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.

Nurses must stay connected to patients and assure that patients get what they need. Patient 2. Counselor Ida Jean Orlando’s Nursing Process Theory Interpersonal process alleviates distress. Leader 5. Nursing actions Joyce Travelbee’s Human To Human Relationship Model Therapeutic human relationships. Elements of nursing situation: 1. Surrogate 6. Teacher 4. Nurse reactions 3. Identification 3. Stranger 2. Orientation 2. until the nurse and patient attained rapport in the final stage. The four phases of nurse-patient relationships are: 1. Resource person 3. Resolution The six nursing roles are: 1. . 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. Peplau: Psychodynamic Nursing Theory Interpersonal process is maturing force for personality. Exploitations 4.Hildegard E. 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.

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

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

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

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

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

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

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

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

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

the stressor breaks through. 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. Thus. predict. or maintain optimal system stability” (Neuman. health (wellness) seems to be related to dynamic equilibrium of the normal line of defense. The person is a composite of physiologic. external. Neuman intends for the nurse to “assist clients to retain. Neuman defines illness as “a state of insufficiency with disrupting needs unsatisfied” (Neuman. sociocultural. and control biologic (physiologic and psychological) phenomenon. A person is constantly affected by stressors from the internal. 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. • • • • Stress/Adaptation Theory as a Framework • • • In contrast to systems theory. “Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences” (Neuman. attain. Stressors are tension-producing stimuli that have the potential to disturb a person’s equilibrium or normal line of defense. developmental. 2002). . 1996). disturbs the person’s equilibrium. The reaction may lead toward restoration of balance or toward death.• • • • • • • • • • 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. 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. This theory has been widely applied to explain. is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. psychological. Adaptation theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. or created environment. The person must adjust to environmental changes to avoid disturbing a balanced existence. 2002). and spiritual variables considered simultaneously. organized around stress reduction. 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. stress and adaptation theories view change caused by person–environment interaction in terms of cause and effect. and triggers a reaction. where stressors are successfully overcome or avoided by the flexible line of defense. This normal line of defense is the person’s “usual steady state.

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

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

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

a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium Peplau’s Concepts Environment. noise External influences can prevent. characteristics and attributes of person giving care First nursing theorist Unsanitary conditions posed health hazard (Notes on Nursing. 1859) 5 components of environment ventilation. cleanliness. warmth. productive. physical. Included everything. light.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. quiet to facilitate person’s reparative process Florence Nightingale. 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. good diet.• • • • • • • • • Degree of wellness or illness experienced by the person Nursing Actions. and social Maintaining well-being by using a person’s powers Maintained by control of environment Provided fresh air.Not defined . personal. warmth. and community living An individual. constructive. effluvia. psychological.

Deliberative Nursing Process The deliberative nursing process is set in motion by the patient’s behavior All behavior may represent a cry for help. therapeutic. 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. thought. 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. will. She must in a sense. or knowledge. Problems are in 3 categories physical. Fay Abdella. home.• Nursing o o A significant. Perception. 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. 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. sick or well. 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. feeling . And to do this in such a way as to help him gain independence as rapidly as possible. emotional. The nurse reacts to patient’s behavior and forms basis for determining nurse’s acts. or social needs The recipient of nursing care. get inside the skin of each of her patients in order to know what he needs". Did not discuss much Includes room.

External regulatory force that is indicated only when there is instability. Environment o • • Health o o Nursing Martha Rogers -Unitary Human Beings • Energy fields . A steady state is maintained through adjusting and adapting to internal and external forces. The person is a behavioral system comprised of a set of organized. and sociological factors. interactive. and integrated subsystems Constancy is maintained through biological. interdependent. psychological. rather than automatic Deliberative actions explore the meaning and relevance of an action.• • • • • Nurses’ actions should be deliberative. 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.

supporting or providing the environment to promote patient’s ability Wholly compensatory nursing system-Patient dependent Partially compensatory. 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 • • • . and infinite Unitary man and environmental field Energy fields are open. infinite. probabilistic.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.o o • • o o o • o • • Fundamental unity of things that are unique.care deficit occurs when the person cannot carry out self-care The nurse then meets the self-care needs by acting or doing for. open. dynamic. teaching. 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. and interactive Characteristic of energy field A wave that changes. 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.Patient can meet some needs but needs nursing assistance Supportive educative-Patient can meet self care requisites. increasing diversity of the human and envrionmental fields. guiding.

interaction. ideas. body image Socialization. development. perception.Adaptation Model • Five Interrelated Essential Elements Patiency.Adapting to change . perception. establish goals and take action to attain goals Each individual brings a different set of values. schools.o o o • o • • • • individual. perceptions to exchange The person is a complete system. self. 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 . time space. self. growth. peers Personal System Interpersonal o o Society The nurse and patient mutually communicate. time space. body image Interpersonal Society Individual. 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.Health Care Systems Model • • • • • • • • • • Normal line of resistance Normal adaptation state Flexible line of defense Protective barrier.The person receiving care Goal of nursing. communication and transaction Family. growth. work. attitudes. changing. development.

nurtured. 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). understood and assisted Society Complete physical.Health-Being and becoming a whole person Environment Direction of nursing activities.Philosophy and Science of Caring Watson’s 10 Carative Factors Watson’s Concepts Environment o Health o o Nursing Rosemary Parse . preventing illness Jean Watson . cared for. 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.Human Becoming Theory • Human Becoming Theory includes Totality Paradigm . respected.

Culture Care Diversity and Universality • • • • • Based on transcultural nursing. whose goal is to provide care congruent with cultural values.o • Man is a combination of biological. recover from illness. psychological. 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. beliefs. valuing. or face death help adapt to or negotiate for a beneficial health status. or face death Cultural care accommodation . complimentary to and evolving with Open process of being and becoming. 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. 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 . 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.

Evelyn. A. . Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. Appleton and Lange. 2nd Ed. Nursing theory utilization and application.).Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. 2002. Mosby.M. not borrow theories form other disciplines 2. Julia . Lippincott. Critically analyze theoretical frameworks Reference • • • • • • • Alligood M. 3rd ed. Lippincott Williamsand wilkins. Foundation of any profession is the development of a specialized body of knowledge. Theoretical Basis for Nursing Philadelphia. Theoretical Nursing : Development and Progress 3rd ed.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.• Cultural care re-patterning o help restructure or change lifestyles that are culturally meaningful Patricia Benner . Norwalk.The base for professional Nursing Practice . 2002. (5th ed. Lippincott. Alligood. Nursing theorists and their work. Responsibility of nurses to know and understand theorists 3. Philadelphia. Tomey AM. MR. Taylor Carol. Potter A Patricia.R. Philadelphia. Tomey. Theories should be developed in nursing. Philadelphia. Philadelphia. George B. McEwen Melanie (2002). London Mosby Year Book. Mosby. Nursing Theories. Wills M. Meleis Ibrahim Afaf (1997) .

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

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

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

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

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

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

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

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

It has been recognised that traditionally nurses are used to ‘speaking with their hands’ (Levine 1995). theory and practice are related. Perhaps this is because the majority of nursing theory is developed by and for nursing academics (Lathlean 1994). This makes it difficult for the majority of nurses to understand and apply theory to practice (Miller 1985). and if nursing is to continue to develop. Therefore. it will continue to develop in the footsteps of other disciplines such as medicine • • • • Summary • • • • • • • • • • • • • • • Conclusion: Reference: . nurses will continue to exhibit a caring response to the ‘sick and troubled’. However. nursing theory still means very little to most practicing nurses. perhaps nurses are ‘nursing’ without the knowledge of theories and theory is irrelevant. If this is true. the concept of theory must be addressed. If nursing theory does not drive the development of nursing. 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. a theory-practice gap still exists in nursing (Upton 1999).• • • It is important that the language used in the development of nursing theory be used consistently. Yet despite the availability of a vast amount of literature on the subject. many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory.

Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Philadelphia. 5. Nursing Theories. McEwen Melanie (2002). Meleis Ibrahim Afaf (1997) . Theoretical Nursing : Development and Progress 4. Norwalk. George B. Taylor Carol. 3rd ed.The base for professional Nursing Practice . Lippincott. 2. Potter A Patricia. London Mosby Year Book. practice and communication Allow the prediction of the consequences of care . definitions and propositions) that present a systematic view about a phenomenon and which is useful for description.Evelyn. prediction and control". UNDERSTANDING THE WORK OF NURSE THEORISTS ……… Creative Beginning Theories of Nursing • Theory is "an internally consistent group of relational statements (concepts. Wills M. Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. 3rd ed. Philadelphia. Lippincott. Theoretical Basis for Nursing Philadelphia. explanation. 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. Julia . 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. Appleton and Lange. Lippincott Williamsand wilkins.1. 3.

Provide a rationale for collecting reliable and valid data about the health status of clients. which are essential for effective decision making and implementation. Offer a systematic approach to identify questions for study. and validate nursing interventions. An illustration…… The germ theory • Explains the phenomenon of disease transmission . Makes to think differently about a problem or a situation Helps to try new approaches or altering behavior. and evaluation of nursing care. interpret findings. Ideas are developed and words defined. 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. • • Serve to guide assessment. • Enhance autonomy (independence and self-governance) of nursing by defining its own independent functions. • • Assist in discovering knowledge gaps in specific field of study. intervention. In education • Provide a general focus for curriculum design.• 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. explain. 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. select variables. and predict everyday experiences. • Guide curricular decision making In research • Offer a framework for generating knowledge and new ideas.

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

or concrete. or abstract. adaptation. especially direct sunlight Deficiencies in these five factors produced lack Of health or illness. • • Nursing. and powerlessness • nursing theories address and specify relationships among four major abstract concepts referred to as the metaparadigm of nursing. and significant others. rash. the internal and external surroundings that affect the client. the recipient of nursing care (includes individuals. Health. • Four concepts are considered to be central to nursing : • • Person or client. (b) indirectly observable. and actions of the nurse providing care on behalf of. or c) non-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 . Used as scientific rationale supporting judgments in nursing care plans. ideas such as equilibrium. the degree of wellness or well-being that the client experiences. stress. 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. characteristics. ideas such as pain and temperature. groups. ideas such as thermometer.• • • • • 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. or in conjunction with. families. Environment. and lesion. and communities). or inferential. the attributes. This includes people in the physical environment. friends. Concepts • Concepts may be (a) readily observable. such as families.

Roy’s adaptation model • Roy focuses on the individual as a biopsychosocial adaptive system that employs a feedback cycle of input (stimuli). and output (behaviors or adaptive responses). and providing an environment that promotes the individual’s abilities to meet current and future demands.• • • • • • • • Maintaining body temperature within normal range by adjusting clothing and modifying the environment. 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. . throughput (control processes). guiding. the reaction to it. Learning. teaching. and communities. Avoiding dangers in the environment and avoiding injuring others Communicating with others in expressing emotions. c) coordinate the human field with the rhythmicities of the environmental field. Watson’s human caring theory • Jean Watson (1979) believes the practice of caring is central to nursing. discovering. • Betty Neuman's model of nursing is applicable to a variety of nursing practice settings involving individuals. fears. and reconstitution factors that are dynamic in nature. Keeping the body clean and well groomed to protect the integument. families. Neuman’s systems model • The model is based on the individual’s relationship to stress. 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. 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. needs. • Nursing interventions related to human care are referred to as carative factors. 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. it is the unifying focus for practice. • Nurses applying Roger's theory in practice (a) focus on the person’s wholeness. both of which are infinite. (b) seek to promote symphonic interaction between the two energy fields (human and environment) to strengthen the coherence and integrity of the person. groups. supporting. or satisfying the curiosity that leads to normal development and health. King’s goal attainment theory • King’s theory offers insight into nurses’ interactions with individuals and groups within the environment.

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

aids in design. It enables the scientist to weave the facts together. analysis and interpretation. 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. Theory guides the research process. constructivism. Relationship between theory and research in nursing is not well understood. Theories from Nursing or Other Disciplines? . 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. It may be give to the relative youth of the discipline and debates over philosophical world views.

• • • 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. 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. Historical Overview of Research and Theory in Nursing • • • • • • • Florence Nightingale supported her theoretical propositions through research. Research and theory developed separately in nursing. Generate nursing diagnosis. for almost century reports of nursing research were rare. as statistical data and prepared graphs were used to depict the impact of nursing care on the health of British soldiers. 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 propose plausible approaches to health problems. Afterwards. Debate is whether the use of borrowed theory has hindered the development of the discipline. 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 . To develop or refine theories Define the concepts and proposed relationships between concepts. Between 1928 and 1959 only 2 out of 152 studies reported a theoretical basis for the research design. In 1990’s borrowed theories were used more. To interpret research findings To develop clinical practice protocols.

