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What are the philosophical assumptions of Roy?

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1. Humanism 2. Veritivity (inherit purposefulness of human life) 3. Cosmic unity

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Humanism for Roy

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a. Broad movement in philosophy and psychology that recognizes the person and subjective dimensions of the human experience as central to knowing and valuing. b. Humans as individuals and in groups: o Share in creative power. o Behave purposefully rather than in a sequence of cause and effect. o Possess intrinsic holism. o Strive to maintain integrity and to realize the need for relationships.

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Veritivity for Roy

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a. Principle of human nature that affirms common purposefulness of human existence. b. Unity of purpose of humankind. c. Activity and creativity for the common good. d. Value and meaning of life.

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Cosmic unity for Roy

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a. Principle that people & the earth have common patterns and integral relationships. b. Roy believes that individuals stand united in a common destiny and find meaning in mutual relations with each other, the world and a God-figure.

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What are the scientific assumptions of Roy?

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1. Systems Theory 2. Adaptation Theory

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Systems Theory

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Important concepts: • Holism • Interdependence • Control processes • Information feedback • Complexity of living systems

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Adaptation Theory

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a. Integration of human and environmental meanings results in adaptation. b. Environment is classified as stimuli: Focal, contextual or residual. c. Behaviour, as a response to changes in the environment, can be adaptive or ineffective. d. Adaptation = stimuli + adaptation level. e. Adaptation levels: • Integrated • Compensatory • Compromised

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What are the cultural assumptions of Roy?

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• Cultural adjustment • Roy recognizes that concepts central to a culture may influence elements of the RAM. • Cultural expressions of RAM elements may lead to changes in nursing practice: o Assessment o Education o Research • Adjustments to RAM are appropriate to ensure cultural relevance.

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Health

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a. A state and a process of being and becoming integrated and whole. b. A continuum of adaptation: constantly growing & developing within a changing environment. c. Soundness: unimpaired condition that can lead to completeness or unity.

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Adaptation

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The process and outcome whereby the thinking and feeling person use conscious awareness and choice to create human and environmental integration.

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Three types of stimuli

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1. Focal 2. Contextual 3. Residual

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Focal Stimuli

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The stimulus, internal or external, most immediately confronting the adaptive system -- the individual or group.

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Contextual Stimuli

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All other stimuli, internal or external, affecting the situation; contribute to the behaviour triggered by the focal stimulus.

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Residual Stimuli

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Those stimuli having an indeterminate affect on the behaviour of the individual or group; their affect cannot be, or has not been, validated. "You know there is something happening, but can't get your fingers on it".

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Three adaptation levels

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• Integrated • Compensatory • Compromised

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Integrated Adaptation

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• Structures and functions of life process working as a whole to meet human needs. • Striving to come back to equilibrium, status quo, and homeostasis.

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Compensatory Adaptation

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• The cognator and regulator have been activated by a challenge to the integrated processes • Integrated doesn't work, so you go to a Plan B.

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Compromised Adaptation

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• Both the integrated and compensatory processes are inadequate, and an adaptation problem can result. • Worst case scenario, system becomes compromised.

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Person

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a. Adaptive system described as a whole comprised of parts. b. Functions as a unity for some purpose. c. Includes people ad individuals or in groups: families, organizations, communities, and society as whole.

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Five goals of the person

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1. Survival 2. Growth 3. Reproduction 4. Mastery 5. Human and environment transformation

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Person's internal subsystems - major processes for coping

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1. Regulator 2. Cognator

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Regulator

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a. Physiological level. b. Receives stimuli, processes them through neural-chemical-hormonal channels to produce a response. c. Major coping process involving neural, chemical and endocrine systems.

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Cognator

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a. Cognitive Level. b. Encompasses psychosocial pathways and apparatus for perceptual / information processing, learning, judgment, emotions. c. Major coping process involving four cognitive-emotive channels: perception and information processing, learning, judgement and emotion.

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How can adaptation responses be assessed?

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a. Observations: using all senses b. Measurement: technical skills c. Subjective data: interviewing skills

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Behaviour

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a. Actions or reactions under specified circumstances. b. Can be observable or non-observable. c. Can be identified as Adaptive or Ineffective.

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Observable vs. Non-observable behaviour

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Observable: crying, shaking, yelling, talking. Non-observable: preoccupation, "butterflies", fear.

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Adaptive Behaviour

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Responses that promote integrity of the person in terms of the goals of survival, growth, reproduction, mastery and human & environment transformation.

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Ineffective Behaviour

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Responses that disrupt or do not contribute to integrity of the human adaptive system in terms of the goals of survival, growth, reproduction, mastery and human & environment transformation.

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Four adaptive modes of behaviour

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1. Physiological 2. Self-concept 3. Role Function 4. Interdependence

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Physiological Mode

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Defined as the way a person responds as a physical being to stimuli from the environment meets the need for physiological integrity. Physiological behaviour indicates whether the coping mechanisms are able to adapt to the stimuli affecting them

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Physiological Mode - Five basic needs

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1. Oxygen 2. Nutrition 3. Elimination 4. Protection 5. Activity and rest

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Physiological Mode - Four Complex Processes

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1. Senses 2. Fluid & electrolytes 3. Neurological function 4. Endocrine

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Physiological submode - Nutrition

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Basic life processes of: digestion and metabolism.

