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FRAMEWORK FOR PROFESSIONAL NURSING PRATICE

HISTORYAlthough the beginning of nursing theory development can be traced to florence Nightingale, it was not until the second half of the 1900s that nursing theory caught the attention of nursing as a discipline.Theory development was a major topic of discussion during 60s and 70s

however in 1980s attention turned from the development of a global theory for nursing as scholars began to recognize multiple approaches to theory development in nursing

CONCEPTA concept is a term or label that describes a phenomenon. ( Melies,2004)

- The Phenomenon described by a concept can be either:1. Empirical II. Abstract

EMPIRICAL / ABSTRACTEmpirical concept is the one that can be either observed or experienced through the senses.An ABSTRACT concept is one that is not observable, such as hope, or caring ( Hickman, 2002)

CONCEPTUAL MODELA conceptual model is defined as a set of concepts and statements that integrate the concepts in to a meaningful configuration ( Lippitt , 1973)

PROPOSITIONS / ASSUMPTIONSPROPOSITIONSThey are statements that describe relationship among events , situations, or actions.ASSUMPTIONSThey also describe concepts or connect two concepts and represent values, beliefs, or goalsWHEN ASSUMPTIONS ARE CHALLENGED, THEY BECOME PREPOSITIONS

STATEMENTConceptual Models are composed of abstract and general concepts and propositions that provide a frame of reference for members of a discipline.This frame of reference determines how the world is viewed by members of a discipline and guides the members as they propose questions and make observations relevant to the discipline.

THEORYIt is an organized, coherent, an systematic articulation of a set of statements related to significant questions in a discipline that are communicated in a meaningful of all.

Theory Vs Conceptual ModelThe primary distinction between a conceptual model and a theory is the level of abstraction and specificity.A conceptual model is a highly abstract system of global concepts and linking statements.A theory, in contrast, deals with one or more specific, concrete concepts and propositions.(Fawcett. 1994)

METAPARADIGMIt is the most global perspective of a discipline and acts as an encapsulating unit, or framework, within which the more restricted structures develop.( Eckberg & Hill, 1979)

METAPARADIGM - CONCEPTEach discipline singles out phenomena of interest that it will deal within a unique manner.The concepts and propositions that identify and interrelate these phenomena as even more abstract than those in the conceptual models.

The conceptual models and theories of nursing represents various paradigms derived from the metaparadigm of the discipline of nursing. Therefore, although each of the conceptual models might link and define the FOUR metaparadigm concepts differently, the four metaparadigm concepts are present in each of the models.

Nursing The central concepts of the discipline of nursing are PRESON, ENVIRONMENT, HEALTH & NURSING.The person receiving the nursing, the environment within which the person exists, the health illness continuum within which the person falls at the time of the interaction with the nurse, and, finally, the nursing actions themselves.

Nursing theories To apply nursing theory in practice, the nurse must have some knowledge of the theoretical works of the nursing profession. theoretical works in nursing are generally categorized either as philosophies, conceptual models, theories, or middle range theories depending upon the level of abstraction.

PHILOSOPHIES IN NURSINGPhilosophies set forth the general meaning of nursing and nursing phenomena through reasoning and the logical presentation of ideas.They are broad.Nursing philosophies contribute to the discipline by providing direction, clarifying values, and forming a foundation for theory development.

ENVIRONMENTAL THEORYBy Florence NightingaleIt include four metaparadigm concepts of nursing.The focus is primarily on the patient and the environment, with the nurse manipulating the environment to enhance patient recovery.Interventions include the following

COMPONENTSVentilation and warmthHealth of housesPetty managementNoise - reductionVariety patients roomFood intake documentation

Food patient preferenceBed and beddingLightCleanliness of roomPersonal cleanlinessChattering hopes and advisesObservation of the sick.