. It is inductive and includes field observations and phenomenology.Causal theory of planned behaviour Theory Generating Research • • • It is designed to develop and describe relationships between and among phenomena without imposing preconceived notations. 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. the researcher moves by logical thought from fact to theory by means of a proposition stated as an empirical generalization. During the theory generating process.

Implications are based on the explanatory power of a framework. • • • Theory as a conceptual framework • • • • • Problem being investigated is fit into an existing theoretical framework. observation. Data may be collected by interview. records or a combination of these techniques. 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. If a conceptual model is used as a theoretical framework for research it is not theory testing. collects data.• • • • • • • • • • • • Methodology – The researcher observes. organizes data and forms theory from the data at the same time. It requires a deductive reasoning process. Theory testing requires detailed examination of theoretical relationships. The interpretation determines whether the study supports are contradicts the propositional statement. which guides the study and enriches the value of its findings. Data are coded in preparation for analysis. A Typology of Research • • • • • • • Testing Analyzing Experimentation Deducting Deductive research Quantitative research The scientific method . Findings are interpreted in light of explanations provided by the framework. The conceptual definitions are drawn from the framework The data collection instrument is congruent with the framework. theoretical statements are translated into questions and hypothesis.

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

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

1966-The Nature of Nursing. 1996.• • • • • Since 1953. researcher. In 1978 the fundamental concept of nursing was revisited by Virginia Henderson from Yale University School of Nursing ( USA ). she has been a research associate at Yale University School of Nursing. In 1985.1991) Although she was retired. teacher. Harmer)-Textbook for the principles and practices of Nursing. 1956 (with B. 1996. Is the recipient of numerous recognitions for her outstanding contributions to nursing? VH was a well known nursing educator and a prolific author. Research and Education 1991. Miss Henderson was honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association.The Nature of Nursing Reflections after 20 years • Contribution • • • • • • Publications • • • . she was a frequent visitor to nursing schools well into her nineties. O’Malley (1996) states that Henderson is known as the modern-day mother of nursing. A definition and its implication for practice. She has received honorary doctoral degrees from the o o o o o Catholic University of America Pace University. she revised: Harmer’s classic textbook of nursing for its 4th edition. incorporating her personal definition of nursing (Henderson. edition. author. University of Rochester. Died: March 19. 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. Yale University Achievements • Her stature as a nurse. and later wrote the 5th. and consumer health advocate warranted an obituary in the New York Times. 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. University of Western Ontario.1991) In 1939. Friday March 22. 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.

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 . When any of these needs are unmet and when a person is unable to fulfill his own needs. 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. A developmental being. Nurses then provide the necessary functions and play those roles that could help patients meet their needs. disease Dependent on medical practice. the care provided by nurses is required. Patient Orientation Role of nurse Need Deficit Illness.Analysis of Nursing Theory • • • Images of Nursing. Conceptualizing functions led theorists to consider nursing client in terms of a Hierarchy of needs.

or to achieve peaceful death. complementary (working with the person).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. sick or well. She described the nurse's role as substitutive (doing for the person). She categorized nursing activities into 14 components. she worked as a visiting nurse in New York City. will or knowledge. she was concerned that many states had no provision for nursing licensure to ensure safe and competent care for the consumer. Then in 1955. p. she participated in the revision of a nursing textbook. to recover. the principles and practice or nursing must be built upon and derived from the definition of the profession. She called her definition of nursing her “concept” (Henderson1991) Although her major clinical experiences were in medical-surgical hospitals. 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. • • . based on human needs. the earlier ANA definition was modified. • • • • • The development of Henderson’s definition of nursing • • • • Two events are the basis for Henderson’s development of a definition of nursing. p. 15). 1966. 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. First. Although official statements on the nursing function were published by the ANA in 1932 and 1937. 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. Henderson viewed these statements as nonspecific and unsatisfactory definitions of nursing practice. Henderson's focus on individual care is evident in that she stressed assisting individuals with essential activities to maintain health. with the goal of helping the person become as independent as possible. And to do this in such a way as to help him gain independence as rapidly as possible" (Henderson. 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. 15). Second. supplementary (helping the person). her work is inductive. She was one of the first nurses to point out that nursing does not consist of merely following physician's orders. 1966. • • Furthermore.• • • Henderson’s concept of nursing was derived form her practice and education therefore.

Play or participate in various forms of recreation. Communicate with others in expressing emotions. Eliminate body wastes. In 1955. Breathe normally. 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. Mind and body are inseparable and interrelated. discover. Learn. or opinions. 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. Worship according to one’s faith. needs. Work in such a way that there is a sense of accomplishment. • • • Patients desire to return to health. Henderson’s theory and the four major concepts Individual • • • Have basic needs that are component of health. Requiring assistance to achieve health and independence or a peaceful death. . The first 9 components are physiological. Henderson’s first definition of nursing was published in Bertha Harmer’s revised nursing textbook. or satisfy the curiosity that leads to normal development and health and use the available health facilities.• • She proposed 14 components of basic nursing care to augment her definition. fears. Select suitable clothes-dress and undress. but this assumption is not explicitly stated. 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. Sleep and rest. Move and maintain desirable postures. Eat and drink adequately.

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

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

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.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.nursing and appropriate laws related to the practice of nursing. emotional balance. Nursing implementation Nursing process Henderson’s 14 components and definition of nursing Use the acceptable definition of . and physical and intellectual capacities. cultural background. Carry out treatment prescribed by the physician. 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 . age. recover from illness. Implementation based on the physiological principles. or to aid in peaceful death.

• • • • • • • • • • • • • • . culture. Theories should be relatively simple yet generalizable. Theories can be the bases for hypotheses that can be tested. Concepts of fundamental human needs. therefore. However. Her ideas of nursing practice are well accepted throughout the world as a basis for nursing care.. 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. Theories can be utilized by practitioners to guide and improve their practice.e. the impact of the definition and components has not been established through research. Her definition of nursing cannot be viewed as theory. it is impossible to generate testable hypotheses. nurse-patient relationship Theories must be logical in nature. Ideally the nurse would improve nursing practice by using her definition and 14 components to improve the health of individuals and thus reduce illness. concept of interactioncommunication i.E. discover. Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal. biophysiology.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. However some questions to investigate the definition of nursing and the 14 components may be useful. communication and is borrowed from other discipline. and interaction. 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. Her work can be applied to the health of individuals of all ages.g. Maslow’s Hierarchy of human needs.

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

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

Publications 4.• Deductively looking for the compatibility of a general nursing theory with nursing practice. Usefulness 12. McEwen Melanie (2002). Julia . Major four concepts 8. Nursing Theories. N George B. Nursing process with Henderson’s theory 9. 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. 14 components 7. Background 2. LWW. Achievements 3. 3rd ed. Norwalk. Theoretical Basis for Nursing . Assumptions 11. Analysis of Nursing theories 5. Abilities and Experiences • • Summary 1. Testability 13. Reference • • • Timber BK. Wills M. Appleton & Lange. Development of Henderson’s definition of nursing 6. Comparison with Maslow's Hierarchy need 10.Evelyn. Fundamental skills and concepts in Patient Care. 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. 7th edition. Her definition of nursing and the 14 components of basic nursing care are uncomplicated and self-explanatory. Henderson provides the essence of what she believes is a definition of nursing. Characteristics 14. imitation Conclusion In conclusion. She didn’t intend to develop a theory of nursing but rather she attempted to define the unique focus of nursing.The base for professional Nursing Practice .

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

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

9. 11. 3. 4. 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.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. 2. 8. Abraham Maslow's and Neal Elger Miller Identified four sequential phases in the interpersonal relationship: 1. 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 . 6. 7. Orientation 2. Identification 3. 10.conveys needs .asks questions. shares preconceptions and expectations of past experiences .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. 5. 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 . Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way 1.

• Nurse responds.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 . 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 . explains roles to client.

Leads to adaptability in any nurse patient relationship.• • • Both are sequential and focus on therapeutic relationship Both use problem solving techniques for the nurse and patient to collaborate on. Theories must be logical in nature Provides a logical systematic way of viewing nursing situations Key concepts such as anxiety. environment and nursing. 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. goals. tension.health. . 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 . 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. The nurse patient interaction can apply to the concepts of human being . Four phases interrelate the different components of each phase.

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

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

to families. intellectual competencies.C . Department of Health and human services. nursing is based on an art and science that mould the attitudes. education for advanced practice in nursing and nursing research. and technical skills of the individual nurse into the desire and ability to help people . influenced by the desire to promote client-centred comprehensive nursing care. pioneer nursing researcher. Abdellah described nursing as a service to individuals. D.nursing includes.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. therefore to.S Public Health Service . sick or well. cope with their health needs. As a comprehensive service . and. nursing care and nursing education Birth:1919 Dr Abdellah worked as Deputy Surgeon General Former Chief Nurse Officer for the U. • • • 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. to society. In 1960. helped transform nursing theory. Washington.

changing nursing education 5. 3. in 1973. pollution. development of nursing leaders from under reserved groups 5. 3. The need to appreciate the interconnectedness of social enterprises and social problems. Assumptions were related to 1. 2. it also has relevance for nursing care in community settings. racism. She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses’ prerogative. ‘he’ for doctors and patients.• • • • • • • 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. The language of Abdellah’s framework is readable and clear. The theory was created to assist with nursing education and is most applicable to the education of nurses.“providing continuous care of the individual’s total health needs” was eliminated. education. 4. the item 3. continuing education for professional nurses 6. . state. Abdellah’s theory was derived. she uses the term ‘she’ for nurses. 4. From these premises. • • • • • 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. As result. change and anticipated changes that affect nursing. Consistent with the decade in which she was writing. CONCEPTS & RELATIONSHIPS 1. Abdellah and colleagues developed a list of 21 nursing problems. 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. 2. . MAJOR ASSUMPTIONS. Although it was intended to guide care of those in the hospital. and so forth on health care delivery. the impact of problems such as poverty. and refers to the object of nursing as ‘patient’ rather than client or consumer.

Problem-solving 9. injury. Validate the patient’s conclusions about his nursing problems 7. or other trauma and through the prevention of the spread of infection .6. Skills of communication 3. Observation of health status 2. 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. Make generalizations about available data in relation to similar nursing problems presented by other patients 4. Test generalizations with the patient and make additional generalizations 6. They also identified 10 steps to identify the client’s problems 7. Planning and organization of work 6. 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. Identify the therapeutic plan 5. sociological. Therapeutic use of the self 11. Teaching of patients and families 5. Identify how the nurses feels about the patient’s nursing problems 10. Discuss and develop a comprehensive nursing care plan 11 nursing skills 1. Direction of work of others 10. Learn to know the patient 2. Use of resource materials 7. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior 8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan 9. Application of knowledge 4. rest and sleep To promote safety through the prevention of accidents. Use of personnel resources 8. Sort out relevant and significant data 3.

emotional. 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. rather than a theory describing relationships among phenomena.• • • • • • • • • • • • • • • 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. with a focus on disease and cure. 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 . feelings. from the practice of medicine. 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. nursing problems. and problem solving. 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. the theory distinguished the practice of nursing. In this way. with a focus on the 21 nursing problems. 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.

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 . which the nurse can assist him or them to meet through the performance of her professional functions. while leaving the client somewhere in the middle. by the patient or family. cope with their health needs. sick or well. and technical skills of the individual nurse into the desire and ability to help people. formulating hypothesis. nursing is based on an art and science that mould the attitudes. from the disease orientation to nursing orientation. The problem solving process involves identifying the problem. The problem can be either an overt or covert nursing problem. The covert nursing problem is a concealed or hidden condition faced. testing hypothesis through the collection of data. selecting pertinent data. she seems to swing the pendulum to the opposite pole.• Acc to her. HEALTH • NURSING PROBLEMS • • • • PROBLEM SOLVING • COMPARISON WITH OTHER THEORIES MASLOW HENDERSON ABDELLAH . intellectual competencies. 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. and revising hypothesis where necessary on the basis of conclusions obtained from the data. An overt nursing problem is an apparent condition faced by the patient or family.

Eat and drink adequately Physiological needs 3. To facilitate the maintenance of nutrition of all body cells 3. To facilitate the maintenance of a supply of oxygen to all body cells 2. To maintain good body mechanics and prevent and correct deformities 6.To facilitate the maintenance & love needs others of effective verbal and non verbal communication 11. To facilitate the maintenance of sensory function Belongingness10. Keep body clean and7. To facilitate progress toward achievement of personal spiritual goals . Maintain body temperature 1. Eliminate by all avenues of elimination 4. Select suitable clothing 7. Communicate with 11. To maintain good hygiene and physical comfort 9. To facilitate the maintenance well groomed & of regulatory mechanisms protect the and functions integument 8. To facilitate the maintenance of fluid and electrolyte balance 4. Move & maintain desirable posture 5. rest and sleep 8. To promote optimal activity: exercise . Sleep & rest 6. To promote the development of productive interpersonal relationships 13. Worship according to faith 12. or other trauma and through the prevention of the spread of infection 10. To facilitate the maintenance of elimination 5. Safety needs Avoid environmental dangers & avoid injuring others 9. To promote safety through the prevention of accidents. injury. Breathe normally 2.1.

