´NURSING THEORIES AND ITS THEORISTSµ
VESA LARA MALAINE P. RAGA, RN
The First Nurse Theorist Developed and described the first theory of nursing. She focused the on changing and manipulating the environment in order to put the patient in best possible conditions for nature to act. She believed that in the nurturing environment, the body could repair itself. Client·s environment is manipulated to include appropriate noise, nutrition, hygiene, light, comfort, socialization and hope.
1. 2. 3. 4. 5.
She defined NURSING as ´the act of utilizing the environment of the patient to assist him in his recoveryµ. She linked health with FIVE ENVIRONMENTAL FACTORS: PURE OR FRESH AIR PURE WATER EFFICIENT DRAINAGE CLEANLINESS LIGHT esp. DIRECT SUNLIGHT Deficiencies in these five factors produced lack of health or illness.
In addition, Nightingale also stressed the importance of keeping the client warn, maintaining a noise-free environment, and noiseattending to client·s diet in terms of assessing intake, timeliness of the food, and its effect on the person. Her general concepts about ventilation, cleanliness, quiet, warmth, and diet remain integral parts of nursing and health care today.
PERSON: PERSON: An individual with vital reparative processes to deal with disease. ENVIRONMENT: ENVIRONMENT: External conditions that affect life and individuals development. HEALTH: Focus is on the reparative process of HEALTH: getting well. NURSING: NURSING: Goal is to place the individual in the best condition for good healthcare.
(INTERPERSONAL RELATIONS MODEL)
Center of Peplau·s Theory is the use of a therapeutic relationship between the nurse and the client. Nurses enter into a personal relationship with an individual when a need is present. To help clients fulfill their needs, nurses assume many roles: stranger, teacher, resource person, surrogate, leader, and counselor. counselor. Her model continues to be used by clinicians when working with individuals who have psychlogic problems.
She identifies FOUR PHASES OF THE NURSENURSE-CLIENT RELATIONSHIP namely: ORIENTATION-During this phase, the client
seeks help, and the nurse assists the client to understand the problem and the extent of the need for help.
IDENTIFICATION-During this phase, the client
assumes a posture of dependence, interdependence, or independence in relation to the nurse. The nurse·s focus is to assure the person that the nurse understands the interpersonal meaning of the client·s situation.
3. EXPLOITATION-In this phase, the client derives full value from what the nurse offers through the relationship. The client uses available services based on self-interest and selfneeds. Power shifts from the nurse to the client. 4. RESOLUTION-In this final phase, old needs and goals are put aside and new ones adopted. Once older needs are resolved, newer and more mature ones emerge.
VIEWS OF COMPONENTS
PERSON: PERSON: An organism striving to reduce tension generated by needs. ENVIRONMENT: ENVIRONMENT: The interpersonal process is always included, and psychodynamic milieu receives attention, with emphasis on the client·s culture and mores. HEALTH: HEALTH: Ongoing human process that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living. NURSING: NURSING: Interpersonal therapeutic process that ´functions cooperatively with others human processes that make health possible for individuals in communities. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality.
(DEFINITION OF NURSING)
She identified fourteen fundamental needs. Her definition of the unique function of nursing was a major stepping stone in the emergence of nursing as a discipline separate from medicine. Like Nightingale, she described nursing in relation to the client and its environment.
Unlike Nightingale, she saw the nurse as concerned with both healthy and ill individuals, acknowledged that nurses interact with clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the nurse. Her emphasis on the importance of nursing·s independence from, the interdependence with, other health care disciplines is well recognized.
14 FUNDAMENTAL NEEDS
1. Breathing Normally 2. Eating and Drinking Adequately 3. Eliminating Body Wastes 4. Moving and Maintaining a Desirable Position 5. Sleeping and Resting 6. Selecting Suitable Clothes 7. Maintaining Body Temperature within Normal 8.
