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Documente Profesional
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CLEANLINESS
VENTILATION
AIR
LIGHT
NOISE
WATER
BEDDING
DRAINAGE
WARMTH
DIET
PATIENT CONDITION
AND NATURE
COMMUNICATION
MORTALITY DATA
ADVICE
VARIETY
PREVENTION OF DISEASES
PSYCHOLOGICAL SOCIAL
ENVIRONMENT ENVIRONMENT
NIGHTINGALES THEORY OF NURSING AS
RELATED TO SCIENTIFIC THEORIES
ADAPTATION
NEED THEORY
STRESS THEORY
Nightingale’s Environmental Concepts
VENTILATION
WARMTH
SMELLS
NOISE
LIGHT
The Evolution of Nursing Research
While caring for victims of the Crimean War, Florence
Nightingale kept careful and objective records.
These records provided baseline data that she later used
to determine which nursing interventions were most
effective in treating her patients.
Since that time, nursing research has taken many different
pathways, and all nurses are involved with research either
as consumers (nurses who use and evaluate research
findings) or as actual investigators who design and
implement research studies.
Dorothea Orem
Born in Baltimore,
Maryland.
One of America’s foremost
nursing theorists.
Father was a construction
worker
Mother was a homemaker.
Youngest of two
daughters.
Education
Studied at Providence Hospital school of Nursing in
Washington D.C. in 1930’s
Got her B.S.N.E. in 1939 and her M.S.N.E in 1946 both
from the Catholic University of America Got her M.S.N.E.
at Catholic University of America in 1946
1958-1960 upgraded practical nursing training at
Department of Health, Education and Welfare
Was editor to several texts including Concepts
Formalization in Nursing: Process and Production, revised
in 1980, 1985, 1991, 1995, 2001
Orem’s Theory of Self Care
Each person has a need for self care in order to maintain
optimal health and wellness.
Each person possesses the ability and responsibility to
care for themselves and dependants.
Theory is separated into three conceptual theories which
include: self care, self care deficit and nursing system.
Theory of Self Care
Self care is the ability to perform activities and meet
personal needs with the goal of maintaining health and
wellness of mind, body and spirit.
Self care is a learned behaviour influenced by the
metaparadigm of person, environment, health and nursing.
Three components: universal self care needs,
developmental self care needs, and health deviation.
Universal Self Care
This includes activities which are essential to health and
vitality.
Eight elements identified these include: air, water, food,
elimination, activity and rest, solitude and social
interactions, prevention of harm, and promotion of
normality.
Developmental Self Care Need
These include the interventions and teachings designed to
return a person to or sustain a level of optimal health and
well being.
Examples can include such things as toilet training a child
or learning healthy eating.
Health Deviation Self Care
This encompasses the variations in self care which may
occur as a result of disability, illness, or injury.
In other words the person with a variation is meeting self
care and maintaining health and wellness in a more
individualize meaning.
Theory of Self Care Deficit
Every mature person has the ability to meet self care
needs, but when a person experiences the inability to do
so due to limitations, thus exists a self care deficit.
A person benefits from nursing intervention when a
health situation inhibits their ability to perform self care
or creates a situation where their abilities are not
sufficient to maintain own health and wellness.
Nursing action focuses on identification of
limitation/deficit and implementing appropriate
interventions to meet the needs of person.
Theory of Nursing Systems
The ability of the nurse to aid the person in meeting
current and potential self care demands.
Focused on person
Three support modalities identified in theory including:
total compensatory, partial compensatory, and
educative/supportive compensatory.
The client’s ability for self care involvement will
determine under which support modality they would be
considered.
Wholly or Total Compensatory
Encompasses total nurse
care-client unable to do
for themselves.
The Body
Natural and
biological
sciences
Intimate bodily
care
aspect of nursing
“The Care”
The Core Circle
The core circle of patient care involves the therapeutic
use of self and is shared with other members of the
health team.
The nurse uses a freely offered closeness to help the
patient bring into awareness the verbal and nonverbal
messages being sent to others. Motivations are
discovered through the process of bringing the awareness
the feelings being experienced. The patient is now able to
make conscious decisions based on understood and
accepted feelings and motivations. The motivation and
energy necessary for healing exist within the patient
rather than in the health care team.