18. To recognize the recreation physiological responses of the body to disease 14. She considers nursing to be comprehensive service that is based on art and science and aims to help people. emotional. In Abdellah’s model. nursing care is doing something to or for the person or providing information to the person with the goals of meeting needs. Work at something14. 21. 19. • • Person . Self actualization needs ABDELLAH’S THEORY AND THE FOUR MAJOR CONCEPTS Nursing • Nursing is a helping profession. To accept the optimum providing a sense of possible goals in the light of accomplishment limitations. discover. 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. To identify and accept positive and negative expressions. cope with their health needs. 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.Esteem needs 12. feelings. or alleviating impairment. increasing or restoring self-help ability. Nursing is broadly grouped into the 21 problem areas to guide care and promote use of nursing judgment. physical and emotional 13. 20. sick or well. Learn. or conditions satisfy curiosity 16. Play or participate in various forms of 15.

• Abdellah describes people as having physical. Although Abdellah does not give a definition of health. This is true when considering • Characteristic2 • • Characteristic 3 Characteristic4 • Characteristic5 • Characteristic6 • . 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. 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. nursing problems. Society is included in “planning for optimum health on local. and international levels”. she speaks to “total health needs” and “a healthy state of mind and body” in her description of nursing as a comprehensive service. or covert. • • • • • Health Society/Environment • • ABDELLAH’S WORK AND CHARACTERISTICS OF A THEORY Characteristic1 • Abdellah’s theory has interrelated the concepts of health. Individuals (and families) are the recipients of nursing Health. or achieving of it. Problem solving is an activity that is inherently logical in nature Framework seems to focus quite heavily on nursing practice and individuals. Patient is described as the only justification for the existence of nursing. as she further delineated her ideas. 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. is the purpose of nursing services. and sociological needs. Abdellah describes health as a state mutually exclusive of illness. In Patient –Centered Approaches to Nursing. national. the focus of nursing service is clearly the individual. consisting of largely physical needs. state. These needs may overt. emotional. The environment is the home or community from which patient comes. such as emotional and social needs. However.

Therefore. Thus. respectively. then it becomes reasonable to conclude that these goals are basically nursing goals. the goals have been established. a plan is developed and appropriate nursing interventions are determined. This step is consistent with that involved in nursing diagnosis The statements of nursing problems most closely resemble goal statements. not the client goals. tachycardia and profuse diaphoresis • • Stage of illness is basic to care Selected Abdellah nursing problem . A principle underlying the problem solving approach is that for each identified problem. once the problem has been diagnosed. 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. According to the American Nurses’ Association Standards of Nursing Practice. The overt or covert nature of the problems necessitates a direct or indirect approach. These specific problems would be grouped under one or more of the broader nursing problems. The results of data collection would determine the client’s specific overt or covert problems. the plan is evaluated in terms of the client’s progress or lack of progress toward the achievement of the stated goals. Using the goals as the framework. pertinent data are collected. 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. the most appropriate evaluation would be the nurse progress or lack of progress toward the achievement of the stated goals. 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.

Amount of pain CONCEPT OF PROGRESSIVE PATIENT CARE 1. Direct and indirect method Selected Nursing Interventions administer oxygen elevate headrest reposition client administer prescribed analgesic remain with client Criterion measure. in nursing homes. services and staff around the changing medical and nursing needs of the patient 2. nursing observation are assigned to the ICU.• • • • • • • • • • To maintain good hygiene and personal comfort Classification and approach Overt problem of pain. PPC is defined as better patient care through the organization of hospital facilities. 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. 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. close and frequent if not constant. 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 . PPC is tailoring of hospital services to meet patients needs 3. PPC is caring for the right patient in the right bed with the right services at the right time 4.

In the intensive care unit.• • • • • • • • • • • • • • • • • • • 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. 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 • • • • . not of an emergency nature. who are ambulatory for short periods. These patients are under the constant audio-visual observation of the nurse. the critically ill patients are concentrated regardless of diagnosis. 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. The three month assignment of professional nurses may no longer be realistic in such a setting.

Abdellah’s publications on nursing education began with her dissertation. 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. nursing problems. This unit serves as a link between the hospital and the home.. 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.accommodations. education for advanced practice in nursing and nursing research. The grouping of such patients will permit staffing patterns that are less costly Home care. It is anticipated that by solving the nursing problems. the client would be moved toward health. 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. nursing research. 21 nursing problems were developed Abdellah’s theory provides a basis for determining and organizing nursing care. The nurse’s philosophical frame of reference would SUMMARY • • CONCLUSIONS • . 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. and problem solving. the fifth element of progressive patient care. her interest in education for nurses continues into the present. with impetus for it being nursing education. Cont… Abdellah has also published on nursing. She has been a leader in nursing research and has over one hundred publications related to nursing care. 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. From this framework. The problems also provide a basis for organizing appropriate nursing strategies.

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

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

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

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

She adds the following three elements: • A high level of overall physical. Health • Watson believes that there are other factors that are needed to be included in the WHO definition of health. in general a philosophical view of a person as a fully functional integrated self. • 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. A general adaptive-maintenance level of daily functioning The absence of illness (or the presence of efforts that leads its absence) Environment/society . • Existential psychology is the study of human existence using phenomenological analysis. the sum of his or her parts”. • Thus the nurse assists the person to find the strength or courage to confront life or death. anorexia and gastro-intestinal ulcers are a just few of the disorders that indicate a complex interaction between the physiological and psychological. 10. Allowance for existential-phenomenological forces • Phenomenology is a way of understanding people from the way things appear to them. 2. Watson’s theory and the four major concepts 1. He. understood and assisted. human is viewed as greater than and different from..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. Human being • She adopts a view of the human being as: “…. 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. from their frame of reference. mental and social functioning • • 3. respected. a valued person in and of him or herself to be cared for. nurtured. According to Watson.

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

• 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 describes caring in both philosophical and scientific terms. • 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. The core of the nursing is that which is intrinsic to the nurse-client interaction that produces a therapeutic result. Watson also indicates that needs are interrelated. • An example is her work in the area of loss and caring that took place in Cundeelee. • She discusses this in the preface of her book when she speaks of the “trim” and the “core” of nursing. the procedure and the techniques. 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 defines trim as the clinical focus. 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. Western Australia and involved a tribe of aborigines. • 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.• • • • • • 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. Its purpose is to describe the phenomena. laws and principles but will leave open unanswered questions that need to be investigated • • • . • The theory is simple relatively but the fact that it de-emphasizes the pathophysiological for the psychosocial diminishes its ability to be generalizable. 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. 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. 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. 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.

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

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

• 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. and her M. • 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 . • She also stated that nursing was “concerned with man as an integrated whole and this is the specific knowledge of order we require”. • Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Johnson has stressed the importance of research-based knowledge about the effect of nursing care on clients. N.P. B. from Harvard University in Boston in 1948. 1919. in 1942. Throughout her career. Johnson was born August 21. an associate professor of nursing.H. Tennessee. 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. S.JOHNSON’S BEHAVIOUR SYSTEM MODEL Introduction • Dorothy E. and a professor of nursing at the University of California in Los Angeles. 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. Georgia. from Vanderbilt University in Nashville. 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". 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.Chin and Rapport) there are 4 assumptions of system: • • . in Savannah. • From 1949 until her retirement in 1978 she was an assistant professor of pediatric nursing.

” 1. The final assumption states “system balance reflects adjustments and adaptations that are successful in some way and to some degree.” Assumptions about structure and function of each subsystem 2.1. 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. Each subsystem must be “nurtured” through the input of appropriate supplies from the environment. events and situations in his environment. These behaviors are “orderly. in certain ways rather than the other ways”. 4. 1. System must be “protected" from noxious influences with which system cannot cope”. Each subsystem has three functional requirements 2. 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. interdependency and integration of the parts and elements of behaviors that go to make up The system ” 2. A behavioral system. which both requires and results in some degree of regularity and constancy in behavior. both in social life and for the individual. it is functionally significant in that it serves a useful purpose. interaction. purposeful. Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation Johnson believes each individual has patterned. 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.” 3. 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. “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. A system “tends to achieve a balance among the various forces operating within and upon it'. 2. This predisposition is called as “set”. 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. First assumption states that there is “organization. is essential to man that is to say. Each subsystem has a repertoire of choices or “scope of action” 1. 4. 3. purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation” Johnson’s Behavioral Subsystem . Each individual has a “predisposition to act with reference to the goal. events and situations in his environment.

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

the nurse should be able to observe the return to the previous behavior patterns.1. Ingestion 7. Smith never looks at Johnny and never speaks to him. 2. If the alterations in the behavior that are planned do occur.to bring about homeostasis in a subsystem. the nurse may have goal for the individual to return to the baseline behavior. 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. . Assessment 1. Affiliation 2. Sexuality 4. Discrepancy 3. If the baseline data are available for an individual. The plan may include protection. His mother holds him in her arms without trunk to trunk contact. based on nursing assessment of the individuals drive. 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. Dependency 3. She says. Insufficiency ingesion subsystem. these plan than have a goal . As the assessment is made the nurse notes that Mrs. nurturance or stimulation of the identified subsystem. and observable behavior. set behavior. her mother told her she was not a good mother because John is not gaining weight like he should. Situation John Smith. Incompatibility 4. Achievement 8. Affiliative subsystem between mother and John. Grubb has proposed 4 categories of nursing diagnosis derived from Johnson's behavioral system model: 1. 4. the plan will focus on nurses actions to modify clients behavior. Evaluation Evaluation is based on the attainment of a goal of balance in the identified subsystems. Aggression 5. Insufficiency 2. He presents with no weight gain since his check up at the age of 2 weeks . He sleeps 4to 5 hour between the feedings. repertoire. with the nurse determining the clients needs and state behavior appropriate for that need. Affiliative subsystem between Mrs.Smith and her mother. Restorative Diagnosis Diagnosis tends to be general to the system than specific to the problem.His mother stated she feeds him but he does not seem to eat much. Elimination 6. 6 weeks brought into the clinic for a routine check-up. She stated he was a planned baby but that she never realized how much work a baby could be. Johnson's behavioral model with the nursing process is a nurse centered activity. Dependency subsystem between mother and John 3.

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

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

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 1957 Completed her Doctorate from Teacher’s college. 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.

growth & development will be enhanced If role expectations and role performance as perceived by nurse & client are congruent. Human being /person: is social being who are rational and sentient. stress. Person has ability to : -perceive -think -feel -choose -set goals -select means to achieve goals -and to make decision According to King. interpersonal relationship in which a person grows and develops to attain certain life goals. Major concepts of king’s theory 1.• • • • 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. stress in nurse-client interaction will occur If nurse with special knowledge skill communicate appropriate information to client. which includes: • • • • • • • • If perceptual interaction accuracy is present in nurse-client interactions. goal will be attained If goal are attained. human being has three fundamental needs: . mutual goal setting and goal attainment will occur. Factors which affects the attainment of goal are: roles. Theory describes a dynamic. satisfaction will occur Proposition cont… If transactions are made in nurse-client interactions. transaction will occur If nurse and client make transaction. 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. transaction will occur If role conflict is experienced by nurse or client or both.

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

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

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

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

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

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

Spiritual. Psychological. PREVENTION • According to Neumann’s model. 2002). 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. 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. 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.Refers to the influence of spiritual beliefs. Primary prevention occurs before the system reacts to a stressor. Primary prevention includes health promotion and maintenance of wellness. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. Developmental. and social/cultural expectations and activities.Refers to mental processes and emotions. Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing system. Socio-cultural.Refer of the physicochemical structure and function of the body.Refers to those processes related to development over the lifespan. Each layer consists of five person variable or subsystems: o o o o o Physiological. Tertiary prevention occurs after the system has been treated through secondary prevention strategies. 2002).o o Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution. prevention is the primary nursing intervention.Refers to relationships. On the one hand. • ENVIRONMENT . the outcome may be death (Neuman.

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

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

• • • • • • • • • • • 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. 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. 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 . 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. age. gender or challenges of illness experiences Example: The response to weakness of cardiac muscle is an increased heart rate. dilation of ventricle and thickening of myocardial muscle While the responses are same. structure and personal and social integrity Every individual has a unique range of adaptive responses The responses will vary by heredity. economic.