Range by Adjusting Clothing and Modifying the Environment Keeping the Body Clean and Well Groomed to
protect the integument 9. Avoiding Dangers in the Environment and avoiding injuring others 10. Communicating with Others in Expressing Emotions, Needs, Fears or Opinions 11. Worshipping according to One·s Faith 12. Working in such a Way that One Feels a Sense of Accomplishment 13. Playing or Participating in Various Forms of Recreation 14. Learning, Discovering, or Satisfying the Curiousity that Leads to Normal Development and Health, and Using Available Health Facilities.
PERSON: PERSON: Individual requiring assistance to achieve health and independence or a peaceful death. Mind and body are inseparable. ENVIRONMENT: ENVIRONMENT: All external conditions and influences that affect life and development. HEALTH: Equated with independence, viewed in terms of the HEALTH: client·s ability to perform 14 components of nursing care unaided: breathing, eating, drinking, maintaining comfort, sleeping, resting clothing, maintaining body temperature, ensuring safety, communicating, worshiping, working, recreation, and continuing development. NURSING: NURSING: Assists and supports the individual in life activities and the attainment of independence.
FAYE GLENN ABDELLAH
(CONCEPT OF TWENTY ONE NURSING PROBLEMS)
The language of Abdellah·s framework is readable and clear. Consistent with the decade in which she was writing, she uses the term ¶she· for nurses, ¶he· for doctors and patients, and refers to the object of nursing as ¶patient· rather than client or consumer. She referred to Nursing diagnosis during a time when nurses were taught that diagnosis was not a nurses· prerogative. Assumptions were related to: change and anticipated changes that affect nursing; The need to appreciate the interconnectedness of social enterprises and social problems;
racism, pollution, education, and so forth on health care delivery; changing nursing education. continuing education for professional nurses. development of nursing leaders from under reserved groups. Abdellah and colleagues developed a list of 21 nursing problems. They also identified 10 steps to identify the client·s problems 11 nursing skills to be used in developing a treatment typology
the impact of problems such as poverty,
10 STEPS TO IDENTIFY THE CLIENT·S PROBLEMS
1. 2. 3.
6. 7. 8.
Learn to know the patient. Sort out relevant and significant data. Make generalizations about available data in relation to similar nursing problems presented by other patients. Identify the therapeutic plan. Test generalizations with the patient and make additional generalizations. Validate the patient·s conclusions about his nursing problems Validate the patient·s conclusions about his nursing problems. Explore the patient·s and family·s reaction to the therapeutic plan and involve them in the plan. Identify how the nurses feels about the patient·s nursing problems. Discuss and develop a comprehensive nursing care plan.
11 NURSING SKILLS
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Observation of health status Skills of communication Application of knowledge Teaching of patients and families Planning and organizing of work Use of resource materials Use of personal resources ProblemProblem-solving Direction of work of others Therapeutic use of the self Nursing procedures
THE TWENTY ONE NURSING PROBLEMS
THREE MAJOR CATEGORIES
Physical, sociological, and emotional needs of clients. Types of interpersonal relationships between the nurse and patient. Common elements of client care.
TYPOLOGY OF THE 21 NURSING PROBLEMS
BASIC TO ALL PATIENTS
To maintain good hygiene and physical comfort. To promote optimal activity: exercise, rest and sleep. To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection. To maintain good body mechanics and prevent and correct deformities
SUSTENAL CARE NEEDS
5. To facilitate the maintenance of a supply of oxygen to all body cells. 6. To facilitate the maintenance of nutrition of all body cells. 7. To facilitate the maintenance of elimination. 8. To facilitate the maintenance of fluid and electrolyte balance. 9. To recognize the physiological responses of the body to disease conditions. 10. To facilitate the maintenance of regulatory mechanisms and functions. 11. To facilitate the maintenance of sensory function
REMEDIAL CARE NEEDS
12. 13. 14. 15. 16. 17. 18.
To identify and accept positive and negative expressions, feelings, 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 , emotional, and developmental needs.
