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Theories, Conceptual Models and Concepts applied to Community Health Nursing.

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Title: Theories, Conceptual Models and Concepts applied to Community Health Nursing.


1
Theories, Conceptual Models and Concepts applied
to Community Health Nursing.
  • By Nataliya Haliyash,
  • MD, BSN
  • TSMU, International Nursing School

2
By the end of this lecture you will be able to
  • Explain what is meant by a theory and a model of
    nursing
  • Discuss the main features of at least two
    theories of nursing
  • Orems Theory
  • Roper, Logan Tierney
  • Callister Roys model
  • Characterize the conceptual models
  • the Omaha System,
  • Neuman System Model

3
Theory
  • is a general statement that summarizes and
    organizes knowledge by proposing a general
    relationship between events - if it is a good one
    it will cover a large number of events and
    predict events that have not yet occurred or been
    observedRobson C.

4
Theories that Define Nursing or Discuss Nursing
in a General Sense (Philosophies)
  • Florence Nightingale
  • Virginia Henderson
  • Ernestine Wiedenbach

5
Theories about Broad Nursing Practice Areas
Grand Theories
  • Myra Estrin Levine's Conservation Model
  • Betty Neuman's Systems Model
  • Sister Callista Roy's Adaptation Model
  • Dorthea Orem's Self-Care Model

6
Theories about Specific Nursing Actions,
Processes, or Concepts Middle-Range Theories
  • Katharine Kolcaba's Theory of Comfort
  • Sister Callista Roy's Adaptation Model
  • Nola Pender's Health-Promotion Model
  • Hildegard Peplau's Interpersonal Relations in
    Nursing

7
Theories that Defy Classification
  • Martha Rogers's Unitary Human Beings
  • Margaret Newman's Health as Expanding
    Consciousness

8
A conceptual model
  • is the synthesis of a set of concepts and the
    statements that integrate those concepts into a
    whole.

9
Theory of Nursing Systems Orems Theory
  • This is the unifying theory that subsumes the
    theory of self-care deficit which subsumes the
    theory of self-care
  • (Orem, 1991, p. 66).
  • The Theory of Nursing Systems attempts to answer
    the question What do nurses do?

10
Dorothea Elizabeth Orem
  • Dorothea Elizabeth Orem (1914 June 22, 2007),
    born in Baltimore, Maryland, was a nursing
    theorist and founder of the Orem model of
    nursing, or Self Care Deficit Nursing Theory.
  • In simplest terms, this theory states that nurses
    have to supply care when the patients cannot
    provide care to themselves.
  • Her Theory is about self-care. It's all about the
    capacity to recover themselves with a little help
    of Nurses

11
  • The nurse determines whether or not there is a
    legitimate need for nursing care. Is a person
    able to meet self-care needs? Does a deficit
    exist? If a deficit exists, then the nurse plans
    care that identifies what is to be done by whom
    the nurse, the client, or other (family or
    significant other).
  • Collectively, the actions of all these people are
    called the nursing system.

12
Orems Theory
  • Orem identified three types of nursing systems
  • wholly compensatory,
  • partly compensatory, and
  • supportive-educative.

13
Orems Theory compensatory nursing system
  • In the wholly compensatory nursing system, the
    nurse supports and protects the client,
    compensates for the clients inability to care
    for self, and attempts to provide care for the
    client. The nurse would use the wholly
    compensatory nursing system when caring for a
    newborn or with a client in a postanesthesia care
    unit who is recovering from surgery. Both of
    these clients are completely unable to provide
    self-care.

14
Orems Theory the partly compensatory nursing
system
  • In the partly compensatory nursing system, both
    the nurse and client perform care measures. For
    example, the nurse can assist the postoperative
    client to ambulate. The nurse may bring in a meal
    tray for the client who is able to feed self. The
    nurse compensates for what the client cannot do.
    The client is able to perform selected self-care
    activities but also accepts care performed by the
    nurse for needs the client is unable to meet
    independently.

15
Orems Theory the supportive-educative nursing
system
  • In the supportive-educative nursing system, the
    nurses actions are to help clients develop their
    own self-care abilities through knowledge,
    support, and encouragement. Clients must learn
    and perform their own self-care activities. The
    supportive-educative nursing system is being used
    when a nurse guides a new mother to breastfeed
    her baby.