• A unique individual in unity and integrity. believing. micro-organism and pollution Conceptual: Part of person's environment including cultural patterns characterized by spiritual existence. 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. feeling. values. 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. 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 . ideas.

most primitive response 2. 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 .reflects.• • • • 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. Stress: Response developed over time and influenced by each stressful experience encountered by person 4.condition and situation Human being sense . Inflammatory: response intended to provide for structural integrity and the promotion of healing 3. Flight or fight: An instantaneous response to real or imagined threat. 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. 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 .

using interventions. those related to the conservational principles Theories can be the bases for hypotheses that can be tested.• • • • 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.they are combined to look at nursing care in a different way (more comprehensive view incorporating total patient care) form previous time. Levine’s idea can be tested Hypothesis can be derived from them . and the evaluation of nursing interventions are interrelated .e. Levine’s idea about nursing care are organized in such a way as to b sequential and logical. 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. 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. 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 • • • • • • • • • • • • • • • . Levine’s theory is easy to use . Theories must be logical in nature. Since Levine’s idea have not yet been widely researched .

an ethnic group. Conservation of social integrity • An individual is recognized as some one who resides with in a family.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.a religious group. 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.• • Theories can be utilized by the practitioner to guide and improve their practice. a community . a political system and a nation Example: • • Position patient in bed to foster social interaction with other patients Avoid sensory deprivation . respect. Levine’s ideas seem to be consistent with other theories. selfhood and self determination Example: Recognize and protect patient’s space needs 4. Conservation of personal integrity • Recognizes the individual as one who strives for recognition. nutrition and exercise • • • Conservational Principle • • • • • • 1. self awareness. Conservation of energy Example: availability of adequate rest Maintenance of adequate nutrition 2. laws and principles but will leave open unanswered questions that need to be investigated . Paula E. 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.

always practiced and studied in concert with all of the disciplines that together from the health sciences" The human interaction relying on communication .it is return to daily activities. 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 • • .• • • • Promote patient’s use of news paper. 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.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. radio. TV Provide support and assistance to family Health is a wholeness and successful adaptation It is not merely healing of an afflicted part . magazines. reads medical reports.

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.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 . plan is revised. acute or long term care unit Theory of therapeutic intention • • • • • • • • • Uses • Theory of therapeutic intention .

operational and conceptual environment Pond used conservation model for guiding the nursing care of homeless at a clinic. 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. shelters or streets Utility of Theory • • • • • • • • • Nursing process according to Levine’s model .Francis de sales.• • • • • • • • • • • Neonates. 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.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.

a wife of an abusive husband. loss of reproductive ability Challenges to the external env:-abusive husband. nausea. Mona. 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 and inability to empty bladder .Mrs. nausea . Post operatively has pain . insanitary condition in home Energy conservation:-weight loss.weight loss.pain Structural integrity:-threatened by surgical procedure. 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.Patient has history of smoking and stays in house which is less than sanitary Assessment • • • • • • • • • • • • • • • • Challenges to the internal env:-weight loss.

Conservation principles 2. Nursing science quarterly. 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.• • • • • • • • • • • Controlled pain Abdominal wound healing Improved appetite .2004 Jul.and if the perception of nurse and patient about the patient ability to participate in care don’t match. well or sick Values patient’s participation in nursing care Comprehensive content in depth Provides direction of nursing research . Assessment 2. education. Nursing process 1.17 (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. Nurse has the responsibility for determining the patient ability to participate in the care . The major limitation is the focus on individual in an illness state and on the dependency of patient. this mismatch will be an area of conflict. Critiquing the theory Limitation • • • Research Highlights • Summary • • • • • • Introduction to the theorist Conservational model Concept of the model Adaptation Wholeness Conservation 1. A theory of health promotion for preterm infants based on conservational model of nursing. Trophicogosis .weight gain Clean urinary self catheterization Assistance from husband She values the holistic approach to all individual.

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

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

The purpose of nurses is to promote health and well-being for all persons wherever they are.• • • • Doctorate in nursing :Johns Hopkins University. New York University. The irreducible nature of individuals is different from the sum of the parts. Consultant. Speaker Died : March 13 . lies in the phenomenon central to its focus. 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. Baltimore.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 . like that of any other science. Division of Nursing. irreducible. the uniqueness of nursing. 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 . 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. 1994 Theoretical basis of nursing (Rogers 1970) Nursing science and art :a prospective (Rogers 1988) Nursing :science of unitary. 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. 1954 Fellowship: American academy of nursing Position: Professor Emerita.

Manifestation emerge from this field and are perceived.environment. 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. indivisible. describing. and pan dimensionality Basic concepts include unitary human being . 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 . pattern.pan dimensional energy field identified by pattern and integral with the human field" The field coexist and are integral. density. openness. The present is relative . Unitary Human Being (person) A unitary human being is an "irreducible. 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 .• • • The identification of the pattern provide knowledge and understanding of human experience Basic characteristics which describes the life process of human :energy field. 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. Health • .there is no temporal ordering of lives.

. 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……….the imaginative. simultaneous interaction of the human and environmental fields" Health and illness are the part of the sane continuum. 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 .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…….• Rogers defined health as an expression of the life process. but continuous. they are the "characteristics and behavior emerging out of the mutual. 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.

continuous relationship of the human energy field and the environmental field . 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 . 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. déjàvu. Irreducible. 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. 1986) Theory of creativity. and other rhythmic development The perspective rhythm model (Patrick 1983) Theory of health as expanding consciousness (Neumann. clairvoyance. 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. 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 . telepathy. simultaneous interaction with a four dimensional world.• The principle of Helicy postulates an ordering of the humans evolutionary emergence Integrality cover the mutual. perception of time passing.psychological rhythm) Theory deals with the manifestations of the whole unitary man as changes in human sleep wake patterns. and therapeutic touch Clairvoyance is rational in a four dimensional human field in continuous mutual. indices of human field motion.

nursing diagnosis. Professional practice in nursing seeks to promote symphonic interaction between man and environment. intervention. nursing education.as life continuous to evolve from earth to space and beyond. 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. 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. music. to help people move toward better health Nursing aims to assist people in achieving their maximum potential. Maintenance and promotion of health. meditation focusing on health potential of the person. 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. humor. 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. use of color. research. but with special relevance for nurses. prevention of disease.including future generation of space kind . such as therapeutic touch. participates in the process of change . to strengthen the coherence and integrity of the human field.• • • 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 . supportive psychotherapy motivation for rehabilitation. consequently to nurses In the evolution it is properly subjected to reformulation and change as the knowledge grows. because it matters to human beings. light. 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. guided imagery.

learning strategies .• Study participants may be any person or group. 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. 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 . Helicy.

community across the life span .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 .the lab setting include homes. industry. actualization. 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 . 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. clinics.• 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. schools. industry. family. space (by 2050AD) Independent practitioner is an advanced practice registered registered nurse who focus on well-being or mutual patterning of individual. hospitals. community.

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. dissonance. 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. exchange. rhythms. 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 .

From past 3 weeks Radha started sitting lonely. decreased ADL.cries inconsolably …on repeated asking expressed sadness of mood Nursing care of Radha with Rogers model • • • • • • With rogerian model. when asked about her illness…. ovarian malignancy..her general appearance is a teary eyed young woman . not talking…. pain Radha has a low educational background A pattern activity of healing is noted through reports of a positive operative course . repeated crying spells. neglecting her child care. and evaluation Pattern appraisal This visible rhythmical pattern is a manifestation of evolution towards dissonance Radha has pattern manifestation of dissonance…….looking perplexed. mutual patterning.…………. the process of caring Radha begins with pattern appraisal Nursing care involve pattern appraisal. muttering to self. appetite.poor nutritional intake. decreased talks.ill-kempt.. decreased sleep . complaints of severe pain in the body.3 days back attempted suicide by consuming rat poison. clinging to her husband . neglects hygiene. Current assessment findings …….• • • • 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…….depression with suicidal ideation.

• • • • • • • • • • • • • • • • • • • • • • • • 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 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. 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. 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. pain. fear. humor . meditation. medication she is receiving are patterning modalities Patterning activities planned by the nurse for Radha …….therapeutic touch.her self knowledge links her illness to her personal belief of being punished for her past sins Appraisal is needed in her sleep patterns. 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.. and mutual patterning is modified or instituted ad indicated based on the evaluation . communication patterns. nutrition and her perception of self Appraisal can be grouped into exchanging patterns. helps in energy transmission for healing and …….

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

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) . goals. 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. needs. past experiences and perceptions.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 .

MAJOR ASSUMPTIONS Nursing · Observable behaviour · In health care system in society · Goal – to help individuals maintain health · Interpersonal process of action. 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. 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 . patient. physicians. reaction.

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. out puts. control and feedback process.• • 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. goals. Adaptational level · a constantly changing point. made up of focal. contextual and residual stimuli · represent the persons own standard of the range of stimuli. 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 . 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.

reproduction and mastery. information · processing. learning · judgment and emotion Adaptive (effector) modes · classification of ways of coping · manifests regulator and cognator activity · physiologic. growth.Regulator · subsystem coping mechanism · responds automatically through neural-chemical-endocrine processes Cognator · subsystem coping mechanism · cognitive – emotive process · responds through · perception. self concept. role function and interdependence Adaptive responses · Promote integrity of the person in terms of the goals of survival. 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 .

complex. that is. 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 . 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. 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. outputs and control and feedback processes input.* 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. • 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. 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. 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. the pooled effect of the focal.

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

.and developmental environment Human being – has the capacity to reflect .Continues to develop her theory after her retirement in 1984 Definitions of domain concepts Nursing – is art. 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 .includes that which makes a person human. a helping service.…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 .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. 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 .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. A human being is the focus of nursing only when a self –care requisites exceeds self care capabilities Nursing problem – deficits in universal.control .symbolize and use symbols Conceptualized as a total being with universal . developmental. conditions . and health derived or health related conditions Nursing process.a system to determine (1)why a person is under care (2)a plan for care .developmental needs and capable of continuous self care A unity that can function biologically.(3)the implementation of care Nursing therapeutics– deliberate . symbolically and socially Nursing client.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 :-- .environmental elements.

or disease . adjusting to a new job adjusting to body changes Health deviation self care Required in conditions of illness . food Provision of care assoc with elimination process Balance between activity and rest.injury. Or associated with an event E.health and well being Self care agency – is a human ability which is "the ability for engaging in self care" -. 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….water.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 . ADL Identifies these requisites as: Maintenance of sufficient intake of air .Self care – practice of activities that individual initiates and perform on their own behalf in maintaining life .Conditioned by age developmental state.g. 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 .

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 . 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 .with or without use of materials or instruments Categories of technologies Social or interpersonal Communication adjusted to age.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 .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 . the patient. health status Maintaining interpersonal .

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. 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. 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 . 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 . Process Diagnosis and prescription . 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.determine why nursing is needed. The steps within the approach are considered to be the technical component of the nursing process.collecting evidence in evaluating results achieved against results specified in the nursing system design ..life style.

Actions are directed by etiology component of nursing diagnosis evaluation Application of Orem’s theory to nursing process Personal factors 29 yr. Environmen t unclean Limited resources EDU deprivation Oppressive living conditions Will receive RT .perform intermittent catheterizatio n Therapeutic self care demand Adequacy of self care agency Nursing diagnosis Methods of helping . 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.

psy support Dev deficit r/t loss of reproductive organs .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. R/T early parenthood Guiding & directing Providing psy support Inadequate Level of education Providing physical.

alterations in health status P/F UTI Guiding & directing.Maintenance of health status Management of disease process Inadequate Inadequate P/F contd. teaching Guiding & directing. 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 .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 .

Throughout her work . Theoretical Basis for Nursing Philadelphia. Retrieved October 31.thing Health is often viewed as dynamic and ever changing . S. Julia .E. Tomey.nursing education administration . St. Potter A Patricia.M. Dorthea E. Significance of theory for nursing as a discipline and profession.). nursing and society . & Alligood.Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. A. In A. G. Mosby. George B. . 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 . Missouri. Lippincott Williams& wilkins. Taylor. Nursing: Concepts of practice (4th ed. (2006).G. (1991). Philadelphia.she interprets the concepts of human beings. London Mosby Year Book.The base for professional Nursing Practice . Nursing Theories.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 . Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. Theoretical Nursing : Development & Progress 3rd ed.The theory has been used as a conceptual framework in assoc.education and administration References • • • • • • • • • Orem. Louis. Norwalk. United States of America. Wills M. McEwen Melanie (2002). Appleton & Lange. St. Whelan. Taylor Carol. Meleis Ibrahim Afaf (1997) . Lippincott. M. Lippincott. Philadelphia.and has defined 3 steps of nursing process It has a broad scope in clinical practice and to lesser extent in research .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 .Evelyn. 2006. MO: Mosby-Year Book Inc. 3rd ed. (1984). D. Analysis and application of Dorothea Orem’s Self-care Practuce Model. Louis. Nursing Theorists and their work. (2002). E. health. Orem: Self-care deficit theory of nursing.

