TFN Nursing Theories 2011-2012

RICHARD B. SAGASAG, RN, MAN, USRN

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FLORENCE NIGHTINGALE

“Environmental Theory”

May 12, 1820 – August 13, 1910

At the age of 31, she entered the Deaconesses School at

Kaisserwerth Institute and received her 3 months “training”

in nursing.

In 1837, when she was 17, she felt a “calling” to help

people.

Born on12 May 1820in Florence, Italy

After training at Kaiserwerth Institute she studied at Paris with the Sisters of

Charity.

In 1854, during the Crimean War, Florence was invited by her friend Sir Sydney Herbert to take a group of 38

female nurses to work in hospitals during the Crimea War.

“LADY with a LAMP

CONTRIBUTIONS OF FLORENCE NIGHTINGALE DURING THE CRIMEAN WAR

She cared for the soldiers during night time by using her LAMP that obtained her title “LADY with a LAMP”

She used her superb statistical & managerial skills to lower the mortality rate of soldiers and victims of war.

She utilized the environment in helping the soldiers.

Richard SagasagRN, MAN, USRN

After the war Florence went back to England, a grateful English public gave her an honorarium of £4,500.

She used the money to develop the NIGHTINGALE TRAINING SCHOOL

FOR NURSES, which opened in 1860.


The school served as model for other training school.

Nightingale focus more on developing the profession

within the hospital.

The first school that provided both theory based knowledge and clinical skills

building.

Formal nursing education and nursing service begun.

Nursing evolved as an art & science.

Compiled notes of her visits to hospitals & her observations of

the sanitary facilities, social problems of the

places she visited.

Not contended with the social custom

imposed upon her as a Victorian Lady, she developed her self-

appointed goal:

“TO CHANGE THE PROFILE OF NURSING”

Advocated for care of those afflicted with

diseases caused by lack

of hygienic practices.

Recognized as Nursing’s first SCIENTIST-

THEORIST for her work:

“NOTES ON NURSING: What It Is, and What It Is

Not”

Disapproved of the restrictions on admission of patients & considered

this unchristian & incompatible with

health care.

OTHER AWARDSORDER OF MERIT

ROYAL RED CROSS

She was the first woman to be granted the Order of Merit

(OM) and the Royal Red Cross (RCC) by Queen Victoria of

Great Britain

Her birthday marks the International Nurses Day

celebration each year

NIGHTINGALE’S ENVIRONMENTAL THEORY

Defined nursing as “act of utilizing the environment of the patient to

assist him in his recovery.

She linked health with FIVE ENVIRONMENTAL FACTORS.

1. Pure fresh air 2. Pure water 3. Efficient drainage 4. Cleanliness

5. Light (direct sunlight)Richard SagasagRN, MAN, USRN

PERSON

-She referred to the person as a patient

- They are defined in relationship to their

environment and the impact of the environment

upon themRichard SagasagRN, MAN, USRN

HEALTH

- She defined health as being well and using every power that the person has

to the fullest extent

- She envisioned the maintenance of health through prevention of

disease via environmental controlRichard Sagasag

RN, MAN, USRN

ENVIRONMENT- Florence believed that the

sick, poor people would benefit from environmental

improvements that addressed their physical and mental

aspects.

-She stressed that nurses could have special role in uplifting

the social status of the poor by improving their living situations


NURSING

- having responsibility for someone else’s health- Nightingale stated that

nursing “ought to signify the proper use of fresh air, light,

warmth, cleanliness, quiet, and the proper selection and

administration of diet – all at the least expense of vital

power to the patient.”Richard SagasagRN, MAN, USRN

Nightingale’s Canons

Nursing process & Thought

1. Ventilation & Warmth

-Check patient’s body temperature, room temperature & ventilation.

-Create a plan to keep the room well-ventilated & free of odor while maintaining the patient’s body

temperature

2. Light-Check room for adequate light. Sunlight is

beneficial to the patient.

-Create & implement adequate light in the room without placing the patient in direct light.

Canon means a rule or law. These canons were found in Notes on Nursing (1860/1946)

NIGHTINGALE CANONS



3. Cleanliness

-Check room for dust, dampness & dirt.

-Keep room free from dust, dirt & dampness

4. Health of Houses

-Check surrounding environment for fresh, pure water, drainage,

cleanliness & light.

-Remove garbage, stagnant water & ensure clean water & fresh air.



5. Noise-Check noise level in the room

and surroundings.

-Attempt to keep noise level in minimum

6. Bed & Bedding

-Check bed & bedding for dampness, wrinkles & soiling.

-Keep the bed dry, wrinkle-free & lowest height to ensure

comfort.



7. Personal Cleanliness

-Attempt to keep the patient dry & clean at all times.

-Frequent assessment of the patient’s skin is essential to maintain good skin integrity.

8. Variety

-Attempt to accomplish variety in the room & with the client.

-This is done with cards, flowers, pictures & books. Also encourage

friends & relatives.



9. Chattering Hopes & Advices

-Avoid giving false advices

-Respect the patient as a person and avoid personal

talk.

10. Taking Food

-Check diet of the patient. Note the amount of food and fluid ingested by the patient

at every meal



11. Petty Management

-This ensures continuity of care.

-Document the plan of care & evaluate the outcomes to ensure

continuity.

12. Observation of

the Sick

-Observe & record anything about the patient.

-Continue observation in the patient’s environment and make

changes in the plan of care if needed.

HILDEGARD PEPLAU

September 1, 1909 - March 17, 1999Richard SagasagRN, MAN, USRN

• Regarded as “mother of psychiatric nursing”

• Born in 1909, Reading, Pennsylvania

• Graduated from a diploma program in Pottstown, Pennsylvania in 1931

• BA in interpersonal psychology from Bennington College in 1943

• MA in psychiatric nursing from Colombia University, New York in 1947


• EdD in curriculum development in 1953

• Professor emeritus from Rutgers University – Started first post baccalaureate program in

psychiatric nursing

• Certified in psychoanalysis by William Alanson White Institute of New York City

• Worked as executive director and president of ANA

• Worked with WHO, NIMH and nurse corps

• Died in 1999


Publications• In 1952 published Interpersonal Relations in

Nursing– Originally delayed because of no physician co-

author

– Credited with transformation of nursing from a group of skilled workers to a profession


Historical Evolution of the Theory

• 1943-45 served in the Army Nurse Corps– 312th Field Station Hospital in England

• American School of Military Psychiatry

• Worked with leading figures in British and American psychiatry

• After war worked to reshape mental health system in U.S.– Passage of National Mental Health Act of 1946


Purpose• The purpose of this theory is to

facilitate the development of problem solving skills, within

the context of the interpersonal relationship between nurse and

client, using education and therapeutic interactions


Person A developing organism that tries to

reduce anxiety caused by needs

An individual is made of physiological, psychological and social spheres striving towards equilibrium in life

Environment• Being and occurring in the context of

the nurse client relationship

• Existing forces outside of the individualRichard SagasagRN, MAN, USRN

Health

• Peplau viewed health as "a word symbol that implied forward

movement of personality and other ongoing human processes in the

direction of creative, constructive, productive, personal, and community

living“• (Peplau,1992, p.12).


Nursing

• An educative and therapeutic relationship in which the nurse makes the client a partner in their health care and promotion

• A significant therapeutic interpersonal process


FOUR PHASES OF A NURSE CLIENT RELATIONSHIP

ORIENTATION

IDENTIFICATION

EXPLOITATION

RESOLUTION


Nurse and patient meet as two meet as two strangersstrangers Individual has a felt need Seeks professional assistanceTrust and empowermentEncourage active participationNurse determines what help client needs

Orientation Phase

Let’s REVIEWRichard SagasagRN, MAN, USRN

If you are a nurse and patient comes to you for the first time, how do you

entertain the client/patient?


Factors influencing the blending of the nurse-patient relationship

Identify problems to be worked on during the relationship

Clarify perceptions and expectations

Level of dependence/independence

Capability to deal with identified problem/s

Decreases helplessness and hopelessness

Identification Phase


Goals are implemented by the nurse but power is shifted to the

patient as these goals would be achieved through personal or self-effort

Dependent person becomes independent.

ExploitationPhase


Client needs met, patient earns full independence from the relationship

Mutual termination of relationship

Goal, support systems, problem prevention

ResolutionPhase


ReadinessReadiness is one of the most important factors in the learning process and learning is initiated by a need or purpose.

Termination occurs only with the successful completion of the previous phases.

ExploitationPhase


NURSING ROLES

“Nursing roles are different roles that the nurse

assumes which empower her in meeting the needs of

the patient”


Nurse should treat the patient courteously.

Nurse should not prejudged the patient.

Nurse should treat the patient as emotionally able.

Role of the Stranger


Role of the Resource Person Nurse provides specific answers to questions by determining the level of understanding of the patient:

- Health information- Advices- Explanation of the health care

team’s course of care Richard SagasagRN, MAN, USRN

Teaching Role Nurse must determine how the patient understands the subject at hand.

Nurse must develop her discussion around the interest of the patient & ability of using the information provided.


Leadership Role Involves the democratic process

Nurse helps the patient meet the tasks at hand through a: - relationship of cooperation - active participation


Surrogate Role The patient dependency for his care gives the nurse a surrogate

(temporary care giver) role.