MODEL

METAPARADIGM

VIRGINIA HENDERSONDEFINITION OF NURSING AND 14 COMPONENTS OF NURSING CARE

VIRGINIA HENDERSONShe perhaps best known for her definition of nursing, which was first published in 1955THE UNIQUE FUNCTION OF THE NURSE IS TO ASSIST THE INDIVIDUAL , SICK OR WELL, IN THE PERFORMANCE OF THOSE ACTIVITIES CONTRIBUTING TO HEALTH OR ITS RECOVERY ( OR TO A PEACEFUL DEATH) THAT HE WOULD PERFORM UNAIDED IF HE HAD THE NECESSARY STRENGHT, WILL OR KNOWLEDGE AND TO DO THIS IN SUCH A WAY AS TO HELP HIM GAIN INDEPENDENCE AS RAPIDLY AS POSSIBLE.HEND 1966

BASIC NEEDS BY HENDERSONBreathe normallyEat and drink .Eliminate body wastePostureSleep & restClothMaintain body temp.Body clean & well groomedAvoid changes in environmentCommunicationWorship Work with a sense of accomplishmentPlay/ recreationLearn, discover or satisfy curiosity

METAPARADIGM

JEAN WATSON PHILOSOPHY AND SCIENCE OF CARING

Theory what it saysThe goal of nursing is to help persons attain a higher level of harmony within the body mind and spirit.Attainment of that goal can potentiate healing and health.This goal is pursued through transpersonal caring guided by carative factors and corresponding caristas processes.

FACTORS - CARITASWatsons theory include 10 carative factorsCarative factors termed to CARITASCaritas means to cherish, to appreciate, and to give special attention. It conveys the concept of love.

MODEL

METAPARADIGM

CONCEPTULA MODELS AND GRAND THEORIES IN NURSING

MARTHA ROGERSSCIENCE OF UNITARY HUMAN BEINGS

According to rogers (1994), nursing is a learned profession, both a science and an art.The art of nursing is the creative use of the science of nursing for human betterment.

About conceptRogers theory asserts that human beings are dynamic energy fields that are integrated with environmental energy fields so that the person and his or her environment form a single unit.Both human energy fields and environmental fields are open systems, pandimensional in nature and in constant state of change. Pattern is the identifying characteristic of energy fields.

ContRogers identified the principles of helicy, resonancy, and integrality to describe the nature of change with in human and environmental energy fields.These principles are known as the principle of hemodynamics.

HelicyDescribe the unpredictable but continuous, nonlinear evolution of energy fields, as evidenced by a spiral development that is a continuous, nonrepeating and innovative patterning that reflects the nature of change.

Resonancy Wave frequency and an energy field pattern evolution from lower to higher frequency wave patterns and is reflective of the continuous variability of the human energy field as it changes.

Integrality Continuous mutual process of person and the environment.

TOYS - THEORYRogers used two widely recognized toys to illustrate her theory and constant interaction of the human- environmental process.They are SLINKY and KALEIDOSCOPE

SLINKYIt illustrates the openness, rhythm, motion, balance, and expanding nature of the human life process which is continuously evolving.

KALEIDOSCOPEIllustrates the changing patterns that appear to be infinitely different.

ASSUMPTIONS BY ROGERS

METAPARADIGM

DOROTHEA OREMSSELF CARE DEFICIT THEORY OF NURSING

contentGENERA FOCUS/IDEA : People function and maintain life, health and well-being by caring for themselves

THEORIES OF Self careSelf care deficitNursing systems

FRAMEWORKSELF CARE - Deliberate self care actions

SELF CARE DEFICIT -People who are incapable of continuous self care

NURSING SYSTEMS - Describes therapeutic self care requisites.

PURPOSES OF OREMS THEORYDirects nursing practice

Directs learning modalities in nursing school curriculum

Directs teaching skills use with patient care and evaluation.

MAJOR CONCEPTSSelf careSelf care agencySelf care requisitesTherapeutic self-care demandsSelf care deficitNursing agency Nursing systemBasic conditioning factors.

THEORY OF SELF CARE

PEOPLE PERFORM ACTION TO CONTROL FACTORS THAT AFFECT THEIR OWN DEVELOPMENT TO ENHANCE LIFE, HEALTH AND WELL BEING.

SELF-CARELearned, goal-directed activity

Directed by individual to regulate factors that affect their own functioning

GOAL DIRECTED,LEARNED, PURPOSEFUL

SELF CARE AGENCYIs complexIs acquiredAllows individual to meet continuing needsIs necessary for health of human structureIs necessary for human development Promotes well-being.

