Based on Some Nursing Philosophies and Theories

1. Florence Nightingales Philosophy - Nursing is the act of utilizing the environment of the patient to assist him in his recovery. 5 Environmental Factors a. Pure or fresh air b. Pure water c. Efficient drainage d. Cleanliness e. Light, especially direct sunlight * Keep the client warm, maintaining a noise-free environment, and assessing intake * Protect patients from possible harm (physical and emotional)

2. Virginia Hendersons Philosophy -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 peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. 14 Fundamental Needs 1. Breathing normally 2. Eating and drinking adequately 3. Eliminating body wastes 4. Moving and maintaining a desirable position 5. Sleeping and resting 6. Selecting suitable clothes 7. Maintaining body temperature within normal range by adjusting clothing and modifying the environment

8. Keeping the body clean and well groomed to protect the integument 9. Avoiding dangers in the environment and avoiding injury to others 10. Communicating with others in expressing emotions, needs, fears, or opinions 11. Worshipping according to ones faith 12. Working in such a way that one feels a sense of accomplishment 13. Playing or participating in various forms of recreation 14. Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities

3. Jane Watsons Philosophy - Human-to-human caring approach 10 Carative Factors 1. The formation of a humanistic-altruistic system of values

2. The instillation of faith-hope

3. The cultivation of sensitivity to ones self and others 4. The development of a helping-trust relationship

5. The promotion and acceptance of the expression of positive and negative feelings 6. The systematic use of the scientific problem-solving method for decision making 7. The promotion of interpersonal teaching-learning 8. The provision for a supportive, protective, and/or corrective mental, physical sociocultural, and spiritual environment 9. Assistance with the gratification of human needs 10. The allowance for existential-phenomenological forces

4. Hildegard Peplaus Interpersonal Relations Model - Central to Peplaus Theory is the use of therapeutic relationship between the nurse and the patient.

- Nurses enter into a personal relationship with an individual when a need is present. The nurseclient relationship evolves in four phases: 1. Orientation 2. Identification 3. Exploitation 4. Resolution

Roles of nurse Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Teacher: who imparts knowledge in reference to a need or interest

Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation Counselors : helps to understand and integrate the meaning of current life circumstances, provides guidance and encouragement to make changes

Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way

Additional Roles include: 1. Technical expert 2. Consultant 3. Health teacher 4. Tutor academe 5. Socializing agent 6. Safety agent removal of hazards 7. Manager of environment 8. Mediator advocate 9. Administrator 10. Recorder observer 11. Researcher

5. Betty Neumans Systems Model

MAJOR CONCEPTS I. PERSON VARIABLES Each layer, or concentric circle, of the Neuman model is made up of the five person variables. Ideally, each of the person variables should be considered simultaneously and comprehensively. Physiological Psychological Spiritual Developmental

II. CENTRAL CORE The basic structure, or central core, is made up of the basic survival factors that are common to the species (Neuman, 1995, in George, 1996). These factors include: system variables, genetic features, and the strengths and weaknesses of the system parts.

Stability, or homeostasis, occurs when the amount of energy that is available exceeds that being used by the system. A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.

III. FLEXIBLE LINES OF DEFENSE The flexible line of defense is the outer barrier or cushion to the normal line of defense, the line of resistance, and the core structure. If the flexible line of defense fails to provide adequate protection to the normal line of defense, the lines of resistance become activated. The flexible line of defense is dynamic and can be changed/altered in a relatively short period of time.

IV. NORMAL LINE OF DEFENSE The normal line of defense represents system stability over time. It is considered to be the usual level of stability in the system. The normal line of defense can change over time in response to coping or responding to the environment.

V. LINES OF RESISTANCE The lines of resistance protect the basic structure and become activated when environmental stressors invade the normal line of defense. Example: activation of the immune response after invasion of microorganisms. If the lines of resistance are effective, the system can reconstitute and if the lines of resistance are not effective, the resulting energy loss can result in death.

VI. RECONSTITUTION Reconstitution is the state of adaptation to the stressor.

VII. STRESSORS The Neuman Systems Model looks at the impact of stressors on health and addresses stress and the reduction of stress (in the form of stressors). Stressors are capable of having either a positive or negative effect on the client system. A stressor is any environmental force which can potentially affect the stability of the system: they may be: Intrapersonal - occur within person, e.g. emotions and feelings Interpersonal - occur between individuals, e.g. role expectations Extra personal - occur outside the individual, e.g. job or finance pressures

VII. PREVENTION As defined by Neuman's model, prevention is the primary nursing intervention. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. Primary -Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors, and on the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness.

Secondary-Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing systems. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. Tertiary -Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution.

Dorothea Orems General Theory of Nursing -includes 3 related concepts: self-care, selfcare deficit, and nursing systems. Self-care theory is based on four concepts: 1. Self-care 2. Self-care agency *self-care agent *dependent care agent

3. Self-care requisites/ Self-care needs Categories 1. Universal requisites

2. Developmental requisites 3. Health deviation requisites 4. Therapeutic self-care demand

Self-care Deficit results when self-care agency is not adequate to meet the known self-care demand. Patients can be assisted through these 5 Methods of Helping: *Acting or doing for others *Guiding another *Teaching others *Supporting another *Providing an environment that promotes the individuals abilities to meet current and future demands

Nursing Systems 1. Wholly compensatory 2. Partly compensatory 3. Supportive-educative