The nurse must assist the patient to accept that her surrogate role is different & only temporary


Counseling Role Has the greatest emphasis in psychiatric nursing

Nurse becomes a listening friend, an understanding family member, and someone who gives sound & emphatic advises

Interpersonal techniquesInterpersonal techniques – help the “patient remember and understand fully the experience & how it be integrated into his daily life”.Richard Sagasag

RN, MAN, USRN

Case Analysis


Mario, a street vendor was hit by a car and obtained

multiple injuries in his body. He was brought in the hospital for treatment.

Scenario:


ORIENTATION PHASE - During admission/Assessment

Role of a stranger- Nurse accepts client regardless of the economic status.

- Establish Trust & Rapport

-Courteously asks questions to gather data


IDENTIFICATION PHASE - Problem Identification - Nursing Diagnosis/Planning

Problem Identified: Multiple injuries (Risk for infection)

Counseling Role

- Nurse listens to the client and gives emphatic advises

- Nurse helps client understand problems by explaining the fracture obtained as well as the multiple injuries


IDENTIFICATION PHASE

Problem Identified: Multiple injuries (Risk for infection)

- Nurse & client together plan for the activities that help the client in his recovery

Example: - Ways of preventing of infection - Procedures ordered by doctor (x-ray) - Medications (ordered by doctor)


Exploitation Phase (Implementation)

Leadership Role- Nurse motivates the patient to actively participate and cooperate in all the activities rendered by nurses and physicians

Teaching Role -Nurse teaches and demonstrates to the client proper hand washing to prevent infection.


Exploitation Phase (Implementation)

Resource person-Courteously explain to the client the reasons why client has to undergo x-ray-Explains the importance of the medications and how it could help in his recovery

Surrogate Role-Nurse serves as the temporary care giver and treats the client like his own family- Nurse attends to his need


Resolutiontion Phase

- Evaluation, Recovery & Discharge-Nurse evaluate the effectiveness of the nursing actions/interventions implemented

Example: - Evaluate the understanding of the client regarding his condition

- Evaluate if client learned about hand washing


Example: - Evaluate if client understand the purpose why he needs to undergo x- ray

- Evaluate If client understand why he needs to take the medications

“If Client recovers from his previous condition then recovery takes place and discharge is ordered by the physician”


ORIENTATION

IDENTIFICATION

EXPLOITATION

RESOLUTION

Overlapping phases in nurse-patient relationships

Admission/Assessment

Nursing Diagnosis/ Planning

Implementation

Evaluation/ Termination/Discharge/

VIRGINIA HENDERSON“14 Basic Human Needs”

Richard Sagasag,RN, MAN November 30, 1897 – March 19, 1996

Richard Sagasag,RN, MAN

BACKGROUND

Virginia Henderson has been called:

“The First Lady of Nursing” “First Truly International Nurse”

She was born in Kansas City, Missouri on March 30, 1897

She graduated from the Army School of Nursing, Washington, D.C. in 1921.

She graduated from Teachers College, Columbia University with a M.A. degree in nursing education.


BACKGROUND

The International Council of Nurses presented her with the first Christianne Reimann Prize in June 1985, aged 87.

She was also an honorary fellow of the UK's Royal College of Nursing.

American Nurse Association Hall of Fame

Virginia Historical Nurse Leadership Award (1988)

Halloran (nurse theorist) wrote,“Henderson was to the 20th century as Nightingale was to the 19th. Both wrote extensive works that have influenced

the world”

“Nursing is primarily assisting the individual (sick or well) in the

performance of those activities contributing to health, or its

recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will knowledge. It is likewise the unique contribution of nursing to help the individual to

be independent of such assistance as soon as possible.”

HENDERSON’S DEFINITION OF NURSING (1955):

PERSONReferred person as the patient that requires assistance to achieve health & independence and/or peaceful deathThe mind and body of the person are inseparable. He must maintain physiological and emotional balance to function efficiently.

4 METAPARADIGM IN NURSING


HEALTH Health is a quality of life and is basic to for a person to function fullyHealth requires independence and interdependencePromotion of health is more important than care of the sick.Individuals will achieve or maintain health if they have the necessary strength, will, or knowledge



4 METAPARADIGM IN NURSING ENVIRONMENTHealthy individuals may be able to control their environment but as illness occurs, this ability is diminished or affected.Nurses must be aware of the different social customs & religious beliefs to assess dangers.Nurses should protect patients from injury.


4 METAPARADIGM IN NURSING NURSING


The nurse functions independently from the physician, but promotes the plan prescribed by the physician.

Care must be provided from all walks of life and empower the patient to gain independence.

Nurse must be knowledgeable in both biological and social sciences.

Must have the ability to assess basic human needs

14 BASIC HUMAN NEEDS


1. Breathe normally.

2. Eat and drink adequately.

3. Eliminate body waste.

4. Move and maintain desirable postures.

5. Sleep and rest. 6. Select suitable clothes


7. Maintain body temperature within normal range by adjusting clothing and modifying the environment.

8. Keep the body clean and well groomed and protects the integument.

9. Avoid dangers in the environment and avoid injuring others.

10. Communicate with others in expressing emotions, needs, fears, or opinions.


11. Worship according to one s faith.

12. Work in such a way that one feels a sense of accomplishment. 13. Play or participate in various forms of recreation.

14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use of the available health facilities.


NURSE-PATIENT RELATIONSHIP

“ Virginia Henderson stated

that there are THREE LEVELS

compromising the NURSE-PATIENT RELATIONSHIP”.

Nurse as a SUBSTITUTE for the patient

“Nurse acts as a substitute as to what the

patient lacks such as knowledge, will and strength in order to make him complete,

whole and independent once again”.


Nurse as a HELPER to the patient

Nurse helps the client to accomplish the

basic needs that the patient cannot meet

regain independence as quickly as

possible..


Nurse as a PARTNER with the patient The nurse and the patient formulate the care plan together.

Nurse acts as both an advocate and a resource person.

Nurse can empower the patient to make effective decisions regarding his care plans.Richard Sagasag,RN, MAN

Relationship to Nursing Process


ASSESSMENT PHASE

The nurse would assess the 14 fundamental needs of the patient and check which one is lacking or fully met.

Gathers data by observing, smelling, feeling and hearing.

The nurse uses critical thinking and analyzes every data collected to come up with a clear picture of the condition of the patient.


Example: During assessment you have noted that the patient abdomen in distended. During interview your patient mentioned she has not passed stool for 4 daysShe drinks 4-5 glasses of water a dayLikes to eat meat and poultry products onlyHas no form of exercise

Analysis: ConstipationAccording to Henderson‘s 14 basic needs the problem fall under “Eliminating body waste”


PLANNING PHASEInvolves giving the plan of care to meet the needs and personality of the patient.

Must serve as a record and at the same time must fit in the prescribed plan made by the physician.


Example:Analysis: ConstipationAccording to Henderson‘s 14 basic needs the problem fall under “Eliminating body waste”

Plan: Goal: Help client eliminate body waste Objective:

- Increase water intake - High fiber diet - Exercise


IMPLEMENTATION PHASE

The nurse uses the 14 basic needs in answering the factors that are contributing to the illness state of the patient.

These interventions are focused on maintaining health, to recover from illness, or to aid in peaceful death.

Performs activities that are directed in helping patient attain his independence.


Example: IMPLEMENTATION

- Encourage the patient to increase fluid intake from 4-6 to 8-10 glasses of water a day- Inform the client and relatives that eating high fiber diet such as green leafy vegetables fruits and root crops (kamote, ube, gabi) helps in digestion and elimination of waste products

- Encourage the patient and relatives to have simple forms of daily exercises such as walking, doing household chores such as sweeping the floor Richard Sagasag,RN,

MAN

EVALUATION PHASE

The nurse and the patient review the relationship and decides whether the goals are met or not.

Nurse also assess if the patient attained independence and if health is achieved.


Example: EVALUATION

- Evaluate the elimination pattern of your patient

-Did the patient follow your health teachings?

-Is the patient able to pass stool?Richard Sagasag,RN,

MAN

1926 - 1973Richard Sagasag,RN,

MAN

JOYCE TRAVELBEE“Human to Human Relationship”

-Born in 1926

-Finished her BS Nursing in 1954 Lousiana State University

-MSN in 1959 at Yale University

-1952 she started as an instructor focusing in psychiatric nursing

-1966, published her first book entitled Interpersonal Aspects of Nursing

-1969 published her second book entitled Intervention in Psychiatric Nursing: Process in the One-to-One Relationship


Background

- Through her observations and experiences working from different

institutions, she concluded that nursing

care rendered to patients lack COMPASSION.

-She believed that nursing needed a “HUMANISTIC REVOLUTION” a

return to focus on the caring function towards the ill person.


Background

“ A nurse does not only seek to alleviate physical pain or render physical care – she

ministers to the whole person. The existence of suffering, whether physical, mental or

spiritual is the proper concern of the nurse”


Background

PERSON

- She defined person as human being

- Unique, irreplaceable individual who is in continuous process of becoming, evolving, and changing.



