy for the last one month .

· He says he has no money to spend her. but the cultural issues are not addressed. · But his expenses are met by his daughter and one brother .4 months back and later referred to Manipal for further management · Patient wants to know whether his illness will get cured. doctors in ---. · His life style related needs hindered in this hospital environment · As he has any regular habits of taking tea or coffee or drinking alcohol · Patient has understanding of the illness as his illness is serious. · Patient underwent orchidectomy and TURP in -------.told me my illness can be cured only in Manipal” · He is taking bath means it interferes with his religious practices · He is advised not to take bath because he may wet the irradiation area.avoid skin excoriation at the site · He maintains adequate cleanliness · He visits toilet with assistance from his wife · He is catheterized for the last 2 months Needs related to life style · He is a nonvegetarian · But he not getting any non-veg food in the hospital Needs related to habits · He does not take tea or coffee · He does not smoke or take drinks Individual’s knowledge and experience of illness Patient’s Knowledge of Present illness Patient explains his illness: · “I have pain and urine block for the last 6 months” · “My illness is serious” · “I have diabetes for the last one year” · “I underwent a surgery for urinary block and pain in ----4 months back” What the patient wants to know about the illness? “will this illness get cured” “I have come here because.

drinking. so I know I have sugar problem” · “I have not had any major illness in my life other than this” Family History · No major illness in his knowledge Whether patient has accepted his illness · “I don’t have any habits. smoking or taking even coffee since childhood. I don’t know why I got this illness” · Patient has accepted the illness as some thing which he does not deserve. they only made all these illness” · “I have sugar illness for the last one year” · “ The doctor in Kundapura told me to check sugar. · He puts it on fate · Patient has consulted many folk doctors for minor illness and never satisfied with them. What is the treatment plan Does the person knows about it · Patient says he has one month duration of x-ray treatment · “nobody tells me what is my illness” · “I’m taking medicines regularly” · Patient has only partial knowledge of his illness and treatment plans · He is illiterate. but no benefits” He had tried alternative medicines and found to have no benefit in his illness Knowledge at present and future course of action.Experience of illness What has been his past experience with illness? Past Illness History · “Earlier I went to many local folk doctors. · He had minor troubles with urinary frequency for about 4 years · So he consulted some folk people for some remedies · But never satisfied Knowledge of formal and alternative therapies · He has adequate information about formal and folk medicines · “I have gone to them. but nobody has explained him about his treatment plans .

we cannot tell anything to the patient” Patient wants to know about his illness. but doctor is preoccupied with the patient’s educational status. · Doctor has advised him RT for 1 month. it is explained to his daughter” Nurse: “doctor has explained everything to him.Coping with the illness and its outcome (Patient and family) · “What will we do?” · “We have to suffer everything” · He looks depressed and tries to avoid visitors · “I don’t have money pay here. Nursing staff is bothered whether they may convey wrong message to the patient. doctor. I don’t know what to do” · Patient is not showing adaptive responses · He has depressive cognitions · He has financial problems Analyse the individuals and family’s views on · · · health team doctors nurses · “Doctor People come and asks how you are? (he explains sarcastically). There is a communication gap exists among these people. nothing else” · “They do not want to know about my pain” · “sometimes. nurse Patient: “they are not asking me anything” Doctor: “he will not understand anything. Observe the patient. so he feels there is nothing more to talk to the patient than The mutual interaction among the treating team and patient is missing in this situation . nurses come asks about me” “Doctor has told something to my daughter” He is not satisfied with the psychological attention given to him by nurse or doctor His wife too has the same opinion Doctor has explained about the illness to his daughter about the diagnosis and prognosis Distinguish between the meanings of the patient. and course of treatment. doctor and nurse interaction What patient says has reason.

enquiring any problems · Nurse is largely functionally oriented and interact with patient only in such occasions

Suchman’s Stages of illness Model

Application of Suchman's Model

Conclusion

Mr. AS has been suffering form Prostate cancer for the last 1 year. But his symptoms started about 4 years back. For about 3 years he tried folk remedies based on the advice of other people. He approached medical advice when his symptoms aggravated. He is currently undergoing radiotherapy for prostate cancer and medications for diabetes and other symptoms. This case study helps to understand the psychosocial aspects of illness development and application illness behaviour model in nursing practice. Reference • • Guptha MC, Mahajan B. Text book of Social Medicine, 3rd Edn. JayPee, ND,2003 Coe RM. Sociology of Medicine. McGraw-Hill Inc. New York, 1978.

APPLICATION OF BETTY NEUMAN'S SYSTEMS MODEL
OBJECTIVES: • • • • • • to assess the patient condition by the various methods explained by the nursing theory to identify the needs of the patient to demonstrate an effective communication and interaction with the patient. to select a theory for the application according to the need of the patient to apply the theory to solve the identified problems of the patient to evaluate the extent to which the process was fruitful.

INTRODUCTION SYSTEM MODEL- BETTY NEUMAN A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing. The Neuman’s system model has two major components i.e. stress and reaction to stress. The client in the Neuman’s system model is viewed as an open system in which repeated cycles of input, process, out put and feed back constitute a dynamic organizational pattern. The client may be an individual, a group, a family, a community or an aggregate. In the development towards growth and development open system continuously become more differentiated and elaborate or complex. As they become more complex, the internal conditions of regulation become more complex. Exchange with the environment are reciprocal, both the client and the environment may be affected either positively or negatively by the other. The system may adjust to the environment to itself. The ideal is to achieve optimal stability. As an open system the client, the client system has propensity to seek or maintain a balance among the various factors, both with in and out side the system, that seek to disrupt it. Neuman seeks these forces as stressors and views them as capable of having either positive or negative effects. Reaction to the stressors may be possible or actual with identifiable responses and symptom.

MAJOR CONCEPTS
I. PERSON VARIABLESEach layer, or concentric circle, of the Neuman model is made up of the five person variables. Ideally, each of the person variables should be considered simultaneously and comprehensively. 1. Physiological - refers of the physicochemical structure and function of the body. 2. Psychological - refers to mental processes and emotions. 3. Sociocultural - refers to relationships; and social/cultural expectations and activities.

4. Spiritual - refers to the influence of spiritual beliefs. 5. Developmental - refers to those processes related to development over the lifespan. II. CENTRAL COREThe basic structure, or central core, is made up of the basic survival factors that are common to the species (Neuman, 1995, in George, 1996). These factors include: system variables, genetic features, and the strengths and weaknesses of the system parts. Examples of these may include: hair color, body temperature regulation ability, functioning of body systems homeostatically, cognitive ability, physical strength, and value systems. The person's system is an open system and therefore is dynamic and constantly changing and evolving. Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system. A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance. III. FLEXIBLE LINES OF DEFENSEThe flexible line of defense is the outer barrier or cushion to the normal line of defense, the line of resistance, and the core structure. If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated. The flexible line of defense acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defense. The flexible line of defense is dynamic and can be changed/altered in a relatively short period of time. IV. NORMAL LINE OF DEFENSEThe normal line of defense represents system stability over time. It is considered to be the usual level of stability in the system. The normal line of defense can change over time in response to coping or responding to the environment. An example is skin, which is stable and fairly constant, but can thicken into a callus over time. V. LINES OF RESISTANCEThe lines of resistance protect the basic structure and become activated when environmental stressors invade the normal line of defense. Example: activation of the immune response after invasion of microorganisms. If the lines of resistance are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death. VI. RECONSTITUTIONReconstitution is the increase in energy that occurs in relation to the degree of reaction to the stressor. Reconstitution begins at any point following initiation of treatment for invasion of stressors. Reconstitution may expand the normal line of defense beyond its previous level, stabilize the system at a lower level, or return it to the level that existed before the illness. VII. STRESSORS-The Neuman Systems Model looks at the impact of stressors on health and addresses stress and the reduction of stress (in the form of stressors). Stressors are capable of having either a positive or negative effect on the client system. A stressor is any environmental force which can potentially affect the stability of the system: they may be: • Intrapersonal - occur within person, e.g. emotions and feelings

• • Interpersonal . Lines of resistance and two lines of defense protect this core. • • NURSING METAPARADIGM A. By means of primary. The person may in fact be an individual.e. e. Tertiary -Tertiary prevention occurs after the system has been treated through secondary prevention strategies. VII. prevention is the primary nursing intervention. Around the basic core structures are lines of defense and resistance (shown diagrammatically as concentric circles. or a community in Neuman's model. genetic structure. The person is seen as being in a state of constant change and-as an open system-in reciprocal interaction with the environment (i. Secondary-Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing systems. PREVENTIONAs defined by Neuman's model. and what Neuman terms 'knowns and commonalities'. consist of the central core. role expectations Extra personal . a group. lines of resistance. The nature of the reaction depends in part on the strength of the lines of resistance and defense. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors. lines of normal defense. PERSONThe person is a layered multidimensional being. with a core of basic structures. is seen as being in constant.occur between individuals. job or finance pressures The person has a certain degree of reaction to any given stressor at any given time. and lines of flexible defense. . On the one hand. a family. e. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. dynamic interaction with the environment. secondary and tertiary interventions. temperature control.g. and on the other hand manipulates the environment to reduce or weaken stressors. The basic core structure is comprised of survival mechanisms including: organ function. • Primary -Primary prevention occurs before the system reacts to a stressor. Each layer consists of five person variables or subsystems: • • • • • Physical/Physiological Psychological Socio-cultural Developmental Spiritual The layers. The person. ego. usually represented by concentric circle. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.occur outside the individual.g. the person (or the nurse) attempts to restore or maintain the stability of the system. and being affected by it). with the lines of resistance nearer to the core. affecting. Primary prevention includes health promotion and maintenance of wellness. response patterns.

and with consideration given to five variables in three stressor areas. The external environment exists outside the client system.these must be negotiated with the patient. 2. The client system moves toward illness and death when more energy is needed than is available. D. C. Neuman envisions a 3-stage nursing process: 1. NURSINGNeuman sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor. NURSING PROCESS BASED ON SYSTEM MODEL Assessment: Neuman’s first step of nursing process parallels the assessment and nursing diagnosis of the six phase nursing process. As the person is in a constant interaction with the environment. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman. The role of the nurse is seen in terms of degrees of reaction to stressors. Neuman states that. The client system moves toward wellness when more energyis available than is needed.considered in relation to five variables. Neuman also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness. families and groups to maintain a maximum level of wellness. and the use of primary.based of necessity in a thorough assessment. then not only must the patient/client's perceptions be assessed. and the primary aim is stability of the patient/client system. Neuman proposes a wellness-illness continuum. HEALTHNeuman sees health as being equated with wellness. Using system model in the assessment phase of nursing process the nurse focuses on obtaining a comprehensive client data base to determine the existing state of wellness and actual or potential reaction to environmental stressors. with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter. through nursing interventions to reduce stressors. interpersonal and extra personal stressors which can affect the person's normal line of defense and so can affect the stability of the system. Nursing Goals . because the nurse's perception will influence the care given. . 1995)". and take account of patient's and nurse's perceptions of variance from wellness 3. • • • The internal environment exists within the client system. Nursing Diagnosis . secondary and tertiary interventions. THE ENVIRONMENTThe environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. The person is seen as a whole.B. rather than in any kind of steady state. Nursing Outcomes . Neuman defines nursing as actions which assist individuals. and achieved through primary. These forces include the intrapersonal. the state of wellness (and by implication any other state) is in dynamic equilibrium. secondary and tertiary interventions. but so must those of the caregiver (nurse). and it is the task of nursing to address the whole person.