PERSONSELF-CARE AGENT PROVIDER OF SELF CARE AGENT-PERSON TAKING ACTION

DEPENDENT CARE GIVEN TO INFANTS, CHILDREN AND DEPENDENT ADULTS

DEPENDENT CARE AGENT PROVIDER OF CARE TO THE ABOVE GROUPS

SELF CARE REQUISITESUNIVERSAL : Common to all human

DEVELOPMENTAL : Promote processes for life/maturationpresent negative conditions

HEALTH DEVIATION : Health issues affect integrated human functioning the person must be able to apply knowledge to own care to become competent in managing

THERAPEUTIC SELF CARE DEMANDDescribes on individual structurally, functionally & developmentallyBasic is self-care as a regulatory functionApplies facts & theories from human & environmental sciences

HEALTHY INDIVIDUAL

Self-care abilityBALANCEUniversal self-care needs

INDIVIDUAL IN NEED OF NURSING INTERVENTION

Self-care abilitiesHealth deviation self careneedsUniversal self care needs

INDIVIDUAL IN NEED OF NURSING INTERVENTION

Self-care abilitiesHealth deviation self careneedsUniversal self care needsDevelopmental Self care needs

INDIVIDUAL IN RECEIPT OF NURSING INTERVENTION

Self-careabilitiesNursing interventionsHealth deviationself-care needsDevelopmentalself-care needsuniversal self-care needsBALANCE

SELF CARE DEFICITDeficit : Action demand for self care >the persons current capability for self care

Self care agency not adequate or operable

Needs are not completely known or met

May apply to some or all of the needs

Needs may exist currently or be projected

Dependent care deficit.

NURSING AGENCYEducated & trained individualsAssist others to recognize their self-care demandsAssists others in meeting these demandsGuide the application or development of self-care agency (or dependent care agency)

HELPING METHODSActing or doing for another

Guiding and directing

Supporting physical & psychological

Providing and maintaining an environment that supports personal development

Teaching

CONDITIONING FACTORSAgeGenderDevelopmental stateHealth stateSocio cultural orientation

Health care system factorsFamily systemLiving patternsEnvironmental factorsResources

THEORY OF NURSING SYSTEMNursing actions are:

Wholly compensatory

Partly compensatory

Supportive educative

THEORY OF NURSING SYSTEMNursing Diagnosis why the person needs nursing carePrescription means to be used to meet the TSCDNursing system design and plan co-ordinated deliberate practice actionNursing treatment

BASIC NURSING SYSTEMS WHOLLY COMPENSATORY SYSTEMPARTLY COMPENSATORY SYSTEMNurse actionPatient actionPatient action limited

Accomplishes the patients therapeutic self careCompensates for the patientsInability to engage in self careSupports and protects the patient

Nurse action

Performs some self care measuresFor the patientCompletes for the patients self care limitationsAssists the patient as requiredaccepts care and assistancePerforms some self care measuresRegulates self care agency

Supportive-EducationAccomplishes self careRegulates the exercise and development of the self care agencyNurse actionPatient action

PERSONA human-being; receiver of care

Engages in deliberate action, interpret experiences and perform beneficial actions.

Conditioning factors influences the persons ability to perform self care

HEALTHPhysical, psychological, interpersonal and social aspects are inseparable

Promotion and maintenance of health, treatment of illness and prevention of complication

ENVIRONMENTHuman environment is described in terms of physical, chemical, biologic and social features which may be interactive.

It can positively or negatively affect a patients ability to provide self care

NURSINGA human service and a helping service

Focuses on the patients continuing therapeutic care

Focus of nursing identification of self care requisites

SISTER CALLISTA ROY: ADAPTATION MODEL

INTRODUCTIONBEGINS WITH MANMAN AS A BIO PSYCHOSICIAL BEING IN CONSTANT INTERACTION WITH HIS ENVIRONMENT

FOCUS OF NURSINGMANS POSITION ON THE HEALTH ILLNESS CONTINUUMINFLUENCED BY ABILITY TO ADAPT TO CONFRONTED STIMULI

MODEL

MAJOR CONCEPTS AND DEFINITIONS SYSTEM :- A SET OF UNITS SO RELATED OR CONNECTED AS TO FORM A UNIT CHARACTERISED BY INPUTS, OUT PUTS, CONTROL AND FEEDBACK PROCESS

ADAPTATIONAL LEVEL:

* A CONSTANTLY CHANGING POINT.* MADE UP OF FOCAL,CONTEXTUAL AND RESIDUAL STIMULI.* REPRESENT THE PERSONS OWN STANDARD OF THE RANGE OF STIMULI.* TO WHICH ONE CAN RESPOND WITH THE ORDINARY ADAPTIVE RESPONSE

ADAPTATION PROBLEMS:

* THE OCCURANCE OF SITUATIONS OF INADEQUATE RESPONSES TO NEED DEFICITS OR EXCESSES

FOCAL STIMULUS:

* STIMULUS MOST IMMEDIATELY CONFRONTING THE PERSON* MUST MAKE AN ADAPTIVE RESPONSE * FACTOR THAT PRECIPITATES BEHAVIOURINDIVIDUAL NEEDS- FAMILY ADAPTATION LEVEL

CONTEXTUAL STIMULI:

* ALL OTHER STIMULI PRESENT* CONTRIBUTE TO BEHAVIOUR CAUSED BY THE FOCAL STIMULIOTHER STIMULI THAT INFLUENCE SITUATION

RESIDUAL STIMULI:

* FACTORS THAT MAY BE AFFECTING BEHAVIOUR* EFFECT NOT VALIDATED

INDIVIDUALS BELIEFS THAT OR ATTITUDES INFLUENCING SITUATION

REGULATOR:

* SUBSYSTEM COPING MECHANISM* RESPONDS AUTOMATICALLY THROUGH NEURAL-CHEMICAL-ENDOCRINE PROCESSES

COGNATOR:* SUBSYSTEM COPING MECHANISM* COGNITIVE EMOTIVE PROCESS * RESPONDS THROUGH PERCEPTION, INFORMATION PROCESSING, LEARNING, JUDGEMENT AND EMOTION

ADAPTIVE (EFFECTOR) MODES:

* CLASSIFICATION OF WAYS OF COPING* MANIFESTS REGULATOR AND COGNATOR ACTIVITY* PHYSIOLOGIC, SELF CONCEPT, ROLE FUNCTION AND INTERDEPENDENCE

ADAPTIVE RESPONSES:

PROMOTE INTERGRITY OF THE PERSON IN TERMS OF THE GOALS OF SURVIVAL, GROWTH, REPRODUCTION AND MASTERY.

INEFFECTIVE RESPONSES:DOES NOT CONTRIBUTE TO ADAPTIVE GOALS

MODEL HUMAN ADAPTIVE SYSTEMS

PHYSIOLOGICAL MODE:* INVOLVES BODYS BASIC NEEDS AND WAYS OF DEALING WITH ADAPTATION

* IN RELATION TO FLUID AND ELECTROLYTESEXERCISE AND RESTELIMINATIONNUTRITIONCIRCULATIONOXYGEN

PHYSIOLOGICAL MODE: CONTINUED

* REGULATION INCLUDES:

THE SENSESTEMPERATUREENDOCRINE REGULATION

SELF CONCEPT MODE:

* COMPOSITE OF BELIEF AND FEELING* FORMED FROM PERCEPTIONS* DIRECTS ONES BEHAVIOUR* COMPONENTS ARE :THE PHYSICAL SELFTHE PERSONAL SELF

ROLE PERFORMANCE MODE:

* PERFORMANCE OF DUTIES* BASED ON GIVEN POSITIONS IN SOCIETY

INTERDEPENDENCE MODE:

* ONES RELATION WITH SIGNIFICANT OTHERS* SUPPORT SYSTEM* MAINTAINS PSYCHIC INTEGRITY* MEETS NEEDS FOR NURTURANCE AND AFFECTION

MAJOR ASSUMPTIONSFROM SYSTEM THEORYFROM HELSONS THEORYFROM HUMANISM

ASSUMPTIONS FROM SYSTEMS THEORYA SYSTEM IS A SET OF UNITS SO RELATED OR CONNECTED AS TO FORM A UNIT OR WHOLEA SYSTEM IS A WHOLE THAT FUNCTIONS AS A WHOLE BY VIRTUE OF THE INTERDEPENDENCE OF ITS PARTSSYSTEMS HAVE INPUTS, OUTPUTS AND CONTROL AND FEEDBACK PROCESSESINPUT, IN THE FORM OF A STANDARD OR FEEDBACK (INFORMATION)LIVING SYSTEMS ARE MORE COMPLEX THAN MECHANICAL SYSTEMS AND HAVE STANDARDS AND FEEDBACK TO DIRECT THEIR FUNCTIONING AS A WHOLE.