RESTORATIVE CARE NEEDS
To accept the optimum possible goals in the light of limitations, 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.
PERSON: PERSON: The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert. ENVIRONMENT: ENVIRONMENT: Not clearly defined. Some discussion indicates that clients interact with their environment, of which nurse is a part. HEALTH: HEALTH: A state when the individual has no unmet needs and no anticipated or actual impairment. NURSING: NURSING: Broadly grouped in ´21 nursing problems,µ which center around needs for hygiene, comfort, activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health promotion, interpersonal relationships, and development of self-awareness. Nursing care is doing selfsomething for an individual. individual.
IDA JEAN ORLANDO
(NURSING PROCESS THEORY)
In the late 1950s, Orlando developed her theory inductively through an empirical study of nursing practice. For 3 years, she recorded 2000 observations between a nurse and patient interactions. She was only able to categorize the records as "good" or "bad" nursing. According to records: *Good Nursing ² nurse·s focus was on the patient·s immediate verbal and nonverbal behavior from the beginning through the end of the contact *Bad Nursing ² nurse·s focus was on a prescribed activity or something that had nothing to do with the patient·s behavior
Based on this research, her formulations were validated, thus she extended her theory to include the entire nursing practice system which then evolved as ´Nursing Process Disciplineµ Orlando's theory remains one the of the most effective practice theories available. Many theory scholars utilized her concept as basis for their further studies.
Assumptions about Nurses: ´The nurse·s reaction to each patient is uniqueµ ´Nurses should not add to the patient·s distressµ ´The nurse·s mind is the major tool for helping patientsµ ´The nurse·s use of automatic responses prevents the responsibility of nursing from being fulfilledµ ´Nurse·s practice is improved through selfselfreflectionµ
Assumptions about Patients: ´Patients· needs for help are uniqueµ ´Patients have an initial ability to communicate their needs for helpµ ´When patients cannot meet their own needs they become distressedµ ´The patient·s behaviour is meaningfulµ ´Patients are able and willing to communicate verbally (and non- verbally nonwhen unable to communicate verbally)µ
Assumptions about the nurse-patient nursesituation: ´The nurse-patient situation is a nursedynamic wholeµ ´The phenomenon of the nursenursepatient encounter represents a major source of nursing knowledgeµ
Assumptions about Nursing: ´Nursing is a distinct profession separate from other disciplinesµ ´Professional nursing has a distinct function and product (outcome)µ ´There is a difference between lay and professional nursingµ ´Nursing is aligned with medicineµ
PERSON: PERSON: Unique individual behaving verbally nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times unable to do so. ENVIRONMENT: ENVIRONMENT: Not defined HEALTH: Not defined. Assumption is that being HEALTH: without emotional or physical discomfort and having a sense of well-being contribute to a healthy state. wellNURSING: NURSING: Professional nursing is conceptualized as finding out and meeting the client·s immediate need for help.
(THREE INTERLOCKING CIRCLES THEORY)
To provide professional nursing care to people past the acute stage of illness. She conceptualized three components of CURE. Nursing: CARE, CORE, and CURE. CARE, CORE,
CARE represents nurturance and is exclusive to nursing. CORE involves the therapeutic use of self and emphasizes the use of reflection. CURE focuses on nursing related to the physician·s order.
VIEWS OF COMPONENTS
PERSON: PERSON: Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing. ENVIRONMENT: ENVIRONMENT: Should facilitate achievement of the client·s personal goals. HEALTH: Development of a mature self-identity that HEALTH: selfassists in the conscious selection of actions that facilitate growth. NURSING: NURSING: Caring is the nurse·s primary function. Professional nursing is most important during the recuperative period.
(HUMAN-TO(HUMAN-TO-HUMAN RELATIONSHIP MODEL)
To assist individuals, families, communities, and groups to prevent or cope with illness, regain health, finding meaning in illness, or maintaining, maximal degree of health. She further viewed that interpersonal process is a human-to-human relationship human-toformed during illness and ´experience of sufferingµ.
