Nursing theory Models/theories Their Usefulness in Community-based Health Care

  Nursing theory Models/theories Their Usefulness in Community-based Health Care  Models: are representations of interactions among and between concepts revealing patterns, while concepts are words used to describe objects, properties or phenomenon. They are also building blocks in the formation of theories and models  It allows concepts in nursing theories to be successfully applied to nursing practice. Nursing theory Models/theories Their Usefulness in Community-based Health Care

They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice e.g. through specific methods of assessment.

Propositions: are statements that explain the relationship among events, situations or actions.

Assumptions: describe concepts, or connect two concepts and represent values or goals. When assumptions are challenged they become proposition.

A phenomenon– described by a concept can be either empirical, inferential or abstract.

An Empirical Concept– is one that can be observed or experienced through the senses.

An Abstract Concept– is one that is not observable such as hope of caring.

An Inferential concept- interprets issues.

Conceptual Models for Nursing Practice

The primary purpose of nursing theories/models is to improve nursing practice. That is, to improve the health and quality of life of the individual, families, communities and the population at large.

It strengthens the focus of care and provides consistency to the interactions and activities related to nursing care.

The development of nursing theories and theory-guided practice models, advance the discipline and professional practice of nursing. There are a lot of theories and models that help the nurse in his/her practice. Nursing theory Models/theories Their Usefulness in Community-based Health Care

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What is a theory?

A theory is a notion or an idea that explains experience, interprets observation, describes relationships, and projects outcomes.

Theories are mental patterns or frameworks created to help understand and create meaning from our experiences, organize and articulate our knowing, and ask questions leading to new insights. As such, theories are not discovered in nature but are human inventions.

Nursing theory is an inductively and/or deductively derived collection of coherent, creative, and focused nursing phenomena that frame, give meaning to, and help explain specific and selective aspects of nursing research and practice. Nursing theory is a conceptualization of some aspect of reality (invented or discovered) that pertains to nursing. Conceptualization is articulated for the purpose of describing, explaining, predicting, or prescribing nursing care (Meleis, Sawyer, Im, Messias, & Schumacher, 2000).

The Purpose of Theory in a Professional Discipline

All professional disciplines have a body of knowledge consisting of theories, research, and methods of inquiry and practice. They organize knowledge, guide inquiry to advance science, guide practice and enhance the care of patients. Nursing theories address the phenomena of interest to nursing, human beings, health, and caring in the context of the nurse–person relationship. Nursing theory Models/theories Their Usefulness in Community-based Health Care

The Importance of Nursing Theories

Nursing theories provide concepts and designs that define the place of nursing in health care. Through theories, nurses are offered positions for connecting with professionals from other disciplines, who join with nurses to provide human services. Nursing theories provide structure and substance to ground the practice and knowledge of nursing.  They flexible and dynamic to keep pace with the growth and changes in the discipline and practice of nursing in today’s technological advanced world.

Characteristics of Nursing Theories

• They interconnect ideas and/or concepts that create different ways of looking at a particular phenomenon.
• They are logical in nature.
• They are generalizable.
• They are the basis for hypothesis that can be tested.
• They increase the general body of knowledge within the discipline through research implementation and validation.
• They are used by practitioners to guide and improve their practice.
• They are consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated.

Classification of Nursing Theories

Grand theory: provides a conceptual framework under which the key concepts and principles of the discipline can be identified.

Middle-range theories– are narrower in scope than grand theories and offer an effective bridge between grand theories and the description and explanation of specific nursing phenomena.

Practice-level theories– have the most limited scope and level of abstraction and are developed for use within a specific range of nursing situations.

Nursing practice theories- provide frameworks for nursing interventions/ activities and suggest outcomes and/or the effect of nursing practice.

Theories are also categorized as follows

• Needs theories
• Interaction theories
• Outcome theories
• Humanistic theories

Needs Theories.

These theories are based on helping individuals to fulfil their physical and mental health needs. However, Needs theories have been criticized for relying too much on the medical model of healthcare. They place the patient in an overtly dependent position, for example, the patient’s social and cultural needs are not taken into consideration.

Interaction Theories –These theories revolve around the relationships nurses form with patients.Such theories have been criticized for largely ignoring the medical model of healthcare and attending to basic physical needs.

Outcome Theories

These portray the nurse as a change agent who enables individuals to adapt to, or cope with ill health. (Roy 1980).Outcome theories have been criticized as being too abstract and difficult to implement in practice.

Humanistic Theories

Humanistic theories are developed in response to the psychoanalytic thought that a person’s destiny is determined early in life. They emphasize a person’s capacity for self-actualization. Humanists believe that the person has within himself the potential for healthy and creative growth. Carl Rogers developed a person-centred model of psychotherapy that emphasizes the uniqueness of the individual. The major contribution Rogers added to nursing practice is the understanding that, each client is a unique individual, hence, person-centred approach is now being practiced in nursing.