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

"Nursing accepts the humanistic approach of valuing other persons’ opinions. The person is a bio-psycho-social being.adaptive system Environment -. Health and illness are inevitable dimensions of the person’s life. The person has 4 modes of adaptation: physiologic needs. 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. Published these ideas in "Nursing outlook" in 1970 Subsequently different components of her framework crystallized during 1970s. To respond positively to environmental changes .goal of nursing Person -. A state of adaptation frees an individual’s energy to respond to other stimuli. psychological and social in origin. role function and inter-dependence. Adaptation -.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.the person must adapt.stimuli Health -. 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.outcome of adaptation Nursing -. and ’90s Over the years she identified assumptions on which her theory is based. self. person uses both innate and acquired mechanisms which are biological. Patient’s values and opinions are to be considered and respected. To cope with a changing world.concept. Nursing is based on causality.promoting adaptation and health Responding positively to environmental changes Explicit assumptions (Roy 1989. The person is in constant interaction with a changing environment. Roy and Andrews 1991) Implicit assumptions • • • • • • • • • • Roy Adaptation Model Concepts: Early and Revised Concepts-Adaptation .

chemical. circumstances. Regulator subsystem — a basic type of adaptive process that responds automatically through neural. judgment and emotion. learning.• The process and outcome of individuals and groups who use conscious awareness. thus contributing to health. and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources. quality of life. 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.internal or external and immediately confronting the person Contextual. 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. 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. communities. and society as a whole Concepts-Environment Focal .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. organizations.

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. usefulness. 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. and faith Scientific Assumptions for the 21st Century • • • • • • • • • • • • • Philosophical Assumptions . protection.• • • • • • • Self Concept Role Function Interdependence Four Adaptive Mode Categories Tested in practice for 10 years Criteria of significance. enlightenment.

sustaining. nations. 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. higher levels of adaptation and transcendence Role transition. families. organizations.• Persons are accountable for the processes of deriving. communities. and transforming the universe Includes relating persons. partners. growth in a new role Compromised Processes .

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 • • . 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.• • • • • • • • • 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.

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

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

Therefore. 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 .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 . MAJOR DIMENSIONS OF THE THEORY Function of professional nursing . relieving. it is focused on the process of care in an immediate experience.is responsive to individuals who suffer or anticipate a sense of helplessness.organizing principle Presenting behavior .internal response Nursing process discipline – investigation Improvement .problematic situation Immediate reaction . thoughts about the perception. The patient's presenting behavior may be a plea for help. it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding.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 .It then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records. This process helps nurse find out the nature of the distress and what help the patient needs.resolution FUNCTIONS OF PROFESSIONAL NURSING – ORGANIZING PRINCIPLE Finding out and meeting the patients immediate needs for help Nursing…. however. nurses need to use their perception. 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. the help needed may not be what it appears to be. or the feeling engendered from their thoughts to explore with patients the meaning of their behavior.

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 . 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.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 presenting behavior of the patient. does add to the distress of the patient Patients are unique and individual in their responses . in its professional character . 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 . causes an automatic internal response in the nurse. regardless of the form in which it appears. they become distressed with feelings of helplessness Nursing .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. may represent a plea for help The presenting behavior of the patient. the stimulus.

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. for avoiding. 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….Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child Nursing deals with people. 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. thoughts and feelings The nurse – patient situation is dynamic. environment and health Patient need help in communicating needs. increase in ability. 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 . 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. Sense of comfort Environment – not defined directly but implicitly in the immediate context for a patient Human being – developmental beings with needs.. they are uncomfortable and ambivalent about dependency needs Human beings are able to be secretive or explicit about their needs. relieving. adequacy in better care of self and improvement in patients behavior Health – sense of adequacy or well being . perceptions. Fulfilled needs.

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.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. 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 .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. laws. Indirect function – calling for help of others . matching of thoughts and feelings with action Automatic activities – perception by five senses. whatever help the patient may require for his need to be met Nursing therapeutics . validation of perceptions. dimensions and goals of interactions Use of field approach Focus on describing psychosocial aspects of nurse .

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. 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.• • • • • • 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. 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. 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 • . in understanding patient’s needs.

In an Veterans Administration (VA) ambulatory psychiatric practice in Providence. Implementation of Orlando’s theory produced substantial benefits. patient-centered outcomes.• • • • • 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. 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. South Dakota State University in Brookings. a model for staff to use to approach patients. decreased hospital stay. In a pilot study. Boston. RI Shea. Their research results indicate that there were: higher patient retention. is using Orlando's theory for teaching entering nursing students. negotiated more effectively in resolving conflict among staff nurses and between staff and physicians. 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 . and increased satisfaction. Lincoln.. and influenced a more positive nursing identity and unity among staff. including determining what constituted nursing versus non-nursing functions. improved decision-making skills among staff nurses. and a decrease in patient’s immediate distress. MA). McBride. Its use increased effectiveness in meeting patient needs. Potter and Bockenhauer (2000) found positive results after implementing Orlando’s theory. These included: positive. and Bauer (1987) used Orlando’s theoretical model with patients (N = 76) having a bipolar disorder. Texas. reduction of emergency services. Gavin. NE and Boston City Hospital.

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

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

Between person and person Represented by verbal and nonverbal behaviours Goal-directed Each individual brings different knowledge . Social beings 2. Communication Information from person to person Directly or indirectly Information component of interaction 3. needs. Stress Dynamic state Human being interacts with the environment 7. Transaction Purposeful interaction leading to goal attainment 5. Purposeful beings 7. goals. 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. Perceiving beings 5. past experiences and perceptions. molecular and behavioural levels of activities Helps individuals move towards maturity 8. reaction. 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. Sentient beings 3. Action – oriented beings . interaction and transaction Person 1. Rational beings 4. which influence interaction 2. Perception Each person’s representation of reality 4. Growth and development Continuous changes in individuals At cellular. Time Sequence of events Moving onwards to the future 9. Controlling beings 6.

Transaction 3. Communication 4. 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. patient. Organization 2. goal will be attained If goal are attained. Stress Social system Concepts 1. Time – oriented beings Health Dynamic state in the life cycle Continuous adaptation to stress To achieve maximum potential for daily living Function of nurse. which includes: If perceptual interaction accuracy is present in nurse-client interactions.8. Authority 3. Role 5. Status. satisfaction will occur Proposition cont… If transactions are made in nurse-client interactions. growth & development will be enhanced . goals. Power 4. 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 Propositions of King’s Theory From the theory of goal attainment king developed predictive propositions. Interaction. transaction will occur If nurse and client make transaction. 2. physicians. Decision making ASSUMPTIONS Perceptions.

Patient has health maintenance related problems. Patient has pain related to surgical incision. set goal mutually and then act to attain those goals. got admitted in L3 ward of . Theory of Goal Attainment and Nursing Process Assumptions Basic assumption of goal attainment theory is that nurse and client communicate information. Assessment King indicates that assessment occur during interaction. The nurse brings special knowledge and skills whereas client brings knowledge of self and perception of problems of concern. perception of self and current health status.If role expectations and role performance as perceived by nurse & client are congruent. “ The wound is getting healed. Mr. roles etc. The first process in nursing process is nurse meets the patient and communicates and interacts with him. What is the patient’s perception of the situation? Patient says ” I have undergone surgery for hernia”. to this interaction. History Identification details Mr. is also the basic assumption of nursing process.Hospital on 27/03/08 with a diagnosis of indirect inguinal hernia underwent herniorraphy with prolene mesh done on 30/03/08. stress in nurseclient interaction will occur If nurse with special knowledge skill communicate appropriate information to client. Patient may develop hypertension related complications in future... Communication is required to verify accuracy of perception. Assessment is conducted by gathering data about the patient based on relevant concepts. mutual goal setting and goal attainment will occur. Patient underwent herniorahaphy operation on 30th March for indirect inguinal hernia which he kept untreated for 35 years. I had undergone a surgery for my right eye about 10 years back”. 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. Sy is 74yrs married. transaction will occur If role conflict is experienced by nurse or client or both. Patient is at risk of developing infection. male. During assessment nurse collects data regarding client (his/her growth & development. Sy is 74yrs married. studied up to 7th What are my perceptions of the situation? What other information do I need to assist this patient to achieve health? . The following areas were addressed to for gathering data.) Perception is the base for collection and interpretation of data. for interaction and transaction.

20000/. a practicing Muslim. No redness.Std is doing Business. adequate nourishment. conscious and oriented Moderately built. The swelling remained stable with uncomplicated progress. got admitted in L3 ward of .. No infection. Aware about health care facilities Physical examination Alert.. Present History of Illness Abdominal swelling for 35 years with difficulty in activities and occasional abdominal pain. He has hypertension for seven years. Subjective problems Pain at the surgical wound site Lack of bowel movement for 2 days Review of relevant systems GI system Inspection: Healing wound. 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.per month Life Style Non vegetarian No habit of smoking or alcoholism.Hospital on 27/03/08 with a diagnosis of indirect inguinal hernia underwent herniorraphy with prolene mesh done on 30/03/08. 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. No swelling .

No prostate enlargement Percussion No fluid collection in scrotum Auscultation Normal Bowel sounds Laboratory Investigations FBS . No swelling or enlargement Palpation No c/o pain. i.134 mEq / dl K+ (3.6 mg/ dl).91 mg/dl Na(130-143mEq/dl) .5-5 mg/dl) .Auscultation: Normal bowel sounds Palpation No pain at the site. No infection. Normal abdominal organs Percussion: No dull sound suggesting fluid collection or ascitis Genito-Urinary system Inspection: Testicles in position.5 mEq / dl Urea(8-35mg/dl)-29 mg / dl Cr (0.3. 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. 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. Patient has risk for infection due to inadequate knowledge and age.6-1. the clinical Patient neglected a health problem for 35 Patient has acute pain at the site of surgical .e.<1 mg/ dl Other investigations Electro cardio gram Ant.

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? . concerns and disturbances about which person seek help. Acc. 3. The client will experience improved comfort. The client will be free of infection as evidenced by normal temperature. Client will acquire adequate knowledge regarding the treatment and home care. The client will have improved bowel elimination. 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. 5. pain medication and NPO or soft diet Deficient knowledge regarding the treatment and home care Ineffective health maintenance Planning After diagnosis. This part of transaction and client’s participation is encouraged in making decision on the means to achieve the goals.Nursing diagnosis The data collected by assessment are used to make nursing diagnosis in nursing process. normal vital signs. the nurse identifies the problems. the ability to rest and sleep comfortably 2. planning for interventions to solve those problems is done. • Acute pain related to surgical incision • • • • Risk for infection related to surgical incision Risk for constipation related to bed rest. to King in process of attaining goal. judgement about the patient’s actual and potential problems. In goal attainment planning is represented by setting goals and making decisions about and being agreed on the means to achieve goals. as evidenced by: Elimination of stool without straining 4. as evidenced by: a decrease in the rating of the pain.

Clarify the doubts of the patient as the patient may present with some matters of importance. Repeat the information whenever necessary to reinforce learning. Goal 4: Explain the treatment measures to the patient and their benefits in a simple understandable language. Goal 5: Health education given about the following. 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. efficient manner that reassures the client and minimizes anxiety Provide a comfortable position as per client’s requests. 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 .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. Explain demonstrate about the home care.

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. 2. Reactions to action lead to transactions that reflect a shared view and commitment 5. Involvement of family member in care of the patient. making judgments about those perceptions. Health teaching can be modified according to developmental stage. 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 . 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. Patient’s condition demands nursing car. a few interventions require immediate attention. Transactions occur as a result of perceiving the other person and the situation. This step reflects implementation in the traditional nursing process. because the patient is motivated to continue home care. 4. 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. and taking some actions in response. 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. 3. Patient is satisfied with my actions Patient’s age is a hindering factor in goal achievement regarding health maintenance. In King’s description evaluation speaks about attainment of goal and effectiveness of nursing care. This step results in transactions being made. Implementations 1. Other interventions are carried out during the period of hospitalization till 5th April.

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

there emerged the research era. 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. Areas Patient details • • • • • OBJECTIVES       . however research and theory produced the nursing sciences. Later graduate education and masters education was given much importance. The development of the theory era was a natural outgrowth of the research era.APPLICATION OF OREM'S SELF-CARE DEFICIT THEORY IN NURSING PRACTICE INTRODUCTION • • • The history of professional nursing begins with Florence nightingale. 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. Later in last century nursing began with a strong emphasis on practice. 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. 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.