PERSON: PERSON: A unique, irreplaceable individual who is in a continuous process of becoming, evolving, and changing. ENVIRONMENT: ENVIRONMENT: Not defined HEALTH: Heath includes the individual·s perceptions HEALTH: of health and the absence of disease. NURSING: NURSING: An interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences.
(SCIENCE OF UNITARY HUMAN BEINGS)
Her theory contains complex conceptualizations related to multiple scientific disciplines. To Rogers, unitary man is a dynamic energy field in constant interaction with the environment, both of which are infinite. She asserted that human beings are more than and different from the sum if their parts; the distinctive properties of the whole are significantly different from its parts.
Furthermore, she believed that both human beings and environment are characterized by pattern, a universe of open systems, and four dimensionality. According to Rogers, UNITARY MAN:
Is an Irreducible, Four-Dimensional Energy Field Fouridentified by Pattern Manifests Characteristics different from the Sum of the Parts Interacts Continuously and Creatively with the Environment Behaves as a Totality As a Sentient Being, Participates Creatively in change
Nurses applying Roger·s Theory in practice:
Focus on the Person·s Wholeness Seek to Promote Symphonic Interaction between the
Two Energy Fields (Human and Environment) to Strengthen the Coherence and Integrity of the Person Coordinate the Human Field with the Rhythmicities of the Environmental Field and, Direct and Redirect Patterns of Interaction between the Two Energy Fields to Promote Maximum Health Potential.
PERSON: PERSON: Unitary man, a four-dimensional energy field. fourENVIRONMENT: ENVIRONMENT: Encompasses all that is outside any given human field. Person exchanging matter and energy. HEALTH: Not specifically addressed, but emerges out of HEALTH: interaction between human and environment, moves forward, and maximizes human potential. NURSING: NURSING: A learned profession that is both science and art. The professional practice of nursing is creative and imaginative and exists to serve people.
IMOGENE M. KING
(GOAL ATTAINMENT THEORY)
To help the client reestablish a positive adaptation to his or her environment. She described nursing as a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them, transactions occur and goals are achieved
DYNAMIC INTERACTING SYSTEMS
y THREE SYSTEMS in the conceptual framework:
yPERSONAL SYSTEMS (the individual) yINTERPERSONAL SYSTEMS (individuals interacting with one another) ySOCIAL SYSTEMS (groups of people in a community/society sharing common goals, interests, and values)
y Study systems as a WHOLE rather than as isolated parts of a system
DYNAMIC INTERACTING SYSTEMS
Elements of each System y GOAL: Health y STRUCTURE: 3 open systems y FUNCTIONS: identified in the reciprocal relationships as they interact y RESOURCES: essential to keep systems in harmony y People & money y DECISION MAKING: critical to perform functions and attain goals
PERSONAL SYSTEM CONCEPTS
y y y
Perception Self y awareness of being a person separate from others Growth and Development Body Image y personal & subjective; acquired or learned; dynamic and changing y includes how person sees self & other·s reactions to one·s appearance) Space Time Learning (1986, not defined)
INTERPERSONAL SYSTEM CONCEPTS
COMMUNICATION TRANSACTIONS ROLE STRESS
SOCIAL SYSTEM CONCEPTS
Organization y formal or informal structure that orders positions and activities y made up of persons with roles and positions to meet goals Authority y regularity, direction and responsibility for actions Power y energy necessary to avoid chaos in a society Status y relationship of one·s place in a group to others Decision Making y changing and orderly process wherein choices are made in relation to goals
PERSON: PERSON: Biopsychosocial being ENVIRONMENT: ENVIRONMENT: Internal and external environment continually interacts to assist in adjustments to change. HEALTH: A dynamic life experience with HEALTH: continued goal attainment and adjustment to stressors. NURSING: NURSING: Perceiving, thinking, relating, judging, and acting with an individual who comes to a nursing situations.
