NCM 100

NCM 100

NURSING AS A SCIENCE A systemic body of knowledge in

diagnosis and treatment of human responses to actual and potential health problems.

I. NURSING THEORIES

A. INTRODUCTION:1. Theories – “an educated guess” i. Set of interrelated concepts that provide

a systemic explanation or description and predictive view of a phenomenon.

ii. Can begin with an untested premise that becomes a theory when tested and supported or can progress in a more inductive manner.

iii. Are tested and validated through research

2. NURSING THEORIES or MODELS

Nursing Theory - is the term given to the body of

knowledge that is used to support nursing practice.

Purposes: 1. provide a definition of nursing 2. provide information about principles

that form the basis for practice 3. provide information about goals and

functions of nurse

Nursing Models - are conceptual models,

constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformly and seamless care.

3. METAPARADIGMS

i. From the Greek word “meta” which means with and “paradigm” meaning pattern

ii. Defined as the most global, conceptual or philosophical framework of a discipline or profession.

iii. It attempts to explain a global view useful in understanding key concepts and principles

iv. It guides the organization of theories and models for a profession

v. It is based on 4 theoritical concepts of nursing

4. Nursing paradigms: comprises of 4 concepts

1. PERSON – refers to the recipient of nursing care and can include the individual, family or community.

2. ENVIRONMENT – refers to all the internal and external conditions, circumstances and influences affecting the person.

3. HEALTH – refers to the degree of wellness or illness experienced by the person

4. NURSING – refers to the actions, characteristics and attributes of the individual providing nursing care.

DIFFERENT NURSING THEORIES:1. Environmental Theory- Florence Nightingale a. About the Theorist/ Author Born in Florence, Italy on May 12, 1820 Was born into a family of position and grew

up well educated(an economist) and well travelled

As an adult, she became interested in social reforms and rebelled against her heritage

She has a systemic mind and sound judgment and against the wishes of her family and friends

She entered the DEACONESS SCHOOL OF KAISERWERTH (Germany) at the age of 31 to study Nursing.

After the training, she continued her studies with the Sisters of Charity in Paris, and then returned to England to assume the position of superintendent in a charity hospital for ill governess.

After reading about the poor treatment of the British soldiers in the CRIMEAN War, she organized 38 nurses to care for the ill and injured in Crimea.

She earned the title “LADY WITH THE LAMP” in the military camp when she was able to make lots of amends in the conditions of these soldiers, like lowering the mortality rate from 42.7 to 2.2. Ten times more soldiers died from illnesses such as typhus, cholera and dysentery than from battle wounds. She believed the death rates were due to poor nutrition and supplies and overworking of the soldiers.

By 1859 after the Crimean war, she set up the Nightingale Training School at St. Thomas’ Hospital on July 9, 1860.(Now called the Florence Nightingale School of Nursing and Midwifery and is part of King’s College London). The first trained Nightingale nurses began working on May 16 at the Liverpool Workhouse Infirmary.

She wrote NOTES ON NURSING which was published in 1860, a slim 136 page book that served as the cornerstone of the curriculum at the nightingale School and other Nursing established. It was sold well to the general reading public and is considered a classic introduction to nursing

Considered as the MOTHER OF MODERN NURSING because of her contribution to the profession.

Some of which are: i. Eradication of patient

discrimination ii. Upgrading nursing from a mere

peasant job to a noble profession. She believes that nurses should be taught in teaching hospitals associated with medical schools and that the curriculum should include both theory and practice.

iii. Advocate of the importance of prevention, public health and health promotion role for nurses.

TRIVIA: She always wore a bracelet made out of her family’s hair.

About the theory:

She described the ENVIRONMENT as all conditions and forces that influences the life and development of an organism. It can prevent, suppress or contribute to disease, or health or death of an organism.

She classified the environment as:1. PHYSICAL consist of physical elements where

the patient is being treated.

It requires maintaining the 5 major components of a positive or healthy environment which are:

1. proper ventilation 2. adequate light 3. sufficient warmth 4. control of noise 5. control of EFFLUVIA

(offensive/unpleasant smell and gaseous odors)

ii. SOCIALConsist of the person’s home as well

as the total community that affects the patient’s specific environment

It requires good communication should be therapeutic, soothing and unhurried

iii. PSYCHOLOGICALShe linked health with 5

environmental factors:

Deficiency in these 5 factors produced lack of health and illness.

1. Pure or fresh air (proper ventilation)2. Pure water3. Efficient drainage4. Cleanliness5. Light (especially adequate direct

sunlight)

Acknowledge that the environment is a critical component of an individual’s health and that in order to attain optimum health and/or facilitate healing, there should be a balance between the factors of environment and the client.