There are mainly 3 types of self care requisites such as universal. 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. Thus the theory could be successfully applied into the nursing practice. 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. stiffness which is more in the morning and reduces by the activities. Therapeutic self-care demand is the totality of the self care measures required. theory of self care deficit and the theory of nursing systems. 2. The care will be provided according to the degree of deficit the patient is presenting with. X 56 years Female No formal education House hold Married Hindu Rheumatoid arthritis Orem’s theory of self care deficit. She came to the hospital with complaints of pain over all the joints. partly compensatory or supportive and educative system. 1. Once the care is provided. X….e. Once the need is identified. OREM’S THEORY OF SELF CARE DEFICIT • The self care deficit theory proposed by Orem is a combination of three theories. the person will be in need of self care or will have a deficit in self care. health care system. she explains self care as the activities carried out by the individual to maintain their own health. Whenever there is an inadequacy of any of these self care requisite. developmental and health deviation self care requisites. the nurse has to select required nursing systems to provide care: wholly compensatory. In the theory of self care. i.         Name Age Sex Education Occupation Marital status Religion Diagnosis Theory applied • • • • • • • • • Mrs. She has these complaints since 5 years and has taken treatment from local hospital. • • The deficit is identified by the nurse through the thorough assessment of the patient. theory of self care. gender. • • • • • • The self care is carried out to fulfill the self-care requisites. family system etc. .

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. items for ADL not in easy reach. BMI = 14. 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. sister’s son 2. Indian. daughter. Deformity of the joint secondary to the disease process and use of the joints. 5. Frequent rest is required due to pain. husband working At home with partner Rural area. no special precautions to prevent injuries Husband. Hospital for further management. Edema present over ankles. Activity level ha s come down. therapeutic self care demand Ego integrity vs despair No formal education. 4.Food intake is not adequate or the diet is not nutritious. UNIVERSAL SELF-CARE REQUISITES: Air Water Breaths without difficulty. The symptoms were not reducing and came to --MC.3. Turgor normal for the age Food Hb – 9.6gm%. no pallor cyanosis Fluid intake is sufficient. Elimination Activity/ rest . Voids and eliminates bowel without difficulty. Hindu Institutional health care Married. DATA COLLECTION ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT 1. She also was malnourished and was not having awareness about the deficiencies and effects. Pain not completely relieved.

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

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

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. Nursing Goals and objectives Goal: to achieve optimal levels of nutrition. Adherence to the medical regimen Awareness of potential problem. Objectives: Mrs. . Outcome: improved nutrition Maintenance of a balanced diet with adequate iron supplementation. modify self image Adjust life style to accommodate health status changes and medical regimen APPLYING THE OREM’S THEORY OF SELF-CARE DEFICIT. Design of the nursing system: supportive educative d. 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. c.Thus in the patient Mrs. that are available in the locality. X will: .List the food items rich in iron .state the importance of maintaining a balanced diet. A NURSING CARE PLAN FOR MRS. Method of helping: guidance support Teaching Providing developmental environment . Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. b.

Method of helping: Guidance: Assess the various hindering factors for self care and how to tackle them. The self care deficit in terms of food will be decreased with the initiation of the nutritional intake. X understood the importance of maintaining an optimum nutrition. EVALUATION Mrs. Support: Provide all the articles needed for self care. Nursing Goals and objectives Goal: to achieve optimal levels of ability for self care. 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. b. 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. near to the patient and ask the family members also to give the articles near to her. Initiate the pain relieving measures always before the patient go for any of the activities of daily living . Outcome: . Provide passive exercises and make to perform active exercises so as to promote the mobility of the joint. OUTCOMES AND PLAN a.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.improved self-care . She listed the foods that are rich in iron and that are locally available. Design of the nursing system: Partly compensatory d. Objectives: Mrs. X -------------------------------------------------------------------------Therapeutic self care demand: deficient area: Activity Adequacy of self care agency: Inadequate NURSING DIAGNOSIS Self-care deficit: dressing. c. The supportive educative system was useful for Mrs. secondary to the inflammatory process in the joints. She told that she will select the iron rich diet for her food. toileting related to restricted joint movement.maintain the ability to perform the toileting and dressing with modification as required.

associated and aggravating factors. She performed the dressing activities with minimal assistance Patient verbalized that she will perform the activities as instructed to get her ADL done. EVALUATION Patient was performing some of the activities and she practiced toileting using a commode in the hospital. method of helping: Guidance: Explore the past experience of pain and methods used to manage them. 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 verbalized an improved comfort and self care ability. Outcome: • • . severity. 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. Design of the nursing system: supportive educative d. b. Support: Provide rest to the joints and avoid excessive manipulations . Objectives: Mrs.Make the patient to use loose fitting clothes which will be easy to wear and remove. Nursing Goals and objectives Goal: to achieve reduction in the pain. The partly compensatory system was useful for Mrs.improved pain self control .achieve and maintain a reduction in the pain. location. 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. Ask the client to report the intensity.

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

b. X will: 1. list the measures to prevent the loss of skin integrity 3. 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. Encourage the patient to use slippers while walking and that should not be tight fitting. . Patient explained the various measures that they will take to prevent the injury. Outcome: Maintenance of normal skin integrity.Provide a safe environment in the hospital by avoiding sharp objects or wooden objects on the way and slippery floor. pitting or non pitting and continue the assessment daily. Design of the nursing system: supportive educative d. Objectives: Mrs. Assess the edema for its degree. OUTCOMES AND PLAN: a. 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. X -----------------------------------------------------------------Therapeutic self care demand: deficient area: prevention of hazards. nursing Goals and objectives Goal: Maintain the skin integrity and take measures to prevent skin impairment. method of helping: Support: Assess the skin regularly for any excoriation or loss of integrity or colour changes. Adequacy of self care agency: Inadequate NURSING DIAGNOSIS: Potential for impaired skin integrity related to edema secondary to renal cysts. identify the measures to relieve edema. The supportive educative system was useful for Mrs. maintain a normal skin integrity 2.

OUTCOMES AND PLAN a. 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. The supportive educative system was useful for Mrs.Provide a leg end elevated position or elevation of the leg on a pillow if no cardiac abnormalities are identified. 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. Objectives: Mrs. b. Design of the nursing system: supportive educative d. 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. nursing Goals and objectives Goal: Improve the knowledge of the patient about the disease process and the complications. Methods of helping: • • • Guidance Teaching Promoting a developmental environment IMPLEMENTATION ------------------------------------------------------------EVALUATION Patient got adequate information regarding the disease . Explain the patient the need for taking care of the edematous parts Explain the patient to report the symptoms like decreased urine output. palpitations. increased edema etc. Outcome: Absence of complications and improved awareness about the disease process.

Patient was very cooperative.” It defines health as a positive dynamic state not merely the absence of disease. (5th ed. Health promotion is directed at increasing a client’s level of wellbeing. Alligood. Nursing Theory: Utilization &Application . Alligood M R. X from various aspects.She verbalized what she understood about the disease and its management. Patient has cleared her doubts regarding the medication actions and the side effect The supportive educative system was useful for Mrs. Nursing theorists and their work. REFERENCES 1. The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health.2002. Mosby.5th ed.). George JB . The model focuses on following three areas: Individual characteristics and experiences Behavior-specific cognitions and affect Behavioral outcomes . Missouri: Elsevier Mosby Publications. New Jersey :Prentice Hall. MR. Philadelphia. Tomey AM. 1996) was designed to be a “complementary counterpart to models of health protection. revised. 2002 3. This was helpful to provide care in a comprehensive manner. 2002.3rd ed. Tomey A M.Nursing Theories: The Base for Professional Nursing Practice . 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. HEALTH PROMOTION MODEL INTRODUCTION The health promotion model (HPM) proposed by Nola J Pender (1982. 2. 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.

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

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

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

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

Families and individuals. and 3) the inherent influence of the broader environment on the individual/community that is the focus of care (e.(4th edn) 2001. 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. 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. Application of Suchman’s Stages of illness Model Introduction Man is a social being. Community Health Nursing Promoting health of Aggregates. and supports practice that exemplifies the standards of community health nursing. The community health nursing process provides the vehicle through which community health nurses work with people. and utilization of the community health nursing process.community.W. Spradely B. such as policies within their workplace and the legislative framework applicable to their work. (8th edn) 2001. knowledge and utilization of all these ways of knowing forms evidencebased practice consistent with these standards. The model illustrates the dynamic nature of community health nursing practice. Community health nursing practice does not occur in isolation but rather within an environmental context.Mosby. its own economic status and by the actions of its individual citizens). they also enhance prospect for disease prevention and health maintenance. the community will be affected by provincial/territorial policies. Social conditions and not only promote the possibility of illness and disability.265-80. The values and beliefs (green or shaded) ground practice in the present yet guide the evolution of community health nursing practice over time.Lippincott. . Allender J. embracing the present and projecting into the future. References 1. Social factors play important role in health. advance the individual’s potential for a longer and healthier life.g.N.342-45. Lancaster J. Health life style and the avoidance of high-risk behaviour. 1. The standards of practice are founded on the values and beliefs of community health nurses. Stanhope M. Community Health Nursing Concepts and practice.

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

observing/ performing activities relating to caring · “I have pain at genital region” · “I have problem of passing urine without control. irritation at the site of urinary catheter.50/ person Role in the family · · · · Head of the family. 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. and sleep disturbance · He was a cook. he is hospitalised for cancer. prostate and is receiving radiotherapy for the last one month . 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.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.5000/month His residence is about 80 km away from ----. that is why tube is inserted” · “I want to get this urine tube removed” · “Who will pay my hospital bill of Rs. earning member. but earns only Rs. to and fro journey costs rs. working most of his life in night time for marriage parties · Currently.50.

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. doctors in ---. · Patient underwent orchidectomy and TURP in -------.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. but the cultural issues are not addressed. · He says he has no money to spend her. · But his expenses are met by his daughter and one brother . · 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.4 months back and later referred to Manipal for further management · Patient wants to know whether his illness will get cured.

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. they only made all these illness” · “I have sugar illness for the last one year” · “ The doctor in Kundapura told me to check sugar. 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. but nobody has explained him about his treatment plans . drinking.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. · He puts it on fate · Patient has consulted many folk doctors for minor illness and never satisfied with them. I don’t know why I got this illness” · Patient has accepted the illness as some thing which he does not deserve. smoking or taking even coffee since childhood. 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.

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. doctor and nurse interaction What patient says has reason. nurse Patient: “they are not asking me anything” Doctor: “he will not understand anything. we cannot tell anything to the patient” Patient wants to know about his illness. 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). but doctor is preoccupied with the patient’s educational status. 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 . · Doctor has advised him RT for 1 month. doctor. it is explained to his daughter” Nurse: “doctor has explained everything to him. Observe the patient. and course of treatment.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. nothing else” · “They do not want to know about my pain” · “sometimes. There is a communication gap exists among these people. Nursing staff is bothered whether they may convey wrong message to the patient.

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

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

2. The person is seen as a whole. Neuman states that. and with consideration given to five variables in three stressor areas. The role of the nurse is seen in terms of degrees of reaction to stressors. 1995)". because the nurse's perception will influence the care given. 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. 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. and it is the task of nursing to address the whole person. These forces include the intrapersonal. and the primary aim is stability of the patient/client system. secondary and tertiary interventions. Neuman defines nursing as actions which assist individuals. secondary and tertiary interventions. Nursing Diagnosis . but so must those of the caregiver (nurse). 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. The client system moves toward illness and death when more energy is needed than is available. families and groups to maintain a maximum level of wellness. Neuman proposes a wellness-illness continuum. the state of wellness (and by implication any other state) is in dynamic equilibrium. The external environment exists outside the client system.these must be negotiated with the patient. through nursing interventions to reduce stressors. and achieved through primary. interpersonal and extra personal stressors which can affect the person's normal line of defense and so can affect the stability of the system. with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter.B. and the use of primary. The client system moves toward wellness when more energyis available than is needed. Neuman envisions a 3-stage nursing process: 1. Nursing Goals . As the person is in a constant interaction with the environment. 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. HEALTHNeuman sees health as being equated with wellness.considered in relation to five variables. C. • • • The internal environment exists within the client system. 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. and take account of patient's and nurse's perceptions of variance from wellness 3. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman.based of necessity in a thorough assessment. . rather than in any kind of steady state. Nursing Outcomes . then not only must the patient/client's perceptions be assessed. D.

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

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

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%)

patient (2432.4 sec) Blood group HIV .4 A+ Negative Urea (8-35mg/dl) Creatinine (0.6 . 28 1.3 26.2 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.6 sec) APTT.415.6-1.Eosinophil 10%) (0- 2.5-5 mEq/L) PT (patient)(11.6 mg/dl) Sodium (130-143 mEq/L) Potassium (3.8 136 4 12.