.Mr. ------STRESSORS AS PERCEIVED BY CLIENT (Information collected from the patient and his wife) 1. AM 2. nausea. Name. and it is more during the evening and will not be relieved by elevation of the affected extremities.the synthesis of data with theory also provides the basis for nursing diagnosis. Patient has pitting type of edema over the ankle region. The nursing diagnostic statement should reflect the entire client condition. Evaluation – evaluation is the anticipated or prescribed change has occurred. Immediate and long range goals are structured in relation to the short term goals. Patient is in depressive mood and does not interacting. palm.66 years 3. ------------------------------------------------------------------- ASSESSMENT PATIENT PROFILE 1. reduced appetite and gross weight loss(8kg with in 4 months) Patient is been diagnosed to have Periampullary carcinoma one week back.e. Patient is disturbed by the thoughts that he became a burden to his children with so many serious illnesses which made them to stay with him at hospital. According to this step the evaluation confirms that the anticipated or prescribed change has occurred. Marital status-married 5.anticipating it as a life threatening condition. and urine. If it is not met the goals are reformed. Outcome identification and planning. or areas of health concern • Patient was suffering from severe abdominal pain . Age. Psychologically disturbed about his disease condition. yellowish discolorations of eye.Nursing diagnosis. Implementation – nursing action are based on the synthesis of a comprehensive data base about the client and the theory that are appropriate to the client’s and caregiver’s perception and possibilities for functional competence in the environment.Referred from ------. The overall goal of the care giver is to guide the client to conserve energy and to use energy as a force to move beyond the present. Referral source. • • • • • • Patient underwent operative procedure i. vomiting.it involves negotiation between the care giver and the client or recipient of care. Major stress area. He had developed BPH few months back (2008 January) and underwent surgery TURP on January 17. Sex-Male 4. WHIPPLE’S PROCEDUREPancreato duodenectomy on 27/3/08. Still he has mild difficulty in initiating the stream of urine.Medical College.

e.e. spending time with family members and relatives 3. watching TV. Was psychologically disturbed during the previous surgery i. local politics has a supportive spouse and family taking mixed diet no habits of smoking or drinking spends leisure time by reading news paper. spending time with grand children.family members psychological support helped him to over come the crisis situation 4. TURP. return back to the social interactions etc .Insulin (4U-0-0). patient is a retired school teacher cares for wife and other family members living with his son and his family 2. going to the church. planning about the activities to be resume after discharge. Life style patterns • • • • • • • • • active in church participates in community group meeting i. reading the Bible Instillation of positive thoughts i.e. Anticipation of the future • • • • Concerns about the healthy and speedy recovery. What doing to help himself? • • • Talking to his friends and relatives Reading the religious materials i. It is adding up his distress regarding his health. What helped then.• Patient is a known case of Diabetes since last 28 years and for the last 4 years he is on Inj. Anticipation of changes in the lifestyle and food habits Anticipating about the demands of modified life style Anticipating the needs of future follow up 5. H.e. Have you experienced a similar problem? • • • • The fatigue is similar to that of previous hospitalization (after the surgery of the BPH) Severity of pain was some what similar in the previous time of surgery i.e. TURP.

Avoiding the negative thoughts i.e. diverts the attentions from the pain or difficulties, try to eliminate the disturbing thoughts about the disease and surgery etc Trying to accept the reality etc..

6. What is expected of others?
• • • •

Family members visiting the patient and spending some time with him will help to a great extent to relieve his tension. Convey a warm and accepting behaviour towards him. Family members will help him to meet his own personal needs as much as possible. Involve the patient also in taking decisions about his own care, treatment, follow up etc

STRESSORS AS PERCEIVED BY THE CARE GIVER.

1. Major stress areas
• • • • • •

Persistent fatigue Massive weight loss i.e.( 8 kg of body weight with in 4 months) History of BPH and its surgery Persistence of urinary symptoms (difficulty in initiating the stream of urine) and edema of the lower extremities Persistent disease- chronic hypertensive since last 28 years Depressive ideations and negative thoughts

2. Present circumstances differing from the usual pattern of living
• • • • • •

Hospitalization acute pain ( before the surgery patient had pain because of the underlying pathology and after the surgery pain is present at the surgical site) nausea and vomiting which was present before the surgery and is still persisting after the surgery also anticipatory anxiety concerns the recovery and prognosis of the disease negative thoughts that he has become a burden to his children Anticipatory anxiety concerning the restrictions after the surgery and the life style modifications which are to be followed.

3. Clients past experience with the similar situations

Patient verbalized that the severity of pain, nausea, fatigue etc was similar to that of patient’s previous surgery. Counter checked with the family members that what they observed. Psychologically disturbed previously also before the surgery. (collected from the patient and counter checked with the relatives) Client perceived that the present disease condition is much more severe than the previous condition. He thinks it is a serious form of cancer and the recovery is very poor. So patient is psychologically depressed. Client is capable of handling the situation- will need support and encouragement to do so. He has the plans to go back home and to resume the activities which he was doing prior to the hospitalization. He also planned in his mind about the future follow up ie continuation of chemotherapy

• •

4. Future anticipations • • •

5. What client can do to help himself?
• • • •

Patient is using his own coping strategies to adjust to the situations. He is spending time to read religious books and also spends time in talking with others He is trying to clarify his own doubts in an attempt to eliminate doubts and to instill hope. He sets his major goal i.e. a healthy and speedy recovery.

6. Client's expectations of family, friends and caregivers
• • • •

he sees the health care providers as a source pf information. He tries to consider them as a significant members who can help to over come the stress He seeks both psychological and physical support from the care givers, friends and family members He sees the family members as helping hands and feels relaxed when they are with him.

Evaluation/ summary of impressionsThere is no apparent discrepancies identified between patients perception and the care givers perceptions. INTRAPERSONAL FACTORS 1. Physical examination and investigations Height- 162 cm Weight – 42 kg TPR- 37o C, 74 b/m, 14 breaths per min

BP- 130/78 mm of Hg • • • • Eye- vision is normal, on examination the appearance of eye is normal. Conjunctiva is pale in appearance. Pupils reacting to the light. Ear- appearance of ears normal. No wax deposition. Pinna is normal in appearance and hearing ability is also normal. Respiratory system- respiratory rate is normal, no abnormal sounds on auscultation. Respiratory rate is 16 breaths per min. Cardiovascular system- heart rate is 76 per min. on auscultation no abnormalities detected. Edema is present over the left ankle which is non pitting in nature. GIT- patient has the complaints of reduced appetite, nausea; vomiting etc. food intake is very less. Mouth- on examination is normal. Bowel sounds are reduced. Abdomen could not be palpated because of the presence of the surgical incision. Bowel habits are not regular after the hospitalization Extremities- range of motion of the extremities are normal. Edema is present over the left ankle which is non pitting in nature. Because of weakness and fatigue he is not able to walk with out support Integumentary system- extremities are mild yellowish in color. No cyanosis. Capillary refill is normal.

• • •

Genitor urinary system- patient has difficulty in initiating the urine stream. No complaints of painful micturation or difficulty in passing urine. Self acre activities- perform some of his activities, for getting up from the bed he needs some other person’s support. To walk also he needs a support. He do his personal care activities with the support from the others Immunizations- it is been told that he has taken the immunizations at the specific periods itself and he also had taken hepatitis immunization around 8 years back Sleep –. He told that sleep is reduced because of the pain and other difficulties. Sleep is reduced after the hospitalization because of the noisy environment. Diet and nutrition- patient is taking mixed diet, but the food intake is less when compared to previous food intake because of the nausea and vomiting. Usually he takes food three times a day. Habits- patient does not have the habit of drinking or smoking. Other complaints- patient has the complaints of pain fatigue, loss of appetite, dizziness, difficulty in urination, etc...
Anxious about his condition Depressive mood

• •

• • 2.

Psycho- socio cultural • • • • •

Patient is a retired teacher and he is Christian by religion. Studied up to BA Married and has 4 children(2sons and 2 daughters)

• • • • •

Congenial home environment and good relationship with wife and children Is active in the social activities at his native place and also actively involves in the religious activities too. Good and congenial relationship with the neighbours Has some good and close friend at his place and he actively interact with them. They also very supportive to him Good social support system is present from the family as well as from the neighborhood
Patient confidently says that he had been worked for 32 years as a teacher and he was a very good teacher for students and was a good coworker for the friends.

3. Developmental factors •

• •

He told that he could manage the official and house hold activities very well He was very active after the retirement and once he go back also he will resume the activities
Patient is Christian by religion

4. Spiritual belief system • • • •

He believes in got and used to go to church and also an active member in the religious activities. He has a personal Bible and he used to read it min of 2 times a day and also whenever he is worried or tensed he used to pray or read Bible. He has a good social support system present which helps him to keep his mind active.
has supportive family and friends

INTERPERSONAL FACTORS • • • • • • • • • •

good social interaction with others good social support system is present active in the agricultural works at home after the retirement active in the religious activities. Good interpersonal relationship with wife and the children Good social adjustment present
All the health care facilities are present at his place

EXTRAPERSONAL FACTORS

All communication facilities, travel and transport facilities etc are present at his own place. His house at a village which is not much far from the city and the facilities are available at the place.

Financially they are stable and are able to meet the treatment expenses.
Physiological- thin body built pallor of extremities, yellowish discoloration of the mucus membrane and sclera of eye. Nausea, vomiting, reduced appetite, reduced urinary out put. Diagnosed to have periampullary carcinoma. Psycho socio cultural factors- patient is anxious abut his condition. Depressive mood. Not interacting much with others. Good support system is present. Developmental –no developmental abnormalities. Appropriate to the age. Spiritual- patient’s belief system has a positive contribution to his recovery and adjustment. pain abdomen since 4 days Discoloration of urine Complaints of vomiting Fatigue Reduced appetite on and off fever Yellowish discoloration of eye, palms and nails Complaints of weight loss Edema over the left leg

Summary •

• •

CLINICAL FEATURES • • • • • • • • •

INVESTIGATIONS Investigations

Values 6.9 21.9 12200 77.2 10.5 4.5

Hemoglobin(1319g/dl) HCT (40-50%) WBC (4000-11000 cells/cumm) Neutrophil 75%) Lymphocyte 45%) (40(25-

Monocyte (2-10%)

6 mg/dl) Sodium (130-143 mEq/L) Potassium (3.2 345000 Basophil (0-2%) Platelet (150000400000 cells/cumm) ESR (0-10mm/hr) RBS mg/dl) Pus C/S USG (60-150 86 148 _ USG shows mild diffuse cell growth at the Ampulla of Vater which suggests peri ampullary carcinoma of Grade I with out metastasis and gross spread.4 A+ Negative Urea (8-35mg/dl) Creatinine (0.415.5-5 mEq/L) PT (patient)(11.Eosinophil 10%) (0- 2.8 136 4 12.patient (2432.6 .3 26.6-1.6 sec) APTT.4 sec) Blood group HIV . 28 1.

.. So they asked for discharge and came to --this hospital There treated with • • Negative Negative Negative Nil Nil 4-5 Nil Post operative period (immediate post op) • • • • • • Inj Pethedine 1mg SOS Inj Phenargan SOS Inj Pantodac 40 mg IV OD Inj Clexane 0.HCV HBsAg Urine Protein (negative) Urine WBC (0-5 cells/hpf) RBC (nil ) Epithelial cell(0-5) Cast – granular cast (absent) THERAPEUTIC MANAGEMENT Initial Treatment: Patient got admitted to ---Medical college for 3 days and the symptoms not relieved.3 ml S/C OD Inj Vorth P 40 mg IM Q12H Inj calcium Gluconate 10 ml over 10 min IV fluids – DNS Inj Tramazac IV SOS IV fluids – DNS Treatment at this hospital. Pre operative period • • • • • • Tab Clovipas 75 mg 0-1-0 Tab Monotrate 10-1 Tab Metalor XL 10-0 Inj H Insulin S/C 6-0-6U Inj Tramazac 50 mg IV Q8H Inj Emset 4 mg Q8H • Late post op period after 3 days of surgery) • • • Inj H Insulin S/C 6-0-6U Tab Pantodac 40 mg 1-0-0 Cap beneficiale .

• • • • Tab Pantodac 40 mg 1-0-0 Cap beneficiale 01-0 Syp Aristozyme 1-1-1 K bind I sachet TID 0-1-0 • • • Tab Clovipas 75 mg 0-1-0 Tab Monotrate 10-1 Tab Metalor XL 10-0 • Incentive spirometry Steam inhalation Early ambulation Diabetic diet Other instructions Surgical management Patient underwent Whipple’s procedure (pancreato duodenectomy) • • • .

Avoid unnecessar y handling as this will affect the Teach the patient about the relaxation techniques and make him to do it Encourage the patient to divert his mind from pain and to engage in pleasurable activities like taking with others Do not allow the patient to do strainous activities. And explain to the patient why those activities are contraindicated.NURSING PROCESS I. NURSING DIAGNOSIS Acute pain related to the presence of surgical wound on abdomen secondary to periampullary carcinoma Desired Outcome/goal : Patient will get relief from pain as evidenced by a reduction in the pain scale score and verbalization Nursing action Primary prevention • Secondary prevention • Tertiary prevention • Assess severity of pain by using a pain scale Check the surgical site for any signs of infection or complicatio ns Support the areas with extra pillow to allow the normal alignment and to prevent strain Handle the area gently. Involve the patient in making decisions about his own care and provide a positive psychological support • • • • Educate the client about the importance of cleanliness and encourage him to maintain good personal hygiene. Involve the family members in the care of patient Encourage relatives to be with the client in order provide a psychologic al well being to • • • • .

