NCMA110 MIDTERMS

MARTHA ROGERS

Author of Theory of Unitary Human Beings

Theory of Unitary Human Beings

views nursing as both a science and an art. The uniqueness of nursing, like any other science, is in the phenomenon central to its focus. The purpose of nurses is to promote health and well-being for all persons wherever they are.

provides a way to view the unitary human being, who is integral to the universe. Nursing focuses on people and the manifestations that emerge from the mutual human-environmental field process

Addresses the importance of the environment as an integral part of the patient and uses that knowledge to help nurses blend science and art of nursing to ensure patients have a smooth recovery and can get back to the best health possible.

Energy Field

Connects and identifies the human field and the environmental field

Factors, events that help humans interact, adjust, and connect to their environment

How the environmental field (environment) can affect the human field (patient)

Human field and environmental field are each identified by wave patterns whose changes are manifested in the whole.

Human field and environmental field are in a process of continuous mutual change. They are integral to each other and influence each other in ways that may be unquantifiable or imperceptible

Pattern

identifies energy fields

Distinguishing characteristic of energy field and perceived as a single wave

innate beliefs, knowledge, information, and characteristics.

Changes continuously and innovatively, and these changes give identity to the energy field.

Each human field pattern is unique and is integral with the environmental field.

Universe of Open Systems

The human field and environmental field interact continuously within a universe of open systems

Humans always and can freely interact with their environment.

Patterns and every flow from humans will continuously flow into the environmental field. The same goes for the environment, which also directly influences the people or patients.

Pandimensionality

An attribute of the unitary whole.

Non-linear domain without facial or temporal attribute

Humans live in the present. Humans describe life events as unrestrained and without strict chronological order.

Resonancy

“the continuous change from lower to higher frequency wave patterns in human and environmental fields.”

Helicy

“the continuous, innovative, unpredictable, increasing diversity in human and environmental field patterns.”

encompassed the concepts of rhythmically, negentropic evolutionary emergence, and the unitary nature of the human-environment relationship

Reciprocy

continuous mutual interaction between the human and environmental fields.

Synchrony

change in the human field and simultaneous state of environmental field at any given point in space-time. Continuous, mutual human field and environmental field process.

DOROTHEA OREM

Author of The Self-Care Deficit Nursing Theory

Wholly Compensatory Nursing

Nurse Actions:

• Accomplishes the patient’s therapeutic self-care.

• Compensates for the patient’s inability to engage in self-care.

• Support and protect patients

Partly Compensatory Nursing

Nurse Actions: 

• Performs some of the self-care measures for the patient.

• Compensates for the self-care limitations of the patient.

• Assists the patient as required.

• Regulates self-care agency.

Patient Actions:

• Perform some self-care measures

• Regulate self-care.

• Accept care and assistance from nurses

Supportive-Developmental/Educative Nursing

Patient Actions:

• Accomplishes self-care

• Regulates the exercise and development of self-care agency.

Nurse Action: 

• Assist in the regulation of the exercise and development of self-care agency

The Self-Care Deficit Nursing Theory

The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon.

Nursing has social features and interpersonal features that characterize the helping relations between those who need care and those who provide the required care.

provides a conceptualization of the distinct helping service that nursing provides

The Theory of Self-care

describes why and how people care for themselves.

Self-care is a human regulatory function that individuals must, with deliberation, perform themselves, must have performed for them, to maintain life, health, development, and well-being. Self-care is an action system.

If a person cannot perform self-care deliberately, it means that they have a self-care deficit.

The Theory of Dependent-care

explains how family members and/or friends provide dependent-care for a person who is socially dependent.

“How the self-care system is modified when it is directed towards a person who is socially dependent and needs assistance in making of their self-care deficit”.

For persons who are socially dependent and unable to meet their therapeutic self-care demand, assistance from other people is necessary.

If a person is socially dependent to another person in performing self-care, then there is a self-care deficit

The Theory of Self-care Deficit

describes and explains why people can be helped through nursing.

