ENVIRONMENTAL THEORY Florence Knightingale

Born in Florence, Italy on May 12, 1820 / Died on August 13, 1910. She was raised in England by wealthy and influential English Parents. She was Linguist and had a broad knowledge of science, arts, math, and literature. Self Appointed Goal: To change the profile of nursing. Greatest Achievement: Establishment of formal preparation for Nursing Practice Became a heroine in Britain during Crimean War wherein she led a group of devoted women to take care of the wounded soldiers. The Lady with the Lamp because she made nightly rounds while carrying a lamp to visit the soldiers during the Crimean War. The Mother of Modern Nursing. She gathered her life experiences to assist her in the development of modern nursing. She considered nursing both as a Science and Art and believes that nurses must be formally educated. She wrote 2 books a. Notes of Nursing, What it is and what is not b. Notes on Hospitals

Nightingales Environmental Theory She didnt believe in the germ theory but her experience in Crimean War magnified her interest in the principles of sanitation and the relationship of environment and health. The core concept most reflective of her writings is the ENVIRONMENT which is viewed as all external conditions affecting the life and development of an individual and capable of preventing, suppressing, and contributing to disease or death. Her writings speak of providing Ventilation, Warmth, Light, Clean Air and Water, Cleanliness, and Smell so that the reparative process that nature has instituted will not be hindered. Medical Process is not viewed as a curative process but functions to assist nature. Nursing is also a non curative practice in which the patient in the best condition for the nature to act upon him, thus encouraging healing. Environmental Model 1. Health of Houses 2. Cleanliness of Rooms and Walls 3. Beds and Beddings 4. Personal Cleanliness 5. Ventilation and Warming 6. Light 7. 8. 9. 10. 11. 12. Noise Variety Nutrition Observations of the Sick Petty Management Chattering Hopes and Advices

INTERPERSONAL PSYCHODYNAMIC THEORY (INTERACTIVE THEORY) Hildegard Peplau

Nursing is therapeutic for its a healing art, assisting an individual whos sick or in need of health care. (Peplau) Nursing is viewed as an interpersonal process because it involves interaction between two or more individuals with a common goal the recovery of the patient.

Four (4) Sequential Phases in Interpersonal Relationships 1. Orientation Focus: Problem Defining Patient and Nurse meet as two strangers. The patient seeks help and the nurse assists the patient and family to understand the problem. 2. Identification Focus: Selection of Appropriate Professional Assistance Patient assumes a position of DEPENDENCE (totally dependent), INTERDEPENDENCE (collaborative), and INDEPENDENCE in relation to the Nurse. Throughout the process, they must clarify each others perceptions and expectations. Patient begins to have a feeling of belonging and capability of dealing with the problem. 3. Exploitation Focus: Use of Professional Assistance for Problem Solving Alternatives Patient uses all hospital services based on interests and needs, and begins to feel an integral part of the helping environment. Thus, the nurse assists patient in exploiting all avenues of help. 4. Resolution Focus: Termination of Relationship Patient needs are met by collaborative efforts of the nurse and the patient. They now need to terminate their relationship. A movement can be done toward new goals. In 1997, Peplau wrote that nurse patient relationship is composed of 3 phases 1. Orientation Phase 2. Working Phase (Identification and Exploitation) 3. Termination Phase Different Nursing Roles 1. Teacher 2. Resource 3. Counselor

4. Leader
5. Technical Expert 6. Surrogate

BEHAVIORAL SYSTEM MODEL Dorothy Johnson

Individual has a patterned, purposeful, repetitive ways of acting. (Johnson) Patient is identified as a behavioral system with multiple behavioral sub systems.

7 Behavioral Subsystems 1. Attachment or affiliative The first response system to develop in an individual that allows social inclusion, intimacy, formation & maintenance of strong social bond. 2. Dependency Succoring behaviors that precipitate nurturing behaviors from other individuals that result in approval, attention or recognition, and physical assistance 3. Eliminative Behaviors surrounding the excretion of body wastes. 4. Ingestive Behaviors surrounding the intake of food 5. Sexual Behaviors related to procreation (reproduction) 6. Aggression Behaviors concerned with protection and self preservation. Produces defensive responses when life or territory is threatened. 7. Achievement Provoke behaviors that attempts to control the environment. Areas Recognized: Intellectual, Physical, Social Skills, and Creativity, Areas of personal success or accomplishment.