NURSING DIAGNOSIS . II. Keep the patients body clean in order to avoid infection. • Educate the family members about the pain managemen t measures. • Provide the primary preventive care when ever necessary. patient . His facial expression also reveals that he got relief from pain. Administer the pain medication s as per the prescriptio n by the pain clinics to relieve the severity of pain. Provide the primary and secondary preventive measures to the client whenever necessary.healing process • Clean the area around the incision and do surgical dressing at the site of incision to prevent any form of infections Provide nonpharmacolo gical measures for pain relief such as diversional activity which diverts the patients mind. • • • • Evaluation – patient verbalized that the pain got reduced and the pain scale score also was zero.

as evidenced by normal vital signs & verbalized understanding of the benefits of gradual increase in activity & exercise. Advice the client to perform exercises to strengthen the extremities& promote activities Tell the client to avoid the activities such as straining at stool etc Teach the client about the importance of early ambulation and assist the patient in early Encourage the client to do the mobility exercises Tell the family members to provide nutritious diet in a frequent intervals Teach the patient and the family about the importance of psychological well being in recovery. and dietary restrictions Outcome/ goals: Client will develop appropriate levels of activity free from excess fatigue. • • • • • • • • • • . Provide the primary and secondary level care if necessary.Activity intolerance related to fatigue secondary to pain at the surgery site. Provide • Instruct the client to avoid the activities which causes extreme fatigue. Nursing actions Primary prevention • Secondary prevention • Tertiary prevention • Adequately oxygenate the client Instruct the client to avoid the activities which causes extreme fatigue Provide the necessary articles near the patients bed side. Assist the patient in early ambulation Monitor client’s response to the activities in order to reduce discomfort s.

He is able to do some of his activities with assistance.nutritious diet to the client. . Fatigue relieved and patient looks much more active and interactive. Schedule rest periods because it helps to alleviate fatigue Teach the mobility exercises appropriate for the patient to improve the circulation • Evaluation – patient verbalized that his activity level improved. Tell the family members to be with him. • ambulation • Avoid psychologic al distress to the client.

Teach the mobility exercises appropriate for the patient to improve the circulation and to prevent contractures Mobilize the patient and encourage him to do so whenever possible Motivate the client to involve in his own care activities Provide primary preventive measures whenever necessary Tertiary prevention • Educate and reeducate the client and family about the patients care and recovery Support the patient. Provide articles near to the patient and encourage doing activities within limits which promote Secondary prevention • Provide positive reinforcement for even a small improvement to increase the frequency of the desired activity. Nursing action Primary prevention • Provide active and passive exercises to all the extremities to improve the muscle tone and strength. Make the patient to perform the breathing exercises which will strengthen the respiratory muscle. pain at the site of surgical incision Outcomes/goals: Patient will have improved physical mobility as evidenced by walking with minimum support and doing the activities in limit. Massage the upper and lower extremities which help to improve the circulation.NURSING DIAGNOSIS-III Impaired physical mobility related to presence of dressing. and family towards the attainment of the goals Coordinate the care activities with the family members and other disciplines like physiotherapy. Teach the importance of psychological well being which influence indirectly the physical recovery Provide primary preventive measures whenever necessary • • • • • • • • • • • .

Nursing Theories: The Base for Professional Nursing Practice.a feeling of well being. New Jersey :Prentice Hall. . (5th ed.). Missouri: Elsevier Mosby Publications.5th ed. Mosby. Philadelphia. References 1.2002. 2002 3. This was helpful to provide care in a comprehensive manner. Tomey AM. Nursing Theory: Utilization &Application . ----------------------------------------------------------Conclusion The Neuman’s system model when applied in nursing practice helped in identifying the interpersonal. The application of this theory revealed how well the primary. MR. Tomey A M. AM from various aspects. 2. George JB . Evaluation – patient’s physical activity improved and he is able to move from bed with support.3rd ed. Alligood M R. Alligood. Patient started doing the active and passive exercises and he verbalized improvement. Nursing theorists and their work. 2002. intrapersonal and extra personal stressors of Mr. secondary and tertiary prevention interventions could be used for solving the problems in the client.

and Mrs. then as a maid. She entered the Sisters of Saint Joseph of Carondelet. first as a pantry girl. and finally as a nurse's aid.APPLICATION OF ROY’S ADAPTATION MODEL IN NURSING PRACTICE Outline • • • • • • • • •     Introduction Assumptions of Roy's Adaptation Model Roy's Adaptation Model (RAM) –Terms Nursing Process First Level Assessment Second Level Assessment Nursing Care Plan Conclusion Reference Born at Los Angeles on October 14. Los Angeles in 1963. 1939 as the 2nd child of Mr. INTRODUCTION . she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College. Fabien Roy At age 14 she began working at a large general hospital.

Johnson Johnson's work with focusing knowledge for the discipline of nursing convinced Sr.Los Angeles in 1966. Callista of the importance of describing the nature of nursing as a service to society and prompted her to begin developing her model with the goal of nursing being to promote adaptation. She also earned a master’s & PhD in Sociology in 1973 & 1977 . Sister Callista Roy (1984). protection. and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are crated in human consciousness Integration of human and environment meanings results in adaptation Philosophical . Introduction to Nursing: An Adaptation Model (2nd ed) ASSUMPTIONS OF ROY’S ADAPTATION MODEL Scientific          Systems of matter and energy progress to higher levels of complex selforganization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes Thinking and feeling mediate human action System relationships include acceptance. Callista had the significant opportunity of working with Dorothy E.    a master's degree program in pediatric nursing at the University of California .respectively Sr.

communities. that is. nations. and personal and environmental transformation Ineffective Responses: responses that do not contribute to integrity in terms of the goals of the human system Adaptation levels represent the condition of the life processes described on three different levels: integrated. role function. and interdependence ENVIRONMENT  All conditions. growth. mastery. and compromised    NURSING • • Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes. thus contributing to health. and culture   HEALTH AND ADAPTATION   Health: a state and process of being and becoming integrated and whole that reflects person and environmental mutuality Adaptation: the process and outcome whereby thinking and feeling persons. and dying with dignity . quality of life. use conscious awareness and choice to create human and environmental integration Adaptive Responses: responses that promotes integrity in terms of the goals of the human system. selfconcept-group identity. family. organizations.     Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness. sustaining. and transforming the universe PERSONS AND RELATING PERSONS      An adaptive system with coping processes Described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groups (families. circumstances. and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources Three kinds of stimuli: focal. compensatory. and residual Significant stimuli in all human adaptation include stage of development. and society as a whole) An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-physical. and faith Persons are accountable for the processes of deriving. as individuals and in groups. survival. enlightenment. reproduction. contextual.

chemical. and purposefulness of 2 modes (physical self. meaning. Focus on the psychological and spiritual aspects of the human system. so that one can exist with a state of unity. Elimination. Basic need-social integrity. and emotion) Behavior -internal or external actions and reactions under specific circumstances Physiologic-Physical Mode • • • • Behavior pertaining to the physical aspect of the human system Physical and chemical processes Nurse must be knowledgeable about normal processes 5 needs (Oxygenation. and personal self) Role function Mode Set of expectations about how a person occupying one position behaves toward a occupying another position. and endocrine) Cognator Subsystem-responds through four cognitive responds through four cognitive-emotive channels (perceptual and information processing. Residual Stimulus-environmental factor. judgment. Nutrition. Regulator Subsystem-automatic response to stimulus (neural. Activity & Rest. point of interaction for the human system and the environment • • • Focal Stimuli-internal or external stimulus immediately affecting the system Contextual Stimulus-all other stimulus present in the situation. learning. and Protection) Self Concept-Group Identity Mode The composite of beliefs and feelings held about oneself at a given time. Each relationship exists for some reason. that effects on the situation that are unclear.• This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions ROY ADAPTATION MODEL (RAM) –TERMS System-a set of parts connected to function as a whole for some purpose. Need to know who one is. the need to know who one is in relation to others Interdependence Mode Behavior pertaining to interdependent relationships of individuals and groups. Stimulus-something that provokes a response. Focus on the close relationships of people and their purpose. Involves the willingness and ability to give to others and accept from .

Balance results in feelings of being valued and supported by others. identifying the capacities and needs of the human adaptive system. 2) Contextual-all other stimuli present that are affecting the situation and 3) Residual. A problem solving approach for gathering data. including the behavior and most relevant stimuli Goal Setting: the forth step of the nursing process which involves the establishment of clear statements of the behavioral outcomes for nursing care. Stimuli are classified as: 1) Focal. Ineffective Responses-neither promote not contribute to the integrity of the human system Copping Process-innate or acquired ways innate or of interacting with the changing of environment NURSING PROCESS 1. selecting and implementing approaches for nursing care. and evaluation the outcome of care provided • • Assessment of Behavior: the first step of the nursing process which involves gathering data about the behavior of the person as an adaptive system in each of the adaptive modes Assessment of Stimuli: the second step of the nursing process which involves the identification of internal and external stimuli that are influencing the person’s adaptive behaviors. DEMOGRAPHIC DATA • • • • • • • • Name Age Sex IP number Education Occupation Marital status Religion • • • • • • • Mr.others. NR 53 years Male ----Degree Bank clerk Married • • • • .those most immediately confronting the person. Basic need . Nursing Diagnosis: step three of the nursing process which involves the formulation of statements that interpret data about the adaptation status of the person.those stimuli whose effect on the situation are unclear. Intervention: the fifth step of the nursing process which involves the determination of how best to assist the person in attaining the established goals Evaluation: the sixth and final step of the nursing process which involves judging the effectiveness of the nursing intervention in relation to the behavior after the nursing intervention in comparison with the goal established.feeling of security in relationships    Adaptive Responses-promote the integrity of the human system.

Normotensive. All other pulsations are normal in rate. Nomothermic. Recently his Weight reduced markedly (10 kg/ 6 month). No redness. Using urinal for micturation. discharge or other signs of infection. Dorsalis pedis pulsation of affected limp is not palpable. No abdominal distension. Apex beat felt on left 5th inter-costal space mid-clavicular line. Mobility impaired. No tenderness. Not following any peculiar relaxation measure. JVP0. No abnormal heart sounds. S1& S2 heard. Sleep pattern disturbed at night due unfamiliar surrounding. Bowel sounds heard. no clubbing or cyanosis. No ronchi or crepitus. No regular pattern of exercise. depth. Pain from joints present. Protection: Left lower fore foot is amputated. Chest expansion normal on either side. Soft on palpation. . Peripheral pulses felt-Normal rate and rhythm. Now. Walking with crutches. Oral mucosa is normal. He has stable digestive process. Apex beat felt. Stool is hard and he complaints of constipation. Air entry equal bilaterally. No paralysis. tension with regular rhythm. activity reduced due to amputated wound. Delayed capillary refill+. no pain during micturation or defecation. Cardiac dull ness heard over 3rd ICS near to sternum to left 5ht ICS mid clavicular line. S1& S2 heard. . No contractures present. ROM is limited in the left leg due to wound.• • Informants Date of admission • • • Hindu Patient and Wife 21/01/08 FIRST LEVEL ASSESSMENT PHYSIOLOGIC-PHYSICAL MODE Oxygenation: Stable process of ventilation and stable process of gas exchange. Normal bladder pattern. Walking from home to office during morning and evening. Wound healing better . Activity and rest: Taking adequate rest. He has complaints of anorexia and not taking adequate food. Non vegetarian. No visible peristaltic movements. Patient need assistance for doing the activities. No abnormal heart sounds. Chest normal in shape. Percussion revealed dullness over hepatic area. NVBS. depth and rate. Like movies and reading. No swelling over the joints. RR= 18Bpm. No difficulty to swallow food Elimination: No signs of infections.normal rhythm. BP. Black discoloration present over the area. Nutrition He is on diabetic diet (1500kcal).