The core circle of patient care
The Person
Social sciences
Therapeutic use of self
aspect of nursing
“The Core”
The Cure Circle
The cure circle of patient care is shared with other
members of the health team.
The Disease
“The Cure”
Interaction of the Three Aspects of Nursing
The three aspects of nursing as Hall identifies them do
not function independently, but are interrelated, and they
interact and change size depending on the patient’s total
course of progress.
In philosophy of Loeb Center the professional nurse
functions most therapeutically when patients have
entered the second stage of their hospital stay (i.e., where
they are recuperating and are past the first acute stage).
Hall’s three aspects of nursing
The Person
“The Core”
Much of her current wok begun with the 1979 publication, Nursing:
The Philosophy of Science and Caring which she says begun as class
notes for a course she was developing. She says the book “emerged from
her quest to bring new meaning and dignity to the world of nursing and
patient care- care that seemed too limited in its scope at that time, largely
defined by medicines paradigm and traditional biomedical science models”.
Nursing: Human Science and Human Care- A Theory of
Nursing, published in 1985 and re-released in 1998, was
her second major work.
The purpose of this book was to address some of the
conceptual and philosophical problems that still existed in
nursing.
She hoped that others would join as she sought to
“elucidate the human care process in nursing, preserved
the concept of person in our science, and better our
contribution to society. This book has been translated to
Chinese, German, Japanese, Korean and Swedish.
In Watson's original philosophy and science of caring, she
referred to caring as the essence of nursing practice.
Caring is more ideal rather than a task oriented behavior
and include such characteristics as the actual caring
occasion and the transpersonal caring moment,
phenomena that occur when an authentic caring
relationship exist between the nurse and the patient.
Watson bases her theory for nursing practice on the
following 10 Carative factor.
•Energy Integrity
•Structural Integrity
•Social Integrity
Concepts
a.Wholeness
It emphasizes a sound,
organic, progressive,
mutuality between
diversified functions
and parts within an
entirety, the boundaries
of which are open and
fluent
Concepts
b. Adaptation
It is the process of
change whereby the
individual retains his
integrity within realities
of his internal and
external environment
(Levine, 1973)
Concepts
c. Conservation
Historicity
Specificity
Redundancy
Concepts
Conservation:
Symbolized by a light bulb in the
center. Light bulbs give light and
are productive. Light bulbs also
symbolize ideas… theories are
ideas.
Historicity: genetics
The hearts show dominant (dark
pink) and recessive (light pink)
traits.
Concepts
Specificity:
Different pathways are coming
from the center of the light
bulb representing the
multiple stimulus response
pathways.
Redundancy:
If one pathway can't get the job
done, another pathway will
compensate
Betty Neuman
The Neuman Systems Model was originally
developed in 1970 at the University of California,
Los Angeles, by Betty Neuman, Ph.D., RN. The
model was developed by Dr. Neuman as a way to
teach an introductory nursing course to nursing
students. The goal of the model was to provide a
wholistic overview of the physiological,
psychological, sociocultural, and developmental
aspects of human beings. After a two-year
evaluation of the model, it was published in
Nursing Research (Neuman & Young, 1972).
Neuman has since published three editions of the
Neuman Systems Model. The Neuman Systems
Model Trustees Group was established in 1988.
This group was established for the perpetuation,
presevation, and protection of the integrity of the
model and any future changes in model must
have the consent of the trustees (George, 1996).
Biographical Information
1924
Born near Lowell, Ohio.
1947
Received RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio
Moved to California and gained experience as a hospital, staff, and head nurse;
school nurse and industrial nurse; and as a clinical instructor in medical-
surgical, critical care and communicable disease nursing.
1957
Attended University of California at Los Angeles (UCLA) with double major
in psychology and public health.
Received BS in nursing from UCLA.
1966
Received Masters degree in Mental Health, Public Health Consultation from UCLA.
Recognized as pioneer in the field of nursing involvement in community mental
health.
Began developing her model while lecturing in community mental health at UCLA.
1972
Her model was first published as a 'Model for teaching total person approach to
patient problems' in Nursing Research.
1985
Received doctorate in Clinical Psychology from Pacific Western University.
1998
Received second honorary doctorate - this one from Grand Valley State University,
Allendale, Michigan.