HEALTH

Health is measured by subjective & objective health

Subjective Health – individually defined state of well being

Objective Health – is the absence disease, disability or defect as measured by physical examination, laboratory test, spiritual director or psychological counselor



ENVIRONMENT- Not clearly defined but he associated illness, pain, or sufferings to the environment

NURSING- Defined nursing as an “interpersonal process whereby the nurse assist 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



Henderson said:

In human-to-human relationship model, the nurse and the patient undergoes the following series of INTERACTIONAL PHASES:

1. Original Encounter2. Emerging Identities3. Empathy4. Sympathy4. Rapport


1. ORIGINAL ENCOUNTER Initial interaction between the nurse and the patient

Characterized as the first first impressionsimpressions by the nurse of the ill person and vice versa

Both perceived each other in stereotyped/traditional rolesRichard Sagasag,RN, MAN

2. EMERGING IDENTITIES Characterized by the nurse and

the patient perceiving each other as unique individualsunique individuals

Bond of a relationship is Bond of a relationship is beginning beginning to formto form


3. EMPATHY The ability to co-experience and relate to the thoughts, emotions, or experience of another without them being communicated directly by the individual

Result of Empathic processEmpathic process is the ability to predict the behavior of the individual. Two qualities that enhanced empathic process:

similarities of experience desire to understand another personRichard Sagasag,RN, MAN

4. SYMPATHY The ability to understand and to support the emotional situation or experience of another being with compassion and sensitivity

Occurs when the nurse desires to alleviate the cause of the patient’s illness or suffering The nurse is to create a:

Helpful Nursing ActionHelpful Nursing Action =

Disciplined Intellectual Approach ++ Therapeutic Use of Self


RAPPORT

The ill person exhibits both trust and confidence in the nurse A nurse is able to establish nurse is able to establish rapportrapport because:

she is able to perceive, respond to, and appreciate the uniqueness of the illRichard Sagasag,RN, MAN

- Relationship, especially one of mutual trust or emotional affinity.

KEY THEORETICAL CONCEPTS

IllnessSuffering

PainHope

CommunicationInteractionEmpathySympathyRapport

Therapeutic Use-of-Self


Therapeutic Use of Self

is the ability to use one’s personality consciously and in full

awareness in an attempt to establish relatedness and to nurture nursing

intervention


it requires: self-insight self-understanding an understanding dynamics of human behavior ability to interpret one’s own behavior and others ability to intervene effectively in nursing situations

Example:Maria, a 24 year old sales lady is confined

in the hospital because of depression brought by the break up with her

boyfriend.


Original Encounter:

Maria & the nurse meet for the first time and both are not yet comfortable talking and expressing deep thoughts & feelings.

Emerging Identities:

Closeness between the nurse and Maria is being established. They are both aware of their differences in thoughts and feelings



boyfriend.


Empathy:

This phase depicts Maria’s experiences that were shared to the nurse. Similarities such as their age and gender will give a deeper understanding on the patient’s behavior and help the relationship to

become therapeutic.



boyfriend.


Sympathy:

The nurse will use intellectual approach and therapeutic use of self to alleviate the distress of

Maria

Rapport:All actions that lessen the Maria’s distress have been implemented, thus result would be a good and trusting relationship and achievement of the

therapeutic goal by the nurse

Patient

Nurse

Nurse

Nurse

Patient

Patient

Nurse Patient

Nurse&

Patient

Sympathy

Empathy

Emerging Identities

Original Encounter


BETTY NEUMAN“Systems Model”

Born in 1924, Ohio USA


“ Health is a condition in which all parts and

subparts are in harmony with the

whole of the client.” --- Betty Neuman


PERSON- An individual, family, group, community or society

- Dynamic composite of interrelationships among physiological, psychological, socio-cultural, developmental, and spiritual factors




PERSON- Neuman sees a person as an open system that works together with other parts of its body as it interact with the environment.



HEALTH

- The state of wellness exists when all the part or system of a person works harmoniously.

-Disharmonious system reflects illness Disharmonious system reflects illness as a result of unmet needs of a person.as a result of unmet needs of a person.

-The state of health varies according to The state of health varies according to the degree of reaction a person has to the degree of reaction a person has to environmental forcesenvironmental forces



HEALTH

- “If a person successfully copes with the environmental

influences and is able to maintain adequate level of

health, the person can preserve the integrity of all the

parts of its system”



ENVIRONMENT

- Environment can be an internal, external forces that interacts which a person exists.

-These forces are what Neuman termed These forces are what Neuman termed as stressors.as stressors.

-Stressors are tensions that produce Stressors are tensions that produce alterations in the normal flow of the alterations in the normal flow of the environment:environment:

IntrapersonalIntrapersonal – occurs within the self – occurs within the self InterpersonaInterpersonal – occurs between individualsl – occurs between individuals



NURSING

-Nursing requires a holistic approach, an approach that considers all factors affecting a client’s health.

-The nurse considers that a client’s The nurse considers that a client’s physical, physiological, mental, physical, physiological, mental, social, cultural, developmental and social, cultural, developmental and spiritual well-beingspiritual well-being

SYSTEM MODEL IN NURSING PRACTICE


Flexible Line of Defense

Normal Line of Defense

Lines of Resistance

Basic structure energy

sources

BASIC STRUCTURE

Basic factors common to all organisms ex:- Normal temperature- Genetic Structure- Response Pattern- Organ Strength or Weakness- Ego Structure

Note: Physiologic, psychologic, sociologic,

developmental, & spiritual


Lines of Resistance

Basic structure energy sources

Flexible line is dynamic & can rapidly altered.

It is the protective buffer that prevents

stressors from penetrating the normal

lines of defense.

Ex: sleep deprivation (stressor)


FLEXIBLE LINE OF DEFENSE


Lines of Resistance


Individual’s reaction to stressors depends on the strength of normal lines of

defense


Ex: 5 hours sleep/day

-People who are used to it are “stress free” (able to adapt)

-People who may not adapt to the stressors (5 hours sleep) may

cause headache, lack of appetite, lack of focus

Normal line of defense represents the person’s state of equilibrium or the state of adaptation developed & maintained over time & considered

normal for that person.

NORMAL LINE OF DEFENSE


Lines of Resistance


Lines of resistance represents internal factor

that help client defend against stressors.

Normal Line of Defense Reaction are the

outcomes or produced result of certain stressors

in the line of defense it can be positive of

negative

REACTIONS:Negentropy – towards

stability

Egentropy – towards disorganization

LINES OF RESISTANCE

Examples: increase in the body’s leukocyte counts to combat an infection.


PreventionPrevention- Is used to attain balance within the Is used to attain balance within the continuum of healthcontinuum of health

Nursing interventions focus on retaining or Nursing interventions focus on retaining or maintaining system stability.maintaining system stability.

These interventions are carried out on These interventions are carried out on three preventive levels.three preventive levels.

1.1.PRIMARY PREVENTIONPRIMARY PREVENTION2.2.SECONDARY PREVENTIONSECONDARY PREVENTION3.3.TERTIARY PREVENTIONTERTIARY PREVENTION

1. PRIMARY PREVENTION-To encourage optimal health and to increase the person’s resistance to illness.

- Health promotion Activities include the following:

Quit smokingAvoid/limit alcohol intakeExercise regularlyEat well balanced dietReduce fat and increase fiber intakeTake adequate fluidsWear hazards device in work siteComplete immunization program


2. SECONDARY PREVENTION

-Health maintenance

- Seeking to identify specific illnesses or condition at an early stage with prompt intervention to prevent or limit disability.

- Early diagnosis/detection/screening Activities include the following:

- Have annual physical examination- Regular Pap smear test- Monthly BSE for women 20 years & above- Sputum examination for tuberculosis- Annual Stool Guaiac Test and Rectal examination for clients over age 40 years- Testicular Self Examination (TSE) for early detection of testicular cancer for clients

age 15-35 year oldRichard Sagasag,RN, MAN

3. TERTIARY PREVENTION

-To support client’s achievement of successful adaptation to known allergies, to known risk, optimal reconstitution, and or establishment of a higher level wellness.

-Occurs after a disease or disability has occurred and recovery process has begun

-Intent is to halt the disease or injury process and assist the person in obtaining an optimal health status.

- RehabilitationRichard Sagasag,RN, MAN

3. TERTIARY PREVENTION

Activities include:

•Physical therapy after CVA (stroke)

•Cardiac rehabilitation after MI ( Myocardial Infarction or heart attack)

•Attending self –management education for diabetes

•Undergoing speech therapy after laryngectomy


Reconstitution

- Adjustment state from the degree of reaction.

- It is a state of going back to the actual state of health before the illness occurred.


APPLICATION OF NEUMAN’S SYSTEM MODEL



Pedro is a 17 year-old nursing student, who is very studious and often times isolate himself from his classmate to give himself time in reading his books.

He works hard on quizzes, term exams and requirements given by his clinical instructors with high expectations. If these expectations are not met, he responds with pressure and intimidating remarks.

Quite often, Pedro exhibit weird mannerisms and behaviors which appear strange to people around him.

He misses breakfast and lunch very often & sleeps late in the night studying his lessons.

Two days after the term exam where he got a low grade because he did not follow the instruction set in the test paper, her family reported having seen Pedro with sudden outburst of laughter with known reason, staring blankly on the wall, and refusing to eat. This prompted his family to bring him in the hospital for confinement.


ASSESSMENT:

The nurse utilizing Neuman’s System Model, assessed the stressors (work, personality, and attitude) that are contributing to Pedro’s condition.

The nurse found out that Pedro is not able to handle the stressors thereby stretching the line of defense. Without seeking help from his support system, he was not able to maintain his flexible lines of defense.