(HEALTH CARE SYSTEM MODEL)
To address the effects of stress and reactions to it on the development and maintenance of health. The concern of nursing is to prevent stress invasion, to protect the client·s basic structure and to obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client stability.
VIEWS OF COMPONENTS
PERSON: PERSON: A client system that is composed of physiologic, psychological, sociocultural, and environmental variables. ENVIRONMENT: ENVIRONMENT: Internal and external forces surrounding humans at any time. HEALTH: Health or wellness exists if all parts and HEALTH: subparts are in harmony with the whole person. NURSING: NURSING: Nursing is a unique profession in that it is concerned with all the variables affecting an individual·s response to stressors.
MYRA ESTRINE LEVINE
Using conservation activities aimed at optimal use of client·s resources. She advocated that nursing is a human interaction and proposed 4 conservation principles of nursing which are concerned with the unity and integrity of the individual.
´FOUR CONSERVATION PRINCIPLESµ
1. CONSERVATION OF ENERGY-The human body ENERGYfunctions by utilizing energy. The human body needs energy producing input (food, oxygen, fluids) to allow energy utilization as output. 2. CONSERVATION OF STRUCTURAL INTEGRITY-The human body has physical boundaries (Skin and Mucous Membrane) that must be maintained to facilitate health and prevent harmful agents from entering the body.
3. CONSERVATION OF PERSONAL INTEGRITYINTEGRITY-The nursing intervention are based
on the conservation of the individual client·s personality. Every individual has a sense of identity, self worth and self esteem, which must be preserved and enhanced by nurses.
4. CONSERVATION OF SOCIAL INTEGRITYThe social integrity of the client reflects the family and the community in which the client functions. Health Care institutions may separate individuals from their family. It is important for nurses to consider the individual in the context of the family.
PERSON: PERSON: A Holistic Being ENVIRONMENT: Broadly, includes all the ENVIRONMENT: individual·s experiences. HEALTH: The maintenance of the client·s HEALTH: unity and integrity. NURSING: A discipline rooted in the organic NURSING: dependency of the individual human being on his or her relationship with others.
SISTER CALLISTA ROY
Viewed humans as Biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms. Focuses on the ability of Individuals., families, groups, communities, or societies to adapt to change. The degree of internal or external environmental change and the person·s ability to cope with that change is likely to determine the person·s health status. Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation. psychologic,
4 MODES OF ADAPTATION
1.PHYSIOLOGIC-PHYSICAL MODE 1.PHYSIOLOGIC-
Behavior pertaining to the physical
aspect of the human system Physical and chemical processes Nurse must be knowledgeable about normal processes 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection
2. SELF CONCEPT-GROUP IDENTITY MODE CONCEPTThe composite of beliefs and feelings held about oneself at a given time Focus on the psychological and spiritual aspects of the human system Need to know who one is, so that one can exist with a state of unity, meaning, and purposefulness 2 modes (physical self, and personal self) Goal: psychological integrity
3. ROLE FUNCTION MODE
Set of expectations about how a
person occupying one position behaves toward a person occupying another position Basic need-social integrity, the need needto know who one is in relation to others Goal: Social integrity
4. INTERDEPENDENCE MODE
Behaviour pertaining to interdependent relationships of individuals and groups Focus on the close relationships of people and their purpose Each relationship exists for some reason Involves the willingness and ability to give to others and accept from others Balance results in feelings of being valued and supported by others Basic need-feeling of security in relationships need-
PERSON: PERSON: Biopsychological beign and the recipient of nursing care. ENVIRONMENT: ENVIRONMENT: All conditions, circumstances, and influences surrounding and affecting the development of an organism or groups of organisms. HEALTH: The person encounters adaptation problems HEALTH: in changing the environment. NURSING: NURSING: A theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill or potentially ill persons.
