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Nursing Theorists

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* Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. * Theories are composed of concepts, definitions, models, propositions & are based on assumptions. * They are derived through two principal methods; deductive reasoning and inductive reasoning. Objectives * to assess the patient condition by the various methods explained by the nursing theory * to identify the needs of the patient to demonstrate an effective communication and interaction with the patient.

* to select a theory for the application according to the need of the patient * to apply the theory to solve the identified problems of the patient

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* to evaluate the extent to which the process was fruitful. Definition * Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing. “A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing. ” | | | The goal of nursing is “to put the patient in the best condition for nature to act upon him”. – Nightingale | Introduction * Born – 12 May 1820

* Founder of mordern nursing. The first nursing theorist. * Also known as “The Lady with the Lamp” * She explained her environmental theory in her famous book Notes on Nursing: What it is, What it is not . * She was the first to propose nursing required specific education and training. * Her contribution during Crimean war is well-known. * She was a statistician, using bar and pie charts, highlighting key points. * International Nurses Day, May 12 is observed in respect to her contribution to Nursing. Died – 13 August 1910 Assumpations of Nightingale’s Theory * Natural laws * Mankind can achieve perfection * Nursing is a calling * Nursing is an art and a science * Nursing is achieved through environmental alteration * Nursing requires a specific educational base * Nursing is distinct and separate from medicineNightingale’s Canons: Major Concepts 1. Ventilation and warming 2. Light, Noise 3. Cleanliness of rooms/walls 4. Health of houses 5. Bed and bedding 6. Personal cleanliness 7. Variety 8. Chattering hopes and advices 9.

Taking food. What food? 10. Petty management/observationNursing Paradigms * Nightingale’s documents contain her philosophical assumptions and beliefs regarding all elements found in the metaparadigm of nursing. These can be formed into a conceptual model that has great utility in the practice setting and offers a framework for research conceptualization. (Selanders LC, 2010)Nursing * 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 (as outlined in canons) which occur in any caregiving situation. They can be done by anyone. ” Person * People are multidimensional, composed of biological, psychological, social and spiritual components. Health * Health is “not only to be well, but to be able to use well every power we have”.

* Disease is considered as dys-ease or the absence of comfort. Environment * “Poor or difficult environments led to poor health and disease”. * “Environment could be altered to improve conditions so that the natural laws would allow healing to occur. Nightingale’s Theory and Nursing PracticeApplication of Nightingale’s theory in practice: * “Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to reduce noise, to relieve patients’ anxieties, and to help them sleep. ” * As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care. Criticisms * She emphasized subservience to doctors. * She focused more on physical factors than on psychological needs of patient.

Applications of Nightingale’s Theory * Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations * Incorporating Florence Nightingale’s theory of nursing into teaching a group of preadolescent children about negative peer pressure. Conclusion * Florence Nightingale provided a professional model for nursing organization. * She was the first to use a theoretical founation to nursing. * Her thoghts have influenced nursing significantly. References 1. Nightingale, F. Notes on nursing: What it is and what it is not. 1860. . Works by Florence Nightingale at Project Gutenberg 3. Selanders LC. The power of environmental adaptation: Florence Nightingale’s original theory for nursing practice. .J Holist Nurs. 2010 Mar; 28(1):81-8. | Florence Nightingale is the most recognized name in the field of nursing. Her work was instrumental for developing modern nursing practice, and from her first shift, she worked to ensure patients in her care had what they needed to get healthy. Her Environmental Theory changed the face of nursing to create sanitary conditions for patients to get care.

Biography of Florence Nightingale Florence Nightingale was born in 1820 in Italy to a wealthy British family. She was raised in the Anglican faith, and believed the God called her to be a nurse. This call came to her in February 1837 while at Embley Park. She announced her intention to become a nurse in 1844. Her mother and sister were angry at her decision, but Nightingale stood strong. She worked hard to learn about nursing, despite society’s expectation that she become a wife and mother. In fact, she rejected a suitor because she thought it would interfere with her nursing career.

In 1853, she accepted the position of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London. She held this position until October 1854. The income given to her by her father during this time allowed her to pursue her career and still live comfortably. Though Nightingale had several important friendships with women, including a correspondence with an Irish nun named Sister Mary Clare Moore, she had little respect for women in general, and preferred friendships with powerful men.