THE CARE, CORE, and CURE Lydia Hall The three interlocking circles 1. The Care Circle Nurturing aspect of nursing which involves mothering (care & comfort) and teacher learning activities. Nurse provides intimate bodily care and helps complete basic biological functions (eating, bathing, elimination, dressing). The Nurses goal is the comfort of the patient in rendering this care and provide teacher learning activities. By providing this care, the nurse can develop closeness with the patient. As closeness develops, patient has an opportunity to share and explore feelings with the nurse (teacher learning aspect of nurturance) Nurses applies knowledge in Natural and Biological Sciences to provide a strong theoretical base of nursing implementations (rationale). 2. The Core Circle Based on social sciences, involves therapeutic use of self, and is shared by other health care team members. The Nurse, by developing interpersonal relationship with the patient is able to help the patient verbally express feelings regarding the disease and discuss the patients role to recovery wherein the patient develops self direction, self identity, and further maturity. 3. The Cure Circle Based on Therapeutic and Pathological Sciences and is shared by other health care team members. Nurse helps the patient and family through medical care, surgical, and rehabilitative prescriptions by the Physician. (Nurse Advocate)

Abraham Maslows Hierarchy of Needs Human Needs A need is something that is desirable, essential, and useful to an individual. Humans need physiologic or psychological condition that must be met to achieve state of well being Each individual has unique characteristic, but certain needs are common to all people. According to Maslow, each need must be satisfied to reach full potential as an individual. 1. Physiological Basic or prime needs for human survival Air, food, water, shelter, clothing, sex, and homeostasis (equilibrium or balance) 2. Safety and Security Personal Security (Physical health and well being) Financial Security (Job Stability, Property or Home) Safety in Home and Environment to protect against violence and illnesses. 3. Love and Belonging (more on emotionally based relationships) To give and receive love and support from significant others Acceptance and appreciation from family and friends To feel that you belong or be a part of a group or team 4. Self Esteem Confidence, Faith in oneself, Importance of oneself Respect of others, Respect by others (Recognition) How people look and value you as an individual Cognitive needs (need of education to know and to understand; competence) 5. Self Actualization Established Personal Growth and Fulfillment of oneself and all needs. Realizes Personal Potential Spirituality enters 6. Self Transcendence Excellence; Able to surpass lifes challenges Helping others to achieve self actualization Person becomes more spiritual and God fearing Acceptance of death Serenity, Harmony Peace, Order, Beauty Maslows Hierarchy of Self Actualized Person 1. Is realistic, sees life clearly (aware of real situations), objective about his observations 2. Judges people correctly 3. Has superior perception, is more decisive. 4. Has a clear notion to what is right or wrong 5. Usually accurate in predicting future events. 6. Understands art, music, politics, and philosophy

7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Possess humility, listens to others carefully Is dedicated to some work, task, duty, or vocation. Is highly creative, flexible, spontaneous, courageous, and willing to make mistakes. Is open to new ideas. Is self confident and has self respect Has low degree of self conflict, personality is integrated Is highly independent, desires privacy Is friendly, loving, and governed more by inner directives than by society. Can make decisions contrary to popular opinion. Is problem centered rather than self centered 17. Accepts the world for what it is; Accepts people as they are and not trying to change them. Orems General Theory of nursing constitutes 3 Interrelated Theories Theory of Self Care 1. Self Care Practice of activities that an individual performs independently to maintain life, health, and well being. 2. Self Care Agency Individuals ability to engage self care activities. Consists of 2 agents a. Self Care Agent individual who performs self care independently. b. Dependent Care Agent a person other than the individual who provides the care. c. Affected by basic conditioning factors such as age, gender, developmental state, health state, health care system, socio cultural, environment, resources, patterns of living, family 3. Therapeutic Self Care Demand All self care activities required to meet self care requisites

4. Self Care Requisites (Needs or Requirements)

Reason for which self care is undertaken that express the intended or desired results. a. Universal Requisites Common to all people because these are the Activities of Daily Living (ADL) Includes maintenance of the intake of air, food, water, elimination; balance between activity and rest, prevention of hazards, etc. b. Developmental Requisites Associated with growth and development and conditions and events occurring during various stages of life cycles that can adversely affect development. Ex. Body changes (facial lines, hair loss); Adjustment in a new job c. Health Deviation Requisites Results from illness, injury, or diseases or its treatment. Includes actions such as seeking health care assistance, carrying out prescribed therapies, and learning to live with the effects of illness and treatment.

Theory of Self Care Deficit The Core of Orems General Theory for it delineates when nursing is needed Nursing is required when an individual is incapable or limited to the provision of effective self care in maintaining life, health, and well being. Orems General Theory states the conditions that validated the need for nursing care.

1. In Adults inability of an individual to continuously maintain the amount of quality self care in 2.
maintaining life, recovering from disease or injury, and coping with their effects. In Children inability of the parent or guardian to continuously maintain the amount of quality care for their children.