Theories applied in Community Health Nursing

Introduction

• The concept of community is defined as “a group of people who share some important feature of their lives and use some common agencies and institutions.”
• The concept of health is defined as “a balanced state of well-being resulting from harmonious interactions of body, mind, and spirit.”
• The term community health is defined by meeting the needs of a community by identifying problems and managing interactions within the community

Basic Elements

• The six basic elements of nursing practice incorporated in community health programs and services are:

(1) Promotion of healthful living

(2) Prevention of health problems

(3) Treatment of disorders

(4) Rehabilitation

(5) Evaluation and

(6) Research.

Major Roles of the Nurse in the Community

The focus of nursing includes not only the individual, but also the family and the community, meeting their multiple needs requires multiple roles. ( Nursing theory Models/theories Their Usefulness in Community-based Health Care)

 

There are seven (7) major roles of a community health nurse these are:

(1) Care provider

(2) Educator

(3) Advocate

(4) Manager

(5) Collaborator

(6) Leader, and

(7) Researcher

Major Settings

Settings for community health nursing can be grouped into six categories:

(1) Homes

(2) Ambulatory care settings

(3) Schools

(4) Occupational health settings

(5) Residential institutions, and

(6) The community at large.

Community health nursing practice is not limited to a specific area, but can be practiced anywhere.

Community-Based Health Care

Community-based care is a coordinated and integrated care. It is provided in a range of community settings. Delivered in a way that is, person and population-centred. It is responsive to economic, social, language, cultural, and gender differences.

 

Community Health

Community health is meeting the needs of a community.  By identifying problems and managing health and related issues within the community. It is a participatory decision-making process which empowers communities for good health. It emphasis active participation from the community in identifying key health issues and strategies to solve them.  Nursing theory Models/theories Their Usefulness in Community-based Health Care

 

Theories/Models use for Community-based Care

1. Nightingale’s theory of environment
2. Orem’s Self-care model
3. Neuman’s health care system model
4. Roger’s model of the science and unitary man
5. Pender’s health promotion model
6. Roy’s adaptation model
7. Milio’s Framework of prevention
8. Salmon White’s Construct for Public health nursing
9. Block and Josten’s Ethical Theory of population focused nursing

(A) Nightingale’s theory of environment

Introduction

Florence Nightingale was born – 12 May 1820, and died 13 August 1910, she is the founder of modern nursing and the first Nursing Theorist. She was the first to propose that nursing required specific education and training, and her contribution during Crimean war is well-known.

The foundation of Nightingale’s theory is the environment- all the external conditions and forces that influence the life and development of an organism.  According to her, external influences and conditions can prevent, suppress, or contribute to disease or death.  Her goal was to help the patient retain his own vitality by meeting his basic needs through control of the environment. Nursing theory Models/theories Their Usefulness in Community-based Health Care

Types of Environment

There are three types of environments; Physical, Psychological and Social Physical Environment:

Physical Environment consists of -physical elements where the patient is being treated. Cleanliness of the environment relates directly to disease prevention and patient mortality. Some aspects of the physical environment influence the social and psychological environments of the person.

Psychological Environment:  Psychological environment can be affected by a negative physical environment which then causes STRESS. It requires various activities to keep the mind active. Which involves communication with the person, about the person, and about other people.

Social environment: includes components of the physical environment – clean air, clean water, proper drainage. It also consists of a person’s home or hospital room, as well as the total community

Healthy conditions ofhomes, the importance of the healthy housingis closely related to the presence of pure air, pure water, efficient drainage, cleanliness and light. Cleanliness of the outside the house affects the inside.

Ventilation and warming- Nurses are“to keep the air the client breathes as pure as the external air, without chilling”. Nightingale was very concerned about “noxious air” or “effluvia” or foul odours that came from excrement.She stressed the importance of room temperature. The patient should not be too warm or too cold.

Light –– She believed that direct sunlight is what patients require and need. She noted that light has “quite and tangible effects upon the human body”.

Noise – She stated that patient should never be waked intentionally or accidentally during the first part of sleep. She asserted that whispered or long conversations about patients are thoughtless and cruel. Nurses’ responsibility is to assess and stop all kinds of noise.

Variety– She believed that varieties in the environment are critical aspectsthat affect the patients’ recovery. She discussed the need for changes in colour and form, for instance, bringing the patient brightly coloured flowers or plants these inspire patients to recovery.

Bed and bedding– She stated that dirty carpets and walls contain large quantities of organic matter that provide ready source of infection, just as dirty sheets on beds do.

Personal cleanliness-The need for cleanliness is extended to the patient, the nurse and the environment. Nightingale viewed the functions of the skin very important, believing that many disease “disorders” or causesaffect in the skin.

Nutrition and taking food– Nightingale addressed the variety of food presented to the patients and discussed the importance of variety in the food presented.

Chattering hopes and advices • False hope was depressing to patients, she felt they cause them to worry and become fatigued. • She believed that sick persons should hear good news that would assist them in becoming healthier.

Social considerations– Nightingale supported the importance of looking beyond the persons to the social environments in which he or she lives. She observed that generations of families lived and died in poverty.  (Nursing theory Models/theories Their Usefulness in Community-based Health Care)

 

 

Four major concepts of Nightingale’s theory

Nursing— is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act. Nursing is the “activities that promote health which occur in any care giving situation.

