NURSING MODEL AND THEORIES – Flashcards

1. Identify an Issue or Need 2. Research and Develop Theory 3. Put Theory into Practice

A logically interrelated set of confirmed hypotheses that describe, explain or predict specific phenomena (observable occurrences) in nursing & practice

Describe - the an issue or need in the health environment Explain- relationship between observed behaviors & their effects on human health Predict - how implementation of specific interventions will influence or change behaviors

We use research to test and develop theories: Quantitative research - objective empirical evidence used to test theories Example: the number of postoperative infections in a surgical unit Qualitative research - subjective data used to develop theories Example: reasons nurses are dissatisfied with their jobs

all stuff with quantitative Considered hard science Objective Deductive reasoning used to synthesize data Focus—concise and narrow Tests theory Basis of knowing—cause and effect relationships Basic element of analysis—numbers and statistical analysis Single reality that can be measured and generalized

Considered soft science Subjective Inductive reasoning used to synthesize data Focus—complex and broad Develops theory Basis of knowing—meaning, discovery Basic element of analysis—words, narrative Multiple realities that are continually changing with individual interpretation

answers coming shortly .....stay tuned folks.

Nursing theories describe, explain and predict behaviors on every level of society

A theory is valuable if it is found to be reliable, valid & beneficial Nurses critique a theory based on internal & external factors of the theory Internal - How well the components of the theory fit together (reliable & valid) (Reliable - able to repeat results) (Valid - degree to which test measures what it is supposed to measure) Accuracy Consistency Logical Development External - How well the theory relates to the existing world (beneficial) Significance Scope Complexity Theories address essential issues & contribute to nursing knowledge

Grand- Broad scope & present general concepts & propositions (Abstract ideas) Not designed for empirical testing Applicable to all instances in nursing Mid-range - Narrower in scope & bridge grand nursing theories with practice Theory-based research Nursing practice strategies They propose an outcome that is testable in practice and research Nursing practice - Most limited scope & more concrete Developed for use within a specific range of nursing situations Provide frameworks for: Nursing interventions Predicting outcomes Clarifying impact on nursing practice

A structure that shows how a group of concepts or theories are linked together to provide a framework for nursing: Practice Judgment Education Research Nursing Models can guide the nursing process and delivery of health care Each model is a different approach to how you care for the patient

*Theoretical Model Abstract Developed through inductive and deductive approaches Present a potential picture of the reality of nursing Example: Callista Roy's Adaptation Model

Personal pattern of individual nurse Developed through personal experience and knowledge Example: Always says goodbye to patients at end of shift

Framework or structure used in clinical area Systematic way for nurses to: Collect data (assessment) Communicate (SBAR) Standardize care (nursing process) Audit practice (outcomes) Example: Care Plan

Abstract Developed through inductive and deductive approaches Present a potential picture of the reality of nursing Example: Callista Roy's Adaptation Model

Person- individuals are unique and motivated by needs Environment- all things that surround and affect people Health- fluctuating degrees of illness or well-being Nursing- nourishes the whole person (holistic care)

― Florence Nightingale, Notes on Nursing: ************ Distinguishes the nurse's focus from the doctor's focus: The nurse's focus is on health of the patient, not the illness Person - (patient) patient is the focus, no upsetting news, minimal noise or disruption Environment - (as opposed to illness) warm, clean and quiet, proper ventilation, sunlight Health - (how environment affects health/recovery from illness) adequate dietary intake, rest Nursing - (as opposed to medicine) protect patient by careful management of surroundings

She identified 4 ways we develop knowledge. Each type of knowing is connected to each other Empirical -Science of Nursing Knowledge is gained by direct and indirect observation. Verifiable, Objective and Factual Research-based Aesthetic - Art of Nursing Subjective and unique to individual Intuition, Interpreting and Understanding that cannot be measured Values a nurse holds Ethical - Moral knowledge How you determine what is right or wrong Ethical decision-making based on moral obligation Good, Valuable and Desirable outcomes Personal - Individual knowledge Self-awareness and how that influences our interactions with others Recognizing our personal strengths and weakness and how they can impact our actions Ability to empathize allows us to connect and help others holistically

Created 5 stages of clinical competence in nursing Novice (Beginner) Follows general rules without deviation No experience to apply to situation Advanced Beginner (Marginally Acceptable) Principles that guide actions have developed based on gaining some experience Able to begin to formulate own plan of action Competent (Abstract Thinking) Able to think abstractly, analyze and formulate own plans based on experience Better organized and efficient with 2-3 years of experience Proficient (Global Perspective) Able to piece together all aspects to view the whole picture and provide holistic care Use experience to know what to expect so is able to plan ahead Still relies on principles to guide actions Expert (Highly Proficient) Wealth of knowledge and experience Intuitive grasp of a situation - able to analyze, interpret and modify care without effort Able to anticipate and adapt to changes quickly

The 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 strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible." Role of the nurse- Nurse cares for patient until patient can care for himself Function of the nurse- To assist the patient