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. 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 .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..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..

• • • • 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) • • • .

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 • • • • . And explain to the patient why those activities are contraindicated. 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. 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. 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.NURSING PROCESS I.

Keep the patients body clean in order to avoid infection. patient . NURSING DIAGNOSIS . • • • • Evaluation – patient verbalized that the pain got reduced and the pain scale score also was zero. II. Provide the primary and secondary preventive measures to the client whenever necessary. • Educate the family members about the pain managemen t measures.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. His facial expression also reveals that he got relief from pain. • Provide the primary preventive care when ever necessary. Administer the pain medication s as per the prescriptio n by the pain clinics to relieve the severity of pain.

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. Assist the patient in early ambulation Monitor client’s response to the activities in order to reduce discomfort s. 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. Provide • Instruct the client to avoid the activities which causes extreme fatigue. as evidenced by normal vital signs & verbalized understanding of the benefits of gradual increase in activity & exercise. • • • • • • • • • • .Activity intolerance related to fatigue secondary to pain at the surgery site. 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.

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.nutritious diet to the client. Tell the family members to be with him. Fatigue relieved and patient looks much more active and interactive. He is able to do some of his activities with assistance. . • ambulation • Avoid psychologic al distress to the client.

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. Teach the importance of psychological well being which influence indirectly the physical recovery Provide primary preventive measures whenever necessary • • • • • • • • • • • . Massage the upper and lower extremities which help to improve the circulation. and family towards the attainment of the goals Coordinate the care activities with the family members and other disciplines like physiotherapy. 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. Nursing action Primary prevention • Provide active and passive exercises to all the extremities to improve the muscle tone and strength.NURSING DIAGNOSIS-III Impaired physical mobility related to presence of dressing. 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.

Alligood M R. Missouri: Elsevier Mosby Publications. Tomey A M.2002. George JB . Nursing theorists and their work. Alligood.3rd ed.5th ed. Evaluation – patient’s physical activity improved and he is able to move from bed with support.). intrapersonal and extra personal stressors of Mr. 2002. 2002 3. Tomey AM. The application of this theory revealed how well the primary. ----------------------------------------------------------Conclusion The Neuman’s system model when applied in nursing practice helped in identifying the interpersonal. AM from various aspects. References 1. New Jersey :Prentice Hall. 2. Mosby.a feeling of well being. . secondary and tertiary prevention interventions could be used for solving the problems in the client. (5th ed.Nursing Theories: The Base for Professional Nursing Practice. Philadelphia. Nursing Theory: Utilization &Application . This was helpful to provide care in a comprehensive manner. MR. Patient started doing the active and passive exercises and he verbalized improvement.

Mary's College. and finally as a nurse's aid. She entered the Sisters of Saint Joseph of Carondelet. 1939 as the 2nd child of Mr. she earned a Bachelor of Arts with a major in nursing from Mount St. and Mrs. first as a pantry girl. INTRODUCTION . Los Angeles in 1963.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. Fabien Roy At age 14 she began working at a large general hospital. then as a maid.

protection.    a master's degree program in pediatric nursing at the University of California . 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. Sister Callista Roy (1984). 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 1966.respectively Sr. Callista had the significant opportunity of working with Dorothy E. She also earned a master’s & PhD in Sociology in 1973 & 1977 . Johnson Johnson's work with focusing knowledge for the discipline of nursing convinced Sr.

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. nations. communities. that is. 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. thus contributing to health. circumstances. and society as a whole) An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-physical. as individuals and in groups. and residual Significant stimuli in all human adaptation include stage of development. and dying with dignity . family. quality of life. growth. sustaining. and faith Persons are accountable for the processes of deriving. compensatory. reproduction. 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. and interdependence ENVIRONMENT  All conditions. selfconcept-group identity.     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. role function. 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. organizations. 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. mastery. enlightenment. contextual. 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. survival.

Activity & Rest. Stimulus-something that provokes a response. Regulator Subsystem-automatic response to stimulus (neural. and personal self) Role function Mode Set of expectations about how a person occupying one position behaves toward a occupying another position. 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. Need to know who one is. that effects on the situation that are unclear. Focus on the psychological and spiritual aspects of the human system. and Protection) Self Concept-Group Identity Mode The composite of beliefs and feelings held about oneself at a given time. Basic need-social integrity. and purposefulness of 2 modes (physical self. Nutrition. Residual Stimulus-environmental factor. Focus on the close relationships of people and their purpose. meaning. Each relationship exists for some reason. Involves the willingness and ability to give to others and accept from .• 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. judgment. the need to know who one is in relation to others Interdependence Mode Behavior pertaining to interdependent relationships of individuals and groups. chemical. Elimination. and endocrine) Cognator Subsystem-responds through four cognitive responds through four cognitive-emotive channels (perceptual and information processing. so that one can exist with a state of unity. learning. 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.

identifying the capacities and needs of the human adaptive system. NR 53 years Male ----Degree Bank clerk Married • • • • . 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. Balance results in feelings of being valued and supported by others. 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. Stimuli are classified as: 1) Focal.those most immediately confronting the person. DEMOGRAPHIC DATA • • • • • • • • Name Age Sex IP number Education Occupation Marital status Religion • • • • • • • Mr. A problem solving approach for gathering data. selecting and implementing approaches for nursing care.others.those stimuli whose effect on the situation are unclear. Nursing Diagnosis: step three of the nursing process which involves the formulation of statements that interpret data about the adaptation status of the person.feeling of security in relationships    Adaptive Responses-promote the integrity of the human system. Basic need . 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. 2) Contextual-all other stimuli present that are affecting the situation and 3) Residual. 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.

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

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

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

i. 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. area. Size of wound decreases to 1x1 cm within 24/4/08. No signs of infection over the wound within 1-wk § Perform wound dressing with betadine which promote healing and growth of new tissue.NURSING CARE PLAN ASSESS.4 to vascular week insufficienc y Long-term objective: § Maintain the wound area 1. amputated clean as area will be contamination affects the completely healing healed by process. 20/5/08 § Follow 2. Continue plan Reassess goal and interventions § Do not move the affected area Unmet: not frequently as it achieved affects the iii. Normal complete granulation WBC values healing of tissue within 1-wk amputated formation. WBC values became normal on 24/4/08 Long term goal: Partially Met: skin partially intact with no ulcerations. Presence § Monitor for Continue plan of healthy signs and Reassess goal .Skin will sterile remain technique while intact with no providing cares ongoing to prevent ulcerations. Impaired Non-healing skin wound after integrity amputation of related to fragility of great and second toe of the skin secondary left leg.) Focal stimuli: 1. Short term goal: Met: size of wound decreased to less than 1x1 cms. ii. iv. infection and Short-Term delay in Objective: healing.

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

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

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

demonstratin g appropriate range effective coping in the treatment ii. § Stress that frequent assessment are routine and do not necessarily imply a deteriorating condition. the disease and financial Residual stimuli: no constrains. § 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. Bring up common Short term concerns. Being able to rest and iii. objective: § Allow the i. Asking fewer questions client and family to verbalize anxiety.Alteration in Physical self in Selfconcept mode (He is anxious about changes in body image) Change in Role performa nce mode. 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. (He was the earning member in the family. His role shift is not compensat e) Contextual stimuli: 3. 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 .

2005 4) Black JM. Suddharth DS.3rd ed.The Base for Nursing Practice. St Louis: Mosby. Medical surgical nursing. Demonstratio n of wound care.Contextual stimuli: ------ 4. Lobo ML. information ii. 5) Brunner LS. § Clear the Short term objective: doubts of the patient as the patient may i. about the home and need of care. 20th ed. t foot care. Hawks JH. St Louis: Mosby. Keene AM. deficient knowledge Known case regarding the foot DM for past 10 years and care. 2006. Nursing theorists and their work. practice in nutrition. Short term goal: Met: Verbalization and demonstratio n of foot care. London: Mosby. Davidson’s principle and practices of medicine. Colledge NR. their day to activity etc. day life. with insulin diabetic for 8 years. Verbalization present with some matters and demonstratio of importance. 6th ed. 6 th ed. 5th ed. 2002 6) Boon NA. 2006. 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. plan iii. on treatment wound care. Long term goal: Unmet: not completely acquired and practiced the required knowledge. and need of follow up Residual care. Walker BR. London: Churchill Livingstone Elsevier. Continue plan Reassess goal and interventions REFERENCE 1) Marriner TA. Chapter 8. diet. Include follow up the points like care and care of wounds. Strictly whenever necessary to following diabetic diet reinforce learning. Raile AM. Strictly following diabetic diet plan Unmet: Demonstratio n of wound care. wound care. Text book of Medical Surgical Nursing. 2005 2) George BJ. Behavioral System Model. § Explain diabetic diet. St Louis: Mosby. . Philadelphia: Elsevier Mosby. Nursing Theories. 2005 3) Alligood MR “Nursing Theory Utilization and Application” 5th ed. Hunter JAA. n of foot § Repeat the care.

APPLICATION OF INTERPERSONAL THEORY IN NURSING PRACTICE .

Outline • • • • • • • • Introduction The four phases of nurse-patient relationships are Overlapping phases in nurse. communication. pattern integration and the roles of the nurse. 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. Identification The patient identifies with those who can help him/ her. Orientation: During this phase. 2. the individual has a felt need and seeks professional assistance. 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.client 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. The interpersonal focus of Peplau’s theory requires that the nurse attend to the interpersonal processes that occur between the nurse and client. 4. Interpersonal process is maturing force for personality. Exploitation During this phase. This theory stressed the importance of nurses’ ability to understand own behavior to help others identify perceived difficulties.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. 3. the patient attempts to derive full value from what he/ she are offered through the relationship. Interpersonal processes include the nurse. The four phases of nurse-patient relationships are: 1. The nurse helps the individual to recognize and understand his/ her problem and determine the need for help. Resolution .

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

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

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

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

self care. the presence of pelvic traction. Planning Implementation Evaluation (Identification (Exploitation (Resolution phase) phase) phase) Self care Goal setting Carried out plans Mrs. Kept the articles Keep all the within t he reach articles within of the client the reach of the patient. JL expresses that she need assistance to get down from bed. 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. 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. JL was free to deficit was done along mutually agreed express problems of related to with patient upon. Remove weight of the the . Client will She used to call for achieve and maintain self care activities with assistance of caregiver or within her limits.Assessment (Orientatio n phase) Mrs. weight as and when needed. Assisted the client in doing her self care activities Assist the patient in doing her self care Removed the activities.

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

Explain in simple understandable language of the client. She and her Allow the client husband and family to expressed their verbalize anxiety. self care. 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. 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 . JL was free to done along with mutually agreed express problems of patient upon.Mrs. and client in simple regarding the Kannada disease process. 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. anxiety Stress that frequent assessment are routine and do not necessarily imply a deteriorating condition. Allow and encourage the client and family to ask questions. JL is enquiring about the disease condition.

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. Planning Implementation Evaluation (Identification (Exploitation (Resolution phase) phase) phase) Goal setting was Carried out plans Mrs. self care. treatment and home care. JL is enquiring about the disease condition.Assessment (Orientatio n phase) Mrs. Repeat the information whenever necessary to reinforce Repeated the information . 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. JL was free to done along with mutually agreed express problems of patient upon.

Client expressed without movement and supine position gave her relief from pain. Exploitation • • • Client explains that she gets relief of pain when lying down supine. 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. Cooperates and participates actively in performing exercises. Summary: 1. 3. 2. Resolution • Client expressed that pain has reduced a lot and she is able to tolerate it now . Client mobilizes changes position and cooperates during position changes.learning. Orientation phase • • • Client is initially reluctant to talk due to pain. Client is expressing that while standing she is having much pain. 4. discharge and home care and follow up.

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

Theories are composed of concepts. models. and guidance for research and education The main exponent of nursing – caring – cannot be measured. predict and explain the phenomenon of nursing It should provide the foundations of nursing practice. improved communication between nurses. definitions..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. explaining. systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing. Importance of nursing theories: • • • • • Nursing theory aims to describe. predicting. 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. propositions & are based on assumptions. and assumptions or propositions derived from nursing models or from other disciplines and project a purposive. Definition: Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing. A nursing theory is a set of concepts. 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 • • • . enhanced professional status for nurses. relationships. definitions. 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. deductive reasoning and inductive reasoning. They are derived through two principal methods. and /or prescribing. 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. 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.

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

George JB .2002. New Jersey :Prentice Hall.3. TRANSCULTURAL NURSING Outline • • • INTRODUCTION TRADITIONAL CONCEPTS OF HEALTH AND DISEASE CONCEPT OF CULTURE .5th ed.Nursing Theories: The Base for Professional Nursing Practice .