Senses: No pain sensation from the wound site. His role clarity is not achieved. ROLE PERFORMANCE MODE: He was the earning member in the family. Relatively. 5 members. No enlarged glands. olfaction. except elevated blood sugar value. not present over the left leg. Fluids and electrolytes: Drinks approximately 2000ml of water. Thinking and memory is intact. Right leg is normal in length and size. INTERDEPENDENCE MODE: . but accepting treatment and coping with the situation. Dorsalis pedis pulsation. Good interaction with the friends. Like to go home as early as possible. Gustatory. Showing signs of stress. His son doesn’t have any work. He believes in god and worshiping Hindu culture.now. because of neuropathy. Using crutches. Blood glucose elevated Neurological function: He is conscious and oriented. Stable intake out put ratio. Good relationship with the neighbours. Pain form knee and hip joint present while walking. Walking with the use of left leg is not possible. rhythm and depth over right leg. and auditory senses are normal. Endocrine function He is on insulin. He deprived of sexual activity after amputation. SELF CONCEPT MODE Physical self: He is anxious about changes in body image. No signs and symptoms of endocrine disorders. Several papules present over the foot. Belongs to a Nuclear family. Stays along with wife and three children. No signs of acidosis or alkalosis. His role shift is not compensated. reduced touch and pain sensation in the lower periphery. He is anxious about the disease condition. Using spectacle for reading. Touch and pain sensation decreased in lower extremity. Moderately active in local social activities Personal self: Self esteem disturbed because of financial burden and hospitalization. Serum electrolyte values are with in normal limit. All peripheral pulses are present with normal rate.

they referred to ---. but switched to insulin and using it for 8 years now. Was on oral hypoglycemic agent for initial 2 years. The wound was non-healing and gradually increased in size with pus collected over the area. Mother had history of PTB. That made them to come to ---Hospital. . RESIDUAL STIMULI: He had TB attack 10 year back.He has good relationship with the neighbours. From there. Patient’s anxiety reduced to a great extends by proper explanation and reassurance. So the physician suggested for below knee amputation. no special knowledge on health matters. Good interaction with the friends relatives. ---. He underwent a plastic surgery 3 week before. no one is capable of helping him at this moment. But he believes. Previously. He studied how to use crutches and mobilized at least twice in a day. He first showed in a local (---) hospital. He is a graduate in humanities. he admitted in ---Hospital for leg pain about 4 year back. CONCLUSION Mr. . Mother’s brother had DM. He was moderately active in local social activities SECOND LEVEL ASSESSMENT FOCAL STIMULUS: Non-healing wound after amputation of great and second toe of left leg. A wound first found on the junction between first and second toe-4 month back. and took complete course of treatment.medical college. CONTEXTUAL STIMULI: Known case DM for past 10 years.NR who was suffering with diabetes mellitus for past 10 years. Diabetic foot ulcer and recent amputation made his life more stressful.4 week. Wound started healing and he planned to discharge on 25th april. Nursing care of this patient based on Roy's adaptation model provided had a dramatic change in his condition. He gained good knowledge on various aspect of diabetic foot ulcer for the future self care activities. During hospital stay great and second toe amputated. He says ”all are under financial constrains”. Not wearing foot wear in house and premises. where he was admitted for 1 month and 4 days. But surgical wound turned to non.healing with pus and black colour.

area. infection and Short-Term delay in Objective: healing. Presence § Monitor for Continue plan of healthy signs and Reassess goal . iv.Skin will sterile remain technique while intact with no providing cares ongoing to prevent ulcerations. Normal complete granulation WBC values healing of tissue within 1-wk amputated formation. Continue plan Reassess goal and interventions § Do not move the affected area Unmet: not frequently as it achieved affects the iii. No signs of infection over the wound within 1-wk § Perform wound dressing with betadine which promote healing and growth of new tissue.) Focal stimuli: 1. 20/5/08 § Follow 2.4 to vascular week insufficienc y Long-term objective: § Maintain the wound area 1. Impaired Non-healing skin wound after integrity amputation of related to fragility of great and second toe of the skin secondary left leg. Size of wound decreases to 1x1 cm within 24/4/08. i.NURSING CARE PLAN ASSESS. WBC values became normal on 24/4/08 Long term goal: Partially Met: skin partially intact with no ulcerations. ii. OF BEHAVIO UR ASSESSMEN NURSING T OF DIAGNOSIS STIMULI GOAL INTERVENTIO EVALUATIO N N Ineffeciti ve protectio n and sense in physicalphysiolog ical mode (No pain sensation from the wound site. Short term goal: Met: size of wound decreased to less than 1x1 cms. amputated clean as area will be contamination affects the completely healing healed by process.

granular tissues in the wound site within 1-wk symptoms of infection or delay in healing. and interventions . § Administer the antibiotics and vitamin C supplementatio n which will promote the healing process.

Impaired physical During hospital stay mobility related to great and amputation second toe of the left amputated. Long term Objective: Patient will attain maximum possible physical mobility with in 6 months. attained 22/4/08 § Massage the maximum iii. walking extremities Long term with which will goal: minimum strengthen the Unmet: not supportmuscle. § Measures for pain relief . But surgical forefoot wound turned and presence of to nonhealing with unhealed pus and black wound colour. He will upper and possible be self lower physical motivated in extremities mobilityactivitieswhich help to Continue plan 20/4/08. improve the Reassess goal circulation. he is self motivated in doing minor excesses Partially Met: walking with minimum support. Correct use of crutches with in 22/4/08 § Assess the level of restriction of movement § Provide active and passive exercises to all the extremities to improve the muscle tone and strength. § Make the patient to perform the ROM exercises to lower ii. and interventions § Provide articles near to the patient and encourage performing activities within limits which promote a feeling of well being. Short term goal: Met: used crutches correctly on 22/4/08. Short term objective: i.Impaired activity in physicalphysiolog ical mode Focal stimuli: 2. § Provide positive reinforcement for even a small improvement to increase the frequency of the desired activity.

should be taken before the activities are initiated as pain can hinder with the activity. .

§ Repeat information as necessary because of the reduced attention span of the client and family § Provide comfortable quiet environment for the client and family Short term goal: Met: demonstrated appropriate range effective coping with treatment He is able to rest quietly. (He was the earning member in the family. special knowledge in health matters Long term Objective: § Allow and encourage the The client will client and remain free family to ask from anxiety questions. Bring up common Short term concerns. His role shift is not compensat e) Contextual stimuli: 3. objective: § Allow the i.Alteration in Physical self in Selfconcept mode (He is anxious about changes in body image) Change in Role performa nce mode. § Stress that frequent assessment are routine and do not necessarily imply a deteriorating condition. Being able to rest and iii. demonstratin g appropriate range effective coping in the treatment ii. Anxiety Known case related to hospital DM for past 10 years and admission on treatment and unknown with insulin Outcome of for 8 years. Long term goal: Unmet: client not completely remained free from anxiety due to financial constrainsContinue plan Reassess goal and interventions . the disease and financial Residual stimuli: no constrains. Asking fewer questions client and family to verbalize anxiety.

with insulin diabetic for 8 years. Include follow up the points like care and care of wounds. Chapter 8. Nursing Theories. Lobo ML. § Clear the Short term objective: doubts of the patient as the patient may i. Raile AM. St Louis: Mosby. St Louis: Mosby. § Explain diabetic diet. . London: Mosby. wound care. Keene AM. Strictly whenever necessary to following diabetic diet reinforce learning. 5th ed. Demonstratio n of wound care. Long term goal: Unmet: not completely acquired and practiced the required knowledge. Hunter JAA. 2005 2) George BJ. 2005 4) Black JM. Nursing theorists and their work. Text book of Medical Surgical Nursing. n of foot § Repeat the care. about the home and need of care. Short term goal: Met: Verbalization and demonstratio n of foot care. 20th ed. stimuli: no special knowledge in health matters Long term Objective: § Explain the treatment measures to Patient will the patient and acquire their benefits in adequate a simple knowledge regarding the understandable language. Strictly following diabetic diet plan Unmet: Demonstratio n of wound care. Continue plan Reassess goal and interventions REFERENCE 1) Marriner TA. day life. t foot care. Hawks JH. 2006. and need of follow up Residual care. 5) Brunner LS. Verbalization present with some matters and demonstratio of importance. St Louis: Mosby. 2006. 2005 3) Alligood MR “Nursing Theory Utilization and Application” 5th ed. plan iii. 6 th ed. Suddharth DS. Medical surgical nursing. Philadelphia: Elsevier Mosby. their day to activity etc.The Base for Nursing Practice. Walker BR. 6th ed. London: Churchill Livingstone Elsevier. Colledge NR. practice in nutrition. on treatment wound care. deficient knowledge Known case regarding the foot DM for past 10 years and care. Davidson’s principle and practices of medicine. information ii. Behavioral System Model. 2002 6) Boon NA.Contextual stimuli: ------ 4.3rd ed. diet.

APPLICATION OF INTERPERSONAL THEORY IN NURSING PRACTICE .

patient relationship Peplau’s theory and nursing process Peplau’s theory application nursing process Summary Evaluation of the theory of application References: Introduction Peplau’s theory focuses on the interpersonal processes and therapeutic relationship that develops between the nurse and client. the patient attempts to derive full value from what he/ she are offered through the relationship. Psychodynamic nursing is being able to understand one’s own behavior to help others identify felt difficulties and to apply principles of human relations to the problems that arise at all levels of experience.Outline • • • • • • • • Introduction The four phases of nurse-patient relationships are Overlapping phases in nurse. communication. This theory stressed the importance of nurses’ ability to understand own behavior to help others identify perceived difficulties. Resolution . Orientation: During this phase. The nurse helps the individual to recognize and understand his/ her problem and determine the need for help. The interpersonal focus of Peplau’s theory requires that the nurse attend to the interpersonal processes that occur between the nurse and client. Identification The patient identifies with those who can help him/ her.client relationship. The four phases of nurse-patient relationships are: 1. The nurse permits exploration of feelings to aid the patient in undergoing illness as an experience that reorients feelings and strengthens positive forces in the personality and provides needed satisfaction. the individual has a felt need and seeks professional assistance. 3. The nurse can project new goals to be achieved through personal effort and power shifts from the nurse to the patient as the patient delays gratification to achieve the newly formed goals. pattern integration and the roles of the nurse. Exploitation During this phase. Interpersonal processes include the nurse. 4. Interpersonal process is maturing force for personality. 2.

Resolution: Occurs after other phases are completed successfully. systematic manner. has feeling of belonging and selectively responds to those who can meet his or her needs. In Nursing Process. meeting initiated by patient who expresses a “felt need”. The interventions are planned. the orientation phase parallels with assessment phase where both the patient and nurse are strangers. clarifies and gathers important information. Peplau’s theory application nursing process: . Exploitation: Patient actively seeks and draws knowledge and expertise of those who can help. clarify and define facts related to need. This is a process in which the patient frees himself from identification with the nurse. work together to recognize. the nurse and patient work together. This leads to termination of the relationship.patient relationship Peplau’s theory and nursing process: Peplau defines Nursing Process as a deliberate intellectual activity that guides the professional practice of nursing in providing care in an orderly. • • • Identification: Patient participates in goal setting. meeting initiated by patient who expresses a felt need. carried out and evaluation done based on mutually established expected behaviours. Conjointly. outcome and goal set. Based on this assessment the nursing diagnoses are formulated. Overlapping phases in nurse. Peplau explains 4 phases such as: • Orientation: Nurse and patient come together as strangers.The patient gradually puts aside old goals and adopts new goals.

JL was free to express problems regarding difficulty in mobilizing. The need for bed rest and restriction was discussed. she is related to restricted the to bed. Provided active and passive exercises to all the extremities She expressed satisfaction when able to move without difficulty.The nursing process for Mrs. Provided article within the reach Massage the of the patient upper and lower extremities which help to improve the . Provide active and passive exercises to all the extremities to improve the muscle tone and strength. JL based on Peplau’s theory is as follows: Mrs. presence of pelvic traction. Evaluation (Resolution phase) Mrs. JL is Impaired Goal setting Carried out plans on pelvic physical was done along mutually agreed traction and mobility with patient upon. JL 27 years Diagnosis: Inter vertebral disc prolapse Assessment Nursing Planning Implementation (Orientatio diagnosis (Identification (Exploitation n phase) phase) phase) Mrs. Patient will have improved physical mobility as evidenced by participating in self care within the limits. Made the patient to perform breathing exercises Make the patient to perform the breathing exercises which Massaged the will strengthen upper and lower the respiratory extremities muscle.

circulation. Provide positive reinforcement for even a small improvement to increase the frequency of the desired activity. Provided positive reinforcement to Provide articles the patient near to the patient and encourage doing activities within limits. Assessmen t (Orientatio n phase) Nursing diagnosis Planning (Identification phase) Implementation (Exploitation phase) Evaluation (Resolution phase) .

diversion. Also the measures to reduce pain were discussed. Pain related to Goal setting was Carried out plans Mrs. JL will have reduction in pain as evidenced by her verbalisation of reduction in pain responses. Provide nonpharmacological measures for pain relief such as diversional activity which diverts the patients mind. Myoril 4mg as prescribed. Provided non Expressed that she pharmacological got slight relief from measures like pain. changes in the lumbar region. pain. Administered Tab.Mrs. massaging. JL expresses pain in the low back region. JL was free to the done along with mutually agreed express problems of degenerative patient upon. Support the areas with extra pillow Used pillows to to allow the normal alignment support the back. Given pelvic traction and explained the need for traction Provide pelvic traction to the patient . Provided supine position to the Always use back client support while turning the Supported the patient that reduces the strainback during position change on the back. physician. and to prevent strain. and pelvic traction. discussion was made to assess the severity and the type and duration of pain. Give the client a neutral position Regarding pain. Mrs. Administer Hifenac P and analgesics as prescribed by the Cap.

Assisted the client in doing her self care activities Assist the patient in doing her self care Removed the activities. Remove weight of the the . self care. weight as and when needed. Planning Implementation Evaluation (Identification (Exploitation (Resolution phase) phase) phase) Self care Goal setting Carried out plans Mrs.Assessment (Orientatio n phase) Mrs. the needs and all her needs were met appropriately Nursing diagnosis Regarding self care discussion was done and discussed regarding the measures to solve the problems. JL expresses that she need assistance to get down from bed. the presence of pelvic traction. Kept the articles Keep all the within t he reach articles within of the client the reach of the patient. She achieved and maintained self care activities within her limits Provide a bell to patient to in emergency call the call any Frequently visited the patient and enquired for any Frequently visitneeds the patient and enquire for any needs. Client will She used to call for achieve and maintain self care activities with assistance of caregiver or within her limits. JL was free to deficit was done along mutually agreed express problems of related to with patient upon.

