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CONCEPTUAL AND THEORETICAL MODEL OF NURSING PRACTICE
It is defined a concept as something conceived is the mind- a thought. Concepts are words that
represent reality and enhance our ability to communicate about it. Concepts may be empirical or abstract,
depending up their ability to be observed in the realworld. Concepts are said to be empirical when they
can be observed or experienced through the senses. Concepts are abstract those that are not observable,
such as hope and infinity
Concept is defined as a word or phase that summarizes the essential characteristics of a phenomenon.
THEORY: It is a statement or a group of statements that describe, explain or predict relationships
It is defined as a construct that accounts for organizes some phenomenon. A nursing theory then describes
or explains nursing. (Barnum)
A conceptual model is defined as a set of abstract pattern,general concepts and the
propositions that integrate these concepts into a meaningful configuration.
Acc. to Newman state that a conceptual model provides direction to the practitioner for
the observations necessary for assessment and intervention.
Acc. to Bush points out that in education, practice and research a model for nursing
serves to unify to give direction and to simplify.
PURPOSES OF CONCEPTUAL MODELS
1. To make scientific findings meaningful and genealizable.
2. Conceptual models are efficient mechanisms for drawing together and summarizing accumulated facts,
sometimes from separate and isolated investigations.
3. The linkage of finding into a coherent structure makes the body of accumulated knowledge more
accessible and thus more useful both to practitioners who seek to implement findings and to researchers
who seek to extend the knowledge base.
4. Conceptual models can guide the scientist’s understanding of only the what of natural phenomena but
also the why of their occurrence
5. A utilitarian model is one that has potential to bring about desirable changes in people’s behavior or the
6. It helps to stimulate research and the extension of knowledge by providing both direction and impetus.
TYPES OF MODELS
Various types of models are described as
1. Physical or isomorphic model:This model represents the reality, not only in form and structure, but
often in content. Because it is similar in appearance to the real life object it represents it is often called an
2. The homomorphic model:This model is similar to the isomorphic one in that it is essentially a
physical.Here the model builder deliberately leaves out some of the properties of the realobject because
they are not needed for the purpose for which the model was designed.
3. The symbolic model:The model bears no physical resemblance to reality. Numbers or symbols such
as shapes or words are used to map out the real situation.
4. The conceptual model:Conceptual model represents reality through words or symbols but do not
resemble it in any real sence. They like symbolic models may also be termed theoretical models. Here the
words or symbols donot represents mere ideas or perception, but concepts. Concepts are constructs
produced by abstracting or sharing the characteristics of ideas, placing them together in classes or
patterns. The e.g. of the nursing process is such as a model; it is a symbolic but also conceptual. A
conceptual model is not just a list of the concepts which occur in some real situation. It must also include
symbols which show the concepts are interconnected or relate to each other. These lines and signs which
link the concepts therefore represent propositions which are claims about the relationships between the
concepts. A conceptual model is thus best viewed in terms of the following formula:
Concepts + Propositions = Conceptual Model
Acc to Fawcett a conceptual model is at a higher level of abstraction than theory, which is expressed in
more descriptive, concrete or realterms, such that it can be readily observed and indeed substantiated
5. Nursing model:Nursing models are with in a type of conceptual model that applies a conceptual
framework to the understanding of nursing and guiding of nursing practice. A nursing model may have
severalcharacteristics,including a representation of:
a. The nature of the people receiving nursing care.
b. The causes of problems likely to require nursing intervention.
c. The nature of the assessment process.
d. The nature of planning and goal setting process.
e. The focus of nursing intervention during the implementation of the nursing care plan.
f. The nature of the process of evaluating the quality and effect of the care giver.
HOLISTIC NURSING – healing the whole person
“Just as the body cannot exist without blood, so the soul needs the matchless and pure strength of
faith.” -MAHATMA GANDHI
INTER RELATED CONCEPTS OF HEALTH
Health is "the condition of being sound in body, mind, or spirit" (Merriam-Webster Online
The WHO defines health as follows: "Health is a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity" (WHO, 1974).
Healing means to be or become whole. It is a state of harmony or balance in the body, mind, and
spirit connection. (Quinn, 2005)
Homeostasis is the balance or stability that the body strives to achieve among these aspects of a
person's life by continuous adaptation.
TRADITIONAL MODELS OF HEALTH
Health Illness Continuum Model
According to this model, health is a dynamic state that fluctuates as a person adapts to
changes in the internal or external environments to maintain a state of well-being.
Illness is a process in which the functioning of a client is diminished or impaired when
compared with his/ her previous condition.
In this model, high-level wellness and severe illness are at opposite ends of the continuum
The person moves back and forth (forward) within this continuum day by day
Wide ranges of health or illness are present.