The requirements of a person for nursing are associated with the subjectivity of mature and maturing persons to health-related or health-care related action limitations. These limitations render them completely or partially unable to know existent and emerging requisites for regulatory care for themselves or their dependents.

Self-care deficit expresses the relationship between the action capabilities of individuals and their demands for care.

The Theory of Nursing Systems

describes and explains relationships that must be brought about and maintained for nursing to be produced

This proposes that nursing is a human action; nursing systems are actions formed by nurses through the exercise of their nursing agency for persons with health-derived or health-associated limitations in self-care or dependent-care.

Self-Care

Comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development, and well-being by meeting known requisites for functional and developmental regulation

The things a person do for their well-being and health without help from other people

Dependent-Care

Refers to the care that is provided to a person who, because of age or related factors, is unable to perform the self-care needed to maintain life, healthful functioning, continuing personal development, and well-being

Self-Care Requisites

A formulated and expressed insights about actions to be performed that are known or hypothesized to be necessary in the regulation of an aspect of human functioning and development, continuously or under specified conditions and circumstances.

Universal Self-Care Requisites

Universally required goals to be met through self-care or dependent-care.

The following eight self-care requisites common to men, women, and children are suggested:

1. Maintenance of a sufficient intake of air.

2. Maintenance of a sufficient intake of food.

3. Maintenance of a sufficient intake of water.

4. Provision of care associated with elimination processes and excrements.

5. Maintenance of balance between activity and rest.

6. Maintenance of balance between solitude and social interaction.

7. Prevention of hazards to human life, human functioning, and human well-being.

8. Promotion of human functioning and development.

Developmental Self-Care Requisites

Each developmental stage of a person requires different self-care requisites.

1. Provision of conditions that promote development.

2. Engagement in self-development.

3. Prevention of or overcoming effects of human conditions and life situations that can adversely affect human development

Health Deviation Self-Care Requisites

These self-care requisites exist for persons who are ill or injured, who have specific forms of pathological conditions or disorders, including defects and disabilities, and who are under medical diagnosis and treatment

Self-care requisites that vary depending on the sickness of a person

Therapeutic Self-Care Demand

Consists of the summation of care measures necessary at specific times or over a duration of time to meet all of an individual’s known self-care requisites, particularized for existent conditions and circumstances by methods appropriate for the following:

• Controlling or managing factors identified in the requisites, the values of which are regulatory of human functioning (sufficiency of air, water, and food).

• Fulfilling the activity element of the requisites (maintenance, promotion, prevention, and provision).

Dependent-Care Demand

The summation of care measures at a specific point in time or over a duration of time for meeting the dependent’s therapeutic self-care demand when his/her self-care agency is not adequate or operational.

Self-Care Agency

A complex acquired ability to mature and maturing persons to know and meet their continuing requirements for deliberate, purposive action to regulate their own human functioning and development.

A person should know what are the things they can do deliberately for their own human function and development and also what are the things they cannot do for themselves

Dependent-Care Agency

Refers to the acquired ability of a person to know and meet the therapeutic self-care demands of the dependent person and/or regulate the development and exercise of the dependent’s self-care agency

As the nurse or the person who provides self-care for another person, responsible for knowing what are the things that the patient needs that he/she cannot perform on his/her own and what are things that a patient/person can perform independently.

Self-Care Deficit

The relation between an individual’s therapeutic self-care demands and his or her powers of self-care agency in which the constituent-developed self-care capabilities within self-care agency are inoperable or inadequate for knowing and meeting some or all components of the existent or projected therapeutic self-care demand.

The things a person cannot do for themself.

Dependent-Care Deficit

a relationship that exists when the dependent care provider’s agency is not adequate to meet the therapeutic self-care demand of the person receiving dependent-care

A nurse or helper who cannot provide dependent-care to a person who has a self-care deficit.