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Nutrition - Adaptive indicators

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Stable digestive processes. Adequate nutritional pattern for body requirements.

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Nutrition - Common Adaptation Problems

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Nausea & vomiting. Nutrition less than body requirements. Weight 20% above or below average. Anorexia. Ineffective coping strategies for altered means of ingestion.

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Self-concept Mode

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a. All beliefs and feelings that a person holds about him or herself at a given time. b. Formed from internal perceptions and the perceptions of others' reactions.

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Self-concept Mode - Physical Self

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Body image Body sensation

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Body image

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How one views oneself physically, one's appearance.

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Example of body image statement

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"I need to lose some weight"

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Body sensation

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Feeling or experiencing oneself as a physical being.

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Example of body sensation statement

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"I feel sick", "I am exhausted"

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Self-concept Mode - Personal Self

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Self consistency Self ideal/expectancy Moral-ethical-spiritual Self

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Self consistency

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Person strives to maintain a coherent self-organization, to avoid disequilibrium. Identifying yourself as being something that you do ("I'm always on time").

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Self ideal/expectancy

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Personal potential, how do you see yourself in the future. Can be greatly compromised by the diagnosis: what you expected to accomplish may not be feasible anymore.

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Moral-ethical-spiritual Self

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Beliefs or practices that are part of who the person is, their culture, their sense of meaning and their coping strategies.

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Role Function Mode

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a. Basic need: social integrity. b. Social integrity: the need to know who one is in relation to others so that one can act. c. Role: functioning unit in society. d. All roles exist in relation to one another. e. Three types of roles: Primary, Secondary, Tertiary.

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Role Function Mode - Primary Roles

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a. Each person has ONE primary role. b. Based on age, gender, developmental stage. c. Determines the majority of behaviours that the individual engages in during a particular period of life. d. Helps to identify specific role expectations in relation to the developmental stage and to social expected processes.

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Examples of Primary Role

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3-year-old, preschool, male 16-year-old, adolescent, female 27-year-old, young adult, male

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Role Function Mode - Secondary Roles

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a. Accomplish the goals of developmental stage/primary role: wife, mother, student, etc. b. Normally achieved position instead of primary qualities. c. Require specific role activities. d. Stable and not given up easily because they are developed and mastered over a period of time.

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Examples of Secondary Role

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Job positions Husband / wife Mother / father Mentor / Teacher

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Role Function Mode - Tertiary Roles

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a. Temporary and chosen. b. Related mainly to secondary roles: ways of meeting the secondary role expectations. c. Include participation in social or professional group activities.

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Examples of Tertiary Roles

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Football coach (2nd: Father) Association member (2nd: Professor) Cook (2nd: husband)

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Interdependence

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a. Focuses on interactions related to giving & receiving of love, respect & value to achieve affectionate & developmental adequacy. b. Focuses on close relationships, and its purpose, structure and development. c. Meets the need for relational integrity and feelings of security in nurturing relationships. d. Three possible behaviours: dependent, independent, interdependent.

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Interdependence - Dependent Behaviour

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Help, attention, affection seeking.

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Interdependence - Independent Behaviour

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Initiative-taking, obstacle mastery, satisfaction from work.

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Interdependence - Interdependent Behaviour

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Balance between dependent & interdependent behaviours in relationships with others.

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Functions of the Nursing Process (4)

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1. Assists the nurse in her/his critical thinking. 2. Provides a guideline for data collection and care planning. 3. Helps organize one's work. 4. Assists with documentation of clients' needs and plan of care.

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The Nursing Process is NOT (4)

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1. A conceptual framework 2. A theory or theoretical framework 3. A model of care 4. A standard for the profession -- it's a guideline.

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How does critical thinking influence the Nursing Process? (5)

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1. Observations made. 2. Focus on client's needs. 3. Prioritizing client's needs. 4. Research, evidence for choice of interventions. 5. Reflect on client's response to interventions using clear measures.

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Five steps of the Nursing Process

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1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation

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NP - Assessment

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a. The nurse gathers & analyzes information to understand the client's health status. b. Subjective and Objective data

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NP - Diagnosis

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a. The nurse identifies the client's response to health problems within the domain of nursing. b. Data analysis, problem identification, label.

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NP - Planning

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a. The nurse prioritizes proposed strategies and interventions and creates a client-centered care plan, identifying expected outcomes. Goal setting (SMART) b. Priorities, goals, interventions.

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NP - Implementation

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a.The nurse carries out the care plan. b. Nurse-initiated or Physician-initiate treatment.

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NP - Evaluation

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a. The nurse looks at achievement of outcomes to determine whether or not the interventions have been effective. b. Data, diagnosis, etiologies, plans, interventions.