5 Methods of Helping that nurses may use: 1. Acting for and doing for another 2. Guiding and Directing 3. Providing physical and psychological support 4. Providing and maintaining an environment that supports personal development. 5. Teaching

Theory of Nursing Systems Orem outlines how the patients self care needs are met by the patient, the nurse or both. Designed by a nurse based on the assessment of the individuals self care needs and abilities to perform self care activities. 1. Wholly Compensatory (Dependence) For individuals who are unable to engage self care activities, monitor and control their environment and process information. They are dependent on others for their existence and well being. Ex. mentally retards, comatose, paralyzed, bed ridden, senile, has vertebral fractures. 2. Partly Compensatory (Interdependence) For individuals who are able to perform some, but not all, self care activities. The patient cooperates with the nurse in performing care measures. Ex. Patient who had a recent abdominal surgery who can brush teeth and wash face. Supportive Educative System For individuals who need to learn to perform self care measures and need assistance to do so. Ex. A 16 yr old who is requesting birth control information (through health teaching, information dissemination)

3.

Nursing Agency Composed of people who are educated and trained as nurses that enable them to help others meet their self care demand by developing their own self care agency. Conceptual Model: When Self Care Demand EXCEEDED Self Care Agency or Ability, DEFICIT Occurs, and Nursing is needed.

Patient Centered Problem Solving Approaches With 21 Key Nursing Problems Faye Abdellah Nursing Problems are classified as: 1. Overt Apparent condition (easily seen; example is patient with fever 3. Covert Hidden or concealed; often missed and perceived incorrectly Can be emotional, sociological, and interpersonal. Solving them may solve overt problems. 3 Major Categories of Nursing Problems 1. Physical, Sociological, and Emotional Needs 2. Types of Interpersonal Relationships between the Nurse and Patient 3. Common Elements of Client Care 21 Nursing Problems 1. Maintain good hygiene and physical comfort 2. Provide optimal activity: exercise, rest, and sleep 3. Promote safety through prevention of accidents, injury or other trauma, or through the prevention of the spread of infection. 4. Maintain good body mechanics and prevent and correct deformities. 5. Maintain supply of oxygen to all body cells. 6. Maintain nutrition to all body cells. 7. Maintenance of elimination 8. Maintenance of fluid and electrolyte balance. 9. Recognize Physiological responses of the body to disease conditions. 10. Maintain body regulatory mechanisms and functions. 11. Maintain body sensory function 12. Identify and accept positive and negative expressions, feelings, and reactions. 13. Identify and accept interrelatedness of emotions and organic illnesses. 14. Maintain effective verbal and non verbal communication. 15. Promote development of productive interpersonal relationship 16. Facilitate progress toward progress of personal spiritual goal. 17. Create or maintain therapeutic environment. 18. Facilitate awareness of self as an individual with varying physical, emotional, and developmental needs.

19. Accept optimum possible goals in the light of limitations. 20. Use community resources as an aid in resolving problems arising from illness. 21. Understand the role of social problems in influencing factors in the case of illness.

DEFINITIONS AND COMPONENTS OF NURSING Virginia Henderson Nursing is primarily assisting the individual (sick or well), in the performance of those activities contributing to health, or its recovery (or a peaceful death), that he would perform unaided, if he had the necessary strength, will, or knowledge. (HENDERSON) The 14 Components of Basic Nursing Care The Individual can: 1. Breathe Normally 2. Eat and Drink adequately 3. Eliminate body wastes 4. Move and maintain desirable postures 5. Sleep and Rest 6. Select suitable clothes 7. Maintain body temperature within normal range 8. Keep the body clean and well groomed 9. Avoid dangers in the environment and injuring others 10. Communicate with others in expressing emotions, needs, fears, or opinions 11. Worship according to ones faith 12. Work to have a sense of accomplishment 13. Play or participate in various forms of recreation 14. Learn and discover things that lead to normal development and health, and use the available health facilities.

OPEN SYSTEMS FRAMEWORK AND THE THEORY OF GOAL ATTAINMENT IMOGENE KING

Theory of Goal Attainment is derived from Open System Framework (Conceptual System) The major elements of the Theory of Goal Attainment is seen in interpersonal systems wherein 2 individuals who are usually strangers, come together in a health care organization to help, and be helped to maintain a state of health that permits functioning in roles.