The nurse concluded that the root cause of the client’s illness is his failure to maintain the different lines that serves as shock absorber to various stressors & balance of health variables.


PLANNING:

Since Pedro is not emotionally stable to formulate for his goals with the nurse, the healthcare team, in coordination with his family, took initiative to direct adequate care. Thus, there is a restoration of his lines of defense.

IMPLEMENTATION:

a.Establish trust as first step towards significant nurse-patient relationship

b.Explore gaps and alterations on his lines of defense, thus pin-pointing stressors where the patient failed to cope.


c. Utilize accepted clinical interventions to restore and strengthen the lines of defense such as therapies, stress-management activities and relaxation techniques, and anger-management exercises.

d. Assist Pedro a less stressing normal and to make appropriate lifestyle changes.

e. Re-assess Pedro’s ability to independently perform and maintain the sphere/variables of health: physiological, sociocultural, developmental and spiritual

EVALUATION:Evaluate the result of the nursing interventions that the nurse implemented.

Goal is met if the Pedro recovered from his illness

DOROTHY JOHNSON“Behavioral System Model”


Born August 21, 1919, in Savannah, Georgia, USA

http://nursingstudyguides.net/dorothy-johnsons-theory/johnson-dorothy1/

Introduction

Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia.

B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston in 1948.

From 1949 until her retirement in 1978 she was an assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at the University of California in Los AngelesRichard Sagasag

RN, MAN, USRN

Introduction

Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Throughout her career, Johnson has stressed the importance of research-based knowledge about the effect of nursing care on clients.


“ Each individual has a redisposition to act with reference to the goal, in

certain ways rather than in other ways.”

Johnson's theory of nursing believes that humans are

behavioral systems made up of seven subsystems.


OVERVIEW OF THE THEORY

BEHAVIOR

Output of intraorganismic structures and processes as they are coordinated and articulated by and responsive to changes in sensory stimulation.


Is a whole that functions as a whole by virtue of the interdependence of its parts

There is “ organization, interaction, interdependency, and integration of the parts and elements” --- Chinn

adjustments ++ adaptations= balance

SYSTEM


BEHAVIORAL SYSTEM Encompasses the patterned, repetitive, and purposeful ways of behaving = organized and integrated functional unit

A person is a behavioral system tries to achieve stability and balance

System is usually flexible enoughrac/2008



PERSON

Johnson views “human being” as having two major systems:

Biological System – It is the role of medicine to focus on biological system

Behavioral System – Focus of nursing


HEALTH

Health is a state that is affected by social, psychological, biological & physiological.

Individual is striving to retain some balance or equilibrium.

Individual’s goal is to sustain the entire behavioral system efficiently & effectively to return to an acceptable balance if malfunction disrupts the original balance.


4 METAPARADIGM IN NURSING ENVIRONMENT

Individual’s behavior is influenced by all the events in the environment.

Cultural influences on the individual’s behavior are viewed as profound.



NURSING

Nursing implementations may focus on correction of a behavior that is not concerned to maintaining equilibrium for the individual.



SEVEN BEHAVIORAL SYSTEM

“The seven subsystems are considered to be interrelated, thus changes in one changes in

one subsystem affect all subsystem”

ATTACHMENT / AFFILIATIVE

Most critical Most critical = basis for all social organization Provides survival and security

Consequences: social inclusion intimacy formation and maintenance of strong social bond


DEPENDENCY

Promotes helping behavior that calls for a nurturing response

Consequences: approval/consent attention or recognition physical assistance


INGESTIVE Relates to the behaviors surrounding the ingestion of food.

“Has to do with when, how, what, how much, and under what conditions we eat”

It serves the broad function of appetitive satisfaction

Associated with social, psychological and biological considerations


ELIMINATIVE

Relates to the behaviors surrounding the excretion of waste products from the body

Human cultures have defined different socially acceptable behaviors for excretion of waste.


SEXUAL

Has the dual functions of procreation and gratification

Begins with the development of gender role identity and includes broad range of sex-role behaviors


ACHIEVEMENT

Contains behaviors that attempt to control he environment.

Areas of achievement: intellectual physical creative mechanical social


AGGRESSIVE

Relates to behaviors concerned with defense & self preservation

It does not include those behaviors with primary purpose of injuring other individual, but rather those whose purpose is to PROTECT & CONSERVE SELF & SOCIETY


Johnson’s Model

IMOGENE KING“Goal Attainment Theory”



OVERVIEW

IMOGENE KING’S Theory derived from her conceptual framework which shows the relationship of personal systems (individuals), interpersonal systems (nurse-

patient), social systems (educational system, health care

system)


OVERVIEWKing’s Theory offers insight to

nurse’s interactions with individuals and groups w/in 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.


INTRODUCTION

Imogene King was born in 1923.

Completed her Bachelor in science of nursing from St. Louis University in 1948

Completed her Master of science in nursing from St. Louis University in 1957

Completed her Doctorate from Teacher’s college, Columbia University

4 METAPARADIGM IN NURSING PERSON- is social being who has the ability to :

PerceiveThinkFeelChooseSet goalsSelect means to achieve goals and To make decision


4 METAPARADIGM IN NURSING PERSON- is social being who has the ability to :

PerceiveThinkFeelChooseSet goalsSelect means to achieve goals and To make decision



PERSON

According to King, human being has three fundamental needs:

(a) The need for the health information

(b) Need for care for illness prevention

(c) The need for care when human beings are unable to help themselves.



HEALTH

Health is viewed as ability of a person to adjust to the stressors that the internal or external environment expose to the client



ENVIRONMENTProcess of balance involving internal & external interactions inside the social system.

External environment is the factor that exist outside the boundary.

Internal environment transforms energy to enable person to adjust to continuous external environmental changes.



NURSING

An act wherein the nurse interacts and communicates with the client.

The goal of the nurse is to help the client maintain health through health promotion & maintenance, restoration, caring for the sick and dying.


INTERACTING SYSTEM FRAMEWORK

Personal – how the nurse views and integrates self based from personal goals & beliefs

Interpersonal – how the nurse interrelates with co-worker or patient, particularly in a nurse-relationship

Social – how the nurse interacts with co- workers, superiors, subordinates and the client environment in general



Action – means of behavior or activities that are towards the accomplishment of certain act.

The accomplishment of a task begins with mental action whereby a person seeks or formulates plan of activities and proceeded by physical action



Actions are aimed towards setting goals through communication between the nurse and the client then exploring and agreeing means to perform thereby achieving the set goals

ReactionIn her theory reaction is not specified but somehow relate reaction as part of action or a form of response to a certain stimuli



InteractionAny situation wherein the nurse relates & deals with a client or patient

Open SystemThe absence of boundary existence, where a dynamic interaction between the internal & external environment can exchange information without barriers or hindrances.


KING’S GOAL ATTAINMENT THEORY10 essential KNOWLEDGE for use by nurses in concrete situations:

Self, Role, Perception, Communication, Interaction, Transaction, Growth & Development, Stress, Time & Personal Space

Patient

Nurse

Reaction

Perception

Judgment

Action

Feedback

Feedback

Action

Judgment

Perception

Interaction Transaction

DOROTHEA OREM“Self Care Theory”


Born: 1914, Baltimore, Maryland, USA.

Introduction

One of foremost nursing theorists.

Dorothea Orem earned her Bachelor of science in nursing education in 1939 and Master of science in nursing in 1945

During her professional career ,she worked as a staff nurse ,private duty nurse ,nurse educator and administrator and nurse consultant

Received honorary Doctor of Science degree in 1976Richard Sagasag

RN, MAN, USRN

Introduction

Dorothea Orem as a member of a curriculum subcommittee at Catholic University, recognized the need to continue in developing a conceptualization of nursing.

Published first formal articulation of her ideas in Nursing: Concepts of Practice in 1971. Second in 1980,and finally in 1995

Reference: http://currentnursing.com/nursing_theory/self_care_deficit_theory.htmlRichard Sagasag

RN, MAN, USRN


Orem’s general theory of nursing in three related parts:

Theory of self care Theory of self care deficitTheory of nursing system

Theory of Self Care


Self-Care

The performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being


Self-Care AgencyHuman ability which is "the ability in engaging self care" -conditioned by age, developmental state, life experience, socio-cultural orientation, health and available resources.


Self-Care Requisites

Actions directed towards provision of self care.

Categories of Self-Care Requisites:

1.Universal Self-Care Requisite - Universally set goals that must be provided to function in scope of healthy living



8 Self-Care Requisites common in men, women and children:

a.Maintenance of sufficient intake of air

b.Maintenance of sufficient intake of food

c.Maintenance of sufficient intake of water

d.Provision of care associated with elimination

e.Maintenance of balance between activity & rest


8 Self-Care Requisites common in men, women and children:

a.Maintenance of balance between solitude & social interaction

b.Prevention of hazards to human life, human functioning & human well-being

c.Promotion of human functioning & development


2. Developmental Self-Care Requisites - Provision of conditions that promote health - Prevention of the effects of human conditions that threatens life

Health deviation RequisitesRequired in conditions of illness, injury, or disease . These include:

Seeking and securing appropriate medical assistance


Health deviation Requisites

Being aware of and attending to the effects and results of pathologic conditions

Effectively carrying out medically prescribed measures

Learning to live with effects of pathologic conditions

Therapeutic Self-Care Demand

These are summation of all the activities needed to alleviate the existing disease or illness


Theory of Self Care Deficit




- Specifies when nursing is needed - Nursing is required when a person is incapable or limited in the provision of continuous effective self care.

