6 – 2 Nursing Theories and Models – Flashcards

a group of related concepts, definitions, and statements that describe a certain view of nursing phenomena/observable occurrences from which to describe, explain, or predict outcomes

metaparadigm, philosophy, conceptual model or framework, and theory

the most abstract aspect of the structure of nursing knowledge The metaparadigm of nursing consists of 5 major concepts of most importance to nursing practice and research and to the nursing discipline—person, environment, health, nursing and caring

a set of beliefs about the nature of how the world works. A nursing philosophy begins to put together some or all concepts of the metaparadigm.

a more specific organization of nursing phenomena than philosophies. As the words "model" or "framework" imply, models provide an organizational structure that makes clearer connections between concepts.

statements that describe linkages between concepts and are more prescriptive; that is, they propose an outcome that is testable in practice and research.

Focused the profession of nursing on the metaparadigm of nursing: person (patient), health (as opposed to illness), environment (how the environment affects health and recovery from illness), and nursing (as opposed to medicine). Stressed importance of surroundings: clean air, water, adequate ventilation, sunlight, balanced diet, the nurse's responsibility to observe and record the patient's intake, cleanliness of the patient, the bed linens, and the sick room; rest for restoration of health; responsibility to shield patients from harm by well-meaning visitors who may provide false hope, discuss upsetting news, or tire the patient with social conversation; visits by small pets

The nurse role is to assist the patient to do whatever he would do for himself if he could 14 areas of nursing care; holistic nature of care encompassing: biological, psychological, sociological and spiritual 1. Breathe normally. 2. Eat and drink adequately. 3. Eliminate body wastes. 4. Move and maintain desirable position. 5. Sleep and rest. 6. Select suitable clothes—dress and undress. 7. Maintain body temperature within normal range by adjusting clothing and modifying the environment. 8. Keep the body clean and well groomed and protect the integument (skin). 9. Avoid dangers in the environment and avoid injuring others. 10. Communicate with others in expressing emotions, needs, fears, or opinions. 11. Worship according to one's faith. 12. Work in such a way that there is a sense of accomplishment. 13. Play or participate in various forms of recreation. 14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

Emphasized 'caring' as central to nursing The 'Transpersonal Caring Process' equates health with harmony/unity of body, mind, and soul; illness/disease with lack of harmony Watson's 10 Caritas Processes/references relationship of nurse & patient 1. Practice loving kindness 2. Decision making 3. Instill faith and hope 4. Teaching and learning 5. Spiritual beliefs and practices 6. Holistic care 7. Helping and trusting relationship 8. Healing environment 9. Promote expression of feelings 10. Miracles

Has 3 interrelated theories: theory of self-care, theory of self-care deficit, and theory of nursing system In this model, the nurse designs and prescribes nursing actions on the basis of the patient's actual or potential self-care deficit Care for the patient is developed through a series of three operations: 1) Diagnostic - the nurse assesses the patient's baseline ability to provide adequate self-care; limitations/self-care deficits are identified 2) Prescriptive - this is a planning stage in which the nurse confirms with the patient the nurse's assessment of the patient's needs and begins to formulate a plan of care 3) Regulatory - operational; the nurse designs, plans, and produces a system for care. May range from compensatory - for patients with few (if any) abilities to provide care for self; to supportive-educative - in which the patient has can effect self-care, but benefits from working with the nurse to further develop these abilities

Understanding of an individual patient as a whole person requires understanding the patient in the context of their family and society (such as at work or in school). Three interacting systems must be examined: the patient (role and related stressors), their interpersonal relationships, and their social contexts (influences on decision making). The phenomena and concerns of importance to the patient must be identified; otherwise mutual goal setting is unlikely to happen. King's work is unique because it provides a view of people from the perspective of their interactions (or communications, both verbal and nonverbal) with other people at three levels of interacting systems. King identifies steps in the nurse-patient relationship from the first encounter to the attainment of the specified goal which are a progression from: perception, judgment, action, reaction, and interaction to transaction

Proposes that an individual is a biopsychosocial adaptive system (with physiological, self-concept, role function, and interdependent modes). A person's adaptive or coping abilities and adaptive behavior are affected by the environment. Therefore a person's ability to cope and behavior can be altered by altering the environment. When the demands of environmental stimuli are too high or the person's adaptive mechanisms are too low, the person's behavioral responses are ineffective for coping. The goal of nursing is to recognize maladaptive behavior; then to promote the patient's adaptation and coping by modifying the environment.

Based on the premise that the relationship between patient and nurse is the focus of attention, rather than the patient only as the unit of attention. The goals of a therapeutic interpersonal relationship are twofold: First is the survival of the patient; second is the patient's understanding of his or her health problems and learning from these problems as he or she develops new behavior patterns with the nurse's guidance. The theory identifies a four-pronged process similar to the nursing process by which the nurse assumes six roles to assist the patient in achieving personal growth including: counselor, resource, teacher, technical expert, surrogate, and leader. Depending on the setting, the nurse will spend more or less time in each of these roles.

The goal of the nurse is to determine and meet patients' immediate needs and to improve their situation by relieving distress or discomfort. Nurses must react to patients based on inferences from patients' behavior, including what they say. However, all actions must be deliberate (rather than automatic); that is, they must be confirmed or denied by the patient, so that assumptions are not made and pressing needs are identified. Use of Orlando's theory improves the effectiveness of the nurse by allowing the nurse to get to the "bottom line" more quickly when observing, listening to, and confirming with patients. Therefore, use of this theory saves time and energy for both the patient and the nurse.

The goal of transcultural nursing involves planning nursing care based on knowledge that is culturally defined, classified, and tested—and then used to provide care that is culturally congruent. It begins with assessing patients in the context of their cultures (recognizing the health beliefs and folk practices of the patient's culture, as well as the culture of traditional health services); requires respecting the culture of the patient and recognizing the importance of its relationship to providing nursing care. Leninger's theory has become increasingly relevant as global migration continues and societies become more diverse.

practice and research developed from the theorists' experiences within a specific population

Swanson's Caring Theory - re: couples experiencing miscarriage Mishel's Uncertainty in Illness Theory - re: men with prostate cancer who were "watchful waiting" for advancing of their disease rather than seeking aggressive treatment Jezewski's Cultural Brokering Theory - re: people made politically and economically powerless or vulnerable as a function of advanced disease Dobratz theory of Psychological Adaptation in Death and Dying - re: defines the psychological adaptation in death and dying as a social phenomenon "using spiritual and social resources, and managing physical symptoms to maintain self-regulation" (builds on conceptual structure of the Roy adaptation model)

research degree that generates new, discipline-specific knowledge through development and testing of new theories through research.

use theoretical perspectives focused on the patient for specific nursing outcomes in their practice

The research emphasis for bachelor's-level students is on learning to critique nursing research, becoming informed consumers of research relevant to evidence-based nursing practice. Whether the curriculum is built around one or many nursing theoretical works, the focus for the BSN level is utilization and application of nursing theory as a guide for nursing practice.

may use nursing theoretical works to teach the unique perspectives of nursing; especially middle-range theories, which are specific to patient care

Theory-based practice

the abstract to the empirical

operational definitions