Assessment (Orientatio n phase) Nursing diagnosis Planning (Identification phase) Implementation (Exploitation phase) Evaluation (Resolution phase) .traction as needed by the patient.

Allow the family members to visit the client frequently Allowed the client and family members to ask questions Allowed the family members to frequently visit the client . its outcome and need for surgery Anxiety related to hospital admission as evidenced by verbalisation and client & family appearing withdrawn Goal setting was Carried out plans Mrs. JL was free to done along with mutually agreed express problems of patient upon. Client will have reduced feeling of anxiety as evidenced by asking fewer questions She asked her doubts regarding the illness and the diagnostic procedures Discussed with the client regarding the disease process and the findings in the client She verbalized that Taught the family her anxiety has reduced to some regarding the Teach the family disease process extent. Explain in simple understandable language of the client. Allow and encourage the client and family to ask questions. and client in simple regarding the Kannada disease process. anxiety Stress that frequent assessment are routine and do not necessarily imply a deteriorating condition.Mrs. self care. JL is enquiring about the disease condition. She and her Allow the client husband and family to expressed their verbalize anxiety.

Assessment (Orientatio n phase) Mrs. Discussed with the client regarding the disease process and the need for follow up She expressed acquisition of knowledge regarding the disease and the signs of aggravation of illness Explained Explain the treatment treatment measures and the measures to the need for follow up patient and their benefits Explained regarding the Explain to the signs of client the signs aggravation of of aggravation of disease illness Use simple and understandable terms Used simple and understandable terms for explaining Clarified her doubts Clarify all the doubts of the patient of importance. Repeat the information whenever necessary to reinforce Repeated the information . JL is enquiring about the disease condition. Planning Implementation Evaluation (Identification (Exploitation (Resolution phase) phase) phase) Goal setting was Carried out plans Mrs. its outcome and need for surgery Nursing diagnosis Deficient knowledge related to the treatment measures to be Patient will continued acquire adequate even after knowledge the regarding the discharge. treatment and home care. self care. JL was free to done along with mutually agreed express problems of patient upon.

Resolution • Client expressed that pain has reduced a lot and she is able to tolerate it now . Summary: 1. discharge and home care and follow up. Cooperates and participates actively in performing exercises. Exploitation • • • Client explains that she gets relief of pain when lying down supine. Orientation phase • • • Client is initially reluctant to talk due to pain. Client is expressing that while standing she is having much pain.learning. 4. Client expressed without movement and supine position gave her relief from pain. Client mobilizes changes position and cooperates during position changes. 2. Identification • • • • The client participates and interdependent with the nurse Expresses the need for measure to get relief from pain Expresses need for improving the mobility Expresses need to know more about prognosis. 3.

Chinn P L. Tomey A M. Missouri: Mosby Elsevier. 3rd edition. References: 1. Craven R F. George J B. 3rd edition. Alligood M R. 5th edition. New Delhi: Sage Publications.a systemic approach. Nursing theories. the client's needs could be assessed. 2006 4. It helped her to achieve them within her limits. 2002 3. and Kramer M K.1991 2. 2007 5.utilization and application. McQuiston C M and Webb A A. New Jersey: Prentice hall. Fundamentals of nursing – human health and function. 1995 APPLICATION OF THEORY IN NURSING PROCESS . Philadelphia: Mosby year book. Nursing theory. Theory and nursing. This theory application helped in providing comprehensive care to the client. Evaluation of the theory of interpersonal relations by Peplau With the help of the theory of interpersonal relations. Hirnle C J. Foundations of nursing theoryContributions of 12 key theorists.• • She has agreed upon to continue the exercises at home She also expressed that she would come for regular follow up after discharge. Philadelphia: Lippincott Williams and Wilkins. 5th edition.

enhanced professional status for nurses.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. it is vital to have the theory to analyze and explain what nurses do As medicine tries to make a move towards adopting a more multidisciplinary approach to health care. predict and explain the phenomenon of nursing It should provide the foundations of nursing practice. to select a theory for the application according to the need of the patient to apply the theory to solve the identified problems of the patient to evaluate the extent to which the process was fruitful. nursing continues to strive to establish a unique body of knowledge This can be seen as an attempt by the nursing profession to maintain its professional boundaries • • • . Theories are composed of concepts. definitions. predicting. help to generate further knowledge and indicate in which direction nursing should develop in the future Theory is important because it helps us to decide what we know and what we need to know It helps to distinguish what should form the basis of practice by explicitly describing nursing The benefits of having a defined body of theory in nursing include better patient care. deductive reasoning and inductive reasoning.. Objectives • • • • • • to assess the patient condition by the various methods explained by the nursing theory to identify the needs of the patient to demonstrate an effective communication and interaction with the patient. definitions. explaining. A nursing theory is a set of concepts. and /or prescribing. They are derived through two principal methods. propositions & are based on assumptions. models. systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing. improved communication between nurses. and assumptions or propositions derived from nursing models or from other disciplines and project a purposive. Importance of nursing theories: • • • • • Nursing theory aims to describe. relationships. and guidance for research and education The main exponent of nursing – caring – cannot be measured. Definition: Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing.

it must be developed co.specific principles and procedures or rules. Procedural rules or principles help to standardise nursing practice and can also be useful in achieving minimum goals of quality of care. Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health professionals. Tomey AM. Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions. Ideas are developed and words defined. and predict everyday experiences. One of the most common ways theory has been organized in practice is in the nursing process of analyzing assessment data.). laws. Provide a rationale for collecting reliable and valid data about the health status of clients. 2. Theories do not provide the same type of procedural guidelines for practice as do situation. Theory is ought to improve the nursing practice. • • • • • Application Goal Attainment Theory Application Orem's Self-care Deficit Theory Theories used in Community Health Nursing Application of Suchman’s Stages of Illness Mode Application of Betty Neuman's Systems Model in Nursing Care REFERENCES 1. Nursing theorists and their work. If theory is expected to benefit practice. which are essential for effective decision making and implementation. Used by the practitioners to guide and improve their practice. explain. and evaluation of nursing care. (5th ed. intervention. Alligood. Consistent with other validated theories. Serve to guide assessment. MR.Characteristics of theories: Theories are • • • • • • • Interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. Bases for hypotheses that can be tested. Logical in nature. Philadelphia. Purposes of theory in practice: • • • • • • Assist nurses to describe.operatively with people who practice nursing. Generalizable. 2002. Tomey A M. Missouri: Elsevier Mosby Publications. Increasing the general body of knowledge within the discipline through the research implemented to validate them. Mosby. Nursing Theory: Utilization &Application . 2002 .3rd ed. and principles but will leave open unanswered questions that need to be investigated. People who do research and develop theories think differently about theory when they perceive the reality of practice. Alligood M R.

5th ed.3.2002.Nursing Theories: The Base for Professional Nursing Practice . George JB . TRANSCULTURAL NURSING Outline • • • INTRODUCTION TRADITIONAL CONCEPTS OF HEALTH AND DISEASE CONCEPT OF CULTURE . New Jersey :Prentice Hall.

Intercultural communication occurs when each person attempts to understand the other’s point of view from his or her own cultural frame of reference. It is important to understand some definition and cultural components that are important in health care. Religion: Is a set of belief in a divine or super human power (or powers) to be obeyed and worshipped as the creator and ruler of the universe? Ethical • • • . dislikes. For a nurse to successfully provide care for a client of a different cultural or ethnic to background. According to the American Nurses’ s Association (1976)”Consideration of individual value systems and lifestyles should be included in the planning and health care for each client Nursing curriculum recognize the contribution nursing to the health care needs of a diverse and multi cultural society life-style may ret1ect cultural heritage. decisions. likes. Culture is also beliefs. After reaching a cultural. The education of nursing students in this field is only now beginning to yield significant results. According to Madeleine Leininger (1987) founder of the filed of transcultural nursing in the mid 1960s. Today nurses with a deeper appreciation of human life and values are developing cultural sensitivity for appropriate individualized clinical approaches. and actions in patterned ways. customs and rituals learn from one’s family. beliefs and traditions. effective intercultural communication must take place. Religious and Cultural knowledge is an important ingredient in health care. (Specter 1991) Culture is the learned.• • • • • • • • PURPOSES OF KNOWING THE PATIENTS CULTURE AND RELIGION FOR HEALTH CARE PERSONNEL USE OF SUBSTANCES ILLNESS CAUSE AND PREVENTION RELATED TO FOOD ECONOMIC BARRIERS SOCIOCULTURAL FACTORS AND THE NURSING PROCESS ROLE OF NURSE CONCLUSION REFERENCES INTRODUCTION Transcultural nursing with established clinical approached to clients with varying cultures are relatively new. • Culture-Broadly defines set of values. Effective intercultural communication is facilitated by the nurse identification of areas of commonalities. that are held by a specific group of people and handed down from generation to generation. shared and transmitted values. habits. beliefs. the nurse must consider cultural factor throughout the nursing process. Major Nursing organizations have emphasized in the last decade the importance of considering culture factors when delivering nursing care. understanding. If the client do not respond as nurse expects the nurse may interpret it as unconcern or resistance the nurse then can be anxious and frustrated in order to incorporate cultural knowledge in care cultural knowledge in care. norms and life way practices of a particular group that guide thinking.

explanations for health and disease that characterized. biology. and interactive. beliefs.refers to a subjective perspective of the person's heritage and to a sense of belonging to a group that is distinguishable from other groups.. Subculture: -composed of people who have a distinct identity but are related to a larger cultural group. Culture-specifies . norms of behavior. social institutions. unfamiliarity. refers to objects (dress. values. treatment. community. Ethnic groups. Ethnicity :a consciousness of belonging to a group. religion). Bicultural : a person who crosses two cultures.values and religion system of beliefs and practices. territory. and sets of values. refers to beliefs customs.. or cure illness. features of another culture. many traditional beliefs about disease causation. share a common social and cultural heritage that is passed on to successive generations. • • • • • • • TRADITIONAL CONCEPTS OF HEALTH AND DISEASE When viewed across a variety of multicultural groups. difference within the culture and across culture are found • • • • • • • Ethnic: refers to a group of people who share a common and distinctive culture and who are members of a specific group. A failure to understand and appreciate these "differences" can have serious implications for the success of any Health Promotion and Disease Prevention (HPDP) effort. and patterns of behavior that tend to be unique to a designate culture. These explanations often involve family. and general health practices can be seen as highly complex. genetic markers. values. art. beliefs. lifestyles. . Cultural Identify: the sense of being part of an ethnic group or culture Culture-universals: commonalities of values. Material culture. religious arti1acts) Non-material culture. languages. People of a minority group tend to assume the attitudes. Diversity: refers to the fact or state of being different. and incompatibility to the stranger's perceptions and expectations at is differentiated from others by symbolic markers (cultures. control. usually observable. dynamic. Diversity can occur between cultures and within a cultural group. placation. Acculturation. individuals who have taken on. Cultural shock:-the state of being disoriented or unable to respond to a different cultural environment because of its sudden strangeness. and life patterns that are similar among different cultures. Not all people of the same race have the same culture. find practices of the dominant society resulting in a blended cultural pattern. Ethnic identity. and/or supernatural agents in cause and effect. Race: the classification of people according to shared biologic characteristics. and treatment rituals to prevent. or features.

Be aware of the need to be flexible in the design of programs. groups may result in people choosing not to seek Western medical treatment procedures because they do not view the illness or disease as coming from within themselves Be aware that in many Eastern cultures and other cultures in the developing world. the locus of control for disease causality often is centered outside the individual. and cure including folk and Western medical interventions Recognize that folk illnesses. Recognize that the use of traditional or alternate models of health care delivery is widely varied and may come into conflict with Western models of health care practice. and behaviors-.• Be aware that the health concepts held by many cultural. beliefs. policies. Understanding these differences may help us to be more sensitive to the special beliefs and practices of multicultural target groups when planning a program. whereas in Western cultures. which are perceived to arise from a variety of causes. Be aware that folk illnesses are generally learned syndromes that individuals from particular cultural groups claim to have and from which their culture defines the etiology. and values.promoting encounter as a negative or perhaps even hostile experience. then that person might not be able to provide or describe his or her symptoms in precise terms that the Western medical practitioner can readily treat (Landline & Logoff. diagnostic procedures. and services to meet the needs and concerns of the culturally diverse population. native healer. Acknowledge that many individual patients and health care practitioners have specific notions about health and disease causality and treatment called explanatory models. and traditional healing or curing practices. These models are generally a conglomeration of the respective cultural and social training. often require the services of a folk healer who may be a local corianders. Remember that most cases of lay illness have multiple causalities and may require several different approaches to diagnosis. spiritualist. or other specialized healer. the greater the potential for. Culture guides behavior into acceptable ways for the people in a specific group as such culture originates and develops within the social structure through inter personal interactions. 1992). root doctor. the personal beliefs. and the understanding of biomedical concepts that each group holds (Klein man. behaviors. • • • • • • Traditional Concepts of Illness Causality • • • • • . groups that are likely to be encountered. 1980). the locus of control tends to be more internally oriented (Dim-out. Recognize that the more disparate the differences are between the biomedical model and the lay/popular explanatory models. values. Remember that if the more traditional person does seek Western medical treatment. on to encounter resistance to Western HPDP programs. prevention methods. 1995). Recognize that individuals from other cultures might not follow through with health-promoting or treatment recommendations because they perceive the medical or other health. shaman. treatment.