Orem identifies 5 methods of helping:Acting for and doing for othersGuiding othersSupporting anotherProviding an environment promoting personal development in relation to meet future demandsTeaching another



- Specifies when nursing is needed - Nursing is required when a person is incapable or limited in the provision of continuous effective self care.

Orem identifies 5 methods of helping:Acting for and doing for othersGuiding othersSupporting anotherProviding an environment promoting personal development in relation to meet future demandsTeaching another

Theory of Nursing Systems


Theory of Nursing Systems


Describes how the patient’s self care needs will be met by the nurse , the patient, or both

Identifies 3 classifications of nursing system to meet the self care requisites of the patient:

a. Wholly compensatory systemb. Partly compensatory systemc. Supportive – educative system

Accomplishes patient’s therapeutic self-care

Supports & protects patient

Compensates for patient’s inability to engage in self-care

Nurse Action

Patient’s action

limited

WHOLLY COMPENSATION SYSTEM

Basic Nursing Systems

Performs some self-care measure for patient

Compensates for self-care limitations of patient

Assists patient as required

Regulates self-care agency

Accepts care & assistance from nurse

Performs some self-care measure

Nurse Action

Patient’s action

Partly compensatory systemBasic Nursing Systems

Accomplishes self-care

Regulates the exercise & development of self-care

agency

Patient’s action

Nurse Action

Support-Educative System

Basic Nursing Systems

FAYE GLEN ABDELLAH“Twenty-one Nursing Problems”



INTRODUCTIONFaye Glenn Abdellah, pioneer nursing researcher, helped transform nursing theory, nursing care and nursing education

Birth:1919

Dr Abdellah worked as Deputy Surgeon General Former Chief Nurse Officer for the US Public Health Service , Department of Health and human services, Washington, D.C.


“ I never wanted to be a medical doctor because I could do all I wanted to do in nursing, which is a caring profession.”

ABDELLAH’S THEORY

HEALTH NURSING PROBLEMS PROBLEM SOLVING


Nursing Problems

A condition faced by the patient or family which the nurse can assist him or them to meet through the performance of professional functioning.


Nursing Problems

Overt (Objective)Overt (Objective) Apparent, obvious or can-be- seen condition

Covert (Subjective)Covert (Subjective) Concealed, hidden, unseen or masked one


Typology of 21 Nursing Problems

Identification and classification of problem

3 areas: Physical, sociological and emotional needs of the patient

Types of interpersonal relationships between the nurse and the patient

Common elements of patient careRichard SagasagRN, MAN, USRN

Problem Solving Problem solving process a. Identifying the overt & covert

problem: (ASSESSMENT)-Interviews-Physical assessment-Laboratory results

b. Selecting relevant data (DIAGNOSIS) - Interpret & analyze the problem


Problem Solving Problem solving process c. Devising hypothesis (PLANNING)

- Nurse & patient formulate a plan of care based on the identified problems

d. Testing hypothesis through the assortment of data (INTERVENTIONS/ IMPLEMENTATIONS)

- Nursing actions provided to the client that leads to solving the problem .Richard Sagasag

RN, MAN, USRN

Problem Solving Problem solving process e. Revising hypothesis (EVALUATION) - Evaluate the client’s response to nursing interventions and compare to your goals & desired outcomes

Note: if the client has a positive response to the interventions = RECOVERY (problem is resolved)

If the problem is not resolved it needs revision. Richard Sagasag

RN, MAN, USRN


10 steps to identify the client’s problems


TEN steps to identify the client’s problems

1. Learn to know the patient

2. Sort out relevant and significant data

3. Make generalizations about available data in relation to similar nursing problems presented by other patients

4. Identify the therapeutic plan

5. Test generalizations with the patient and make additional generalizations

6. Validate the patient’s conclusions about his nursing problems


10 steps to identify the client’s problems

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. Identify how the nurses feels about the patient’s nursing problems

10. Discuss and develop a comprehensive nursing care plan


Typology of 21 Nursing Problems


1. To maintain good hygiene and physical comfort

2. To promote optimal activity: exercise, rest and sleep

3. To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection

4. To maintain good body mechanics and prevent and correct deformity


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.

12. To identify and accept positive and negative expressions, feelings, and reactions

13. To identify and accept the interrelatedness of emotions and organic illness

14. To facilitate the maintenance of effective verbal and non-verbal communication


15. To promote the development of productive interpersonal relationships

16. To facilitate progress toward achievement of personal spiritual goals

17. To create and / or maintain a therapeutic environment

18. To facilitate awareness of self as an individual with varying physical , emotional, and developmental needs


19. To accept the optimum possible goals in the light of limitations, physical and emotional

20. To use community resources as an aid in resolving problems arising from illness

21. To understand the role of social problems as influencing factors in the case of illness

SISTER CALLISTA ROY“Adaptation Model”



INTRODUCTION

Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy

At age 14 she began working at a large general hospital, first as a pantry girl, then as a maid, and finally as a nurse's aid.

She entered the Sisters of Saint Joseph of Carondelet.


She earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in 1963. A master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966.

She also earned a master’s & PhD in Sociology in 1973 & 1977, respectively


Sr. Callista had the significant opportunity of working with Dorothy E. Johnson

Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. 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.

http://currentnursing.com/nursing_theory/application_Roy's_adaptation_model.html


“Roy's theory sees the person as "a bio-psycho-social being in

constant interaction with a changing environment"

(Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with

stressors”


Terms used in theRoy Adaptation Model (RAM)


System-a set of parts connected to function as a whole for some purpose.

Stimulus-something that provokes a response, point of interaction for the human system and the environment

Three types of STIMULI:- Focal Stimuli- Contextual Stimuli- Residual Stimuli


Focal Stimuli-internal or external stimulus immediately affecting the system. Ex: Immobility

Contextual Stimulus-all other stimulus present in the situation. Ex: Amputation of the Limb

Residual Stimulus-environmental factor, that can affect the focal stimulus but the effects are unclear.


The adaptation level is modulated by persons coping mechanism & control process. Thus person does not respond passively to environmental stimuli.

Two categories of COPING MECHANISMS:a.Regulator subsystemb.Cognator subsystem


Regulator Subsystem- automatic response to stimulus transpires through neural, chemical, and endocrine. Ex: (increase vital signs)

Cognator Subsystem - responds through four cognitive-emotional channels: perceptual and information processing, learning, judgment and emotion.


“The Four Adaptive Modes are interrelated through perception. An adaptive response in one mode can

influence adaptation in the other modes” ….Sister Callista Roy


1. Physiological-Physical Adaptive Mode Goal: Physiological Integrity

-The way the person responds as a physical well-being to stimuli from the environment-Nurse must be knowledgeable about normal processes -Five Physiologic Needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)


2. Self Concept-Group Identity Adaptive Mode

Goal: Psychological Integrity

Psychological & spiritual characteristics of the person consist of all beliefs & feelings that one has formed about oneself.

two components:Physical Self = body sensation & body imagePersonal Self = self consistency, self ideal & moral ethical spiritual self


3. Role Function Adaptive Mode-Different roles that a person performs in the society

A role is a set of expectations about how a person occupying ones position behaves towards a person occupying another position.

Goal: Social Integrity


4. Interdependence Adaptive ModeCoping mechanism from close relationship which results to giving & receiving of love, respect and value.

Occurs between the person & the most significant other or support system.

Goal: Affectional adequacy Ex: giving & receiving love, respect & value through effective communication


Nursing Process:

Step 1: Assessment of the behavior - gather data about the behavior of the person as an adaptive system in each of the adaptive mode Observable behavior (Overt/Objective) Non-observable (Covert/Subjective)

Step 2. Assessment of Stimuli Focal Contextual Residual


Nursing Process:

Step 3: Nursing Diagnosis - formulation of statements that interpret data about the adaptation status of the person, including the behavior and most relevant stimuli.

Step 4: Goal Setting - Establishment of statements of the behavioral outcomes for nursing care which is realistic and attainable. This is done together with the client.


Nursing Process:

Step 5: Intervention - determination of how best to assist the person in attaining the established goals

Step 6: Evaluation - Judging the effectiveness of the nursing intervention in relation to the behavior after it was performed in comparison with the goal established.


Application of Roy’s Adaptation Theory utilizing

the Nursing Process


Mang Goryo, a 50-year-old driver has diabetes for 5 years and has not followed the prescribed treatment regimen.

He has a non-healing would on his right foot which prompted the surgeon to perform above-knee amputation to prevent further complication.

His past health history revealed that Mang Goryo seldom visit his doctor for his check up. He smokes approximately two packs of cigarretes per day for the past 10 years and also drinks alcohol


In addition Mang Goryo is the bread-winnerIn the family. He has 6 children & described his wife as verbally abusive (bungangera) at times because of financial instability.

A day after the surgery Mang Goryo said. “Namatay ang tatay at nanay ko dahil s diabetes. Bakit pa ako magbabago kun mamamatay rin lang ako”.

When the nurse explored his feelings, Mang Goryo become extremely tearful and expressed his concern about about him being worthless, the future of his family. He believes that the Illness is a punishment for his past life.


Physiologic Adaptive Mode

Step 1. Assessment of the behavior- Mang Goryo had undergone amputation of the leg, his mobility is impaired.