Nursing Agency

to provide guides for achieving needed and foreseen results in the production of nursing toward the achievement of nursing goals; these units taken together constitute the pattern that guides the production of nursing

Nursing Systems

series and sequences of deliberate practical actions of nurses performed at times in coordination with the actions of their patients to know and meet components of patients’ therapeutic self-care demands and to protect and regulate the exercise or development of patients’ self-care agency

Helping Methods

from a nursing perspective it is a sequential series of actions that, if performed, will overcome or compensate for the health-associated limitations of individuals to engage in actions to regulate their own functioning and development or that of their dependents.

Basic Conditioning Factors

Condition or affect the value of the therapeutic self-care demand and/or  the self-care agency of an individual at particular times and under specific circumstances

IMOGENE KING

Author of Conceptual System and Theory of Goal Attainment

Conceptual System

“framework differs from other conceptual schema in that it is concerned not with fragmenting human beings and the environment but with human transactions in different kinds of environments”

“An awareness of the complex dynamics of human behavior in nursing situations prompted [King’s] formulation of a conceptual framework that represented personal, interpersonal, and social systems as the domain of nursing”

Every person has a different way of interacting with their environment. These differences in how a person interacts with different systems affect their beliefs and health-care and how they apply health to themselves

It is important for nurses to understand these differences to further help patients

Personal Systems (Individuals)

King specified the concepts of body image, growth and development, perception, self, space, and time in order to comprehend human beings as persons

The unique characteristics of individuals affect how they interact with other people and how they take care of themselves

Interpersonal Systems (Groups)

form when two or more individuals interact, forming dyads (two people) or triads (three people).

The dyad of a nurse and a patient is one type of interpersonal system. Families, when acting as small groups, also can be considered interpersonal systems. Understanding the interpersonal system requires the concepts of communication, interaction, role, stress, and transaction

Social Systems (Society)

A more comprehensive interacting system consists of groups that make up society. Religious, educational, and health care systems are examples of social systems. The influential behavior of an extended family on an individual’s growth and development is another social system example.

Theory of Goal Attainment

The idea of this theory is for nurses to help patients achieve their goal.

“The human process of interactions formed the basis for designing a model of transactions that depicted theoretical knowledge used by nurses to help individuals and groups attain goals.”

A process of human interactions that lead to transactions: A model of transaction

focuses on the interpersonal system and the interactions that take place between individuals, specifically in the nurse-patient relationship.

In the nursing process, each member of the dyad perceives the other, makes judgments, and takes actions. Together, these activities culminate in reaction. Interactions result and, if perceptual congruence exists and disturbances are conquered, transactions will occur. The system is open to permit feedback because each phase of the activity potentially influences perception

In order for the interpersonal system to be successful, a nurse and a patient should have a therapeutic relationship. If both have a mutual goal, then congruence will exist, transaction will occur hence the goal can be met.

MYRA LEVINE

Author of The Conservation Model Theory

The Conservation Model Theory

Conserving the integrity of a person as a whole

Wholeness/Health/Integrity (Holism)

The word “health” comes from the Anglo-Saxon word ha-l. The translation of ha-l is whole. Human life must be described in the language of “wholes”

“integrity” reflects this same concept of holism: “I use the word ‘integrity’ to encompass the wholeness of the individual and the sense of independence and selfhood that is implied in that term. Conserving the integrity of the individual is the hallmark of nursing intervention”

“Wholeness emphasizes a sound, organic, progressive mutuality between diversified functions and parts within an entirety, the boundaries of which are open and fluid”

Adaptation

critical for conserving wholeness in the midst of constant environmental change: “There must be a bridge that allows ready movement from one environmental reality to another. It is the bridge. It is the process by which individuals ‘fit’ the environments in which they live.”

The goal of adaptive change is the conservation of wholeness (health) and integrity.