Neuman’s Model was influenced by a variety of
sources:
Pierre Telhard deChardin was a catholic priest and
scientist who is credited with first proposing the idea of
spiritual evolution. He believed that spiritually humans are
evolving toward an ultimate perfection that he called the
omega point.
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.
Implications for Practice and Research
The main use of the Neuman Model in practice and in
research is that its concentric layers allow for a simple
classification of how severe a problem is.
If a stress response is perceived by the patient or assessed by
the nurse, then there has been an invasion of the normal line
of defense and a major contraction of the flexible line of
defense.
Thus, the level of insult can be quantified allowing for
graduated interventions.
The drawback of this is that there is no way to know whether
our operationalization of the person variables is a good
representation of the underlying theoretical structures.
Person
The person is a layered multidimensional being.
The person may in fact be an individual, a family, a group,
or a community in Neuman's model.
The person, with a core of basic structures, is seen as
being in constant, dynamic interaction with the
environment.
The person is seen as being in a state of constant change
and-as an open system-in reciprocal interaction with the
environment.
Environment
The environment is seen to be the totality of the internal and
external forces which surround a person and with which they
interact at any given time.
These forces include the intrapersonal, interpersonal and
extrapersonal stressors which can affect the person's normal
line of defense and so can affect the stability of the system.
Personal system
Interpersonal system
Social system
The Personal System
It refers to the individual.
An individual’s perceptions of self, of body image, of time
and space influence the way he or she responds to
persons, objects, and events in his or her life. As
individuals grow and develop through the life span,
experiences with changes in structure and function of
their bodies over time influence their perceptions of self.
Interpersonal System
Clarity of purpose.
Mastery of skills and knowledge.
Ability
Interest
Dedication
Wiedenbach prescriptive theory
a situation-producing theory
5 Realities
the agent
the recipient
the goal
the means
the framework
Realities – offer uniqueness in every situation
Wiedenbach conceptualization of the nursing process
Nursing action
is the visible portion of nursing practice in w/c the nurse
interacts by the word, look, manner or deed with the another
person.
Energized phenomenon.
Nursing process – is the essentially an internal
personalized mechanism.
Wiedenbach’s 7 levels of awareness
Sensation – experience sensory impression
Perception – the interpretation of the sensory impression
Assumption – the meaning the nurse attaches to the
perception
Realization – in w/c the nurse begins to validate the
assumption she had previously made about the patient
behavior
Insight – w/c includes joint planning and additional knowledge
about the cause of the problem
Design – the plan of action decided upon by the nurse and
confirmed by the patient
Decision – the nurse performance of action
Comparison of Wiedenbachs theory and the nursing
process
Implementation phase
Design level – the nurse
plan a course of action.
Nursing diagnosis - made Assumption – compared
after much conscious to the nursing diagnosis
thought and deliberation •should be validated by
about the assessment data gathering more data
•voluntary
Planning
Insight level – includes
joint planning
Evaluation After the plan decided on, the
nurse confirmed it with the
patient. Once the plan has been
decided it on and confirmed
the nurse perform the action
Wiedenbach and the concept of man, health, society and
nursing
Dorothy Johnson
Johnson’s first paper on this topic outlined her philosophy of nursing, arguing that
the key element was hands-on nursing services. She defined these services as caring
for, rather then curing the patient.
The definition of caring Johnson used defined caring as basic nursing procedures:
comfort measures, environmental management, emotional support, and teaching.
She believe that the physicians could be as kind as nurses but they focused their
work on curing, rather than sustaining the patient.
CENTRAL THEME
Nursing problems arise when there are disturbances in the system or subsystem or
the behavioral function is below an optimal level.
In 1949 she joined the faculty of UCLA where she and Lulu K. Wolf Hassenplug
developed the “ first four year generic basic nursing program” in the United States.
Dorothy Johnson was a prolific writer on the subject of nursing theory. Her many
publications on this subject profoundly influenced theoretical thinking in nursing
during the second half of the 20th century.
She held a strong conviction that continuing improvement of care was the ultimate
goal of nursing. Her 1968 paper, entitled, “ One Conceptual Model of Nursing “ is a
classic contribution to Nursing Literature.