ASSUMPTIONS FROM HELSONS THEORYHUMAN BEHAVIOUR REPRESENTS ADAPTATION TO ENVIRONMENTAL AND ORGANISMIC FORCESADAPTIVE BEHAVIOUR IS A FUNCTION OF THE STIMULUS AND ADAPTATION LEVEL, THAT IS, THE POOLED EFFECT OF THE FOCAL, CONTEXTUAL AND RESIDUAL STIMULIADAPTATION IS A PROCESS OF RESPONDING POSITIVELY TO ENVIRONMENTAL CHANGESRESPONSES REFLECT THE STATE OF THE ORGANISM AS WELL AS THE PROPERTIES OF STIMULI AND HENCE ARE REGARDED AS ACTIVE PROCESSES.

ASSUMPTIONS FROM HUMANISMPERSONS HAVE THEIR OWN CREATIVE POWERA PERSONS BEHAVIOUR IS PURPOSEFUL AND NOT MERELY A CHAIN OF CAUSE AND EFFECTPERSON IS HOLISTICA PERSONS OPINIONS AND VIEW POINTS ARE OF VALUETHE INTERPERSONAL RELATIONSHIP IS SIGNIFICANT.

ELEMENTS

NURSINGHEALTHENVIRONMENTPERSON

NURSINGA SCIENCE AND PRACTICE DISCIPLINEA THEORETICAL SYSTEM OF KNOWLEDGEPRESCRIBES A PROCESS OF ANALYSIS AND ACTIONRELATED TO THE CARE OF THE ILL OR POTENTIALLY ILL PERSON

PERSONA BIOPSYCHOSOCIAL BEINGA LIVING, COMPLEX, ADAPTIVE SYSTEMWITH INTERNAL PROCESSES (THE COGNATOR AND REGULATOR)ACTING TO MAINTAIN ADAPTATION TO THE FOUR MODES

HEALTHA STATE AND A PROCESS OF BEING AND BECOMING AN INTEGRATED AND WHOLE PERSON

ENVIRONMENTALL THE CONDITIONS, CIRCUMSTANCES AND INFLUENCES SURROUNDING AND AFFECTING THE DEVELOPMENT AND BEHAVIOUR OF PRSONS OR GROUPS

MAJOR CONCEPTS AND DEFINITIONS

IMOGENE KING: THEORY OF GOAL ATTAINMENT

INTERACTIONA PROCESS OF PERCEPTION AND COMMUNICATIONBETWEEN PERSON AND ENVIRONMENT BETWEEN PERSON AND PERSONREPRESENTED BY VERBAL AND NONVERBAL BEHAVIOURSGOAL DIRECTEDEACH INDIVIDUAL BRINGS DIFFERENT KNOWLEDGE , NEEDS, GOALS, PAST EXPERIENCES AND PERCEPTIONS, WHICH INFLUENCE INTERACTION

COMMUNICATIONINFORMATION FROM PERSON TO PERSONDIRECTLY OR INDIRECTLYINFORMATION COMPONENT OF INTERACTION

PERCEPTIONEACH PERSONS REPRESENTATION OF REALITY

TRANSACTIONPURPOSEFUL INTERACTION LEADING TO GOAL ATTAINMENT

ROLEA SET OF BEHAVIOURS EXPECTED OF PERSONS OCCUPYING A POSITION IN A SOCIAL SYSTEMRULES THAT DEFINE RIGHTS AND OBLIGATIONS IN A POSITION

STRESSDYNAMIC STATEHUMAN BEING INTERACTS WITH THE ENVIRONMENT

GROWTH AND DEVELOPMENTCONTINOUS CHANGES IN INDIVIDUALSAT CELLULAR, MOLECULAR AND BEHAVIOURAL LEVELS OF ACTIVITIESHELPS INDIVIDUALS MOVE TOWARDS MATURITY

TIMESEQUENCE OF EVENTSMOVING ONWARDS TO THE FUTURE

SPACEEXISTING IN ALL DIRECTIONSSAME EVERYWHEREIMMEDIATE ENVIRONMENT (NURSE AND CLIENT INTERACTION)

MAJOR ASSUMPTIONS

NURSINGOBSERVABLE BEHAVIOURIN HEALTH CARE SYSTEM IN SOCIETYGOAL TO HELP INDIVIDUALS MAINTAIN HEALTHINTERPERSONAL PROCESS OF ACTION; REACTION, INTERACTION AND TRANSACTION

PERSONSOCIAL BEINGSSENTIENT BEINGSRATIONAL BEINGSPERCEIVING BEINGSCONTROLLING BEINGSPURPOSEFUL BEINGSACTION ORIENTED BEINGSTIME ORIENTED BEINGS