Kings Conceptual System is composed of 3 Interacting Systems. 1. Personal System Individuals consist of 1 type of system in the environment Related concepts are perception, self, growth, and development, body image, space and time. 2. Interpersonal System Two interacting individuals form dyads, triads, and small and large groups Related concepts are communication, role, interaction, transaction, and stress. 3. Social System Large groups with special interests and needs from organization. Related concepts are organization, authority, power, status, decision making, plus all the concepts from personal and interpersonal systems. Ex. Peers, families, communities, religious groups, educational organizations, governments, and work systems. Note: The personal system of the Nurse and client meet in the interaction with the interpersonal system in their dyad. The interpersonal system is influenced by the social systems that surround them. Cycles of the Theory Professional Nurse + Client in need of Nursing Meet as Strangers Interact mutually to identify problem Establish and Achieve Goals ADAPTATION Sister Callista Roy

MODEL

Persons / Human Beings Viewed as living adaptive systems whose behaviors may be classified as adaptive or ineffective responses. As living adaptive systems, humans are in constant interaction with the internal and external changes in the environment. With these changes, persons must maintain their integrity and must adapt to the changes. They are viewed as Holistic Adaptive System Between the system and environment occurs an exchange of information, matter and energy. Characteristics of a system include input, output, controls, and feedback. 5 Elements of Adaptation Model 1. The Person (recipient of nursing care) 2. Goal of Nursing 3. Concept of Health 4. Concept of Environment 5. Direction of Nursing Activities DELIBERATIVE NURSING PROCESS DISCIPLINE Ida Jean Orlando

Based on the process by which any individual acts. Purpose: Meet the patients immediate need for help for the improvement of his or behavior.

1. Patient Behavior All patients behavior, no matter how insignificant (regardless in any form), must be considered as an expression of need of help or represents a plea for help. a. Verbal Patients use of language (complaints, questions, requests, demands, comments b. Non Verbal Physiological manifestations (heart rate, motor activity) Can be vocal (sobbing, laughing, shouting, sighing, smiling) 2. Nurse Reaction (Exploration with the patient) Patient behavior stimulates the nurses reaction, which marks the beginning of the deliberative nursing process discipline. 3 Sequential Steps 1st Perception (the nurse perceives the behavior through her senses) 2nd Thought (perception leads to automatic thought) 3rd Feeling (the thought produces an automatic feeling)

3. Nurses Action The nurse gives an appropriate action to resolve the need of help in cooperation with the patient. If the patient behavior improves, goal is achieved and process is completed. Paradigm Patient Behavior (Verbal / Non Verbal) Nurses Reaction (Explored with the patient) Need for Help Nurse Action.

Science of Unitary Human Beings Martha Rogers Rogers 5 Assumptions 1. Man is a unified whole who posses integrity and manifest characteristics that are more than and different from the sum of his parts. 2. Man (as an open system) and environment continuously exchange matter and energy with one another. 3. Life process evolves irreversibly and unidirectional along the space time continuum. 4. Pattern and organization identify man and reflect his innovative wholeness. 5. Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion. 5 Building Blocks of Conceptual System (condensed assumptions) 1. Unitary Being 2. Energy Field 3. Environmental Energy Field 4. Pandimensionally 5. Pattern The most current conceptualizations are the 3 Principles 1. Principles of Resonancy Humans are perceived a wave patterns and a variety of life rhythms Ex. sleep wake rhythms, hormone levels, and fluctuating emotional states

2. Principles of Helicy Humans do not regress but become diverse and complex Ex. slinky toy illustrates humans as spiral like continually progressing towards increased
diversity

3. Principles of Integrality

Continuous mutual nature of the human environmental field. Ex. a child playing outside in the sun on a bright summer day. The child gets sunburn. This might be the perceived as an interaction between the child and the sun.

The Conservation Principles: A Model for Health Myra Levine

Levine discussed the interrelation of adaptation, conservation, and integrity. Adaptation is the process by which conservation is achieved. Human Beings are constantly interacting with the environment which creates the need for adaptation. As the environment changes, human must adapt to achieve the best fit with the environment and to conserve energy, structural integrity, personal integrity, and social integrity for the conservation of integrity or wholeness of a person (purpose of the theory)

The Core of Levines Theory is the Four (4) Principles of Conservation 1. Conservation of energy of the individual Balancing of energy input and energy output to avoid excessive fatigue. Ex. Limitation of activities for coronary patients or the planned gradual resumption of activities post op.

2. Conservation of Structural Integrity

Focuses on the healing process Maintenance and restoration of the body structure to limit injury. Ex. Proper positioning and range of motion to prevent skeletal deformities, pressure areas and loss of muscle tone.

