[NCM107L] Theories Related to Maternal and Child Nursing

One requirement of a profession

a discipline's knowledge flows from a base of established theory

Nursing theories

are designed to offer helpful ways to view patients so nursing activities can be created to best meet patient needs

Calista Roy's theory

stresses that an important role of the nurse is to help patients adapt to change caused by illness or other stressors

Dorothea Orem's theory

concentrates on examining patients' ability to perform self-care

Patricia Benner's theory

- describes the way nurses move from novice to expert as they become more experienced and prepared to give interprofessional care
- described 5 LEVELS of nursing experience and developed examplars and paradigm cases to illustrate each level

Use of theoretical basis

can help you nurses appreciate the significant effect of a child's illness or the introduction of a new member on the total family

Issues most nursing theorists address

include how nurses should be viewed or what the goals of nursing care should be

- teaching
- counseling
- supporting
- advocacy
- keeping parents and children well

components of health promotion

health promotion

its becoming a greater priority in care cause extensive changes in the scope of maternal and child health nursing to occur

Dorothea Orem

- born in 1914 in Baltimore, US
- earned her diploma at Providence Hospital Washington, DC
- 1939 - BSN Ed. Catholic University of America
- 1945 - MSN Ed. Catholic University of America
- worked as a staff nurse, private duty nurse, nurse educator and administrator and nurse consultant
- Honorary Doctor of Science degree in 1976
- Theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001

Self-care

- the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being
- "The ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider."

Composition of self-care

activities performed independently by an individual to promote and maintain person well-being

Self care agency

the individual's ability to perform self care activities

Self-care deficit

occurs when the person cannot carry out self-care

1. Wholly Compensatory Nursing System
2. Partial Compensatory Nursing System
3. Supportive-Educative System

three classification of nursing systems according to Dorothea Orem

Wholly Compensatory Nursing System

- a situation in which the individual is unable "to engage in those self-care actions requiring self-care directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity
- persons with these limitations are SOCIALLY DEPENDENT on OTHERS for their continued existence and well-being"

- care of newborn
- care of client recovering from surgery in a post-anesthesia care unit

example of Wholly Compensatory Nursing System

Partial Compensatory Nursing System

- a situation in which "BOTH nurse and client perform care measures or other actions involving manipulative tasks or ambulation
- either the patient or the nurse may have a major role in the performance of care measures"

- Nurse can assist postoperative client in ambulating
- Nurse can bring meal tray for a client who can feed himself

example of Partial Compensatory Nursing System

Supportive-Educative System

- the person "can perform or can and should learn to perform required measured of externally or internally oriented therapeutic self-care but cannot so so without assistance"

Supportive-development system

other name for Supportive-Educative System

Nurse guides a mother on how to breastfeed her baby

example of Supportive-Educative System

Patricia Benner

- received BSN from Pasadena College in 1964
- received MSN in 1970 from the University of California, Berkeley
- received PhD in 1982 from University of California, Berkeley
- Retired professor of University of California, San Francisco

From Novice to Expert: Excellence and Power in Nursing Practice

book that Patricia Benner authored

1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert

5 Levels of Nursing Experience

Sister Callista Roy

- Master's and PhD in Sociology in 1973 and 1977
- Worked as faculty of Mount St. Mary's College in 1966
- Organized course content according to a view of person and family as adaptive systems
- RAM as a basis of curriculum at Mount St. Mary's College
- 1970 - the model was implemented in mount St. Mary's school
- 1971 - she was made chair of the nursing department at the college

Dorothy E. Johnson

also a nursing theorist with whom Sister Callista Roy worked with

Roy Adaptation Model

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

- a focus on the person receiving nursing care
- adapting nursing goals to any change
- adapting to the health, environment, and facilitation of evolving care

essential elements of Roy Adaptation Model that are interrelated necessitating modes of adaptation to address these elements

Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which they adjust effectively to changes in the environment and, in turn, affect the environment"

Person according to Sister Callista Roy

Is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way

Health according to Sister Callista Roy

the conditions, circumstances and influences surrounding and affecting the development and behavior of persons or groups, with particular consideration of the mutuality of person and health resources that includes focal, contextual and residual stimuli

Environment according to Sister Callista Roy

The goal of ----- is the promotion of adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality of life, and dying with dignity

Nursing according to Sister Callista Roy

1. The Internal Processes
2. The Adaptive Modes
3. The Six-Step Nursing Process

3 Major Components of RAM

- Regular subsystem
- Cognator subsystem

2 Subsystems in The Internal Processes

Regular subsystem

physiological coping mechanism

Cognator susbsystem

our mental coping mechanism

1. Physiological-Physical Mode
2. Self-Concept Group Identity Mode
3. Role Function Mode
4. Interdependence Mode

4 Adaptive Modes

Physiological-Physical Mode

- the manifestation of the regulator, meant to achieve our five needs of physiological integrity including: oxygenation, nutrition, elimination, activity and rest, and protection
- these are the ACTUAL processes put in motion by the regulator subsystem

Self-Concept Group Identity Mode

- the goals of coping in this mode are a sense of unity, meaning and purposefulness in the universe, as well as a sense of identity integrity
- includes BODY IMAGE and SELF-IDEALS

Role Function Mode

- this mode focuses on the primary, secondary, and tertiary roles that person occupies in society, and knowing where he or she stands as member of society
- this might include knowing the function of being a female, a wife and/or nurse, and being able to behave with others as SUCH

Interdependence Mode

- this mode focuses on attaining relational integrity through the giving and receiving of love, respect and value
- achieved with EFFECTIVE COMMUNICATION and RELATIONS

Nurse's role in Adaptation Model

manipulate the stimuli (by removing, decreasing, increasing, altering the stimuli) so that the patient's response to his or her environment can be enhanced

1. Assess the behaviors manifested from the four adaptive modes
2. Assess the stimuli, categorizing them as focal, contextual, or residual
3. Make a statement or nursing diagnosis of the person's adaptive state (e.g. lack of motivation etc.)
4. Set a goal to promote adaptation
5. Implement interventions aimed at managing the stimuli
6. Evaluate whether the adaptive goal has been met

the Six-Step Nursing Process