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Six steps of ROM Process

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1. Assessment of behaviour/response (including judging the response as adaptive or ineffective). 2. Assessment of stimuli 3. Nursing diagnosis. 4. Goal setting 5. Intervention 6. Evaluation

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RAM - Assessment of Behaviour

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Behavioural data and responses Tentative judgment of behaviour

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RAM - Assessment of Stimuli

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Focal, contextual and residual

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RAM - Nursing Diagnosis

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Within each mode or across modes

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RAM - Goal setting

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Planning using SMART criteria

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RAM - Intervention

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Management or decrease or elimination of stimuli Enhancing adaptation threshold

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RAM - Evaluation

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Change in behaviour (client response to stimuli)

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Level 1 Assessment

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The behaviour: output observed in each of the 4 modes (Physical,

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Level 2 Assessment

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Stimuli: focal, contextual, residual.

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When does the Regulator/Cognator kick into action?

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In Compensatory Adaptation.

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Six sources of data about the patient

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1. Patient 2. Family & significant others 3. Healthcare Team 4. Medical records 5. Literature 6. Nurse's experience

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Four methods of collecting data from the patient

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1. Interview: open ended & closed ended questions 2. Nursing health history 3. Family history 4. Physical examination

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Holistic Assessment

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A detailed database that allows you to focus on your client's strengths and available supports, as well as on the presenting problem.

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Problem-based Assessment

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Client presents with a specific concern, and data is collected with a goal of honing into the root of the problem. As you collect data, you will begin to categorize "cues", make "inferences" about the data, and identify emerging patterns. You will start to see patterns of information that point to some sort of conclusion about the nature of the problem.

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What are the landmarks of Ineffective Behaviours?

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1. Pronounced regulator activity. 2. Ineffective cognator activity. 3. Useless spending of energy, without changes in behaviour or improvement of the stimuli.

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Behaviour/response observed in one mode may be a stimulus in another mode. True or False?

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True.

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Each focal stimulus can affects only one mode. True or False?

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False. One focal stimulus can affect more than one mode.

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Medical diagnosis

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Identification of a disease condition on the basis of a specific evaluation of physical signs, symptoms, medical history, diagnostic tests and procedures.

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Nursing diagnosis

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A clinical judgement about individual, family, or community responses to actual or potential health problems or life processes that is within the domain of nursing.

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NANDA

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North American Nursing Diagnosis Association. Established in 1973 to identify standards and classify health problems treated by nurses.

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Two parts of the Nursing Diagnosis

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1. Diagnostic label. 2. Statement of related facts: actual, risk, health promotion or wellness.

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Collaborative Problem

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Actual or potential physiological complication that nurses monitor to detect the onset of changes in a client's status.

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Data Validation

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Comparison of data collected with another source to determine data accuracy. Validate inferences about client's behaviours by asking the client if your inference is correct. Validate findings from physical examination by analyzing medical records or consulting with the healthcare team.

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Data Analysis and Interpretation

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Recognizes patterns in data which indicate a current or potential problem. Data interpretation uses inferential reasoning: attaching meaning to clinical data.

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Three steps of Data Analysis

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1. Recognize a pattern or trend by cues. 2. Compare with normal standards. 3. Make a reasoned conclusion.

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Data cluster

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Set of signs or symptoms grouped together in a logical way.

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Four sources of error in the Nursing Diagnosis

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1. Data collection. 2. Interpretation and analysis of data. 3. Clustering data. 4. Diagnostic statements.

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Data collection errors arise from (4)

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Lack of knowledge or skill. Inaccurate data Missing data Disorganization

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Data interpretation errors arise from (5)

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Inaccurate interpretation of cues. Failure to consider conflicting cues. Insufficient number of cues. Unreliable or invalid cues. Failure to consider cultural or developmental stage influences.

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Data clustering errors arise from (3)

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Insufficient clustering of cues. Premature clustering of cues. Incorrect clustering.

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Data labelling/diagnostic statement errors arise from (5)

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Wrong diagnostic label. Evidence of a more suitable diagnosis. Condition assumed to be a collaborative problem. Failure to validate diagnosis with client. Failure to seek guidance.

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Actual nursing diagnosis

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Describes responses to health conditions or life processes that exist presently. - Data: sufficient assessment data.

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Risk nursing diagnosis

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Describes human responses to health conditions or life processes that will possibly develop. - Data: risk factors that confirm client's vulnerability.

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Wellness nursing diagnosis

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Describes levels of wellness in a client that can be enhance -- strengths. Identify transitions from a specific level of wellness to a higher level.

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Two parts of the Diagnosis Statement

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1. Diagnostic label 2. Related factors

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Diagnostic label (nursing diagnosis statement)

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a. Describes the patient's response to health conditions. b. Includes descriptors to strengthen meaning and describe the nature of the change observed. c. Example of descriptors: impaired, decreased, compromised.

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Related factors (nursing diagnosis statement)

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a. Condition or etiology identified from the client's assessment data. b. Associated with the client's actual or potential response to the health problem. c. Can be changed through nursing interventions.

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Defining characteristics

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Clinical criteria or assessment findings that help confirm an Actual nursing diagnosis.

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Risk factors

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Environmental, physiological, genetic or chemical elements that increase the vulnerability of a client to experience an unhealthful event. Must be used in all Risk nursing diagnoses.

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