3. Conservation of Personal Integrity Maintenance of sense of self, self identity, and self importance or self worth. Ex. Observed in severely brain injured persons to retain their personal identity. 4. Conservation of Social Integrity

Acknowledgement of the patient as a social being. Recognition and presence of human interactions, particularly with significant others. Ones identity is connected to family, friends, community, work place, school, culture, ethnicity, religion, vocation, education, and socio economic status.

Prescriptive Theory of Nursing (A situation producing theory) Ernestine Weidenbach Interrelationship of 3 concepts of the Theory: The nurse develops a prescription that is based on her central purpose (nurses philosophy for care) which is implemented in the realities of the situation. Three Factors of Prescriptive Theory 1. Central Purpose (Commitment) The nurses central purpose defines the quality of health she desires to sustain in her patient and specifies what she recognizes to be her special responsibility in caring for the patient which is based on his own philosophy. 3 Essential components for a nursing philosophy a. A reverence for the gift of life b. A respect for dignity, worth, autonomy, and individuality of each human being. c. A resolution to act dynamically in relation to ones belief.

2. Prescription (Plan of Care) Once the nurse has identified his own philosophy and recognizes that the patient has
autonomy and individuality, she can now develop or implement a prescription for the fulfillment of his central purpose.

Directive to 3 kinds of voluntary actions a. Mutually understood and agreed upon action.(patient understands the implications of the intended action and psychologically and physically receptive to it)

b. Recipient directed action (patient directs the way it is to be carried out) c. Practitioners directed action (practitioners carries out the action)
3. Realities The nurse must consider the realities of the situation in which she is to provide nursing care. Consists of all factors physical, physiological, psychological, emotional, and spiritual. 5 realties in immediate situation: a. The agent (practicing nurse as competent) b. The recipient (the patient) c. The goal (desired outcome the nurses wishes to achieve) d. The means (activities and devices wherein the nurse enable to attain her goal; ex. skills, techniques, procedures, and devices) e. The framework (humans, environmental, professional, and organizational facilities that affect the nurses ability to obtain desired result)

Humanistic Nursing Josephine Patterson and Loretta Zderad

Developed from the lived experiences of the nurse and the nursed. Concerned with the phenomological experiences of individuals and exploration of human experiences. It requires entering the nursing situation full aware of the lenses what we wear Rooted in Extensialism. The philosophical approach understanding life that individuals are faced with possibilities when making choices and these choices determines the meaning of ones life.

Humantistic Nursing Theory A nurturing response of one person that aims toward the development of well being and more being (max full potential) by helping to increase the possibility of making responsible choices. Dialogue Nursing is a lived dialogue. a. Meeting Expectation that there will be a nurse and nursed. b. Relating Process of nurse nursed relating with each other. c. Presence Being open, receptive, ready, & available in a reciprocal manner. d. Call and Response

Nurses and clients call and responds to each other both verbally and non verbally, and there is the potential to be all at once (nurses being able to relate to subjective and objective aspects of the lived situation) Community It is 2 or more persons striving together, living dying all at once. To understand community is to recognize and value uniqueness. Experience of persons and it is through community, persons relating to others. Occurs with clients, families, professional collegeus, and other health care providers. Each community is influenced by its past, values, goals, and resources. Because each of us is in a process of becoming, there is bound to be struggle within ourselves, between ourselves, and between communities. Its the responsibility of the nurse to acknowledge and value those differences in our struggles in our communities.

Theory of Nursing as Caring Boykin and Schoenhofer

The focus of nursing is Nurturing persons living caring and growing in caring the bases of the theory.The 8 caring Honesty Hope Humility Courage

They summarized Mayernoffs caring ingredients as ingredients are the ff: 1. Knowing (knowledge) 5. 2. Alternating Rhythm (action & reflection) 6. 3. Patience 7. 4. Trust 8.

Two Major Perspectives of the Theory 1. Perception of Persons as Caring All persons are seen as caring. Knowing self as a caring person and coming to see others as caring. 7 Assumptions 1. Persons are caring by virtue of their humanness. 2. Persons are caring from moment to moment

3. Persons are whole or complete in the moment 4. Persons are viewed as complete and continuously growing in completeness, fully caring, and unfolding caring possibilities moment to moment. 5. Personhood is enhanced thru nurturing relationship with caring others. 6. Personhood is a process of living grounded in caring 7. Nursing is both a discipline and profession 2. Conception (Beginning) of Nursing as a Discipline and Profession The Dance of Caring Persons Represents respect and value in the dance to know self and other person as caring.