(HUMAN CARING THEORY)
Focus on curative factors derived from a humanistic perspective and from scientific knowledge. Watson·s Theory of Human Caring has received worldwide recognition and is a major force in redefining nursing as a caring-healing health model. caring
Forming a Humanistic-Altruistic System of HumanisticValues Instilling Faith and Hope Cultivating Sensitivity to One·s Self and Others Developing a Helping-Trust (Human Care) HelpingRelationship Promoting and Accepting the Expression of Positive and Negative Feelings
WATSON·S ´CORE OF NURSINGµ
Systematically Using the Scientific
Problem-Solving Method for Decision ProblemMaking Promoting Interpersonal TeachingTeachingLearning Providing a Supportive, Protective, or Corrective Mental, Physical, Sociocultural, and Spiritual Environment Assisting with the Gratification of Human Needs Allowing for Existential-Phenomenologic ExistentialForces
WATSON·S ´ASSUMPTIONS OF CARINGµ
Human Caring in Nursing is Not just an Emotion, Concern, Attitude or Benevolent Desire. Caring Connotes a Personal Response. Caring is an intersubject human process and is the Moral Idea of Nursing. Caring can be Effectively Demonstrated Only Interpersonally. Effective Caring Promotes Health more the does Curing.
Caring responses accept a person not only as they are now, but also for what the person may become. A Caring Environment offers the Development of Potential while Allowing the Person to Choose the Best Action for the Self at a given point in time. Caring occasions involve action and choice by nurse and client. If the caring occasion is transpersonal, the limits of openness expand, as do human capacities. The most abstract characteristic of a caring person is that the person is somehow responsive to another person as a unique individual, perceives the other·s feelings, and sets one person apart from another.
The Human Caring involves values, a will and a commitment to care, knowledge, caring actions and consequences. The Ideal and Value of Caring is a starting point, a stance, and an attitude that has to become a will, an intention, a commitment, and a conscious judgment that manifests itself in concrete acts.
PERSON: PERSON: A valued being to be cared for, respected, nurtured, understood, and assisted, a fully functional, integrated self. ENVIRONMENT: ENVIRONMENT: Social environment, caring and the culture of caring affect health. HEALTH: HEALTH: Physical, mental, and social wellness NURSING: NURSING: A human science of people and human health; illness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions.
DOROTHY E. JOHNSON
(BEHAVIORAL SYSTEM MODEL)
To reduce stress so the client can recover as quickly as possible. According to Johnson, each person as a behavioral system is composed of seven subsystems namely: INGESTIVE, ELIMINATIVE, AFFILIATIVE, AGGRESSIVE, DEPENDENCE, ACHIEVEMENT, and SEXUAL AND ROLE IDENTITY.
1. INGESTIVE - Taking in nourishment in socially and culturally acceptable ways. 2. ELIMINATIVE - Riddling the body of waste in socially culturally acceptable ways. 3. AFFILIATIVE - Security seeking behavior Self4. AGGRESSIVE - Self-protective behavior. 5. DEPENDENCE - Nurturance-seeking behavior Nurturance6. ACHIEVEMENT - Master of oneself and one·s environment according to internalized standard of excellence. 7. SEXUAL AND ROLE IDENTITY BEHAVIOR
In addition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting and adapting to environmental forces through learned pattern of response. Furthermore, She believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in ways that support biologic imperatives; who is able to benefit to the fullest extent during illness from the health care professional·s knowledge and skills; and whose behavior does not give evidence of unnecessary trauma as a consequence of illness.
PERSON: PERSON: A system of interdependent parts with patterned, repetitive, and purposeful ways of behaving. ENVIRONMENT: ENVIRONMENT: All forces that affect the person and that influence the behavioral system HEALTH: Focus on person, not ill ness. Health is a HEALTH: dynamic state influenced by biologic, psychological, and social factors NURSING: NURSING: Promotion of behavioral system, balance and stability. An art and a science providing external assistance before and during balance disturbances
ROSEMARIE RIZZO PARSE
(HUMAN BECOMING THEORY)
Parse·s Model of Human Becoming emphasizes how individuals choose and bear responsibility for patterns of personal health. She contends that the client, not the nurse is the authority figure and decision maker. ´In true presence the nurse·s whole being is immersed with the client as the other illuminates the meanings of his or her situation and moves beyond the moment.µ(Parse, 1994)
She proposes THREE ASSUMPTIONS about Human Becoming: Becoming:
1. Human Becoming is freely choosing personal
meaning in situations in the inter-subjective interprocess relating value priorities. 2. Human Becoming is co-creating rhythmic copatterns or relating in mutual process with the universe. 3. Human Becoming is co-transcending comultidimensionally with the emerging possibles. possibles.