14 Components of Patients Basic Health Needs 1 Breathe normally. Eat and drink adequately. 2 Eliminate body wastes. 3 Move and maintain desirable postures. 4 Sleep and rest. 5 Select suitable clothing. That is, dress and undress appropriately. 6 Maintain body temperature within normal range by adjusting clothing and modifying the environment. 7 Keep the body clean and well groomed and protect the integument. 8 Avoid dangers in the environment and avoid injuring others. 9 Communicate with others in expressing emotions, needs, fears, or opinions. 10 Worship according to one's faith. 11 Work in such a way that there is a sense of accomplishment. 12 Play or participate in various forms of recreation. 13 Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. 14 waka go

A substitute for the patient A helper to the patient A partner with the patient

Caring is passed onto nurses by creating/promoting a professional culture of caring guides practice Developed from 1974-79, The Caring Theory has 3 Concepts:

1) Carative Factors (evolved into Clinical Caritas - to cherish greek origin) * Clinical Caritas incorporates spirituality into caring* -Core values that show caring for patients and caregivers -Caring is the basis for taking a holistic view -Caring promotes an authentic connection between the nurse and patient 2) Transpersonal Caring Relationship Nurse shows concern for the well being of patient, not just the physical health Committed to protecting, enhancing and preserving human dignity, humanity, wholeness, and inner harmony 3) Caring Moment The moment when the nurse and patient engage each other at a human level through caring Caring Occasion the spiritual connection lasts beyond the caring moment and influences the lives of both

The nurse's role is to: Establish a caring relationship with patients Treat patients as holistic beings (body, mind and spirit) Display unconditional acceptance Treat patients with a positive regard Display unconditional acceptance Treat patients with a positive regard Promote health through knowledge and intervention Spend uninterrupted time with patients: "caring moments"

Focus: Extent of patient's ability to care for self Formulation of nursing plan that meets the patient's self-care needs Underlying principles: Patients want to be in control of their lives Nurses are needed when there is an actual or Potential self-care deficit

3 operations that govern how nurses develop plan of care Diagnostic -Determine patient's ability to provide adequate self-care Prescriptive -Nurse considers appropriate interventions that allow patient to care for self when possible Regulatory -Nurse works with the patient to create a system that promotes self-care

3 systems that interact with one another to form framework to view the whole person within their family and social contexts Personal Understanding person and person understand self Interpersonal Interactions between people Social Interactions in society and social settings Nurse views person based on their interactions with people at each level of the 3 systems * Personal - consider the patient's perceptions * Interpersonal - consider patient's roles and the stressors associated with those roles *Social - consider influences on the patient's choices it is important to: Understand the goals of the patient within the context of the 3 systems in order to create an appropriate plan of care with the patient

Spectrum of person' adaptive ability to cope with internal and external environmental stimuli Adaptive - patient has tools that are used to produce responses that effectively cope with stressors Maladaptive - patient lacks tools that are used to produce responses that effectively cope with stressors ********** Modifying the stimuli promotes adaptation and promotes homeostasis Effective adaptive responses promote the integrity of the patient by: -Conserving energy -Promoting survival, growth and reproduction -Mastering the human system *********Nurses develop plans of care that promote adaptation

A person is an adaptive system (biopsychosocial being) whose ability to adapt is influenced by 4 modes 1) Physiologic (physical balance) 2) Self-concept (psychic balance) 3) Role function (social balance) 4) Interdependent modes (relationship balance) The nurse determines how well the patient is adapting based on behaviors exhibited within each mode.

Focus is on establishing a therapeutic nurse-patient relationship not the patient alone As the patient develops new behavior patterns, the nurse expands her understanding of how stressors impact the lives and behaviors of individual patients Nurse has 6 roles when interacting with patient: Technical expert Teacher Resource person Surrogate Leader Counselor Goal: The survival of the patient The patient's understanding of his or her health problems and understanding of his or her health problems as he or she develops new behavior patterns

"Mother of Psychiatric Nursing" Four Phases of the therapeutic nurse-patient relationship: 1) Orientation phase - nurse engages patient and establishes a rapport 2) Identification phase - patient collaborates with nurse and expresses feelings 3) Exploitation phase - patient uses all the services made available by the nurse 4) Resolution phase - relationship ends; services no longer needed

Goal: -nurse determines and meet patient's immediate needs and -improves their situation by relieving distress or discomfort Nursing Process: ADPIE is a deliberative action based on inferences from verbal and nonverbal patient behaviors

Patient is an open system whose goal is to resist stressors and maintain boundaries (homeostasis): 3 types of stressors that alter stability: ~Client - Internal ~ Environment - External ~Health - Physical, Emotional and Mental

Each person has 2 lines of resistance As each line of resistance is broken, protection against stressors is lost The responsibility of the nurse - identify potential and actual stressors and: -Promote wellness -Health Promotion (1st line of resistance) - Remove stressors - Health Prevention and Maintenance (2nd line) - Facilitate reconstruction - Health Rehabilitation (lines are broken)

Neuman's Nursing "Action which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduces stressors."

~Established Transcultural Nursing (MSN offered in this specialty) ~Different cultures behave in a unique way ~Cultural norms impact how they view, respond to and engage in healthcare ~Caring is an essential part of providing culturally competent care ~Nursing should provide culturally congruent care in order to be therapeutic *****Cultural competence is needed due to increases in global migration

...