HEALTHDYNAMIC STATE IN THE LIFE CYCLECONTINOUS ADAPTATION TO STRESSTO ACHIEVE MAXIMUM POTENTIAL FOR DAILY LIVINGFUNCTION OF NURSE, PATIENT, PHYSICIANS, FAMILY AND OTHER INTERACTIONS

ENVIRONMENTOPEN SYSTEMCONSTANTLY CHANGINGINFLUENCES ADJUSTMENT TO LIFE AND HEALTH

PERSONAL SYSTEMCONCEPTSPERCEPTIONSELFBODY IMAGEGROWTH AND DEVELOPMENTTIMESPACE

INTERPERSONAL SYSTEMCONCEPTSINTERACTIONTRANSACTIONCOMMUNICATIONROLESTRESS

SOCIAL SYSTEM CONCEPTSORGANIZATIONAUTHORITYPOWERSTATUSDECISION MAKING

ASSUMPTIONSPERCEPTIONS, GOALS, NEEDS AND VALUES OF THE NURSES AND CLIENT INFLUENCE INTERACTION PROCESSINDIVIDUALS HAVE THE RIGHT TO KNOWLEDGE ABOUT THEMSELVES AND TO PARTICIPATE IN DECISIONS THAT INFLUENCE THEIR LIFE, HEALTH AND COMMUNITY SERVICESHEALTH PROFESSIONALS HAVE THE RESPONSIBILITY THAT HELPS INDIVIDUALS TO MAKE INFORMED DECISSIONS ABOUT THEIR HEALTH CAREINDIVIDUALS HAVE THE RIGHT TO ACCEPT OR REJECT HEALTH CAREGOALS OF HEALTH PROFESSIONALS AND RECIPIENTS OF HEALTH CARE MAY NOT BE CONGRUENT

DOROTHY.E .JOHNSON BEHAVIORAL SYSTEM MODEL

INTRODUCTION

Dorothy Johnson began her work on the model in the late 1950 and wrote into the 1990.Focus-needs,human as a behavioral system and relief of stress as nursing care.

BACKGROUND OF THE THEORIST

1919 August 21 Dorothy was born1938 A.A.From Arm Strong Junior College.1942 B.S.N from Vanderbilt University1948 M.P.H from Harvard university

1943-1944 she was a staff nurse at the Chatham-Savannah Health Council1949-1978 She was an assistant professor in Pediatric Nursing, Assoc.Professor of Nursing and Professor of Nursing at the University of California in Los Angeles1955-1956 Johnson was pediatric Nursing advisor assigned to the CMC in Vellore.1965-1967 She Chaired the committee of the California Nurses Association.

1975 Faculty award from graduate students.1977 Lulu Hassenplug Distinguished Achievement Award from the California Nurses Association 1981 Vanderbilt University School of Nursing Award for Excellence in Nursing.1999 She died in February at the age of 80.

PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

Johnson stated that Nightingales work inspired her model.Person experiencing a disease more important that the disease itself.She reported that she derived portions of her theory from the works of Selye on stress,Grinkers theory of human behavior,and Buckley and Chin on systems theories.

MAJOR ASSUMPTIONS

There are four assumptions about mans behavioral subsystems.First is the belief that drives serve as focal points Which behavioral are organized to achieve specific goals.Second, it is assumed that behavior is differentiated and organized within the prevailing dimensions of set and choice.

Third, the Specialized parts or systems of the behavioral system are structured by dimensions of goal, set, choice, and actions; each has observable behaviors.

Finally, interactive and interdependent subsystems tend to achieve and maintain balance between and among subsystems through control and regulatory mechanisms.

METAPARADIGMS

Nursing is seen as an external regulatory force which acts to preserve the organization and integration of the patients behavior constitutes a threat to physical or social health, or in which illness is found

Human was defined as a behavioral system that strives to make continual adjustments to achieve, maintain or regain balance to the steady-state that is adaptation.

Health an elusive, dynamic state influenced by biological ,psychological ,and social factors.

Environment, is implied to include all elements of the surroundings of the human system and includes interior stressors.