GOAL OF THE THEORY: Ensure an environment with a physically, socially and psychologically healthy atmosphere.

ROLE OF THE NURSE: - Manipulate the environment in

order to place the client in the best possible position for nature to act upon him thus encouraging healing and restoring health

2. NATURE OF NURSING THEORYVIRGINIA HENDERSON “First Lady

Nurse”a. About the Theorist/ Author Virginia Avenel

Henderson( November 30,1897-March 19,1996) was an American nurse, researcher, theorist and author.

She was born in Kansas City, Missouri, the 5th of 8 children and a descendant of a long line of scholars and educators.

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

She is part of the “Columbia School” of nursing theory, having graduated from Teacher’s College, Columbia University, with a M.A. Degree in nursing education, and having been a member of the faculty from 1930 to 1948.

She wrote and/or edited several editions of the The principles and Practice of Nursing, along with Harmer in the early years of the fundamentals text and Nite in the later years.

Virginia Henderson defined nursing as “assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery”

She categorized nursing activities into 14 components, based on human needs.

She was one of the first nurses to point out that nursing does not consist of merely following physician’s orders.

b. ABOUT THE THEORY:Believes that quality health rather

than life would allow a person to work effectively and reach his highest potential of satisfaction.

Introduced the 14 fundamental needs of which when realized contributes to the achievement and maintenance to health.

The following are often called Henderson’s 14 Basic needs, provide a framework for nursing care:

1. Breath normally 2. eat and drink adequately 3. Eliminate by all avenues of

elimination 4. Move and maintain a desirable

position 5. Sleep and rest

6. select suitable clothing; dress & undress7. Maintain body temperature within

normal range8. Keep the body clean & well groomed9. Avoid dangers in the environment10. Communicate with others11. Worship according to faith12. Work at something that provides13. Play or participate in various forms of

recreation 14. Learn, discover or satisfy the curiosity

that leads to normal health development

The person can respond to these needs unaided if he has the necessary strength, knowledge and will

ROLE OF THE NURSE:She described the Nurse’s role as:i. Substitutive (doing for the person)ii. Supplementary (helping the personiii. Complementary (working with the

person) With the goal of helping the person

become as independent as possible

3. GENERAL THEORY OF NURSING/Self care Deficit Theory – DOROTHEA OREM Born: 1914, Baltimore, MarylandEducation: Diploma (early 1930’s),

Providence Hospital School of Nursing, Washington, D.C.

BSN education(1939) & MSN(1945) from the Catholic University of America, Washington

Honorary Doctorates: Doctor of Science from Georgetown University(1976) & Incarnate Word College in San Antonio, Texas (1980)

Doctor of Humane Letters from Illinois Wesleyan University, Bloomington, Illinois (1988)

Doctor Honoris Causae, University of Missouri-Columbia (1988)

Dr. Orem continues to be active in theory development

She completed the 6th edition of Nursing: Concepts of Practice, published by Mosby in January 2001

About the THEORYFirst published in 1971, this theory

includes three related theories or concepts:

i. The self theoryii. Self care deficit theoryiii. Nursing systems theory Self care is based on 4 CONCEPTS:1. SELF CARE- refers to those activities

& individual who performs independently throughout life to promote & maintain personal well-being.

2. SELF CARE AGENCY- refers to individuals this to perform this self care activities.

3. SELF CARE REQUISITE/NEEDED- measures or action to provide self care. These needs are categorized into:

i. Universal requisites-common to all people

ii. Developmental requisites- result from maturation or are associated with conditions or events such as adjusting to a change in the body image or loss of spouse.

iii. Health deviation requisite- result from illness, injury or disease or it’s treatment

4. THERAPEUTIC SELF CARE DEMAND- refers to all self care activities required to meet existing self-care requisite.

Self care deficit result when the self care agency is not adequate to meet the therapeutic self care demand.

Nursing system attempt to answer the question ” what do nurse do?” since it refers to the series of action that the nurse takes to

meet patient’s self care requisites. These actions/interventions would be based on the nurse’s Nursing agencies

TYPES of Nurses Systems includes:a. Wholly Compensatory Nursing

Systems i. The nurse supports and protects

the client, compensates for the inability to care for self & attempts to provide care for the client

ii. For the clients who are completely unable to provide self care.

b. Partly Compensatory Nursing Systems

i. Both the client and the nurse perform care measures

ii. The clients compensates for what the nurse cannot do

iii. Client is able to perform selected self care but also accepts care perform by the nurse for needs which he is unable to meet independently.

c. Supportive – Educative Nursing Systems

i. The nurses action are to help client develop his own self care abilities through knowledge, support and encouragement

ii. Client must and can perform own self care.