16
Interpretation of Orems theory through Mandala
art
  • Amy Devis, student

17
Interpretation of Orems theory through Mandala
art
  • Self care The flag design represents
    independence. People are independent when they do
    what they can to maintain life, health, and
    well-being.
  • Self-care deficit The handicap symbol, made into
    a compass, symbolizes dependency of the patient
    coupled with the guidance, direction, and support
    of the nurse.
  • Nursing systems Represented by the fish and hook
    because it reminds me of the saying "Give a man
    a fish, feed him for a day. Teach a man to fish,
    feed him for a lifetime." The nurse compensates
    for what the patient cannot do for himself while
    teaching how to care for himself.
  • Nursing Process All the symbols are encompassed
    in a larger symbol- an apothecary symbol. This
    symbol represents diagnosis and prescription,
    determining why nursing care is needed.

18
  • Dorthea Orem's Self-Care Model

19
Nursing systems
  • Nursing systems is conceptualized as the
    providers, resources, structures, methods and
    processes essential for the efficient and
    effective delivery of nursing care to aggregates
    of individuals.
  • The concentration is directed toward preparing
    nurse scientists with expertise in
  • (1) evaluating theoretical and empirical
    knowledge about inter-and intra-organizational
    phenomena relevant to the delivery of nursing
    care
  • (2) developing and validating new theoretical
    constructs and models that explain nursing
    phenomena from a systems perspective.

20
Neuman's systems model
  • is based on the individual's relationship to
    stress, the reaction to it, and reconstitution
    factors that are dynamic in nature.
  • is a unique, open systems-based perspective that
    provides a unifying focus for approaching a wide
    range of international health concerns.
  • Being universal in nature, it is open to creative
    interpretation and is widely used throughout the
    world as a multidisciplinary, wholistic, and
    comprehensive guide for excellence in nursing
    practice, education, research, and
    administration.

21
Betty Neuman
  • Betty Neuman is a community health nurse and
    clinical psychologist who has developed this
    theory.
  • Betty M. Neuman, R.N., B.S.N., M.S., Ph.D., PLC.,
    FAAN

22
Neuman's systems model
  • The Neuman Systems Model was originally developed
    in 1970 at the University of California
  • 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.

23
Neuman's systems model
  • The model's basic central core consists of
  • energy resources (normal temperature range,
    genetic structure, response pattern, organ
    strength or weakness, ego structure, and knowns
    or commonalities)
  • that are surrounded by
  • several lines of resistance,
  • the normal line of defense, and
  • the flexible line of defense.

24
Neuman's systems model
  • The lines of resistance represent the internal
    factors that help the patient defend against a
    stressor
  • The normal line of defense represents the
    person's state of equilibrium
  • The flexible line of defense depicts the dynamic
    nature that can rapidly alter over a short period
    of time.

25
Betty Neumans Theory interpreted through Mandala
Art
  • (Created by Amy, undergraduate nursing student
    Fall 2004)

26
Betty Neumans Theory interpreted through Mandala
Art (cont)
  • The large circle in the center is the focal point
    and includes the symbol for Maslow's hierarchy of
    needs Physiological, sociocultural,
    developmental, spiritual. The concentric circles
    around the center signify client (brown triangle
    with a circle on top), environment (blue clouds
    and yellow circle sunshine), health (red
    crosses), and nursing (pink hearts).

27
  • Students art

28
The Omaha System
  • The Omaha System is a research-based,
    comprehensive practice and documentation
    standardized classification
  • it can be used by multidisciplinary health care
    practitioners in any setting from the time of
    client admission to discharge.
  • http//www.omahasystem.org/

29
The Omaha System
  • Consists of three relational, reliable, and valid
    components designed to be used together
  • Problem Classification Scheme (client assessment)
  • Intervention Scheme (service delivery)
  • Problem Rating Scale for Outcomes (client
    change/evaluation)

30
The Omaha System
  • Is a research-based, comprehensive, standardized
    taxonomy. It is designed to enhance practice,
    documentation, and information management. It is
    intended for use with individuals, families, and
    communities who represent all ages, geographic
    locations, medical diagnoses, socio-economic
    ranges, spiritual beliefs, ethnicity, and
    cultural values.
  • Its terms are arranged from general to specific,
    and are intended to be easily understood by
    health care professionals and the general public.
    It provides a structure to document client needs
    and strengths, describe multidisciplinary
    practitioner interventions, and measure client
    outcomes in a simple and user-friendly, yet
    comprehensive, manner.