Language is primary through means of transmitting culture The practices of particular culture often arise because of the group's social and physical environment Culture practice and beliefs are adapted over time but they mainly remain constant as long as they satisfy needs. recognizing biases and prejudices and assumptions about other people PURPOSES OF KNOWING THE PATIENTS CULTURE AND RELIGION FOR HEALTH CARE PERSONNEL Cultural background affect a person's health in all dimensions.CONCEPT OF CULTURE • • • Culture is learned by each generation through both formal and informal life experiences. Cultural awareness It is an in-depth self-examination of one's own background. so the nurse should consider the client's cultural background when planning care .

facilitate. 1. Nursing Decisions Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care.(Leininger. and outcome. rather than based on predetermined criteria. Discovering client's culture care values. Cultural preservation or maintenance: Retain and or preserve relevant care values so that clients can maintain their well-being. To foster understanding. beliefs and practices as they relate to nursing and health care requires nurses to assumes the roles of learners of client’s culture and copartners with client's and families in defining the characteristics of meaningful and beneficial care. organizational and social levels. 2. support. or face handicaps and/or death .2002 Culturally competent care is the ability of the practitioner to bridge cultural gaps in caring.Although basic human needs are the same for all people. spirituality and culture regarding illness. values. or greatly modify client’s life ways for a new. skills. and attitudes in the delivery of culturally congruent care and awareness. To strengthen in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply more to the pathophysiology of disease. cause. meanings. Culturally competent care requires specific knowledge. treatment. different and beneficial health care pattern . All three modes of professional decisions and actions are aimed to assist. the way a person seeks to meet those needs is influenced by culture. respect and appreciation for the individuality and diversity of patients beliefs.2002a) has defined transcultural nursing as a comparative study of cultures to understand similarities (culture universal) and difference (culturespecific) across human groups Culturally congruent care. and actions proposed in the theory are predicted to lead to health and well being. or enable people of particular cultures The three modes for congruent care. Pacquiato (2003) identifies three distinct levels of cultural competence at the practitioner. change. Cultural care repatterning or restructuring : Records. such as ayurveda and pancha karma • • • Leininger (1991. To facilitate in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient.Cultural care accommodation or negotiation.Adapt or negotiate with the others for a beneficial or satisfying health outcome 3. its meaning. recover from illness. or to face illness and death. and recognizes the physician as a dynamic component of that relationship. Care that fits the people's valued life patterns and set of meanings -which is generated from the people themselves. suffering and death. • • To heighten awareness of ways in which their own faith system. Provides resources for encounters with illness. emotional and spiritual self-care introduce therapies from the East. work with cultural differences and enable clients and families to achieve meaningful and supportive caring. decisions. To encourage in developing and maintaining a program of physical.

safe. rituals of redemption. wrist. Others cross ethnic and community lines and are used in certain Geographic areas in the person's country of origin. must be made to determine properties of vegetation-plants. People from many ethnic backgrounds eat raw garlic or onion In an effort to prevent illness or wear them on' the body or hang them in the home. This practice uses diet and consists of many different observances. Religion dictates social. tested stems. flowers. (Morgenstern. an effort must be made to determine if they are worn or hung in the home. illness. 1966) USE OF PROTECTIVE OBJECTS Protective objects can be worn or carried or hung in the home. and In many instances a heritage consistent person may prayer. and spirit. charms worn on a string or chain around the neck. Amulets are objects with magical powers. The pharmaceutical. and dietary practices designed to keep a traditional healer (Kaptchuk and Croucherl987) Traditional Remedies The admitted use of folk or traditional medicine increasing. moral. or the restoration of holistic health RELIGIOUS PRACTICES Another traditional approach to illness prevention female centers around religion and includes practices such as from a divine source the burning of candles. or waist to protect the wearer from the evil eye or evil spirits. cataloged. When patients -do not adhere to a pharmacological regimen an effort must be made to determine the remedy if they are taking traditional remedies. well-being. For example. 1947) mind. and the practice is seen among people from all walks of life and cultural ethnic back ground Use of folk medicine is not a new practice among heritage consistent people. and used for countless centuries. and it plays a strong role in rituals associated with health protection. Many of these plants are used by specific communities. Religion strongly affects the way people attempt to prevent illness. so many of the remedies have been used and passed on for generations. Jews also believe that milk and meat must never be mixed or eaten at the same meal (Steinberg. roots. 1978) USE OF SUBSTANCES Substances are ingested in certain ways or amounts regimen. and meaningful care to clients of diverse or similar cultures. Status of Traditional Practices Many traditional practices are used to prevent and a redemptive practice used to prevent illness and harm treat illness.PURPOSE AND GOAL OF THE THEORY The central purpose of the theory is to discover and explain diverse and universal culturally based care factors influencing the health. for all walks of life and cultural and ethnic backgrounds is example. Frequently. . It is believed that the body is kept in balance or harmony by the type of food eaten so many food taboos and combinations exist in traditional belief systems. seeds. or death of individuals or groups. it is believed that some food substances can be ingested to prevent illness. including objects and substances and religious practices. Amulets exist in societies all over the world and are associated with protection from trouble (Budge. The purpose and goal of the theory is to use research findings to provide culturally congruent. and herbs-have been studied tested.

or in conjunction with a modern health care provider.the active ingredients of traditional remedies are unknown. These approach may originate in culture. A hot-cold imbalance. based on a client's experience and perception. 'When people anticipate fear or experience an illness or crisis. no matter which family member is involved cultures where the male dominate. This classification can vary from .of a person family. often require the services of a folk healer who may be a local curandero. taking them an effort must be made to determine the remedy as well as its active in gradients Often. IMMIGRATION Every immigrant group has its own cultural attitudes ranging beliefs and practices regarding these areas Health and illness can be interpreted in terms of personal experience and expectations. The female usually is passive. In cultures where this is time. Over dose may occur. and people base their responses on cultural. for example. spiritualist. which are perceived to arise from a variety of causes. or social back ground . Many differences exist between the Western physician and the Eastern A broad range of health and illness beliefs exist many of these beliefs have roots in the culture. religious. they may use a modern or traditional approach toward prevention and healing. however as well as in many Caucasian families. they may be due to external social forces not within the person's control Examples of external social forces include communication barriers. specific people are known to have the power to heal. such as language differences. is primarily caused by improper diet. ILLNESS CAUSE AND PREVENTION RELATED TO FOOD Several factors cause illness. Food substances are classified as hot or cold with and without regard to their actual temperature. These beliefs and practices may be internal or personal and person may be able to define or describe them. root doctor. or other specialized healer. health care facilities. males make decisions for other family members well as for themselves. The responses are culture specific. religious. native healer. these ingredients can be antagonistic or synergistic to prescribed medications. The healer may be male or and is thought to have received the gift of healing In many instances a heritage consistent person may consult a traditional healer before. Within a given community. Gender Roles In many cultures. In African -American families. Healer's In the traditional context. ethnic. Understanding these differences may help you to be more sensitive to the special beliefs and practices of multicultural target groups when planning a program. Recognize that the use of traditional or alternate models of health care deliveries widely varied and may come into conflict with Western models of health care practice. shaman. For example. If a client is believed to be. the female often is dominant Knowledge of the dominant member of the family is important consideration in planning Nursing care folk illnesses. healing is the restoration of the person to a state of harmony between the body. However. the male is dominant figure. and ethnic back ground. or economic barriers causing limited access or lack of access to modem. ethnicity or religion. There are countless ways to explain health and illness. instead of. or community.

In the United States. bananas. honey. avocados. which includes his room.and long-tem problems. lack of health insurance poverty prevent people from entering the health care system. Poor health. Belief regarding medical care Comments (cremation is preferred) ROLE OF NURSE 1. Mental wellness occurs when psychological and physiologic functions are integrated.person to person. . The nurse should try. Belief about birth &death. and inferior are contributing social causes of poverty. but essentially. drug and alcohol abuse. such as rural populations. and lima beans. both governmental and private. Some elderly Asian Americans share the Buddhist belief that problems in this life are most likely related to transgressions committed in a past life. The nurse should begin the assessment by attempting to determine the client's cultural heritage and language skills. In addition our previous life and our future life are as much a part of the life cycle. coffee. SOCIOCULTURAL FACTORS AND THE NURSING PROCESS Religious belief that effect the care Nursing. and illegal aliens. closet. mental illnesses are caused by a lack of harmony of emotions or. homelessness. A client may be late for an appointment not because of reluctance or lack of respect for the nurse but because he is less concerned about planning ahead to be on time than with the activity in which he is currently engaged. Traditional beliefs about mental health In the traditional belief system. Illness can occur if these foods are eaten in improper combinations or amounts. sometimes. aid people with short. to respect the client's territory as much as possible. crippling diseases. kidney beans. Poverty is by far the most critical factor. and others are known to be cold. Examples of cold food are. It is important for the nurse to be aware clients needs and financial resources available in the local community. This can remind the client of home. and belongings. the elderly migrant workers. onions. Personal space involves a person's set of behaviors and attitudes toward the space around himself. poverty is pervasive and found extensively among people in certain norms geographical areas. bed. certain foods are known to be hot. and peas. ECONOMIC BARRIERS Several economic barriers. by evil spirits. lessening the effects of isolation and shock from hospitalization. garlic. The nurse should also welcome visiting members of the family and extended family. The client should be asked if any of his health beliefs relate to the cause of the illness or to the problem. Examples of hot foods-are chocolate. such as unemployment. Belief about diet and food practices. . Time orientation It is varies for different cultures groups. Staff members and other clients frequently encroach on a client's territory in the hospital. especially when performing nursing procedures. Poverty a relative term and changes from time and place. com meal. Several programs. poor education. PERSONAL SPACE AND TERRITORIALITY. underemployment.

Important sub culture influences on children include ethnicity social class. if any. 18. attitudes. 15. 6. 12. individualized . 4.holistic care. 16. 13. but should always individualize care rather than generalize about all clients in these groups. nurses should assess how they are influenced by their own culture. Many ethnic and cultural groups in country retain the cultural heritage of their original culture. Before assessing the cultural background of a client. The process of self-evaluation can help the nurse become more comfortable when providing care to clients from diverse backgrounds 5. Primary groups are characterized by intimate contact mutual support and pressure for conformity. Nurses have a responsibility to understand the influence of culture.The nurse should then determine what. can become cultural racism. race &ethnicity on the development of social emotional relationship child rearing practices &attitude toward health. A child's self concepts evolves from ideas about his or her social roles 8. Stereotyping ethnic group members can lead to mistaken assumptions about a client. Some nurses may believe they should treat all clients the same and simply act naturally. Ethnocentrism can impede the delivery of care to ethnic minority clients and. and values depends on many factors and thus is not the same for different members of a cultural group. How culture influences behaviors. but this attitude fails to acknowledge that cultural differences do exist and that there is no one "natural" human behavior The nurse cannot act the same with all clients and still hope to deliver effective. inexperienced nurses are so self-conscious about cultural differences and so afraid of making a mistake that they impede the nursing process by not asking questions about areas of difference or by asking so many questions that they seem to try into the client' personal life. 17. The nursing diagnosis for clients should include potential problems in their interaction with the health care system and problems involving the effects of culture. 7. Specific to member of an intergenerational group. Sometimes. occupation school peers and mass culture 10. when pervasive. . 14. community or population. 9. Culture is the sum total of mores traditions & beliefs about how people function encompasses others products of human works & thoughts. home remedies the person is taking to treat the symptoms 2. Nurses should evaluate their attitudes toward ethnic nursing care. Socioeconomic influences play major role in ability to seek opportunity for health promotion for wellness 11. The nurse should have an understanding of the general characteristics of the major ethnic groups. Religious practices greatly influences health promotion belief in families. 3.