Historicity

patterned responses passed on through genetics

Specificity

unique adaptive responses to specific environmental challenges

Redundancy

availability of multiple adaptive responses

“the possibility exists that aging itself is a consequence of failed redundancy of physiological and psychological processes”

Environment

Consist of the internal environment (physiological and pathophysiological processes) and the surrounding external environment.

Internal Environment

physiological (normal function of the body) and pathophysiological processes (abnormalities that the body experiences).

External Environment

anything outside of the body

Perceptual

aspects of the world that individuals intercept and interpret with their sense organs

Operational

environmental components that physically affect individuals, although they cannot directly perceive them, such as microorganisms

Conceptual

characterized by cultural patterns, spirituality, and aspects mediated through the symbols of language, thought, and history.

Organismic Response (Integrated or Holistic Response)

How the body responds to a stressor that can destroy our integrity

Response to fear (fight or flight)

these adrenocortical-sympathetic reactions are the most  primitive response, activated whenever the individuals perceive that they are threatened, whether or not threat actually exists.

Inflammatory-immune response

as the mechanism that protects the organism from environmental irritants and pathogens, it is a primary mechanism of healing; however, it drains energy reserves. Many nursing interventions focus on supporting the reparative components of the inflammatory-immune process while minimizing the coincident tissue damage.

Response to stress

predictable behavioral and biological responses to various nonspecific stressors of life. Selye referred to the “adaptive energy” expended over time to respond to stressors and noted that long-term stress can take a toll on the individual, sometimes leading to a state of exhaustion when adaptive energy is depleted. Irreversible stress-induced structural tissue changes can also occur

Sensory response

individuals experience the perpetual components of the external environment through biologic sensory stimuli. Individuals are continually immersed in an environmental background of sensory input that never ceases, even during sleep. Responsiveness to this incessant sensory input prompts individuals to maintain safety and seek wholeness. The use of our senses to maintain our integrity.

Nursing

actively support the patient’s adaptive efforts to achieve the best available environmental fit, thus conserving wholeness and integrity. Both the nurse and the patient have active roles in this conservation of wholeness

“Nursing intervention must be founded not only on scientific knowledge, but specifically on recognition of the individual’s behavioral responses which indicate the nature of the adaptation taking place”

The goal of nursing care is to support adaptation and the strong drive of the individual to seek wholeness. Because of the uniqueness of each individual, nursing care for each patient must be highly individualize

Levine specifically viewed the individual receiving nursing care as a patient, not as a client, to emphasize the nursing goal of returning the patient to a state of wholeness and health, restoring as much independence as possible. 

Conservation

is from the Latin word conservatio, which means “to keep together”. It is a natural law which “describes the way complex systems are able to continue to function even when severely challenged”. Through it, individuals are able to confront challenges, adapt accordingly, and maintain their uniqueness.

Conservation of Energy

the concept of energy balance, as stated in the first law of thermodynamics, which applies to everything in the universe, including people. “All of life’s processes are fundamentally dependent upon the production and expenditure of energy”

Conservation of Structural Integrity

involves maintaining the structure of the body to promote normal functioning.

Conservation of Personal Integrity

maintenance of one’s sense of personal worth and self-esteem

Conservation of Social Integrity

this acknowledges that a patient is a social being

BETTY NEUMAN

Author or Systems Model

Systems Model

a unique, open systems-based perspective that provides a unifying focus for approaching a wide range of concerns. A system acts as a boundary for a single client, a group, or even a number of groups; it can also be defined as a social issue. A client system in interaction with the environment delineates the domain of nursing concerns

a dynamic, open, systems approach to client care originally developed to provide a unifying focus for defining nursing problems and for understanding the client in interaction with the environment. The client as a system may be defined as a person, family, group, community, or social issue

protect the basic structure and to maintain stability of the basic structure

Wholistic Approach

Clients are viewed as wholes whose parts are in dynamic interaction. The model considers all variables simultaneously affecting the client system: physiological, psychological, sociocultural, developmental, and spiritual