31
The Omaha System
  • It enables collection, aggregation, and analysis
    of clinical data. It supports quality
    improvement, critical thinking, and
    communication. It fosters research involving best
    practices/evidence-based practice. It links
    clinical data to demographic, financial,
    administrative, and staffing data. It is a middle
    range theory that supports other established
    health care theories. Examples include
    Donabedians structure, process, and outcome
    approach and the Neuman Systems Model.
  • It is a framework for integrating and sharing
    clinical data that has existed in the public
    domain since 1975.

32
The Omaha SystemProblem Classification Scheme
  • Four levels.
  • Four domains appear at the first level and
    represent priority areas of practitioner and
    client health-related concerns.
  • Forty-two terms (concepts), referred to as client
    problems or areas of client needs and strengths,
    appear at the second level.
  • The third level consists of two sets of problem
    modifiers health promotion, potential, and
    actual as well as individual, family, and
    community.
  • Clusters of signs and symptoms describe actual
    problems at the fourth level.
  • The Problem Classification Scheme provides a
    structure, terms, and system of cues and clues to
    help practitioners collect, sort, document,
    classify, analyze, retrieve, and communicate
    client needs and strengths.

33
The Omaha SystemProblem Classification Scheme
  • Environmental Domain Material resources and
    physical surroundings both inside and outside the
    living area, neighborhood, and broader community.
  • Income
  • Sanitation
  • Residence
  • Neighborhood/workplace safety

34
The Omaha SystemProblem Classification Scheme
  • Psychosocial Domain Patterns of behavior,
    emotion, communication, relationships, and
    development.
  • Communication with community resourcesSocial
    contactRole changeInterpersonal
    relationshipSpiritualityGriefMental
    healthSexualityCaretaking/parentingNeglectAbus
    eGrowth and development

35
The Omaha SystemProblem Classification Scheme
  • Physiological Domain Functions and processes
    that maintain life.
  • HearingVisionSpeech and languageOral
    healthCognitionPainConsciousnessSkinNeuro-mus
    culo-skeletal functionRespirationCirculationDig
    estion-hydrationBowel functionUrinary
    functionReproductive functionPregnancyPostpartu
    mCommunicable/infectious condition

36
The Omaha SystemProblem Classification Scheme
  • Health Related Behaviors Domain Patterns of
    activity that maintain or promote wellness,
    promote recovery, and decrease the risk of
    disease.
  • NutritionSleep and rest patternsPhysical
    activityPersonal careSubstance useFamily
    planningHealth care supervisionMedication
    regimen

37
The Omaha System Intervention Scheme
  • It consists of three levels of professional
    actions or activities.
  • Four broad categories of interventions appear at
    the first level.
  • An alphabetical list of 75 targets or objects of
    action and one other appear at the second
    level.
  • Client-specific information generated by
    practitioners is at the third level.
  • Because the Intervention Scheme is the basis for
    planning and intervening, it enables
    practitioners to describe and communicate their
    practice including improving or restoring health,
    decreasing deterioration, or preventing illness.

38
The Omaha System Intervention Scheme
  • Categories
  • Teaching, Guidance, and Counseling Activities
    designed to provide information and materials,
    encourage action and responsibility for self-care
    and coping, and assist the individual/family/commu
    nity to make decisions and solve problems.
  • Treatments and Procedures Technical activities
    such as wound care, specimen collection,
    resistive exercises, and medication prescriptions
    that are designed to prevent, decrease, or
    alleviate signs and symptoms of the
    individual/family/community.
  • Case Management Activities such as coordination,
    advocacy, and referral that facilitate service
    delivery, improve communication among health and
    human service providers, promote assertiveness,
    and guide the individual/family/community toward
    use of appropriate resources.
  • Surveillance Activities such as detection,
    measurement, critical analysis, and monitoring
    intended to identify the individual/family/communi
    tys status in relation to a given condition or
    phenomenon.