21. Explanations of and practices into nursing therapies. Evaluation should include the nurse's self-evaluation of attitudes and emotions toward providing nursing care to clients from diverse sociocultural backgrounds. The client should be asked if any of his health beliefs relate to the cause of the illness or to the problem.The identification of the cause of the problem further individualizes the nursing care plan and encourages selection of appropriate interventionscultural variables as they relate to the client. questions should be clear and explanations should be explicit. This should be done in every case. if any. The planning and implementation of nursing interventions should be adapted as much as possible to the client's cultural background. The nurse can find out what care the client considers appropriate by involving him and his family in planning care and asking about their expectations. The nurse should then determine what. 27. In addition the nursing diagnosis should state the probable cause . The nurse may have to alter her usual ways of interacting with clients to avoid offend ignore alienating a client with different attitudes toward social interaction and etiquette. or religious values and health care beliefs. A client who is modest and self-conscious about the body may need psychological preparation before some procedures and tests. assess and listen carefully to health and illness beliefs and practices. Assessment enables the nurse to cluster relevant data and develop actual or potential nursing diagnoses related to the cultural or ethnic need of the client. so that interventions can be individualized for the client. The nursing process enables the nurse to provide individualized care 22.acculturated clients to avoid confusion. misunderstanding. educational level and language skills should be considered when planning teaching activities.19. The nurse should begin the assessment by attempting to determine the client's cultural heritage and language skills. The client’s the nursing process. and respect and not challenge cultural. Evaluation continues throughout the nursing process and should include feedback from the client and family. determining the extent to which the goals of care have been met. they must be aware of and sensitive to the clients' sociocultural background. home remedies the person is taking to treat the symptoms 23. The nurse evaluates the results of nursing care for ethnic clients as for all clients. aspects of care usually not questioned by acculturated clients may be required for nonEnglish speaking or non. self-evaluation . The extended family should be involved in the care the Client's strongest support group. 29. Cultural beliefs and practices can be in-corporate into therapy. When nurses provide care to clients from a background other than their own. ethnic. With an ethnic minority client. 24. 25. Because both the nurse and the client are likely to take many aspects of their cultures for granted. however. 26. Discussing cultural questions related to care with the client and family during the planning stage helps the nurse understand how cultural variables are related to the client's health beliefs and practices. or cultural conflict. even if the nursing care cannot be modified. 20. 28.

Leninger M. J: Rites of birth. develop expertise to implement culturally acceptable strategies to provide nursing care. death. Barman A. 2001. marriage. Research. 5. 4. The nurse should consider questions such as the following: . McFarland M. concepts. Fundamentals of nursing. Synder AJ. Erb G. and identify and use resources acceptable to the client (Boyle. and community. The practice of nursing today demands that the nurse identify and meet the cultural needs of diverse groups. Boyle. 3. • • • • • Am I open to understanding ways in which the client's values differ from mine? Have I given sufficient attention to communicating with the client with limited language skills? Have I have successful client's family in nursing process? Am I incorporating the client's traditional beliefs and practices into nursing therapies? Is my therapeutic relationship with the client grounded on respect for the client regardless of cultural differences? CONCLUSION Nurses need to be aware of and sensitive to the cultural needs of clients. Transcultural Nursing Morgenstern. Potter A. HELPING AND HUMAN RELATIONSHIPS THEORY . 1987). Transcultural Nursing: Concepts. understand the social and cultural reality of the client. 1990. and Practice. The body of knowledge relevant to this sensitive area is growing. George Julia B. Nursing theories: The base of professional nursing practice 3rd edition. JS: The practice of trans cultural nursing. and it is imperative that nurses from all cultural backgrounds be aware of nursing implications in this area. McGraw-Hill Professional. Edn 3rd. New York.by the nurse is crucial as he or she increases skills for interaction. Kozier B. Norwalk. family. Edn 3rd Mosby Company. Edn 7th. process and practice. 2002. and kindred occasions 2. Perry G . Theory.Basic Nursing-Theory and Practice. CN: Appleton and Lange. REFERENCES 1.

emotionally expansive and intellectually acute. politics etc. Parents. They will give their lives meaning through their productivity in living. may produce persons and non persons. they will also teach the others the skills they need to grow and develop themselves. It depends upon the helping skills one has. the effects of skills depend upon how we sequence them. Children as they become capable of both nourishing and directionful behavior. They will create new life through their helping skills. The cycle of life continues. Helpers who are fully responsive and fully initiative teach their helpees to be fully responsive and fully initiative. An effective helper is initially nourishing or responsive. emotionally shallow and intellectually dull. they can communicate fully. They are now prepared to help others to achieve their own levels of wholeness. . with retarding agents the recipients may be physically listless. If the person is ceded the power in the relationship is functioning at a high level. employee-employer etc. health care provider-patient. Consequences may be constructive or destructive. learning and working arenas. With facilitative agents the recipients may be physically energetic. they assume the mantle of adulthood and later perhaps parenthood. Unfortunately power relations are developed for reasons other than functionality like tradition. Persons who are fully alive help other persons to become fully alive. CARKHUFF Introduction When adults have reached full maturity. The effects of the power relationships depend upon the skills. This nourishment prepares the person being helped for the more directionful or initiative behavior of the helper. Thus helping in real sense is a developmental process like child rearing. then all parties involved can benefit from the relationship. they have satisfied their needs for fullness in all aspects of life and become full persons. the consequences of all human relationships may be for better or for worse. They can act constructively in the lives of their own and others thus we call them fully adults or they are now helpers for they are capable of helping others as well as themselves. The effects may be positive or negative or any of the degrees in between these extremes. Eg. They will become the models and the agents for the growth of others. The effects are seen in physical. Power and human relationships The effects of human relationships depend upon the power relationship. emotional and intellectual functioning. Potentially all relationships are helping relationships. Effective parenting involves both responsive and initiative skills. Responsive and initiative behaviours are the basic dimensions of helping and development. Like a marriage. They will not only communicate fully with others struggling to grow and develop.By ROBERT R. It makes good sense that if people have not discovered themselves they can only handicap others in finding their own way of life. Helping Helping is a process leading to new behavior for the person being helped . Human Relationships Human Relationships may be facilitative or retarding effects.

Evolution of dimensions . explore herself in relation to herself and in relation to her world. Responding and initiating skills These skills are cycled in an individual’s personal development before his or her interpersonal development. it is the powerful person’s level of functioning in basic human relations skills that determines the effects of relationships. There are two sets of skills which are the basic ingredients of all human relationships in the areas of endeavor. further it stimulates the other person to take action to achieve the goal. In exploring herself. There is no effective action that is not based upon a depth of understanding. is the test of responsive skills. to be able to describe and predict and influence that experience constructively. it is more than a mechanical process. In acting the person acts upon how to get from where she is to where she wants to be. which involves empathy. • • • When people share their problems. Responsive skills thus involve experiencing another’s condition and communicating to her own experience. It involves the other person in a process leading to her own self-exploration and self-understanding. Responsiveness is the most profound variable in the human condition. It involves operationalizing the goal or breaking it down into it’s components. how do you help them to initiate steps to get to their goals. Initiative Initiative is the basic ingredient of human functionality. It begins with a vision of the possible. A person must respond to understand himself before initiating an action program or product. the person seeking help is attempting to understand where she is in relation to where she wants to be. the more constructively she can act for herself and others. The more accurately a person understands herself. what skills do you have to truly show that you are responding to their experience? How do you physically show this? Emotionally? Intellectually? What do you do and say that will assure the people that you are sensitively attuned to their experience? How do you show you heard them? What feedback do you give? When you are wrestling with their problems. It involves developing the steps and systems to achieve the goal. We must know the problems before we can change the behavior. New behavior is the overall goal of helping. Responsiveness Responsiveness is the basic ingredient of human relations. One must explore where she is. how do you share your experience to help them to develop achievable goals that solve their problems? Now that you have responded to their experience. building upon our own experience to see a goal. Self understanding is not real until the individual has acted upon it. we must understand the goals of helping.Skills Most fundamentally. • • New Behaviour Before we can acquire the skills of helping. To know more than that person does of her own experience.

self disclosure. ii. The dimension of physical functioning was added. i. to measure fitness and energy. emphasized the client’s insight as the basis for the development of an effective set of assumptions about his or her world. genuineness. respect or regard. the helpees must act differently from the way they did before. Helping Process: In order to demonstrate gain in behaviour. The responsive dimensions (empathy. which matches people to jobs and vice versa. confrontation and immediacy. These were in turn complemented by other dimensions including specificity or concreteness. The initiative dimensions were later extended to incorporate the problem solving skills and program development skills needed to fully help the helpee's to achieve appropriate outcomes. These were later extended to incorporate the interpersonal functioning of the helpee's. we must understand four things. the helpees must explore their world experientially. The insight approach was supported by many traditional therapeutic schools. intellectual dimension to measure the intellectual achievement and capabilities. Helpee Outcomes: emphasized the emotional changes or gains of he helpee's.Before we understand the dimensions. the process emphasized helpee exploration and outcome assessments measured the changes in the helpee’s level of emotional insights. specificity of expression) responded to the helpee’s experience and thus facilitated the helpee’s movement towards understanding. With the feedback they can recycle the learning process Exploration -----------Understanding------------Action-----------Feedback Feedback-------further exploration----self understanding--------real understanding Real Understanding-----------modification of action (effective action). which were restrictive because they were assessing only one dimension of the helpee’s functioning. respect. respect and genuineness. Thus they must have insights or understand accurately the gaols and ways to achieve them. self disclosure. Levels: First: no empathy is taking place( no evidence of the helper characteristic) . confrontation. Since the helping methods were insight oriented. warmth. iv. immediacy and concreteness) were generated from the helper’s experience and stimulated the helpee’s movement toward action. concreteness. then factored into responsive and initiative dimensions. which were then operationalized into accurate empathy. Helper Skills: The historic dimension of empathy was complemented by unconditional positive regard and genuineness. who emphasized the client’s development and implementation of rational action plans for managing his or her world. iii. The action approach has been promulgated by the learning theory and behaviour modification schools as well as the trait and factor school. in order to understand their goals. Finally they must act to get from where they are to where they want to be. The dimensions are empathy. In order to effectively help human beings to change behaviour the insight and action approaches must be integrated into one effective helping process. The initiative dimensions (genuineness. Levels and styles of functioning Carkhuff and Berenson(1967) described five levels of dimensions. Helping Sources: There are two approaches to helping -insight and action.

Personalizing: “To enable the helpee to understand where she is in relation to where she wants or needs to be”. Responding: Responding to the helpee’ s expression of her experience. which signals the helper to begin personalizing. by observing and listening. The purpose is to facilitate helpee self understanding in the areas of concern to her. involves building a base of interchangeable responses before personalizing the meaning. The attending skills are transitional between responding and initiating. emotional and intellectual helpee outcomes. . As a result of attempts to teach they are further refined into concrete helping skills (A+R+P+I). T thus she signals her readiness for the next goal of helping. thus she signals readiness for using initiating. helper learns from and about the helpee. By attending physically the helper communicates interest in the helpee’s welfare. feeling and feeling and content together. involves responding to content.Second: Empathizing very little and at a level that detracts from helpee functioning(10% of time) Third: minimum level of feeling response necessary to be efective(50% of time) Fourth and fifth: Higher levels of helper empathy(4th – 75%. The function of attending is to give them the feelings of security that make their involvement in the helping process. helper establishes the conditions for the helpee’s involvement in the helping process. Attending : “Being attentive to to the helpee” is made up of attending physically. the problem. They serve to stimulate the helpee’s exploration of where he or she is in his or her experiences of the world and that the helper is fully in tune with the helpee’s experience. Personalizing skills culminate in the helpee’s personal experience of the problem as the inability to handle difficult situations.understanding. They are used to provide a transition from responding to initiating and from exploring to acting. The function of he responding to the helpee’s experience is to facilitate self exploration. the feelings and the goal. By communicating interest in the helpee. 5th – consistently present) The responsibility continuum: Helping skills The responsive and initiative factors of helping dominate the helping process facilitating E+ U+A That culminate in the physical. observing and listening to the helpee.