From Novice to Expert Patricia Benner Benner described 5 Levels of nursing experience and developed a paradigm to illustrate each level. She is interested in the Model of Skill Acquisition and applied it to nursing. Her concern was not how to do nursing, but rather, HOW DO NURSES LEARN TO DO NURSING Nursing skills as experience is a prerequisite to become an expert nurse. Expert nurses develop skills and understanding of patient care through education and multitude of experiences. The 5 Levels of Nursing Experience 1. STAGE 1 NOVICE No experience of the situation which they are expected to perform Performance is limited, governed by rules and regulations. Ex. Nursing Students 2. STAGE 2 ADVANCED BEGINNER (0 2 years) Demonstrates marginally acceptable performance Ex. Fresh Graduates who passed the board exam.

3. STAGE 3 COMPETENT (2 3 years experience) Nurse has enough experience and developed understanding of the patient. Can apply in abroad 4. STAGE 4 PROFICIENT (3 5 years experience) Has holistic understanding of the client which improves decision making Focuses on long term goals 5. STAGE 5 EXPERT (above 7 years) Performance is fluid, flexible, and highly proficient. Demonstrates highly intuitive skills and analytic ability in new situations.

Health as Expanding Consciousness Margaret Newman

According to Newman, Disease is a manifestation of underlying pattern. She said that Health and Disease are not separate entities but each is reflection of the larger whole.

Newmans 4 Assumptions 1. Health encompasses a condition called Disease. 2. Disease is the manifestation of an underlying pattern of the person. 3. The pattern of the person that manifests itself as disease is primary and exist prior structural and functional changes. 4. Health as expansion of consciousness Newmans 4 Initial Concepts of the Theory 1. Time 2. Space 3. Movement 4. Consciousness

The relationship among the concepts: 1. Time and Space have a complementary relationship 2. Movement is where time and space become a reality 3. Movement is the reflection of consciousness. 4. Time is the function of movement. 5. Time is the measurement of consciousness. Characteristics of Humans as seen in the theory: 1. Open Energy Fields 2. Has a constant interaction with the environment 3. Has intuitive and cognitive abilities 4. Has abstract thinking and sensation 5. More than the sum of his parts.

The Modeling and Role Modeling Theory Erickson, Swain, and Tomlin An interpersonal and interactive theory that requires the nurse to assess (model), plan (role model), and intervene (5 aims of intervention) based on the clients perception of the world.

Modeling Process used by the nurse to develop understanding of the clients perception of the world (how he perceives life; understand underlying behavior and beliefs.) Role Modeling Facilitation of clients health that involves individualization of care based on clients perception of the world and the use of theoretical bases when planning and implementing nursing care. 5 Aims of Interventions 1. Build Trust 2. Promote Positive Orientation

3. Promote Perceived Control 4. Promote Strengths 5. Set Mutual Goals that are Health Directed 3 Aspects of Self Care in the Theory (Nurse must assist the client in the ff) 1. Self Care Knowledge Client can identify what makes them ill or well. 2. Self Care Resources Internal and external resources (strengths and support) that will help gain, maintain, and promote holistic health. 3. Self Care Action Development and use of self- care knowledge and self care resources. Other Important Terms: 1. Affiliated Individualization Individuals need to be attached and separated from other individuals 2. Adaptive Potential Individuals ability to mobilize resources to adapt with stressors

Philosophy and Science of Caring (Carative Theory) Jean Watson Watson believes that caring is a major aspect in nursing. The carative factors are a major part which is derived from humanistic perspective combined with scientific knowledge. 7 Assumptions of the Science of Caring 1. Caring is effectively expressed, demonstrated, and practiced only interpersonally 2. Caring consist of carative factors that results in satisfaction of certain human needs 3. Caring responses accepts a person not only for who or she is but for who / she may become 4. Caring develops ones potential 5. Caring promotes health and well being and individual and family growth 6. Caring is more healthogenic than curing. Science of caring is complementary with science of curing 7. Practice and Giving of care is the essence of nursing. Theory of Human Becoming

Rosemarie Parse

She presented a nursing theory called Man Living Health/ She said that man refers to HOMO SAPIENS

2 Paradigms or Worldview of Nursing 1. Totality Paradigm Man is a total summative being whose nature is a combination of BIO PSYCHOSOCIAL SPIRITUAL aspects. Environment is viewed as external and internal stimuli surrounding man. Man interacts and adapts with his environment to maintain equilibrium and achieve goals. 2. Simultaneity Paradigm Views man as more than and different from the sum of his parts and an open being free to choose. If a man lives a healthy life. HE LIVES Its a mans choice to give his life a healthy state.