After her retirement from UCLA she moved to the Florida coast to pursue her
hobby of the study of sea shells. She remained active in retirement as a speaker and
advocate for nursing education.
KATHERINE KOLCABA
THEORY OF COMFORT
Credentials and Background of the Theorist
Catherine Kolcaba was born in Cleveland Ohio, where
she spent most of her life. In 1965 she received her
diploma in nursing from St. Luke’s Hospital School of
Nursing in Cleveland. She practiced part time for many
years in medical-surgical nursing, long term care and
home care before returning to school. In 1987, she
graduated in the first RN to MSN class at the Frances
Payne Bolton School of Nursing, Case Western Reserved
University, with a specialty in gerontology. While going to
school, Kolcaba job shared a head nurse position on a
dementia unit. In the context of that unit, she begun
theorizing about the outcome of comfort.
Following graduation with her master’s degree in nursing,
Kolcaba joined the faculty at the University of Akron College
of Nursing. Since that time she has maintained American
Nurses Association Certification in Gerontology. She returned
to Case Western Reserved University to pursue her
doctorate in nursing on a part time basis while continuing to
teach full time. Over the next ten years, she used coursed
work from her Doctoral program to develop and explicate her
theory. During that time, Kolcaba published a concept analysis
of comfort with her philosopher husband, diagrammed the
aspects of comfort, operationalized comfort as an outcome of
care, contextualized comfort in a midrange theory and tested
the theory in an intervention study.
Theoretical Sources
Kolcaba originally begun her theoretical work when she
diagrammed her nursing practiced early in her Doctoral
work. When Kolcaba presented her framework for
dementia care, an audience member asked, “have you
done a concept analysis of comfort?” Kolcaba’s reply was
“No but that is my next step.” This begun her long
investigation on the concept of comfort.
The first step, the promised concept analysis, begun with an
extensive review of the literature about comfort from the
disciplines of nursing, medicine, psychology, psychiatry,
ergonomics and English ( specifically Shakespeare’s use of
comfort and the Oxford English dictionary, which traces
origins of words.) from 1900 to 1929, comfort was the central
goal of nursing and medicine because, through comfort
recovery achieved.
The nurse was duty bound to attend to details influencing
patient comfort. Comfort of the patient was the nurse’s first
and last consideration. A good nurse made patients
comfortable and the provision of comfort was the primary
determining factor of the nurse ability and character.
Comfort is positive, it is achieved with the help of nurses
and in some cases, in indicates an improvement from
previous state or condition. Intuitively, comfort is
associated with a nurturing activity.
From its origins, Kolcaba explicated its strengthening
features and from ergonomics, comforts direct link to job
performance.
However, often its meaning is implicit, hidden in context
and ambiguous. The concept varies semantically as a verb,
noun, adjective, adverb, process and outcome.
Four Major Tenets about the Nature of Holistic
Comfort
Comfort is generally state specific.
The outcome of comfort is sensitive to changes over
time.
Any consistently applied holistic nursing intervention with
established history for effectiveness enhances comfort
over time.
Total comfort is greater than the sum of its part.
Major Concepts and Definitions
Health Care Needs
Kolcaba defines health care needs as needs for comfort,
arising from a stressful healthcare situations, that cannot
be met by recipient’s traditional support systems.
These needs include physical, psychospiritual, social and
environmental needs made apparent through monitoring
and verbal or non verval reports, needs related to
pathophysiological parameters, needs for education and
support and needs for financial counseling and
intervention.
Comfort Measures
Comfort measures are defined as nursing interventions
designed to address specific comfort needs of recipients,
including physiological, social, financial, psychological,
spiritual, environmental and physical.
Intervening Variables
Intervening variables are defined as interacting forces that
influence recipients perception of total.
These consist of variables such as past experiences, age,
attitude, emotional state, support system, prognosis,
finances and the totality of elements in recipients
experience.
Comfort
Comfort is defined as the state that is experienced by
recipients of comfort measures. It is the immediate and
holistic experience of being strengthened through having
the needs met for the three types of comfort ( relief,
ease, and transcendence) in four context of experience (
physical, psychospiritual, social and environmental)
TYPES OF COMFORT ARE DEFINED AS:
Relief: the state of a recipient who has had a specific need
met.
Strategic Vision
Inspiration