She died in 1910. Florence Nightingale’s Contribution to Nursing Theory: Environmental Theory Florence Nightingale is attributed with establishing the modern practice of nursing. She also contributed to the field with nursing theories still used today. One of her nursing theories is the Environmental Theory, which incorporates the patients’ surrounding environment in his or her nursing care plan. In this theory, the role of the nurse is to use the patient’s environment to help him or her recover and get back to the usual environment.

The reason the patient’s environment is important is because it can affect his or her health in a positive or negative way. Some environmental factors affecting health according to Nightingale’s theory are fresh air, pure water, sufficient food and appropriate nutrition, efficient drainage, cleanliness, and light or direct sunlight. If any of these factors is lacking, it can delay the patient’s recovery. Nightingale also emphasized providing a quiet, warm environment for patients to recover in.

The theory also calls for nurses to assess a patient’s dietary needs, document food intake times, and evaluate how the patient’s diet affects his or her health and recovery. Determining a patient’s environment for recovery based on his or her condition or disease is still practiced today, such as in patients suffering from tetanus, who need minimal noise to keep them calm and prevent seizures. Virginia Henderson’s Need Theory “Nursing theories mirror different realities, throughout their development; they reflected the interests of nurses of that time. Introduction * “The Nightingale of Modern Nursing” * “Modern-Day Mother of Nursing. ” * “The 20th century Florence Nightingale. “

* Born in Kansas City, Missouri, in 1897. * Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D. C. in 1921. * Worked at the Henry Street Visiting Nurse Service for 2 years after graduation. * In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia * In 1929, entered Teachers College at Columbia University for Bachelor’s Degree in 1932, Master’s Degree in 1934. Joined Columbia as a member of the faculty, remained until 1948. * Since 1953, a research associate at Yale University School of Nursing. * Recipient of numerous recognitions. * Honorary doctoral degrees from the Catholic University of America, Pace University, University of Rochester, University of Western Ontario, Yale University * In 1985, honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. * Died: March 19, 1996.

Theory Background * She called her definition of nursing her “concept” (Henderson1991) * She emphasized the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed (Henderson,1991) * “assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery” (Henderson, 1966). * She categorized nursing activities into 14 components, based on human needs. She described the nurse’s role as substitutive (doing for the person), supplementary (helping the person), complementary (working with the person), with the goal of helping the person become as independent as possible. * Her definition of nursing was: “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible” (Henderson, 1966).

The 14 components * Breathe normally. Eat and drink adequately. * Eliminate body wastes. * Move and maintain desirable postures. * Sleep and rest. * Select suitable clothes-dress and undress. * Maintain body temperature within normal range by adjusting clothing and modifying environment * Keep the body clean and well groomed and protect the integument * Avoid dangers in the environment and avoid injuring others. * Communicate with others in expressing emotions, needs, fears, or opinions. * Worship according to one’s faith. * Work in such a way that there is a sense of accomplishment. Play or participate in various forms of recreation. * Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. The first 9 components are physiological. The tenth and fourteenth are psychological aspects of communicating and learning The eleventh component is spiritual and moral The twelfth and thirteenth components are sociologically oriented to occupation and recreation Assumption The major assumptions of the theory are: * “Nurses care for patients until patient can care for themselves once again.

Patients desire to return to health, but this assumption is not explicitly stated. * Nurses are willing to serve and that “nurses will devote themselves to the patient day and night” A final assumption is that nurses should be educated at the university level in both arts and sciences. Henderson’s theory and the four major concepts 1. Individual * Have basic needs that are component of health. * Requiring assistance to achieve health and independence or a peaceful death. * Mind and body are inseparable and interrelated. * Considers the biological, psychological, sociological, and spiritual components. The theory presents the patient as a sum of parts with biopsychosocial needs. 2. Environment

* Settings in which an individual learns unique pattern for living. * All external conditions and influences that affect life and development. * Individuals in relation to families * Minimally discusses the impact of the community on the individual and family. * Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided 3. Health * Definition based on individual’s ability to function independently as outlined in the 14 components. Nurses need to stress promotion of health and prevention and cure of disease. * Good health is a challenge -affected by age, cultural background, physical, and intellectual capacities, and emotional balance Is the individual’s ability to meet these needs independently. 4. Nursing * Temporarily assisting an individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14 basic needs.