The focus of Orem’s model is to enhance the person’s ability for self-care and this also extends to the care of dependents

Person(client) self-care deficits are the result of environmental situations

3 systems exist within this professional

Nursing practice modeli. Compensatory system-nurse

provides total careii. Partially compensatory system-

nurse & patient share responsibility for care

iii. Educative-development system-client has primary responsibility for personal health, with nurse acting as a consultant

The basic premise of the model is that individuals can take responsibility for their health & the health of others. In a general sense, individuals have the capacity

To care for themselves or their dependents.ROLE OF THE NURSE: Assist patient in the

design, provision and management to self care to maintain or improve human functioning at some level of effectiveness.

Areas Applicable to Self-Care Theory Direct Nursing Care(providing care or teaching in the ff. Areas)1. Nutrition 4. Medications2. Hygiene 5. Behavior3. mobility

Maintaining health and/or enhancing health with client/family:

1. Exercise & physical fitness2. Nutrition and weight control3. Stress management4. Maintenance of social support systems5. Environmental control Areas not applicable to Self-Care

Theory Indirect Activities i. Obtaining equipment/supplies for

patient procedure

ii. Making appointments for patients iii. Completing patient paperwork iv. Assisting MD/NP’s with patient

procedures Module Activities i. Coordinating nurse and extender

work flow, breaks, etc. ii. Checking module supplies iii. Checking crash cart iv. Ordering stock meds

Examples of Self Care applied to Ambulatory Nursing:

Compensatory systems - nurse provides total care

o Bedridden oncology patient arrives via ambulance for chemotherapy. Family insists upon keeping patient at home; however, leaves patient alone with nurse in chemo clinic for treatment. Patient requires O2 at 2L/min, continous tube feeding @ 90cc/hr, foley cathether, bedpan. Nurse in clinic administers O2 at 2L; empties foley at end

of treatment ; places patient on bedpan one time. With the exception of administering chemotherapy, the nurse is providing total self care for this patient. Administering chemotherapy is the “assisting physician”role

Partially compensatory system-nurse & patient share responsibility for care

o Preterm labor patient regularly visits clinic for BP monitoring, etc. Patient on bedrest(at home), except for weekly visit to module. Nurse assists patient out of wheelchair into

bathroom, assists with urine sample collection, and onto exam table. Nurse administers injection of terbutaline and educates patient regarding oral terbutaline.

Educative-development systemNewly diagnosed diabetic patient

received diabetic care teaching while in hospital. Now, patient visits module and reports highly variable chemstrip readings. Nurse suspects patient maybe performing procedure incorrectly. Nurse assesses that patient has

Been cutting some of his chemstrips in half to save money. Nurse instructs patient that cutting strips exposes chemicals and inaccurate readings may result. Additionally, nurse assesses that patient’s wife(who does family cooking) did not receive any nutritional education while patient was hospitalized. Nurse begins nutritional counselling and provides wife with referral to nutritional services department.

4. CULTURE CARE DIVERSITY & UNIVERSAL THEORY- Madeleine Leininger

a. About the AUTHOR/THEORIST Madeleine Leininger was a pioneer

nurse anthropologist. Appointed Dean of the University of

Washington, School of Nursing in 1969, she remained in that position until 1974

Her appointment followed a trip to New Guinea in the 1960’s that opened her eyes to the need for nurses to understand their

patients’ culture and background in order to provide care.

She is considered by some to be the “Margaret Mead of Nursing” & is recognized worldwide as the founder of transcultural nursing, a program that she created at the School in 1974.

She has written or edited 27 books and founded the Journal of Transcultural Nursing to support the research of the Transcultural Nursing Society, which she started in 1974.

Dr. Leininger enjoys helping students and she responds to questions as her time permits.

b. About the THEORY:Focus on the importance of

understanding the universalities & diversities of people across culture with respect to their caring behavior, nursing care health values and belief patterns.

Emphasized the importance of nurse’s awareness to the culture of the client and of the nurse in order to assist client with diverse

culture. Leininger presented 3 intervention

modes:a. Culture care preservation and

maintenance- culture as long as it will not give harm from the man.

b. Culture care accomodation and negotiation- traditional birth attendant accomodate give some connecting

c. Culture are restructing and repatterning- change the culture

Also emphasized care and caring as the