Step 2. Assessment of the stimuli- Bacause of amputation the patient has impaired mobilityFocal Stimulus is immobilityContextual Stimulus is amputation of the limb

Step 3. Nursing DiagnosisImpaired mobility related to amputation of the right leg



Step 4. Goal Setting“ Mang Goryo should be able to verbalize understanding of the situation & rehabilitation treatment regimen & safety measures.

Step 5. Interventiona.Encourage to participate in self-care activities & rehabilitationb.Demonstrate proper use of crutchesc.Allow Mang Goryo to do return demonstration of proper use of crutchesd.Emphasize safety measures in using the assistive device



Step 6. Evaluationa. Mang Goryo was able to verbalize understanding of the importance of rehabilitation

b.Mang Goryo is able to properly demonstrate crutch walking

Adaptive or

ineffective responses

Coping Mechanism:

a. Regulatorb.Cognator

PhysiologicalSelf-ConceptRole Function

Interdependence

Stimuli Adaptation

level

INPUT CONTROL PROCESS

EFFECTOR OUTPUT

FEEDBACK

MADELEINE LEININGER“Transcultural Theory”

(Current Title: Culture Care or Culture Care Diversity & Universality



Madeleine Leininger was born in Sutton, Nebraska

In 1948, she received her diploma in nursing from St. Anthony’s School of Nursing in Denver, Colorado.

In 1950, she earned a B.S. from St. Scholastica (Benedictine College) in Atchison, Kansas.


In 1954 earned an M.S. in psychiatric and mental health nursing from the Catholic University of America in Washington, D.C.

In 1965, she was awarded a Ph.D. in cultural and social anthropology from the University of Washington, Seattle

(Tomey and Alligood, 2001).


“For a nurse to successfully provide care for a client of a different cultural or

ethnic to background, effective intercultural communication must take

place.

Intercultural communication occurs when each person attempts to

understand the other’s point of view from his or her own cultural frame of

reference”


CONCEPT OF CULTURE


Culture is learned by each generation through both formal and informal life experiences.

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.


PURPOSES OF KNOWING THE PATIENTS CULTURE AND

RELIGION FOR HEALTH CARE PERSONNEL

“Cultural background affect a person's health in all dimensions, so the nurse should

consider the client's cultural background when planning care. Although basic human

needs are the same for all people, the way a person seeks to meet those needs is

influenced by culture.”


a. To heighten awareness of ways in which their own faith system. Provides resources for encounters with illness, suffering and death.

b. To foster understanding, respect and appreciation for the individuality and diversity of patients beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome.


Culturally Congruent Care

Care that fits the people's valued life patterns and set of meanings -which is generated from the people themselves, rather than based on predetermined criteria.

Discovering client's culture care values, meanings, beliefs and practices as they relate to nursing and health care requires nurses to assumes the roles of learners of client’s culture and co-partners with client's and families in defining the characteristics of meaningful and beneficial care.(Leininger,2002)


Culturally Competent Care

The ability of the nurse to bridge cultural gaps in caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring.

Culturally competent care requires specific knowledge, skills, and attitudes in the delivery of culturally congruent care and awareness.


Nursing Decisions (Nursing Actions)

Three modes of professional decisions and actions are aimed to assist, support, facilitate, or enable people of particular cultures to achieve culturally congruent care.

1.Cultural preservation or maintenance

2.Cultural care accommodation or negotiation

3.Cultural care repatterning or restructuring


Nursing Decisions (Nursing Actions)

1. Cultural Preservation or Maintenance: Retain and or preserve relevant care values so that clients can maintain their well-being.

2. Cultural Care Accommodation or Negotiation: Adapt or negotiate with the others for a beneficial or satisfying health outcome

3. Cultural Care Repatterning or Restructuring Records, change, or greatly modify client’s life ways for a new, different and beneficial health care pattern

Tech

nolo

gica

l fa

ctor

sReli

giou

s &

philo

soph

ical

fact

ors

Kinship &

social

factors

Cultural values & life-ways

Political & legal factors Economic

factors

Educational

factors

Influences care patterns and expressions

Health (well-being)of

Individuals, families, groups, and institutions

Diverse Health Systems

SUNRISE MODEL

Folk systems Nursing Professional

systems

Nursing care decisions and actions

Cultural care preservation/maintenance Cultural care accommodation/negotiation

Cultural care repatterning/restructuring

CULTURE CONGRUENT CARE

JEAN WATSON“The Phylosophy & Science of

Caring”



IntroductionBorn: West Virginia

Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of Colorado, 1973

Dr. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado Health Sciences Center.


Introduction

She is founder of the original Center for Human Caring in Colorado and is a Fellow of the American Academy of Nursing. She previously served as Dean of Nursing at the University Health Sciences Center and is a Past President of the National League for Nursing Watson believes that the main focus in nursing is on carative factors. She believes that for nurses to develop humanistic philosophies and value system, a strong liberal arts background is necessary.


Introduction

This philosophy and value system provide a solid foundation for the science of caring.

A humanistic value system thus under grids her construction of the science of caring.

She asserts that the caring stance that nursing has always held is being threatened by the tasks and technology demands of the curative factors.


The focus of nursing is on carative factors that

are derived from a humanistic perspective

combined with scientific knowledge base

-------Jean Watson

SEVEN ASSUMPTIONS

1.Caring can be effectively demonstrated and practiced only interpersonally

2. Caring consists of carative factors that result in the satisfaction of certain human needs

3. Effective caring promotes health and individual or family growth


4. Caring responses accept a person not only as he/she is now but as what he/she may become

5. A caring environment offers the development of potential while allowing the person to choose the best action for himself at a given time


6.Caring is more “healthogenic” than is curing. A science of caring is therefore complementary to the science of curing.

7. The practice of caring is central to nursing.


1. Formation of Humanistic-Altruistic System of Values

Learned in early life, but can be greatly influenced by nurse-educators

Satisfaction through giving and extension of the sense of self


2. Instillation of Faith-Hope

Facilitates the promotion of holistic nursing care and positive health within the patient population

Describes the nurse’s role in developing NPI and promoting wellness by helping the patient adopt health-seeking behavior


3. Cultivation of Sensitivity to Self and to Others

Recognition of feelings leads to stabilization through self- acceptance for both nurse and the patient

As nurses acknowledge their sensitivity and feelings, they become more genuine, authentic and sensitive to othersRichard Sagasag

RN, MAN, USRN

4. Development of a Helping-Trust Relationship

Crucial for transpersonal caring

Trusting relationship promotes and accepts the expression of both + and – feelings Involves:

Congruence – being real, honest, genuine, and authentic



Involves: Empathy – ability to experience and, thereby understand the other person’s perceptions and feelings and to communicate those understandings



Involves: Nonpossessive warmth

Demonstrated by a moderate speaking volume A relaxed, open posture Facial expressions that are congruent with other communications



Involves:

Effective communication – has cognitive, affective

and behavior response components


5. Promotion and Acceptance of the Expression of Positive and Negative

Feelings

Sharing of feelings – a risk-taking experience for both nurse and patient

Nurse must: Be prepared for either + or – feelings

Recognized that intellectual and emotional understandings of a situation differRichard Sagasag

RN, MAN, USRN

6. Systematic use of the Scientific Problem-Solving

Method for Decision Making

Use of the nursing process brings scientific problem-solving approach to nursing care

Nursing process is similar to the research process in that it is systematic and organized


7. Promotion of Interpersonal Teaching-Learning

Important concept for nursing It separates caring from curing Allows patient to be informed and shifts the responsibility for wellness and health to the patient Nurse facilitates this with T-L techniques that are designed to enable patients to provide self-care


8. Provision for Supportive, Protective, and Corrective Mental, Physical,

Sociocultural and Spiritual Environment

Nurse must recognize the influence that internal and external environment have on health and illness

Internal environment: Mental and spiritual Sociocultural beliefs


External variables: Comfort Privacy Safety Clean surroundings


8. Provision for Supportive, Protective, and Corrective Mental, Physical,

Sociocultural and Spiritual Environment

Nurse recognizes the biophysical, psychophysical, and intrapersonal needs of self and patient

Patients must satisfy lower-order needs before attempting to attain higher-order needs

9. Assistance with Gratification of Human Needs


Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference

Existential psychology Science of human existence that uses phenomenological analysis Provide a thought-provoking experience leading to a better understanding of the self and others

10. Allowance for Existential Phenomenological Forces


ERNESTINE WIEDENBACH“The Helping Art of Clinical

Nursing”Prescriptive Theory of Nursing



INTRODUCTION

Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany.

Wiedenbach's conceptual model of nursing is called ' The Helping Art of Clinical Nursing".

Education:B.A. from Wellesley College in 1922R.N. from Johns Hopkins School of Nursing in 1925M.A. from Teachers College, Columbia University in 1934Certificate in nurse-midwifery from the Maternity Center Association School for Nurse-Midwives in New York in 1946..


INTRODUCTION

Career: Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing. Assistant professor of obstetric nursing in 1954 and an associate professor in 1956.She wrote Family-Centered Maternity Nursing in 1958. She was influenced by Ida Orlando in her works on the framework.

She died on March 8, 1998.


KEY ELEMENTS


KEY ELEMENTS

Wiedenbach proposes 4 main elements to clinical nursing.

a philosophya purposea practice andthe art.


The Philosophy

The nurses' philosophy is their attitude and belief about life and how that effected reality for them.