* Assists and supports the individual in life activities and the attainment of independence. * Nurse serves to make patient “complete” “whole”, or “independent. * The nurse is expected to carry out physician’s therapeutic plan Individualized care is the result of the nurse’s creativity in planning for care. * “Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver. ” * In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and supplement his strength will or knowledge according to his needs. ” Henderson’s and Nursing Process ”Summarization of the stages of the nursing process as applied to Henderson’s definition of nursing and to the 14 components of basic nursing care.

Nursing Process| Henderson’s 14 components and definition of nursing| Nursing Assessment| Henderson’s 14 components| Nursing Diagnosis| Analysis: Compare data to knowledge base of health and disease. | Nursing plan| Identify individual’s ability to meet own needs with or without assistance, taking into consideration strength, will or knowledge. | Nursing implementation| Document how the nurse can assist the individual, sick or well. | Nursing implementation| Assist the sick or well individual in to performance of activities in meeting human needs to maintain health, recover from illness, or to aid in peaceful death. Nursing process| Implementation based on the physiological principles, age, cultural background, emotional balance, and physical and intellectual capacities. Carry out treatment prescribed by the physician. | Nursing evaluation| Henderson’s 14 components and definition of nursingUse the acceptable definition of ;nursing and appropriate laws related to the practice of nursing. The quality of care is drastically affected by the preparation and native ability of the nursing personnel rather that the amount of hours of care.

Successful outcomes of nursing care are based on the speed with which or degree to which the patient performs independently the activities of daily living| Characteristic of Henderson’s theory * There is interrelation of concepts. * Concepts of fundamental human needs, biophysiology, culture, and interaction, communication are borrowed from other discipline. Eg.. Maslow’s theory. * Her definition and components are logical and the 14 components are a guide for the individual and nurse in reaching the chosen goal. * Relatively simple yet generalizable. * Applicable to the health of individuals of all ages. can be the bases for hypotheses that can be tested. * assist in increasing the general body of knowledge within the discipline. * Her ideas of nursing practice are well accepted. * can be utilized by practitioners to guide and improve their practice. Limitations

* Lack of conceptual linkage between physiological and other human characteristics. * No concept of the holistic nature of human being. * If the assumption is made that the 14 components prioritized, the relationship among the components is unclear. * Lacks inter-relate of factors and the influence of nursing care. Assisting the individual in the dying process she contends that the nurse helps, but there is little explanation of what the nurse does. * “Peaceful death” is curious and significant nursing role. Conclusion * Henderson provides the essence of what she believes is a definition of nursing. * Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs. * Her definition of nursing and the 14 components of basic nursing care are uncomplicated and self-explanatory.

References 1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N 2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. 3. Wills M. Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. 4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. 5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. 6.

Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. 7. Vandemark L. M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225 9. Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002 10. Metaparadigm in Nursing 11. · Leave a Comment 12. The different metaparadigm in nursing: 13.

Nursing Paradigms are patterns or models used to show a clear relationship among the existing theoretical works in nursing. At present, many nursing theories are focused on relationships among four major concepts (metaparadigms: Greek “meta“-with and “paradeigma“-pattern): 14. 15. The 4 Metaparadigm in Nursing 16. 1. Person – The recipient of nursing care like individuals, families and communities. 17. 2. Environment – The external and internal aspects of life that influence the person. 18. 3. Health – The holistic level of wellness that the person experiences. 19. 4.

Nursing – The interventions of the nurse rendering care in support of, or in cooperation with the client. 20. These concepts are collectively referred to as metaparadigm for nursing. These four major concepts establish a better direction and understanding of nursing profession. The Nursing Metaparadigm embodies the knowledge base, theory, philosophy, research, practice, and educational experience and literature identified with the profession. These given concepts vary in accordance to the experiences and views of different nursing theorists. 21. Theory of Interpersonal Relations| This page was last updated on January 31, 2012| Introduction * Theorist -Hildegard. E. Peplau * Born in Reading, Pennsylvania [1909], USA * Diploma program in Pottstown, Pennsylvania in 1931. * BA in interpersonal psychology – Bennington College in 1943.

* MA in psychiatric nursing from Colombia University New York in 1947. * EdD in curriculum development in 1953. * Professor emeritus from Rutgers university * Started first post baccalaureate program in nursing * Published Interpersonal Relations in Nursing in 1952 * 1968 :interpersonal techniques-the crux of psychiatric nursing * Worked as executive director and president of ANA. Worked with W. H. O, NIMH and Nurse Corps. * Died in 1999. * Theory of interpersonal relations is a middle range descriptive classification theory. * The theory was influenced by Harry Stack Sullivan’s theory of inter personal relations (1953). * The theorist was also influenced by Percival Symonds, Abraham Maslow’s and Neal Elger Miller. * Peplau’s theory is also refered as psychodynamic nursing, which is the understanding of ones own behavior. Major Concepts * The theory explains the purpose of nursing is to help others identify their felt difficulties. Nurses should apply principles of human relations to the problems that arise at all levels of experience.