Open System

when there is a continuous flow of input and processes, output, and feedback. Stress and reaction to stress are basic components of an open system

Input and Output

For the client as a system, these are the matter, energy, and information that are exchange between the client and the environment

Feedback

System output in the form of matter, energy, and information serves as feedback for future input for corrective action to change, enhance, or stabilize the system

Negentropy

a dynamic and desirable state of balance in which energy exchanges can take place without disruption of the character of the system, which points toward optimal health and integrity

Environment

Internal and external forces surrounding the client, influencing and being influenced by the client, at any point in time

Created Environment

Developed by the client to express system wholeness symbolically. Its purpose is to provide protection for client system functioning and to insulate the client from stressors

Customized environment depending on the need of the patient

Client System

a composite of five variables (physiological, psychological, sociocultural, developmental, and spiritual) in interaction with the environment

Basic Structure

The client as a system is composed of a central core surrounded by concentric rings

Lines of Resistance

These rings represent resource factors that help the client defend against a stressor. Lines of resistance serve as protection factors that are activated by stressors penetrating the normal line of defense

Normal Line of Defense

The model’s outer solid circle

It represents the adaptational level of health developed over the course of time and serves as the standard by which to measure wellness deviation determination

innate defense mechanism

Flexible Line of Defense

The model’s outer broken ring

It is perceived as serving as a protective buffer for preventing stressors from breaking through the usual wellness state as represented by the normal line of defense.

Health

A continuum of wellness to ilness that is dynamic in nature. Optimal wellness exists when the toal system needs are being completely met

Wellness

Exists when all system subparts interact in harmony with the whole system and all system needs are being met

Illness

exists at the opposite end of the continuum from wellness and represents a state of instability and energy depletion

Stressors

are tension-producing stimuli that have the potential to disrupt system stability, leading to an outcome that may be positive or negative

Intrapersonal Forces

occurs within the individual

Interpersonal Forces

occurs outside the client system though at a proximal range

Extrapersonal Forces

occurs outside the client system at a distal range

Degree of Reaction

represents system instability that occurs when stressors invade the normal line of defense

Prevention As Intervention

Interventions are purposeful actions to help the client retain, attain, or maintain system stability. They can occur before or after protective lines of defense and resistance are penetrated

Interventions are based on possible or actual degree of reaction, resources, goals, and anticipated outcomes

Primary Prevention

is used when a stressor is suspected or identified. A reaction has not yet occurred, The purpose is to reduce the possibility of encounter with the stressor or to decrease the possibility of a reaction

Secondary Prevention

involves interventions or treatment initiated after symptoms from stress have occurred.

Tertiary Prevention

occurs after the active treatment or secondary prevention stage. It focuses on readjustment toward optimal client system stability. The goal is to maintain optimal wellness by preventing recurrence of reaction or regression.

 Reconstitution

occurs after treatment for stressor reactions. It represents return of the system to stability, which may be at a higher or lower level of wellness than before stressor invasion

SISTER CALLISTA ROY

Author of Adaptation Model

Adaptation Model

Roy explained that adaptation occurs when people respond positively to environmental changes, and it is the process and outcome of individuals and groups who use conscious awareness, self-reflection, and choice to create human and environmental integration

for a person to easily adjust and adapt to this situation and to the ever changing environment

System

“a set of parts connected to function as a whole for some purpose and that does so by virtue of the interdependence of its parts”

Adaptation Level

“A constantly changing point, made up of focal, contextual, and residual stimuli, which represent the person’s own standard of the range of stimuli to which one can respond with ordinary adaptive responses”

Adaptation Problems

“broad areas of concern related to adaptation. These describe the difficulties related to the indicators of positive adaptation”

Focal Stimulus

“the internal or external stimulus most immediately confronting the human system”

Contextual Stimuli

“Are all other stimuli present in the situation that contribute to the effect of the focal stimulus”

Residual Stimuli

“Are environmental factors within or without the human system with effects in the current situation that are unclear”