Wiedenbach believed that there were 3 essential components associated with a nursing philosophy:

Reverence for life (profound honor)

Respect for the dignity, worth, autonomy and individuality of each human being

Resolution to act on personally and professionally held beliefs.


The PurposeNurses purpose is that which the nurse wants to accomplish through what she does.

It is all of the activities directed towards the overall good of the patient.

The Practice Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patient’s need for help.


The Art

The Art of nursing includes:Understanding patients needs and concerns

Developing goals and actions intended to enhance patients ability and

Directing the activities related to the medical plan to improve the patients condition.

The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns.


PRESCRIPTIVE THEORY(Situation Producing Theory)


Wiedenbach's prescriptive theory is based on three factors:

Central purpose- defines the quality of health the nurse desires to effect what she recognizes to be her special responsibility

Prescription- plan for client’s care. It is directive to activity

Realities- one the nurse recognizes her central focus and developed her prescription, the nurse must then consider the realities that she will provide nursing care.


Central Purpose in

Nursing

Prescription

Realities

Realities

Realities

MYRA ESTRINE LEVINE“Conservation Model”



Levine’s Conservation Model is focused in promoting adaptation and

maintaining wholeness using the principles of conservation.

The nurse accomplishes the goals of the model through the conservation of energy, structure, and personal and social integrity (Levine, 1967)


COMPOSITION OF CONSERVATION MODEL


a. Adaptation is the process of change, and conservation is the outcome of adaptation.

Adaptation is the process whereby the patient maintains integrity within the realities of the environment (Levine, 1966, 1989a).


b. Wholeness is based on Erikson’s description of wholeness as an open system: “Wholeness emphasizes a sound, organic, progressive mutuality between diversified functions and parts within an entirety, the boundaries of which are open and fluid.”

Levine stated that wholeness, exists when the interaction or constant

adaptations to the environment, permit ease—the assurance of integrity…in all

the dimensions of life.”


Conservation is the product of adaptation

The primary focus of conservation is keeping together of the wholeness of the individual.


KEY CONCEPTS (Conservational principle)


I. Conservation of Energy

Refers to balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition and exercise.

Examples: Availability of adequate rest; Maintenance of adequate nutrition


II. Conservation Of Structural Integrity:

Refers to maintaining or restoring the structure of body preventing physical breakdown and promoting healing.

Examples: Assist patient in ROM exercise; Maintenance of patient’s personal hygiene


III. Conservation Of Personal Integrity

Recognizes the individual as one who strives for recognition, respect, self awareness, selfhood and self determination.

Example: Recognize and protect patient’s space needs


IV. Conservation Of Social Integrity

An individual is recognized as some one who resides with in a family, a community, a religious group, an ethnic group, a political system and a nation.

Example: Help the individual to preserve his or her place in a family, community, and society.

ANN BOYKIN & SAVINA SCHOENHOFER

“Nursing as Caring”


Dr. Anne BoykinR.N., Ph.D

Dr. Savina O. SchoenhoferR.N., Ph.D.


The basic premise of Nursing as Caring is that all persons are caring. (Boykin & Schenhofer,

1993)


Seven Major Assumptions


a. Persons are caring by virtue of their humanness

b. Persons are caring moment to moment

c. Persons are whole or complete in the moment

d. Personhood is a process of living grounded in caring

e. Personhood is enhanced through participating in nurturing relationships with caring others


f. Nursing is both a discipline and a profession

g.Persons are viewed as already complete and continuously growing in completeness, fully caring and unfolding caring possibilities moment –to-moment


To understand the person as CARING one needs….

To focus on VALUING

To celebrate the wholeness of human

To view humans as both living & growing in caring

To actively seek engagement on a personal level with others


The focus of nursing is “ nurturing persons living caring & growing in

caring”

“The call for nursing is a call for acknowledgement and affirmation of the person living caring in specific in

specific ways in this immediate situation”

The Dance of Caring Persons

The circle represents relating with respect for and valuing of the other in the basic dance to know self and other as caring person.

Each dancer in the circles make contribution and moves within the dance as the nursing situation evolves.

There is always a room for more in the circle and dancers may move in or out as the nurse calls for services.

While dancers may or may not connect by holding hands eye-to-eye contact facilitates knowing others as caring

JOSEPHINE PATERSON & LORETTA ZDERAD

“Humanistic Nursing”



“Humanistic nursing practice is developed from the lived experiences of the nurse & the person receiving

care”

“Humanistic nursing is concerned with the phenomenological

experiences of individuals and exploration of human experiences”


Three Concepts that provide the basis (or components) of nursing

DialogueCommunity Phenomenologic Nursology


DIALOGUE-Nursing is a live dialogue-Nursing is an INTERSUBJECTIVE EXPERIENCE in which there is REAL SHARING

a. Meeting – is the coming together of human beings and is characterized by expectation that there will be a nurse and a nursed.

b. Relating – the process of nurse-nursed “doing” with each other is relating, being with the other


DIALOGUE

c. Presence – the quality of being open, receptive, ready, and available to another person in a reciprocal manner is presence

d. Call and Response – are transactional, sequential, & simultaneously

Nurses & clients call & respond to each other both verbally & non-verbally, and there is the potential to be “all at once”


COMMUNITY -Humanistic nursing leads to community, it occurs within a community, and is affected by community

-Community is the experience of persons, and it is through community, persons relating to others , that it is possible to become


PHENOMENOLOGIC NURSOLOGY

-Nursing, its practice & theory would not be completed without a METHODOLOGY called phenomenologic nursology.

Five phases in this approach:

a. Preparation of the nurse knower for coming to know - this involves to take risks, being open to experiences, to one’s own view of the world, and to another’s perceptual framework.


b. Nurse knowing the other intuitively - intituitive knowing requires getting “inside”, into the rhythm of the other’s experience, resulting in a special, difficult to express, knowledge of the other.

- Avoid expectations, labeling, and judgments


c. Nurse knowing the other scientifically

- This phase implies a separateness from what is known

- It requires taking the all-at-once phenomena that are known intuitively, then looking at them, pondering, analyzing, sorting, comparing, contrasting, relating, interpreting, naming, and categorizing them.


d. Nurse complementarily synthesizing known others.

-The nurse compares and synthesizes multiple known realities and arrives at an expanded view.

- In this phase the nurse uses not only personal experience but also the rich theoretical foundation of education and practice in order to put the clinical situation in perspective.


e. Succession within the nurse from the many to paradoxical one

-This phase evolves from the descriptive process of a lived phenomenon.

-It is articulated vision of experience that becomes expressed in a coherent whole.

MARTHA ELIZABETH ROGERS“Science of Unitary Human

Beings”



Concepts of Roger’s Model


1. Energy Field- Energy field is the fundamental unit of both

the living & non-living- This energy field “provide a way to perceive

people & environment as irreducible whole- The energy field continuously varies in

intensity, density, and extent

2. Openness- Human field & environmental field are

constantly exchanging their energy

3. Pattern- Defined as the distinguishing characteristic of

an energy field perceived as a single wave


Homeodynamic Principles

-The way of perceiving unitary human beings

a.Resonanceb.Helicy

c.Integrality


Resonance-An ordered arrangement of rhythm between human field & environmental field

-Field that undergoes continuous dynamic

Helicy-Describes the unpredictable, but continuous, non-linear evolution of energy field as evidenced by non repeating rhythmicities

Integrality-It covers the mutual, continuous relationship of the human energy field and the environmental field

-The fields are one & integrated but unique to each other

Margaret Newman

“Health as an Expanding Consciousness”



Background of the theory


Margaret Newman believed human beings as unitary,

health and disease is inseparable from each other and they are the part of the

same entity.


Humans are open to the whole energy system of the universe and constantly interacting with the energy. With this process of interaction humans are evolving their individual pattern of whole.

According to Newman understanding the pattern is essential. The expanding consciousness is the pattern recognition.


The nurse helps to understand people to use the power within to develop the higher level of consciousness.

Thus it helps to realize the disease process, its recovery and prevention.

Time and space are the temporal pattern (series of events) of the individual, both have complementary relationship.

Humans are constantly changing through time and space and it shows unique pattern of reality


Application of the theory


Health as expanding consciousness is not only focus in treating the disease but it also helps to understanding the patient pattern of interacting with environment and how to move forward


Holistic Nursing:

It is the understanding of the relationship among all the components like biologic, psychological, social and spiritual dimensions of an individual and also it involves understanding as an integrated whole interacting with internal and external environments.


Therapeutic touch:

It is believed that human body has energy and produces an aura manipulating that energy can help in healing but it does not have any scientific base.

ROSEMARIE RIZZO PARSE

“Theory of Human Becoming”



Three Assumptions on Human Becoming

(updated from Parse 1992, p.38)


a. Human becoming is freely choosing personal meaning in situations in the intersubjective process of relating value priorities

b. Human becoming is cocreating rhythmical patterns of relating in open interchange with the universe

c. Human becoming is contrascending (moving beyond/stooping) multidimensionally with the unfolding possibilities.


PRINCIPLES

Meaning

Rhythmicity

Transcendence


Meaning- Refers to the linguistic and imagined content of something & the interpretation that one gives to something

Rhythmicity- Refers to the paced, paradoxical patterning of the human-universe mutual process

Transcendence- Described as reaching beyond with possibilities – the hopes & dreams as seen in multidimensional experiences

- options from which to choose personal ways of becoming

LYDIA HALL“Care, Core, Cure”



CARE CORE CURE


CARE

The care circle represents the nurturing component and is exclusive to nursing.