 Person– Nightingale referred to person as a patient, he/she is affected by the environment. A person is multidimensional, composed of biological, psychological, social and spiritual components.  He/she has a vital reparative power to deal with disease, recovery is within the person’s power as long as a safe environment for recuperation exists.

Health/Disease- Health is “not only to be well, but maintaining well-being by using a person’s power to the fullest extent”.  Health is maintained by controlling the environmental factors to prevent disease. Disease is considered as dys-ease or the absence of comfort.  Health and disease are the focus of the nurse, who helps a person through the healing process.

Environment– “Poor or difficult environments lead to poor health and disease”.  “Environment could be altered to improve conditions so that the natural laws would allow healing to occur.”

Relevance of Environmental theory in nursing practice, education and research

1. Disease control

2.Sanitation and water treatment

3. Utilized by modern architecture in the prevention of “sick building syndrome” applying the principles of ventilation and good lighting.
4. Waste disposal
5. Control of room temperature
6. Noise management.

Relevance of theory in nursing practice, education and researchEducation

1. Principles of nursing training. Better practice result from better education.
2. Skills measurement through licensing by the use of testing methods and case studies.

 Research

1. Use of graphical representations like the bar, pie diagrams.
2. Notes on nursing.

Application of nightingale’s theory in nursing process

Assessment– The following information should be adequate.

• Adequacy of ventilation
• Cleanliness of environment
• Presence of draughts
• Sudden noises
• Amount of sunlight and artificial light

Application of nightingale’s theory in nursing process

• Variety of dietary offerings
• Odours present in and throughout the ward
• Methods of disposal of human waste and sputum
• Opportunity to communicate with others
• Insufficient warmth
• Company from family and other patient
• Insufficient knowledge regarding disease.

What are the basic concepts and relationships presented by the theory? Nightingale presented her ideas not as a theory but as strategies to help women care for their ill ones in the home and in hostels.  Relationship of concepts are not clearly articulated. However she presented her ideas in a clear manner.  Using the basic concepts, she presented, new insights into phenomena of interest to which nursing can be identified.

What major phenomena of concern to nursing are presented?  The manipulation of the environment by the nurse to put the patients in the best place.  Nightingale did not address interpersonal relations specifically but did talk about the need for the nurse to consider what she says when talking around the patient.  Cleanliness is also of major importance.

To whom does this theory apply?In what situations? In what way? Nightingale’s writing are simple. Nightingale’s theory applies in all situations in which nursing care is provided. Concepts related to pure air, light, noise and cleanliness can be applied across specific environments.  Reading her work raises a consciousness in the nurse about how the environment influences clients’ outcomes. It has directed interventions toward modulating the environment. Her works are in line with ecological, systems, adaptation and interpersonal theories.  Her focus on the environment has relevance to practitioners in today’s global health care climate.

By what method or methods can this theory be tested? While direct testing of Nightingale’s theory has not been done, she has stimulated the development of nursing science with her work. For example: she did not believe in germ theory; however the practices she recommended were not inconsistent with scientific knowledge we have today. Both quantitative and qualitative methods of research could be used to test relationships in the environmental model.

(B) Dorothea Orems Theory of Self-care

Dorothea Orem was born 1914 in Baltimore, US and died in 2007

• Earned her diploma in nursing at Providence Hospital – Washington, DC
• In 1939 she had her BSN Ed. in Catholic University of America
• In 1945 she had her MSN Ed. in Catholic University of America
• She worked as a staff nurse, private duty nurse, nurse educator and administrator as well as a nurse consultant.
• She received honorary Doctor of Science degree in 1976.
• Her theory was first published in Nursing: Concepts of Practice in 1971, second in 1980, in 1995, and 2001.

Her theory believes that;  people should be self-reliant and responsible for their own care and others in their families that need care. People are distinct individuals, and nursing is a form of action and interaction between two or more persons.Successfully meeting universal and development selfcare requisites is an important component of primary care prevention and ill health,  A person’s knowledge of potential health problems is necessary for promoting self-care behaviours.Self care and dependent care are behaviours learned within a socio-cultural context. Her theory defined the four concepts as;

Nursing – is art, a helping service, and a technology. Actions deliberately selected and performed by nurses to help individuals or groups under their care to maintain or change conditions in themselves or their environments. It encompasses the patient’s perspective of health condition ,the physician’s perspective , and the nursing perspective.

Goal of nursing – is to render to the patient or members of his family the capability of meeting the patient’s self care needs. To maintain a state of health and also to regain normal or near normal state of health in the event of disease or injury. To stabilize, control, or minimize the effects of chronic poor health or disability.

Health – health and healthy are terms used to describe living things, it is when they are structurally and functionally whole or sound. Wholeness or integrity includes that which makes a person human, operating in conjunction with physiological and psychophysiological mechanisms and a material structure, in relation to and interaction with other human beings.

Environment: environmental components are environemental factors, environmental elements, conditions, and developed environments.

Human being – has the capacity to reflect, symbolize and use symbols,  the human being is conceptualized as a total being with universal, developmental needs and capable of continuous self care, and as a unit that can function biologically, symbolically and socially.