Concepts in Johnsons Behavioral System Theory Concept DefinitionBehavioral system :Man is a system that indicates the state of the system through behaviorsSystem : That which functions as a whole by virtue of organized independent interaction of its partsSubsystem :A minisystem maintained in relationship to the entire system when it or the environment is not disturbed

Johnson (1980) delineated seven subsystems to which the model applied. These are as follows:1.Attachment or affiliative subsystem-serves the need for security through social inclusion or intimacy.2.Dependency subsystem-behaviors designed to get attention, recognition and physical assistance3.Ingestive subsystem -fulfills the need to supply the biologic requirements for food and fluids 4.Eliminative subsystem -functions to excrete wastes

5.Sexual subsystem -serves the biologic requirements of procreation and reproduction

6.Aggressive subsystem -functions in self and social protection and preservation

7Achievement system-functions to master and control the self or the environment

Functional requirements of human in Johnsons(1980) model

1.To be protected from noxious influences with which the person cannot cope2.To be nurtured through the input of supplies from the environment 3.To be stimulated to enhance growth and prevent stagnation

Faye ABDELLAHS 21 Problems

Faye AbdellahNursing research and theorist First woman to become a surgeon general as a nurseInfluenced nursing theory aimed towards the patientGraduated with a Doctoral degree from Columbia UniversityTheory revolved around the idea that nurses should make decisions competently and focus primarily on the patient. Abdellah theorized 21 problems to help influence this idea

Abdellahs Theory and Nursing Influence NursingPATIENTPhysiologic SociologicPsychological

Rehabilitation NursingFocused on returning patients to their optimal level of functioning physically, emotionally, and cognitivelyAreas include: Neuro, Spinal Cord Injury, TBI, Orthopedic, Pain Management, and several progressive disease processesInpatient environment offers physical therapy , occupational therapy, speech therapy, and nursing care

PhysiologicHygiene and ComfortActivity, Exercise, and SleepSafety (Accidents vs. Infections)Body MechanicsNutritionFluid and Electrolyte MaintenanceDisease ProcessMaintaining or Improving Sensory FunctionOxygenationElimination

PsychologicalEffective verbal and nonverbal communicationHelping the patient accept self during and after diseaseContinued motivation to accomplish goalsAcknowledging and identifying the patients emotions

SociologicalTherapeutic RelationshipsSpirituality/ Religious BeliefsSupportive EnvironmentCommunity ResourcesBeing aware of domestic concerns and how they may potentially affect care or treatment of the patient

Application of Theory related to Rehabilitation NursingPhysiological- PAIN, HYGIENE, SAFETY, ELIMINATION, HEALING

Psychological-TRAUMA, EMOTIONS, COGNITIVE FUNCTION

Sociological- Environmental Factors, Family Dynamics

How the 21 Problems Theory Influences Future uses in Practice and Potential Limitations of these Concepts:Future Uses in Practice: Framework relates to all fields and specialties of nursing, this was a theory based off of research so further innovations in research could help clarify or breakdown topics into specialty practice standards. For ex: how can hygiene and activity better be applied to a newborn rather than remaining generalized.

Potential Limitations include: research funding, standards of care, healthcare laws and regulations, and the later effects of a nursing shortage can affect the number of nursing educators and researchers in the future.

ConclusionThe 21 Problems theorized by Faye Abdellah directly relate to nursing care in all specialties. It focuses on patient care overall and can be utilized in nursing to provide an outline that encompasses all aspects of psychological , physiological, and sociological needs. The theory also ensures that the nurse taking care of the patient practices competent care and makes precise nursing judgements.

THE NEUMAN SYSTEMS MODEL OF NURSING

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Betty Neuman, RN, BSN, MSN, PhD, FAANBorn in Ohio & lives in Watertown, OhioWorked in many areas of nursing practiceProfessor at UCLAFamily TherapistFounder/ Director of the NSMTG, Inc.Holds two Honorary Doctorates (1992-Honorary Doctorate of Letters, Neumann College; 1998-Honorary Doctorate of Science, Grand Valley State University)Fellow, American Academy of Nursing, 1993

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KEY TERMS: Client/client system is conceptualized as:

IndividualFamilyGroup/ aggregateCommunityCopyright 2005 by Dr. Betty Neuman158

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INTERACTING VARIABLES:

Physiological VariablePsychological VariableSociocultural VariableDevelopmental VariableSpiritual Variable

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Environments:Internal environment

External environment

Created environmentCopyright 2005 by Dr. Betty Neuman160

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Stressors:Intra-personal stressors EMOTIONS FEELINGS

Inter-personal stressors COMPETITION, DISCRIMINATION

Extra-personal stressors - ENVIRONMENTAL

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Central Core:The central or core structure consists of basic survival factors [normal temp range, genetic structure, response pattern, organ strength/ weakness, ego structure] (Neuman, 2002).