Refers to the independent roles & functions of the nurse insofar as her knowledge & skills about the patient’s condition will allow her to carry on with her nursing responsibilities.

CORE CURE


CORE

The core circle of patient is based in the social sciences, involves the therapeutic use of self, and is shared with other members of the health team

The nurse makes sure that the patient receives the highest level of care by collaborating, coordinating & cooperating with other health care team

CARE CURE


CORE

The cure circle of patient care is based in the pathological and therapeutic sciences and is shared with other members of the health team

It delineates nursing functions that are dependent on the members of the medical profession

Example: medication administration, diagnostic procedure

CARE CURE

IDA JEAN ORLANDO“The Nursing Process Theory”



The nursing process discipline is based on the “process by which any individuals acts”.

The purpose of the process discipline, when it is used between a nurse & patient, is to meet the patient’s immediate need for help


Patient Behavior

All patient behavior, no matter how insignificant, must be considered an expression of need for help until its meaning to a particular patient in the immediate situation is understood.

Verbal (complaints, requests, questions, refusal, demands, comments or statements

Nonverbal ( heart rate, perspiration, edema, urination, motor activity, avoiding eye contact)


Nurse Reaction

Patient’s behavior stimulates a nurse reaction.

Three sequential parts:a.Nurse perceives the behavior through any sensesb.Perception leads to automatic thoughtc.Finally, the thought produces an automatic feeling

Example:Nurse sees the patient grimacing. Shen then thinks that patient is in pain. Then feels concern about the feelings of the patient


Nurse Action

Once the nurse has validated or corrected her reaction to the patient’s behavior through exploration with him, she can complete the nursing process discipline with the nurse’s action.

Orlando said that only what the nurse says or does with or for the benefit of the patient as “professional nursing action”

The nurse must be certain that her action is appropriate to meet the patient’s need for help.

JOYCE FITZPATRICK“Rhythm Model”



The primary purpose of nursing is the promotion and maintenance of an optimal level of wellness.

The professional nurse participates in a multi-disciplinary approach to health in assessing, planning, implementing, and evaluating programs in regards to how they affect optimum wellness for patients.


When assessing health care needs, the professional nurse incorporates the physical, emotional, social, environmental and spiritual aspects of the profession into her daily routine.


FOUR CONTENT CONCEPTS:

Person

Health

Wellness-Illness

Metaparadigm


Person

The term person integrates the concepts of both self and others, and recognizes individuals as having unique biological, psychological, emotional, social, cultural, and spiritual attitudes.

Throughout a person’s life, many factors develop within a social setting and interact with a multitude of environments that can significantly influence that person’s health and wellness


Health:

Health is a dynamic state of being that results from the interaction of person and the environment.

Optimum health is the actualization of both innate and obtained human potential gleaned from rewarding relationships with others, goal directed behavior, and expert personal care.


Wellness-Illness

Professional nursing is rooted in the promotion of wellness practices, the attentive treatment of those who are acutely or chronically ill or dying, and restorative care of people during convalescence and rehabilitation

Nursing is a practice discipline and a profession that is based upon a synthesized body of knowledge.


Metaparadigm

Transition is one of the core concepts of nursing theory, derived from and related to the basic metaparadigm concepts of person, environment, health and nursing.

PATRICIA BENNER“Novice to Expert”



Introduction

Dr Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences.

She proposed that one could gain knowledge and skills ("knowing how") without ever learning the theory ("knowing that").


Introduction

She further explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge (know how) through research and the characterization and understanding of the "know how" of clinical experience.

She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert.


Levels of Nursing experience

She described 5 levels of nursing experience as; Novice Advanced beginner Competent Proficient Expert

These levels reflect: Movement from reliance on past abstract principles to the use of past concrete experience as paradigms and

Change in perception of situation as a complete whole in which certain parts are relevant


NOVICE

Novice Stage describes that a person has no background experience of the situation in which he/she is involved.

To guide performance, context free rules and objective attributes must be given.

The novice has also difficulty discriminating between relevant and irrelevant aspects of a situation.

Examples: Students or nurses placed in an unfamiliar situation


ADVANCE BEGINNER

Advance beginner has sufficient experience to easily understand aspects of the situation.

It requires experience based on recognition in the background of the situation.

Nurse at this stage feel more responsible for managing patient care, yet still rely on the help of those more experienced.

Example: Newly graduate nurses


COMPETENT2-3 years experience

Competent performance considers consistency predictability, and time management as essential components.

The sense of mastery is acquired through planning and predictability.

Increased level of efficiency is evident. However time management & the nurses organization of the task are more important than on timing in relation to the patients needs.


PROFICIENTHas 3-5 experience

According to Dreyfus model, the performer of this stage perceives the situation as a whole rather than in terms of aspects, and performance is guided by maxims (rule of conduct).

The proficient level is qualitative leap beyond the competent. – the performer identifies the most significant aspects and has a better understanding of the situation based on background understanding.


PROFICIENT

They no longer rely on preset goals for organization , and they show an increased confidence in their knowledge and skills. There is much involvement of the patient & family.


EXPERT

Dreyfus said that in the expert stage is accomplished when the expert performer no longer relies on analytical principle like rules, guidelines and maxims to connect her understanding of the situation to an appropriate action.

Benner viewed an expert nurse as possessing an intuitive grasp of the problem without losing time considering a range of alternative diagnosis and solutions.

EXPERT

Dreyfus said that in the expert stage is accomplished when the expert performer

no longer relies on analytical principle like rules, guidelines and maxims to connect her understanding of the situation to an

appropriate action.Benner viewed an expert nurse as possessing an intuitive grasp of the

problem without losing time considering a range of alternative diagnosis and

solutions.


CARMENCITA M. ABAQUIN“PREPARE ME” interventions & the

Quality of Life of Advance Progressive Cancer Patients

Biographic Sketch

Carmencita M. Abaquin

- is a nurse with Master's and Doctoral Degree in Nursing obtained from the University of the Philippines College of Nursing.

- She is an expert of medical surgical nursing with subspecialty in oncologic nursing, which made her known both here and abroad.


She had served UP college of nursing, her alma mater, as faculty and held the position as secretary of the college of nursing.

Her latest appointment as chairman

of the board of nursing speaks of her competence and integrity in the field she has chosen.


PREPARE ME Interventions are said to be effective in improving the quality of life of cancer patients. This can be further applied not only with terminally- ill patients but also promisingly introduced to those patients with acute and chronic diseases and those with prolonged hospital stays.


Basic Assumptions and Concepts

PREPARE ME (Holistic Nursing Interventions) are the nursing interventions provided to address the multi – dimensional problems of cancer patients that can be given in any setting where patients choose to be confined.


This emphasizes a holistic approach to nursing care. PREPARE ME has the ff. components:

• Presence- being with another person during the times of need. This includes therapeutic communication, active listening, and touch.

• Reminisce Therapy- recall of past experiences, feelings and thoughts to facilitate adaptation to present circumstances.


Prayer

• Relaxation- breathing- techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension and anxiety.


Meditation - encourages an elicit form of relaxation

for the purpose of altering patient’s level of awareness by focusing on an image or thought to facilitate inner sight which helps establish connection and relationship with God.

It may be done through the use of music and other relaxation techniques.


Values clarification- assisting another individual to clarify his own values about health and illness in order to facilitate effective decision making skills. Through this, the patient develops an open mind that will facilitate acceptance of disease state or may be help deepen or enhance values. The process of values clarification helps one become internally between what we do and what we consistent by achieving closer feel.

Quality of life is a multifaceted construct that encompasses the individual’s capacities and abilities with an aim of enriching life when it cannot longer be prolonged. This includes proper care of the body, mind, and spirit to maintain integrity of the whole person despite limitations brought by the present situation. This can be seen with the ff. dimensions of man – physical, psychological, social, religious, level of independence, environment, and spiritual.



SISTER LETTY KUAN

““Retirement and Role Discontinuities”

Basic Assumptions and Concepts


Retirement

Leaving of job or career

The act of leaving a job or career at or near the usual age for doing so, or the state of having left a job or career


Time after having stopped working

the time that follows the end of somebody's working life.

Being away from busy lifea state of being withdrawn

from the rest of the world or from a former busy life.


Physiologic Age

Is the endurance of cells and tissues to withstands the wear-and-tear phenomenon of the human body. Some individuals are gifted with the strong genetic affinity to stay young for a long time.


Role

Refers to the set of shared expectations focused upon a particular position.


Change of Life

Is the period between near retirement and post retirement years.


Retiree

Is an individual who has left the position occupied for the past years of productive life because he/she has reached the prescribed retirement age or has completed the required years of service.


Role Discontinuity

Is the interruption in the line status enjoyed or role performed. The interruption may be brought about an accident, emergency and change of position or retirement.


Coping Approaches

Refer to the interventions or measure applied to solve a problematic situation or state in order to restore or maintain equilibrium and normal functioning.


Health Status

Refer to the physiologic and mental state of the respondents classified as either sickly or healthy.


Income (economic level)

Refers to the financial affluence of the respondents which can be classified as poor, moderate, and rich.


Documents

TFN Nursing Theories 2011-2012