• Culture-Broadly defines set of values. The education of nursing students in this field is only now beginning to yield significant results. 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. 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 • • • . that are held by a specific group of people and handed down from generation to generation. It is important to understand some definition and cultural components that are important in health care. Intercultural communication occurs when each person attempts to understand the other’s point of view from his or her own cultural frame of reference. likes. beliefs and traditions. understanding. 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. habits. Major Nursing organizations have emphasized in the last decade the importance of considering culture factors when delivering nursing care. According to Madeleine Leininger (1987) founder of the filed of transcultural nursing in the mid 1960s. and actions in patterned ways. decisions.• • • • • • • • 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 is also beliefs. For a nurse to successfully provide care for a client of a different cultural or ethnic to background. norms and life way practices of a particular group that guide thinking. effective intercultural communication must take place. Today nurses with a deeper appreciation of human life and values are developing cultural sensitivity for appropriate individualized clinical approaches. shared and transmitted values. (Specter 1991) Culture is the learned. Effective intercultural communication is facilitated by the nurse identification of areas of commonalities. the nurse must consider cultural factor throughout the nursing process. customs and rituals learn from one’s family. After reaching a cultural. Religious and Cultural knowledge is an important ingredient in health care. dislikes. beliefs.

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

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. beliefs. the locus of control tends to be more internally oriented (Dim-out. behaviors. 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. on to encounter resistance to Western HPDP programs. • • • • • • Traditional Concepts of Illness Causality • • • • • . often require the services of a folk healer who may be a local corianders. Recognize that the more disparate the differences are between the biomedical model and the lay/popular explanatory models.promoting encounter as a negative or perhaps even hostile experience. Understanding these differences may help us to be more sensitive to the special beliefs and practices of multicultural target groups when planning a program. the locus of control for disease causality often is centered outside the individual. values. 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. root doctor. prevention methods. 1992). Be aware of the need to be flexible in the design of programs. and cure including folk and Western medical interventions Recognize that folk illnesses. the greater the potential for. Remember that most cases of lay illness have multiple causalities and may require several different approaches to diagnosis. and behaviors-. spiritualist. Acknowledge that many individual patients and health care practitioners have specific notions about health and disease causality and treatment called explanatory models. and values. 1995). and the understanding of biomedical concepts that each group holds (Klein man. shaman. 1980). the personal beliefs. and traditional healing or curing practices. diagnostic procedures. whereas in Western cultures. which are perceived to arise from a variety of causes.• Be aware that the health concepts held by many cultural . groups that are likely to be encountered. These models are generally a conglomeration of the respective cultural and social training. Remember that if the more traditional person does seek Western medical treatment. 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 services to meet the needs and concerns of the culturally diverse population. Recognize that individuals from other cultures might not follow through with health-promoting or treatment recommendations because they perceive the medical or other health. policies. 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. native healer. or other specialized healer. treatment.

Cultural awareness It is an in-depth self-examination of one's own background. 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. so the nurse should consider the client's cultural background when planning care . 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.

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

or waist to protect the wearer from the evil eye or evil spirits. The purpose and goal of the theory is to use research findings to provide culturally congruent. tested stems. Many of these plants are used by specific communities. Religion strongly affects the way people attempt to prevent illness. The pharmaceutical. Amulets are objects with magical powers. 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. and used for countless centuries. moral. an effort must be made to determine if they are worn or hung in the home.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. including objects and substances and religious practices. 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. This practice uses diet and consists of many different observances. For example. cataloged. seeds. Frequently. wrist. and it plays a strong role in rituals associated with health protection. so many of the remedies have been used and passed on for generations. well-being. 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. 1966) USE OF PROTECTIVE OBJECTS Protective objects can be worn or carried or hung in the home. Religion dictates social. Amulets exist in societies all over the world and are associated with protection from trouble (Budge. and dietary practices designed to keep a traditional healer (Kaptchuk and Croucherl987) Traditional Remedies The admitted use of folk or traditional medicine increasing. must be made to determine properties of vegetation-plants. charms worn on a string or chain around the neck. safe. Jews also believe that milk and meat must never be mixed or eaten at the same meal (Steinberg. Others cross ethnic and community lines and are used in certain Geographic areas in the person's country of origin. 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. 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. flowers. 1947) mind. and spirit. for all walks of life and cultural and ethnic backgrounds is example. roots. and herbs-have been studied tested. When patients -do not adhere to a pharmacological regimen an effort must be made to determine the remedy if they are taking traditional remedies. and In many instances a heritage consistent person may prayer. illness. or death of individuals or groups. (Morgenstern. . it is believed that some food substances can be ingested to prevent illness. rituals of redemption.

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

Several programs. Staff members and other clients frequently encroach on a client's territory in the hospital. 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. Poverty a relative term and changes from time and place. but essentially. onions. kidney beans. such as unemployment. aid people with short.and long-tem problems. The nurse should try. com meal. and inferior are contributing social causes of poverty.person to person. Mental wellness occurs when psychological and physiologic functions are integrated. The nurse should also welcome visiting members of the family and extended family. closet. crippling diseases. Poor health. Illness can occur if these foods are eaten in improper combinations or amounts. This can remind the client of home. Examples of hot foods-are chocolate. Traditional beliefs about mental health In the traditional belief system. certain foods are known to be hot. honey. It is important for the nurse to be aware clients needs and financial resources available in the local community. PERSONAL SPACE AND TERRITORIALITY. bed. coffee. and peas. poverty is pervasive and found extensively among people in certain norms geographical areas. and others are known to be cold. The nurse should begin the assessment by attempting to determine the client's cultural heritage and language skills. lack of health insurance poverty prevent people from entering the health care system. Poverty is by far the most critical factor. mental illnesses are caused by a lack of harmony of emotions or. ECONOMIC BARRIERS Several economic barriers. underemployment. both governmental and private. Time orientation It is varies for different cultures groups. Belief about birth &death. . garlic. such as rural populations. Examples of cold food are. to respect the client's territory as much as possible. SOCIOCULTURAL FACTORS AND THE NURSING PROCESS Religious belief that effect the care Nursing. which includes his room. . and belongings. The client should be asked if any of his health beliefs relate to the cause of the illness or to the problem. poor education. avocados. homelessness. sometimes. Belief regarding medical care Comments (cremation is preferred) ROLE OF NURSE 1. In the United States. In addition our previous life and our future life are as much a part of the life cycle. Belief about diet and food practices. by evil spirits. the elderly migrant workers. bananas. and illegal aliens. especially when performing nursing procedures. Some elderly Asian Americans share the Buddhist belief that problems in this life are most likely related to transgressions committed in a past life. Personal space involves a person's set of behaviors and attitudes toward the space around himself. and lima beans. lessening the effects of isolation and shock from hospitalization. drug and alcohol abuse.

. Some nurses may believe they should treat all clients the same and simply act naturally. Primary groups are characterized by intimate contact mutual support and pressure for conformity. 16. 18. occupation school peers and mass culture 10. 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. 7. 13. if any. 15. 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. individualized . when pervasive. but should always individualize care rather than generalize about all clients in these groups. community or population. The nursing diagnosis for clients should include potential problems in their interaction with the health care system and problems involving the effects of culture. A child's self concepts evolves from ideas about his or her social roles 8. 6. Ethnocentrism can impede the delivery of care to ethnic minority clients and. 9. race &ethnicity on the development of social emotional relationship child rearing practices &attitude toward health. 17. Specific to member of an intergenerational group. and values depends on many factors and thus is not the same for different members of a cultural group. How culture influences behaviors. Stereotyping ethnic group members can lead to mistaken assumptions about a client. Sometimes. Nurses have a responsibility to understand the influence of culture. Religious practices greatly influences health promotion belief in families. The process of self-evaluation can help the nurse become more comfortable when providing care to clients from diverse backgrounds 5. Many ethnic and cultural groups in country retain the cultural heritage of their original culture.The nurse should then determine what. 12. The nurse should have an understanding of the general characteristics of the major ethnic groups.holistic care. Culture is the sum total of mores traditions & beliefs about how people function encompasses others products of human works & thoughts. Important sub culture influences on children include ethnicity social class. nurses should assess how they are influenced by their own culture. 3. 4. can become cultural racism. attitudes. 14. Before assessing the cultural background of a client. 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.

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

Theory. Norwalk. Nursing theories: The base of professional nursing practice 3rd edition. Erb G. Barman A. Edn 3rd. death. Boyle. J: Rites of birth. The nurse should consider questions such as the following: . Kozier B. • • • • • 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. and kindred occasions 2. Perry G . 4. develop expertise to implement culturally acceptable strategies to provide nursing care. The practice of nursing today demands that the nurse identify and meet the cultural needs of diverse groups. and it is imperative that nurses from all cultural backgrounds be aware of nursing implications in this area. McGraw-Hill Professional. concepts. Fundamentals of nursing. 1987). and Practice. George Julia B. JS: The practice of trans cultural nursing. New York. 1990. Research. marriage. and identify and use resources acceptable to the client (Boyle. REFERENCES 1. 5. Transcultural Nursing: Concepts. The body of knowledge relevant to this sensitive area is growing.by the nurse is crucial as he or she increases skills for interaction. understand the social and cultural reality of the client. 2001. and community. Transcultural Nursing Morgenstern. Edn 3rd Mosby Company. 3. Potter A. McFarland M. HELPING AND HUMAN RELATIONSHIPS THEORY .Basic Nursing-Theory and Practice. 2002. family. CN: Appleton and Lange. process and practice. Synder AJ. Leninger M. Edn 7th.

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

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

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

By attending physically the helper communicates interest in the helpee’s welfare. thus she signals readiness for using initiating. Personalizing skills culminate in the helpee’s personal experience of the problem as the inability to handle difficult situations. . emotional and intellectual helpee outcomes. The function of he responding to the helpee’s experience is to facilitate self exploration. by observing and listening.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%. involves responding to content. 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. which signals the helper to begin personalizing. Attending : “Being attentive to to the helpee” is made up of attending physically. observing and listening to the helpee. the problem. The purpose is to facilitate helpee self understanding in the areas of concern to her. The attending skills are transitional between responding and initiating. 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. helper establishes the conditions for the helpee’s involvement in the helping process. By communicating interest in the helpee. the feelings and the goal. As a result of attempts to teach they are further refined into concrete helping skills (A+R+P+I). involves building a base of interchangeable responses before personalizing the meaning. helper learns from and about the helpee. Personalizing: “To enable the helpee to understand where she is in relation to where she wants or needs to be”. T thus she signals her readiness for the next goal of helping. Responding: Responding to the helpee’ s expression of her experience.understanding. The function of attending is to give them the feelings of security that make their involvement in the helping process. They are used to provide a transition from responding to initiating and from exploring to acting. feeling and feeling and content together.

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

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 Non attending Non attending covers all behaviours. feelings and goal 3. 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. The nature of the informal agreement implies a growth contract. • • • • • • • Basic Helping scale I + E + U + A = New learning (behaviour) 5.The only assumption made in developing the helping skill programs involves one’s motivation. both verbal and non verbal that are unrelated or irrelevant to the helpee’s situation or expressions.0 Responding to content 1. Other assumption is that one wants to grow. Each individual behaves in a competent and trustworthy manner if given the freedom and encouragement to do so. Helper must assume some responsibility for creating conditions of trust whereby helpeescan respond in a trusting manner and help themselves.5 Initiating goal operationalization 4.0 Personalizing problem.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. .5 Responding to feeling 2. with minimal helper assistance.. 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. want to be like the facilitative helpers and teachers one has experienced. that helpees will try to change under their own initiative. Helper must be alert to the impact on the helpee of other people and of the physical environment.0 Responding to feeling and content 2. .5 Personalizing meaning 3. to solve problems and to face crises.5 Attending 1. Helping takes place over the lifespan. one wants to become involved in a life long learning process. The aim of all help is self help and self sufficiency.

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

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

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

recognise own weak spots and work on prevention Dual relationships. Summarising Skills Ethical issues in helping relationships: Informed consent Worker self care. Termination: evaluating outcomes and terminating the relationship.• • Consolidation: exploring alternatives. Reflecting skills iv. Is there a a power difference between us? . 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. Confronting skills: v. working through feelings. • Helping skills for understanding: of self and others i. Leading Skills iii.SYMBOLIZING IDEAS AND FEELINGS Informing skills Advising – giving suggestions and opinions based on experience Informing.giving valid information based on expertise Pulling themes together. Listening skills • • • • • • • • • • • • • • • • • vi. ii. • • • 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.recognise them and manage them Ask following questions. practicing new skills Planning: developing a plan of action using strategies to resolve conflicts. reducing painful feelings. and consolidating and generalizing new skills or behaviours to continue self-directed activities. Interpreting skills vii.

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

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