39
The Omaha System Intervention Scheme
  • Targets
  • anatomy/physiologyanger managementbehavior
    modification bladder care bonding/attachment
    bowel care cardiac care caretaking/parenting
    skills cast care communicationcommunity
    outreach worker servicescontinuity of care
    coping skills
  • day care/respitedietary management discipline
    dressing change/wound care durable medical
    equipment education employmentend-of-life care
    environment exercises family planning care
    feeding procedures finances gait
    traininggenetics growth/development care home
    homemaking/housekeeping infection precautions
    interaction

40
The Omaha System Problem Rating Scale for
Outcomes
  • The Scale consists of three five-point,
    Likert-type scales for measuring the entire range
    of severity for the concepts of knowledge,
    behavior, and status.  Each of the sub scales is
    a continuum providing an evaluation framework for
    examining problem-specific client ratings at
    regular or predictable times.  Suggested times
    include admission, specific interim points, and
    discharge.  The ratings are a guide for the
    practitioner as client care is planned and
    provided the ratings offer a method to monitor
    client progress throughout the period of
    service.  Using the Problem Rating Scale for
    Outcomes with the other two schemes of the Omaha
    System creates a comprehensive problem-solving
    model for practice, education, and research.

41
The Omaha System Problem Rating Scale for
Outcomes
  • http//www.omahasystem.org/shmrate.htm

42
Roy's Model Of Nursing
  • Sister Callista Roy developed the Adaptation
    Model in 1976.
  • Definition
  • Roy's model of nursing sees an individual as a
    set of interrelated systems, biological,
    psychological, and social. The individual tries
    to maintain a balance between each of these
    systems and the outside world. However, there is
    no absolute level of balance. According to Roy we
    all strive to live within a band where we can
    cope adequately. This band will be unique to an
    individual. The adaptation level is the range of
    adaptability within which the individual can deal
    effectively with new experiences.

43
Roy's Model Of Nursing
  • This model comprises the four domain concepts of
  • person,
  • health,
  • environment, and
  • nursing and involves a six step nursing process.

44
Roy's Model Of Nursing
  • Roy's models sees the person as "a
    biopsychosocial being in constant interaction
    with a changing environment" (Rambo, 1984). The
    person is an open, adaptive system who uses
    coping skills to deal with stressors.
  • Roy sees the environment as "all conditions,
    circumstances and influences that surround and
    affect the development and behaviour of the
    person" (Andrews Roy, 1991).
  • Roy describes stressors as stimuli and uses the
    term 'residual stimuli' to describe those
    stressors whose influence on the person is not
    clear

45
Roy's Model Of Nursing
  • Roy employs a six-step nursing process which
    includes
  • assessment of behaviour,
  • assessment of stimuli,
  • nursing diagnosis,
  • goal setting,
  • intervention and evaluation.

46
Roy's Model Of Nursing
  • In the first step, the person's behaviour in each
    of the four modes is observed. This behaviour is
    then compared with norms and is deemed either
    adaptive or ineffective.
  • The second step is concerned with factors that
    influence behaviour. Stimuli are classified as
  • focal,
  • contextual or
  • residual

47
Roy's Model Of Nursing
  • The nursing diagnosis is the statement of the
    ineffective behaviours along with the
    identification of the probable cause.
  • In the fourth step, goal setting is the focus.
  • Goals need to be realistic and attainable and are
    set in collaboration with the person (Andrews
    Roy, 1991).
  • Intervention occurs as the fifth step, and this
    is when the stimuli are manipulated. It is also
    called the 'doing phase' (Rambo).
  • In the final stage, evaluation takes place. The
    degree of change as evidenced by change in
    behaviour, is determined. Ineffective behaviours
    would be reassessed, and the interventions would
    be revised

48
Sister Callista Roy's Adaptation Model
  • Mandala Representing Roys Adaptation Model
  • By Noreen Frodella BSN, RN, BC, Graduate student
  • http//nursing.jbpub.com/sitzman/artGallery.cfm

49
Sister Callista Roy's Adaptation Model
  • This Mandala, representing Roys Adaptation
    Model, was created to show the grouping of
    related/connected units which form a unified
    whole (environment/nature) and the adaptations
    that human beings undertake while living within
    an unpredictable natural environment. The
    client/client system is the central or focal
    point and is represented by the sun, the four
    modes of adaptation are represented by the four
    lightening bolts (representative of
    activity/energy and interaction needed to adapt),
    the four major concepts are represented by the
    clouds, the stars represent the nursing process,
    and the crescent moons represent the ten
    supporting scientific and philosophical concepts.
  • This Mandala utilizes symbols from nature to
    conceptualize Roys theory that focuses on human
    beings as an adaptive system and as such must
    also adapt to the environment and the forces of
    nature. It reveals our continual interaction
    with environmental stimuli.

50
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