* Peplau’s theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. * Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. * Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. * The attainment of goal is achieved through the use of a series of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the process. Definitions * Person: A developing organism that tries to reduce anxiety caused by needs. * Environment: Existing forces outside the organism and in the context of culture * Health: A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living. * Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities.

Roles of nurse * Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. * Teacher: who imparts knowledge in reference to a need or interest * Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation * Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes * Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way Phases of interpersonal relationshipIdentified four sequential phases in the interpersonal relationship:1. Orientation 2. Identification 3. Exploitation 4.

ResolutionOrientation phase * Problem defining phase * Starts when client meets nurse as stranger * Defining problem and deciding type of service needed * Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences * Nurse responds, explains roles to client, helps to identify problems and to use available resources and services Factors influencing orientation phase Identification phase * Selection of appropriate professional assistance * Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness Exploitation phase * Use of professional assistance for problem solving alternatives * Advantages of services are used is based on the needs and interests of the patients * Individual feels as an integral part of the helping environment

* They may make minor requests or attention getting techniques * The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem * Patient may fluctuates on independence * Nurse must be aware about the various phases of communication * Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step Resolution phase * Termination of professional relationship * The patients needs have already been met by the collaborative effect of patient and nurse * Now they need to terminate their therapeutic relationship and dissolve the links between them. Sometimes may be difficult for both as psychological dependence persists * Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals Interpersonal theory and nursing process

* Both are sequential and focus on therapeutic relationship * Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs * Both use observation communication and recording as basic tools utilized by nursing Peplau’s work and characteristics of a theory * Interrelation of concepts * Four phases interrelate the different components of each phase. Applicability * The nurse patient interaction can apply to the concepts of human being, health, environment and nursing. Theories must be logical in nature – * This theory provides a logical systematic way of viewing nursing situations * Key concepts such as anxiety, tension, goals, and frustration are indicated with explicit relationships among them and progressive phases * Generalizability * This theory provides simplicity in regard to the natural progression of the NP relationship.

* Theories can be the bases for hypothesis that can be tested * Peplau’s theory has generated testable hypotheses. * Theories can be utilized by practitioners to guide and improve their practice. Peplau’s anxiety continuum is still used in anxiety patients * Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. * Peplau’s theory is consistent with various theories Limitations * Personal space considerations and community social service resources are considered less. * Health promotion and maintenance were less emphasized * Cannot be used in a patient who doesn’t have a felt need eg. With drawn patients, unconscious patients * Some areas are not specific enough to generate hypothesis References 1. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N 2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. 3. Wills M. Evelyn, McEwen Melanie (2002).

Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. 4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. 5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. 6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. 7. Vandemark L. M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225 9.

Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002. | Callista Roy Sister Callista Roy (born October 14, 1939) is an American nursing theorist, professor and author. She is known for creating the adaptation model of nursing. Roy was designated as a 2007 Living Legend by the American Academy of Nursing Roy’s Adaptation Model| | | Introduction * Sr. Callista Roy- nurse theorist, writer, lecturer, researcher and teacher * Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill * Born at Los Angeles on October 14, 1939. * Bachelor of Arts with a major in nursing – Mount St.

Mary’s College, Los Angeles in 1963. * Master’s degree program in pediatric nursing – University of California ,Los Angeles in 1966. * Master’s and PhD in Sociology in 1973 and 1977. * Worked with Dorothy E. Johnson * Worked as f 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 i 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. Assumptions (Roy 1989; Roy and Andrews 1991) Explicit assumptions * The person is a bio-psycho-social being. The person is in constant interaction with a changing environment. * To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin. * Health and illness are inevitable dimensions of the person’s life. * To respond positively to environmental changes, the person must adapt. * The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level

* The person’s adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response. * The person has 4 modes of adaptation: physiologic needs, self- concept, role function and inter-dependence. “Nursing accepts the humanistic approach of valuing other persons’ opinions, and view points” Interpersonal relations are an integral part of nursing * There is a dynamic objective for existence with ultimate goal of achieving dignity and integrity. Implicit assumptions * A person can be reduced to parts for study and care. * Nursing is based on causality. * Patient’s values and opinions are to be considered and respected. * A state of adaptation frees an individual’s energy to respond to other stimuli. Major Concepts * Adaptation — goal of nursing * Person — adaptive system * Environment — stimuli * Health — outcome of adaptation * Nursing- promoting adaptation and health Adaptation