THEORY OF CULTURE DIVERSITY AND UNIVERSALITY MADELEINE LEININGER The Theory and its Central Purpose Recognizing the clients cultural similarities and differences and incorporating this knowledge along with the clients care to make the right decision on what nursing care is appropriate, safe, culturally acceptable, and beneficial to the client and family. Leininger defined the following important terms in her theory 1. Transcultural Nursing A branch of nursing that focuses on comparative study of cultural care values, beliefs, and practices of similar or different cultures in the world in order to provide culture specific and universal nursing care practices in promoting health and well being.

2.

Ethnonursing The study of nursing care beliefs, values, and practices as perceived and known by a designated culture through their direct experiences, beliefs, and values. Cultural Care Diversity (Culture Specific) Variability or differences in meanings, patterns, values, life ways, or symbols of care that are culturally derived by humans for their well being, to improve their condition, or to face death.

3.

4.

Cultural Care Universality Common and similar meanings, patterns, values, life ways, or symbols of care that are culturally derived by humans for their well being, to improve their condition or to face death.

5.

Culture Learned, shared, and transmitted knowledge of values, beliefs, norms, and life ways of a specific group that guides their thinking, decisions, and actions in patterned ways.

6. Culture Care Subjectively & objectively learned and transmitted values, beliefs, and life ways that assist, support, facilitate or enable other individual or group to maintain well being and health, to improve condition and life way, or to deal with illness, handicaps, or death. 7. Cultural and Structure Dimensions Elements of the social structure of a specific culture. Cultures are influenced by technology, religious and philosophical factors, kinship and social systems, cultural values, political and legal factors, economic factors, and educational factors. 8. Environmental Context Totality of an event, situation, or particular experience that give meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical and or cultural settings. 9. Ethnohistory Past experiences of individuals, groups, cultures, and institutions that are primarily people centered and which describe, explain, and interpret human life ways within particular cultural contexts over short or long periods of time. Two Types of Cultural Health Care Systems 1. Generic (Folk or Lay) Care Systems Culturally learned and transmitted, traditional and home based (folk) knowledge and skills used to provide assistive, supportive, and facilitative acts towards another individual or groups with anticipated needs to improve health and well being. 2. Professional Care System Formally taught, learned and transmitted professionally care knowledge and skills obtained thorough educational institutions that are expected to provide assistive, supportive, and facilitative acts towards another individual or groups in order to improve health and well being.

COMPARATIVE FEATURES OF GENERIC AND PROFESSIONAL HEALTH CARE SYSTEM FROM THE CONSUMERS VIEW Generic Folk, Lay Care Professional Health Care 1. Humanistically oriented and people - 1. Scientifically oriented and patient illness centered centered 2. Uses practical knowledge in familiar ways to care for others 3. Focuses on holistic values, beliefs, life ways, and life experiences and worldviews of people. 4. Focus in caring and curing modes using home, community, or familiar resources 5. Relies on lay practices and understanding cultural factors to help people regain health 6. Focuses on preventing illnesses and deaths by maintaining cultural rules, practices, and taboos known and tested in the culture over time. 7. Focuses on how to use folk home remedies and carers or healers as they know what is best for the client. A client goes to professional staff and hospitals as a last resort 8. Reflects high cultural context modes of communication 9. Limits the use of high tech tools and instruments; Uses Cultural Rituals 2. Uses unfamiliar terms and approaches to treat patients 3. Focuses on symptoms, body mind parts, specific diagnoses, and curative medical treatments with diverse staff 4. Focus on mind body curing modes in unfamiliar hospital settings 5. Relies on biophysical and emotional factors of patients with pathologies and treatment regimes 6. Focuses on repairing body or mind conditions based on medical specialists in the profession and some care givers 7. Cost for services are very high and often beyond ability for many poor or minority cultures to use. Consumers tend to avoid using unless they have lots of money. 8. Reflects low cultural context modes of communication 9. Uses many high tech tools and machines in hospital with rituals.

3 Modes of Nursing Decisions and Actions / Implementations 1. Cultural Preservation or Maintenance Help clients of a specific culture to MAINTAIN OR PRESERVE RELEVANT CARE VALUES so that the clients can maintain their health and well being, recover from illness, or face handicaps and or death.

2. Cultural Care Accommodation Help clients of a specific culture ADAPT OR NEGOTIATE with others for a beneficial
or satisfying health outcome with professional care providers. 3. Cultural Care Repatterning or Restructuring Help clients of a specific culture REORDER, CHANGE OR MODIFY CLIENTS LIFE WAYS for a new different and beneficial health care pattern while respecting clients cultural values and beliefs.

Culturally Congruent Nursing Care Assistive, supportive, and facilitative decisions or acts that are made to fit with individual, groups or institutional cultural values, beliefs, and life ways in order to provide or support meaningful, beneficial, and satisfying health care or well being services.