If you have attended to to the helpee’s needs and responded to her experience. concerned and capable of communicating thierliving energy. understanding and acting. Initiating skills conclude the first cycle of helping process in which helper facilitate helpee’s acting to get to where he or she wants to be in the world. Fosters the development and implementation of the mechanical steps required to achieve the personally meaningful goals that the helpee has developed. to go out on her own is her ability to respond to the experience of the helper. communicates fully. is life long learning. It means being simultaneously aware of both the helpee’s and one’s own experience. A whole person is always talking about what she seems to be talking about. A less than whole person is never actually talking about what she seems to be talking about. no matter how advanced is the stage of the helping relationship. which means understanding and interpreting in the moment what is going on between you and the helpee (highest levels of responsive and initiative behaviour). over an extended period of time each person can learn to personalize and initiate with the people with whom they are involved At the highest level people communicate with immediacy. As helpers our tasks is to become whole people. Growing is more than learning and helping. you have facilitated her understanding of where she is in relation to where wants to be. All people can do with each other in their daily contacts. may talk in comparison or relation to other people. she is always checking back with the helpee accuracy of the responses. concern and capability to those who are most in need. One clear demonstration of the helpee’s readiness to terminate the helping process. bringing direction to culmination – giving life meaning in productivity and creativity”. Thus you have helped her solve her problems and achieve her goals. E. understand and act plus recycle. There is no edge in helping. Thus helping is a process of teaching people who do not communicate fully to communicate fully with themselves and others. You have seen her grow and develop. The Assumption . It involves operationalizing goals and initiating steps. The helper is fully alive. A growing person is constantly involved in the learning person. If you have personalized your understanding of the helpee.g. But one must initiate the helping process by communicating her openness to understanding the other. schedules and reinforcements to achieve these goals. In fully alive communication each person may be helper to the other. The helpee informs us that she is ready to function as a helper by her behaviour. Having begun by attending and responding. If you have initiated to help the helpee achieve her goals have facilitated her acting to get from where she is to where she wants to be.Initiating: ”Finding direction in life or acting in following the direction. THE CLEAR DEMONSTRATION OF THE ABILITY TO FUNCTION AS A HELPER WILL BE ONE’S ABILITY TO RESPOND AND INITIATE EFFECTIVELY. These goals resolve helpee’s problems. which means to explore. It is helping others to learn. Whatever the effective helper or the whole person is doing. first and foremost by attending and making an effective response to the other. you have facilitated her exploration of where she is. Life long Learning is recycling exploring. Mutual problems are resolved. She makes this by making responses that are interchangeable with the feeling and content expressed by the helpee. But growth is not static. In doing so she establishes the model for the other to imitate.

one wants to become involved in a life long learning process. Helping takes place over the lifespan. with minimal helper assistance. feelings and goal 3.0 Personalizing problem.5 Personalizing meaning 3. Other assumption is that one wants to grow. Voluntary quality of the helping process is a crucial point since many persons wanting to help others have their own helping agenda and seek to meet their own unrecognised needs. .5 Responding to feeling 2. The act of helping people with the presumed goal of doing something for them or changing them in some way has an arrogant quality too. both verbal and non verbal that are unrelated or irrelevant to the helpee’s situation or expressions. Each developmental period and the transitions between usually require some form of outside help to make life more effective and satisfying..0 Initiating steps 4.0 Responding to feeling and content 2. . • • • • • • • Basic Helping scale I + E + U + A = New learning (behaviour) 5. want to be like the facilitative helpers and teachers one has experienced. Helper must assume some responsibility for creating conditions of trust whereby helpeescan respond in a trusting manner and help themselves.0 Non attending Non attending covers all behaviours. Each individual behaves in a competent and trustworthy manner if given the freedom and encouragement to do so. The aim of all help is self help and self sufficiency. Helper must be alert to the impact on the helpee of other people and of the physical environment. that helpees will try to change under their own initiative.0 Responding to content 1.5 Attending 1. The nature of the informal agreement implies a growth contract. to solve problems and to face crises.CARKHUFF Brammer and Macdonald• • • • The basic interpersonal communication processes implied by the specialized helping relationships are similar People know their needs Basically it is a process of enabling the person to grow in the directions that person chooses.The only assumption made in developing the helping skill programs involves one’s motivation.5 Initiating goal operationalization 4.

Levitt 1963. Initiating steps: involves responses that identify specific steps toward accomplishing the operationalised goal. e. Naturalistic studies: (Rogers et al 1967. Initiating goal operationalization: covers responses that express a clear understanding of the helpee’s personalized problem. feelings and goal: involves responding to identify the personal deficits (assets) of the helpee that are contributing to the problem or situation. Responding to content: involves summarising what the helpee has shared concerning her situation. Traux and Carkhuff 1967) The clients and patients of professional helpers demonstrated a greater range of effects than those in professionally untreated groups.g. The accuracy of the discriminations and communications is the effective ingredient. But study revealed a very distressing conclusion that counseling and psychotherapy have a two edged effect. Skills of helping: Apply the skills then only you recognise the need for more skills.Attending: includes the verbal and non verbal behaviours that are directly related to involving the helpee. Discipline: Employ skills with discipline. Personalizing problem. While working hard they must protect themselves by receiving the maximum return for the minimum investment. 1960’s: (Eysenk. the feelings that the helpee is experiencing about her deficits (assets) and the goal that the helpee wants to achieve. ii. rehabilitation and psychotherapeutic techniques. Personalizing meaning: involves responding to identify the personal significance or implications of the expressed situation for the helpee. Within 3-5 years after treatment 65-75% of the patients were once again patients. 1965. The most of basic of all skills is learning how to learn. gained as much on the average as people assigned to professional counselors and therapists. They discovered that both adults and children who were in control groups that were not assigned to professional practitioners. Once you understand the response deficits of the helpees they will tend to employ teaching in groups as the preferred mode of treatment. Ingredients to secret of success a.they may . N ext is the basic skill of teaching. c. The gainful employment of patients was below 20%. 1960. About two thirds of the patients improved and remained out of the hospital a year after treatment whether they were treated or not. b. applying skills with disciplines in a variety of human experiences. Conclusion was that psychotherapy has lasting positive effects in 17-22% of the cases. but do not respond to what the helpee has shared about where she is. Work: Our real learning in life comes from working very hard. Lewis 1965) stated that psychotherapy and counseling did not make a difference. This research was updated in longitudinal studies in more than 50 treatment setting by Anthony(1979) who studied lasting effects of counseling. Responding to feeling and content: involves the clear communication of helper understanding of both the content and feelings expressed by the helpee. feelings and goal in behavioural terms. Evaluation of theory i. Responding to feeling: involves accurately identifying a feeling word that is interchangeable with the helpee’s experience of the situation.

such as nurses. ii.be harmful or helpful. Student teacher relations (Carkhuff 1969). The students of teachers offering high levels of these interpersonal dimensions demonstrated significant constructive gains in areas of emotional. recidivism rates and a variety of other areas including self reports. The results were significantly more positive than all other forms of treatment. . Thus parents of emotionally disturbed children were systematically trained in the skills which they needed to function effectively with themselves and their children. For example. The concept of training as treatment led to the development of programs to train entire communities to create a therapeutic milieu. Lay helpers were able to elicit significant changes in work behaviours. Generalization Studies: To study the effects of teacher’s levels of interpersonal functioning upon learner’s development. Indigenous personnel: They can work effectively with the populations from which they are drawn. significant other reports and expert reports. iv. interpersonal and intellectual functioning (Aspy and Roebuck. With credentialed counselors and therapists: Trained counselors were able to demonstrate success rates between 74-91%. Extension studies: Michelson and Stevic(1971) found that career information seeking behaviour was dependent upon the helper’s levels of interpersonal functioning in interaction with their reinforcement program Helping dimensions were validated in predictive studies of both helping process and outcome. discharge rates. Patients were trained to offer each other rewarding human relationships. Piaget et al 1968. The effects could be determined by the levels of functioning of the helpers on certain interpersonal dimensions such as empathy/empathetic understanding. drawn from the ranks of unemployed have systematically helped others to learn the skills they needed in order to get and hold meaningful jobs. dormitory counselors. hospital attendants. v. policeman. (Carkhuff and Alexik 1967. Traux and Carkhuff 1967). counselor –client relation and therapist patient relations v. community volunteers were trained and their effects in treatment studied. emotional and intellectual functioning. Predictive studies: involved manipulating the levels of helpers functioning on interpersonal dimensions such as empathy and its effects both within the helping process and upon the helping outcomes. Helpees of helpers functioning at high levels of these interpersonal dimensions moved towards higher levels of functioning (explored their problems in meaningful ways) iv. Functional Professionals: Staff personnel. iii. The acceptance of the fundamental ingredients of helping has been widely demonstrated in the professional literature. parent child relations (Carkhuff 1971. 1977) These effects have been generalised in all areas of helping and human relationships where the more knowing person influences the less knowing person. Aspy and Roebuck(1977) demonstrated positive effects of helping skills upon student physical. Helpee population: in the kinds of skills which they need to service themselves. The applications: i. 1976). new career teachers. prison guards. One who offered high level of core interpersonal dimensions facilitated the process movement. iii. Holder et al 1967. Science and art of helping: On implication of the research into helping is to select persons as helpers who already possess the artful qualities and then quickly and systematically give them basic helping skills and behaviour concepts.

inspirational methods. They use many sources of help that are outside conventional helping methods. Self Help Groups: Hurvitz (1970) studied many groups as participant observer and concluded saying much of their effectiveness was due to peer relationships. which is the agreement of helper and helpee on the goals and tasks and the experience of an emotional bond in this mutual act. planning strategies. family. The working alliance is considered equal in importance to helper attitudes (Gelso & Carter. Helping affiliations Helping affiliations can be classified into formal and structured (professional. learning new skills. Phase 2: Facilitating Positive Action . Abrego and Shostrom 1993) uniqueness-commonality and intellectual – emotional content. the relationship is the principal process vehicle for both helper and helpee to express and fulfill their needs as well as to mesh helpee problems with helper expertise. gathering facts. Helping relationship is dynamic at verbal and nonverbal levels. Helping Relationship (Brammer) The third component of the helping relationship is described as the working alliance. the helper must resist the urge to move the focus to his or her experience. community& general human). expressing deeper feelings.vi. However helping relationship is different from friendship. paraprofessionals and volunteer helper) to informal and unstructured (friendships. All authorities on the helping process agree that the quality of the helping relationship is important to effective helping(Sexton and Whiston 1994. The focus is on the helpee’s emotional and intellectual issues. Stages in helping process There are eight stages contained in the two basic phases of the helping process. fellow ship and a variety of helping procedures. explicit goals.)All agree that good working relationship established early. Its dimensions are (Brammer. is not a reciprocal relationship. yield a helping relationship. formulating goals. Phase 1: Building relationships: • • • • • Entry: preparing the helpee and opening relationship Clarification: state the problem or concern and reasons for seeking help Structure: formulating the contract and the structure Relationship: building the helping relationship Exploration: exploring problems. 1994).

Leading Skills iii.SYMBOLIZING IDEAS AND FEELINGS Informing skills Advising – giving suggestions and opinions based on experience Informing. Termination: evaluating outcomes and terminating the relationship. Reflecting skills iv. diffusion and vagueness Questioning – conducting open and closed inquiries Reflecting feeling – responding to feelings Reflecting experience – responding to toal experience Reflecting content – repeating ideas in fresh words or for emphasis Recognising feelings in oneself – being aware of helper experience Describing and sharing feelings – modeling feeling expression Feeding back opinions – reacting honestly to helpee expressions Self-confrontation INTERPRETIVE QUESTIONS – FACILITATING AWARENESS FANTASY AND METAPHOR. • • • Attending – noting verbal and nonverbal behaviours Paraphrasing – responding to basic messages Clarifying – self disclosing and focusing discussion Perception checking – determining accuracy of learning Indirect leading – getting started Direct leading – encouraging and elaborating discussion Focusing – controlling confusion. ii.recognise own weak spots and work on prevention Dual relationships.• • Consolidation: exploring alternatives. practicing new skills Planning: developing a plan of action using strategies to resolve conflicts. Is there a a power difference between us? . Listening skills • • • • • • • • • • • • • • • • • vi.recognise them and manage them Ask following questions. Interpreting skills vii. and consolidating and generalizing new skills or behaviours to continue self-directed activities. reducing painful feelings.giving valid information based on expertise Pulling themes together. • Helping skills for understanding: of self and others i. Confronting skills: v. Summarising Skills Ethical issues in helping relationships: Informed consent Worker self care. working through feelings.

1995. Foundations of mental health nursing. Stuart G W. 2005. out of compassion or to express care is controversial. Shea C A. Walsh M. Boston: Allyn and Bacon. 2006. Boon NA. Morrison M. Davidson’s principle and practices of medicine. Principles and practice of psychiatric nursing. The art of helping. Psychiatric nursing. Amherst: Human Resource Development press. Louis: Mosby. 6th ed. 7th ed. The only meaning to life is to grow for growing is life. 1999 4. Fundamentals of nursing. Topalis M. is growth and growth is learning skills. Verhey M P. 7. St. References 1. London: Churchill Livingstone Elsevier. 6. St Louis: Mosby Harcourt Pvt. London: Chapman & Hall. Lillis C. we can be healthy and we can help each other to actualize our human potential. Helping relationship process and skills. Taylor C. Life is process. 3. Hunter JAA. Limited. Macdonald G. 2nd ed. 8. Psychiatric skills a pateint centred approach. Le Mone P. St. Brammer L M. Louis: Mosby. Walker BR. 4th ed. 6th ed. Advanced practice nursing in psychiatric and mental health care. Philadelphis: Lippincott Williams & Wilkins. Carkhuff R. 20th ed. our own as well as others which is growth. Lynn P. 1997. 5. 9. Aguilera D C. Pelletier L R. When we use the helping skills effectively. . St Louis: C V Mosby. 1978. 1983 2.What other role obligations do I have in this situation? How will my knowledge about you change our relationship? Physical contact with helpees: Sexual relationships of any kind are unethical Touching clients for support. Laraia M T. 1996. 2001. Dexter G. Colledge NR. Conclusion Our task in life is to improve the quantity and quality of human experience. Poster E C. Stuart G W.

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