* Responding positively to environmental changes. The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration Person * Bio-psycho-social being in constant interaction with a changing environment * Uses innate and acquired mechanisms to adapt * An adaptive system described as a whole comprised of parts * Functions as a unity for some purpose * Includes people as individuals or in groups-families, organizations, communities, and society as a whole. Environment * Focal – internal or external and immediately confronting the person * Contextual- all stimuli present in the situation that contribute to effect of focal stimulus

* Residual-a factor whose effects in the current situation are unclear * All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of erson and earth resources, including focal, contextual and residual stimuli Health * Inevitable dimension of person’s life * Represented by a health-illness continuum * A state and a process of being and becoming integrated and whole Nursing * To promote adaptation in the four adaptive modes

* To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions Subsystems * Cognator subsystem — A major coping process involving 4 cognitive-emotive channels: perceptual and information processing, learning, judgment and emotion. * Regulator subsystem — a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels Relationships * Derived Four Adaptive Modes * 500 Samples of Patient Behavior * What was the patient doing? * What did the patient look like when needing nursing care?

Four Adaptive Modes * Physiologic Needs * Self Concept * Role Function * InterdependenceTHEORY DEVELOPMENTPhilosophical Assumptions * Persons have mutual relationships with the world and God * Human meaning is rooted in an omega point convergence of the universe * God is intimately revealed in the diversity of creation and is the common destiny of creation * Persons use human creative abilities of awareness, enlightenment, and faith * Persons are accountable for the processes of deriving, sustaining, and transforming the universe Adaptation and Groups * Includes relating persons, partners, families, organizations, communities, nations, and society as a whole Adaptive Modes A. Persons * Physiologic * Self Concept * Role Function * Interdependence B.

Groups * Physical * Group Identity * Role Function * Interdependence Role Function Mode * Underlying Need of Social integrity * The need to know who one is in relation to others so that one can act * The need for role clarity of all participants in group Adaptation Level * A zone within which stimulation will lead to a positive or adaptive response * Adaptive mode processes described on three levels: * Integrated * Compensatory * Compromised Integrated Life Processes * Adaptation level where the structures and functions of the life processes work to meet needs * Examples of Integrated Adaptation * Stable process of breathing and ventilation * Effective processes for moral-ethical-spiritual growth Compensatory Processes

* Adaptation level where the cognator and regulator are activated by a challenge to the life processes * Compensatory Adaptation Examples: * Grieving as a growth process, higher levels of adaptation and transcendence * Role transition, growth in a new role Compromised Processes * Adaptation level resulting from inadequate integrated and compensatory life processes * Adaptation problem * Compromised Adaptation Examples * Hypoxia * Unresolved Loss * Stigma * Abusive Relationships THE NURSING PROCESS * RAM offers guidelines to nurse in developing the nursing process. The elements : * First level assessment * Second level assessment * Diagnosis * Goal setting * Intervention * evaluation Usefulness of Adaptation Model

* Scientific knowledge for practice * Clinical assessment and intervention * Research variables * To guide nursing practice * To organize nursing education * Curricular frame work for various nursing colleges Characteristics of the theory * interrelated * logical in nature * relatively simple yet generalizable * can be the basis for the hypotheses that can be tested * contribute to and assist in increasing the general body of knowledge of a discipline * can be utilized by the practitioners to guide and improve their practice * consistent with other validated theories, laws and principles * TestableSummary * 5 elements – person, goal of nursing, nursing activities, health and environment * Persons are viewed as living adaptive systems whose behaviours may be classified as adaptive responses or ineffective responses. * These behaviors are derived from regulator and cognator mechanisms. These mechanisms work with in 4 adaptive modes.

* The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes, using information about person’s adaptation level, and various stimuli. * Nursing activities involve manipulation of these stimuli to promote adaptive responses. * Health is a process of becoming integrated and able to meet goals of survival, growth, reproduction, and mastery. * The environment consists of person’s internal and external stimuli. References * George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. * Wills M. Evelyn, McEwen Melanie (2002).

Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. * Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. * Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. * Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. * Vandemark L. M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 * Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225

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