Culture Care Conflict Areas of distress, concern, or incompatibility when nursing care practices doesnt fit with the clients beliefs, values, and expectations.

Leininger speaks concern about the possibility of the nurse being involved in the ff: Cultural Shock May result when an outsider attempts to comprehend or adapt to a different cultural group. The outsider is likely to experience feelings of discomfort, helplessness, and some degree of disorientation because of the differences in cultural values, beliefs, behaviors, and practices. May be reduced by seeking knowledge of the culture before encountering with that specific culture.

Cultural Imposition The efforts of an outsider to impose his or her own cultural values, beliefs, behaviors, and practices from a different cultural group.

Betty Neumans Health Care System Model

A multidimensional view of individuals, families, and communities who are in constant interaction with environmental stressors. It focuses on clients reaction to stress and the factors of adaptation to stress. The 2 major components of the theory are stress and reaction to stress. Neuman viewed client as an open system with repeated cycles of input, output, process and feedback that constitute a dynamic organizational pattern. Exchanges with the environment are reciprocal and both may be affected either positively or negatively. The system may adjust to the environment or adjust the environment to itself. The goal is to achieve OPTIMAL SYSTEM STABILITY (Equilibrium or Balance) Revitalization occurs if the goal is achieved.

Neuman viewed client as an open system that consist of the ff 1. Basic Structure and Energy Resources Basic survival factors common to all individuals (System or Client variables)

Physiological (structure and functions of the body) Psychological (mental processes) Socio cultural (social and cultural expectations) Developmental (growth and development) Spiritual (influences spiritual beliefs)

2. Lines of Resistance Protects the basic structure and energy resources and becomes activated when normal line of defense is invaded by stressors. If lines of resistance are effective, system can reconstitute; if not energy depletion may lead to death. Ex. Immune system activation 3. Flexible Line of Defense Initial protection and response to stressors. Protects the normal line of defense 4. Normal Line of Defense State of equilibrium of an individual that is developed and maintained overtime 5. Stressors Stimuli that produces tension and system irritability; found inside out the system a. Extrapersonal a. occur outside individual (job loss, unemployment) b. Intrapersonal i. occur within individual (Inside emotions: anger, self expectation) c. Interpersonal 1. occur between individuals (parent child role expectation, employee employer working relationship)

6. Reaction reaction to stressors may be positive or negative 7. Reconstitution in energy that occur r/t the degree of reaction to stressor.

Social Learning Theory Albert Bandura

Emphasizes the importance of observing the behaviors, attitudes, and emotional reactions of others. It focuses on learning by observation and modeling. Explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, and environmental determinants.

5 General Principles of the Theory 1. People can learn by observing the behavior of others and the outcome of their behaviors. 2. People can learn not only by formal education but by interaction with others. 3. Cognition is an important role in Learning 4. Learning can occur without a change in behavior

5. The theory can be considered as a bridge or transition between cognitive and behavioral learning theories. Modeling doing what others do. Imitation using the behavior of others as discriminative stimulus for imitative response. Observational Learning individuals beliefs based on observing others. Conditions for an effective Modeling 1. Attention 2. Retention (ability to remember the observed behavior) 3. Motor Reproduction (ability to replicate the demonstrated behavior) 4. Motivation (having a good reason for imitation) Theory of Caring by Kristen Swanson Nursing is delivered as a set of interrelated concepts that evolves on the nurses own convictions, knowledge, and interaction with the patient. Caring is defined as a nurturing way of relating to valued others to whom we feel a personal sense of commitment and responsibility. 5 Caring Processes 1. Knowing strive to understand the event that has a meaning to others. 2. Being with be emotionally present to others. 3. Doing for doing for others so she or he may do it to himself or herself if possible. 4. Enabling facilitate others during transitions and unfamiliar events. 5. Maintaining beliefs sustain faith in others capacity to get through during unfamiliar events, transitions, and to face future with meanings. Human to Human RelationshipModel by Joyce Travelbee The observable and goal oriented behaviors of 2 or more individuals in mutual presence. A therapeutic relationship between the nurse and the patient, the purpose is to assist individuals, families, groups, and institutions to prevent or cope to illness and regain health. Original Encounter 1st impression of the nurse and patient with each other. Emerging Identities beginning of the relationship between nurse and patient. Empathy ability to understand what the patient feels and experiences. Sympathy theres involvement; it goes beyond empathy, nurse puts himself to the clients situation, and wants to lessen the cause of the patients suffering. Rapport human to human being relationship; nurse is able to build rapport with patient; nurse has the skills and knowledge that requires assisting the patient and able to perceive, respond, and appreciate the uniqueness of patient

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