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Flexible Line of Defense (FLD)Forms the outer boundary of the defined client system [individual/ family/ group/ community] (Neuman, 2002)Acts as a protective buffer system for the clients normal line of defense or wellness state Prevents stressor invasion of the client systemCopyright 2005 by Dr. Betty Neuman163

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Normal Line of Defense (NLD)The client/ client systems normal or usual wellness levelThis line represents what the client has become/ evolved over time (Neuman, 2002)The NLD defines the stability and integrity of the client system, its ability to maintain stability and integrityThis normal defense line is the standard against determining any variance from wellnessCopyright 2005 by Dr. Betty Neuman164

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Lines of ResistanceA protective mechanism that attempts to stabilize the client system and foster a return to the usual wellness LOR contain certain known and unknown internal and external resource factors that support the clients basic structure and NLD (mobilize WBC, activate immune system mechanisms)Copyright 2005 by Dr. Betty Neuman165

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Optimal System StabilityOptimal wellness is the greater possible degree of system stability at a given point in time (Neuman, 2002).Optimal client system stability means the highest possible health condition achievable at a given point in time (Neuman, 2002).Copyright 2005 by Dr. Betty Neuman166

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Variance from WellnessVarying degrees of system instability (Neuman, 2002).The difference from the normal or usual wellness condition (Neuman, 2002).

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IllnessIllness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002).Illness is an excessive expenditure of energy when more energy is used by the system in its state of disorganization than is built and stored, the outcome may be death (Neuman, 2002).Copyright 2005 by Dr. Betty Neuman168

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ReconstitutionIs the determined energy increase related to the degree of reaction to a stressor, and represents the return and maintenance of system stability following treatment for stressor reactions (Neuman, 2002)May be viewed as feedback from the input/ output of secondary intervention Complete reconstitution may occur beyond the previously determined NLD or usual wellness state, may stabilize the system to a lower level, or return to the level of wellness prior to illness.Copyright 2005 by Dr. Betty Neuman169

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Prevention as InterventionBasis for health promotionNursing is prevention as intervention encompass three dimensions:Primary PreventionSecondary PreventionTertiary PreventionCopyright 2005 by Dr. Betty Neuman170

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Neumans Nursing ProcessNursing DiagnosisNursing GoalsNursing OutcomesCopyright 2005 by Dr. Betty Neuman171

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HEALTH BELIEF MODEL

INTRODUCTIONThe Health Belief Model (HBM) is one of the first theories of health behavior.

It was developed in the 1950s by a group of U.S. Public Health Service social psychologists

Cont..They wanted to explain why so few people were participating in programs to prevent and detect disease.HBM is a good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV) (Croyle RT, 2005

AREAS OF ACTIONThe health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas: the severity of a potential illness,the person's susceptibility to that illness,the benefits of taking a preventive action, andthe barriers to taking that action.

ABOUT THE THEORYHBM is a popular model applied in nursing, especially in issues focusing on patient compliance and preventive health care practices. The model postulates that health-seeking behaviour is influenced by a persons perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat.

ABOUT THE THEORYHBM addresses the relationship between a persons beliefs and behaviors. It provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL

SIX MAJOR CONCEPTS

1. Perceived Susceptibility2. Perceived severity3. Perceived benefits 4. Perceived costs5. Motivation6. Enabling or modifying factors

PERCEIVED SUSCEPTIBILITYPerceived Susceptibility: refers to a persons perception that a health problem is personally relevant or that a diagnosis of illness is accurate.

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

PERCEIVED BENEFITSPerceived benefits: refers to the patients belief that a given treatment will cure the illness or help to prevent it.

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

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

MODIFYING FACTORSModifying factors: include personality variables, patient satisfaction, and socio-demographic factors

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The focus of her model is on needs, the human as a behavioral system, and relief of stress as nursing care.She wanted the curricula to be focused on nursing rather than derived from the knowledge bases of other health care disciplines.She believed that nursing, although relying on the contributions of other sciences, is a discrete and a unique discipline.

Equilibrium :Process of maintaining stabilityStressor :A stimulus from the internal or external world that results in stress or instabilityTension :The systems adjustment to demands,change or growth, or to actual disruptions

USEFULNESSJohnsons model guides-nursing practiceeducationresearch