Parse·s Three Assumptions focus on
MEANING, RHYTHMICITY and COTRANSCENDENCE. MEANING arises from a person·s interrelationship with the world and refers to happenings to which the person attaches varying degrees of significance. RHYTHMICITY is the movement toward greater diversity. COTRANSCENDENCE is the process of reaching out beyond the self.
PERSON: PERSON: A major reason for nursing existence ENVIRONMENT: ENVIRONMENT: Man and environment interchange energy to create what is in the world, and man chooses the meaning given to the situations he creates HEALTH: A lived experience that is a process of being HEALTH: and becoming NURSING: NURSING: Nursing Practice is directed toward illuminating, synchronizing and mobilizing family interrelationships in light of the meaning assigned to health and its possibilities as language in the cocreated patterns of relating.
(SELF-CARE THEORY) SELF-
Defined Nursing: ´The act of assisting others in the provision and management of selfselfcare to maintain/improve human functioning at home level of effectiveness.µ Focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-being. wellHas a strong health promotion and maintenance focus.
Identified 3 related concepts: SELF-CARE ² activities an Individual SELFperforms independently throughout life to promote and maintain personal wellwellbeing. SELF-CARE DEFICIT ² results when selfSELFselfcare agency (Individual·s ability) is not adequate to meet the known self-care selfneeds. NURSING SYSTEM ² nursing interventions needed when Individual is unable to perform the necessary self-care activities: self-
WHOLLY COMPENSATORY ² nurse provides entire selfselfcare for the client.
Example: care of a new born, care of client recovering from
surgery in a post-anesthesia care unit post-
PARTIAL COMPENSATORY ² nurse and client perform
care, client can perform selected self-care activities, but selfalso accepts care done by the nurse for needs the client cannot meet independently.
Example: Nurse can assist post operative client to ambulate,
Nurse can bring a meal tray for client who can feed himself
SUPPORTIVE-EDUCATIVE ² nurse·s actions are to help SUPPORTIVEthe client develop/learn their own self-care abilities selfthrough knowledge, support and encouragement. encouragement.
Example: Nurse guides a mother how to breastfeed her baby,
Counseling a psychiatric client on more adaptive coping strategies.
PERSON: An integrated whole composed of an internal physical, psychologic, and social nature with varying degrees of self-care psychologic, selfability ENVIRONMENT: Prevailing internal and external conditions in some time and place frame of reference HEALTH: A state of physical, mental, and social well-being, and wellnot merely the absence of disease or infirmity NURSING: An art through which the practitioner of nursing gives specialized assistance to persons with disabilities of such a character that greater than ordinary assistance is necessary to meet daily needs for self care and to intelligently participate in the medical care they are receiving from the physician
The Culture Care Diversity and Universality theory, according to Dr. Leininger, focuses on describing, Leininger, explaining and predicting nursing similarities and differences focused primarily on human care and caring in human cultures. The Culture Care Diversity & Universality theory does not focus on medical symptoms, disease entities or treatments. It is instead focused on those methods of approach to care that means something to the people to whom the care is given.
PERSON: Should refer to families, groups, and communities HEALTH: Not distinct to nursing as many disciplines use this term ENVIRONMENT: Included events with meanings and interpretations given to them in particular physical, ecological, sociopolitical or cultural setting. NURSING: Care has the greatest meaning which explains nursing
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