Rosenstoch and Becker and Maiman proposed the Health Belief Model.
This model addresses the relationship between a person’s beliefs and behaviors.
The Health Belief Model helps to understand the factors influencing patients’ perceptions,
beliefs, and behaviour to plan the care.
1. Individual’s perception of susceptibility to an illness
2. Individual’s perception of the seriousness of the illness
3. Likelihood of taking preventive action
Health – Illness Continuum Model
1. Measure person’s perceived level of wellness
2. Health and illness/disease opposite ends of a health continuum
3. Move back and forth (forward) within this continuum day by day
4. Wide ranges of health or illness
5. Health and illness can be viewed as the opposite ends of a health continuum
6. From high level of health a person’s condition can move through good health -- normal health --
poor health -- extremely poor health -- to death.
7. People move back and forth within this continuum day by day.
8. How people perceive themselves and how others see them in terms of health and illness will also
affect their placement on the continuum.
Characteristics ofHealth-Illness Continuum Model
At any time any person’s health status holds a place on certain point between two ends of
Any point on the health-illness continuum is a synthetically representation of various aspects
of individual in physiology, psychology and society.
• To help the client to identify their place on the health-continuum.
• To assist the clients to adopt some measures in order to reach a well state of health.
Travi’s Illness – WellnessContinuum
Composed of two arrows pointing in opposite directions and joined at a neutral point 1.Movement to the
right on the arrows (towards high-level wellness) equals an increasing level of health and well-being
Achieved in Three Steps: a. Awareness b. Education c. Growth
2. Movement to the left on the arrows (towards premature death) equates a progressively decreasing state
of health Achieved in Three Steps: a. Signs b. Symptoms c. Disability
3. Most important is the direction the individual is facing on the pathway a. If towards high-level health, a
person has a genuinely optimistic or positive outlook despite his/her health status b. If towards premature
death, a person has a genuinely pessimistic or negative outlook about his/her health status
4. Compares a treatment model with a wellness model a. If a treatment model is used, an individual can
move right only to the neutral point Example: a hypertensive client who only takes his medications
without making any other life-style changes b. If a wellness model is used, an individual can move right
past the neutral point Example: hypertensive client who not only takes his medications, but stops
smoking, looses weight, starts an exercise program, etc.
High Level ofWellness Model
It shows a method of functioning oriented towards maximizing the potential of an individual
while maintaining balance and purposeful direction with environment. This is holistic in nature.
It allows nurse to care for individual with regard to all dimensional factors. It emphasizes health
promotion and illness prevention rather than only treatment. It defines process that help
individual to know who and what he/she is
Being- recognizing self as separate and individual
Belonging being part of a whole
Becoming- growing and developing
Befitting- making personal changes to belief the self for the future
Dun (1961), recognizes health as an ongoing process toward a person’s highest potential of
functioning. This process involves the person, family and the community.
It describe high level wellness as the experience of a person alive with the glow of good health,
alive to the tips of their fingers with energy to burn, tingling with vitality at times like this the
world is a glorious place
Two axes – X- axis is health: it extends from peak wellness to death – Y- axis is environment: it
extends from very favorable environment to very unfavorable environment
Quadrant 1 – High-level wellness in favorable environment e.g.,a person who implements
healthy life- style behaviors and has the biopsychosocialspiritual resources to support this life-
Quadrant 2 – Protected poor health in favorable environment e.g., an ill person whose needs are
met by the health care system and who has access to appropriate medications, diet, and health
Quadrant 3 – Poor health in unfavorable environment e.g.,a young child who is starving in a
drought ridden country
Quadrant 4 – Emergent high level wellness in unfavorable environment e.g., a woman who has
the knowledge to implement healthy life-style practices but does not implement adequate self-
care practices because of family responsibilities, job demands, or other factors
What is holistic care ???
The word holistic was coined in 1926 by Gen. J.C. Smuts (1870-1950) and based on the Greek root
“holos”, which means ‘whole’.
Holistic health views the physical, intellectual, sociocultural, psychological , and spiritual aspects of a
person's life as an integrated whole.
I. When applying the concept of holism to states of health , ellicited that health can be
influenced by an individual’s ability to adapt to Changing environments Aging Times of
suffering Expectation of death
II. This implies that individuals have the potential to influence their own lives and that holistic
care should consider the whole human experience.
III. Ancient approach 5000 years ago in India and China, stressed living healthy way of life in
harmony with nature.
IV. An approach to health based on a love of life, not a fear of death.
V. Leads to high level of wellness for the total person throughout the total life style.
Each factor constantly interacts with the others
When in balance, health is maintained
When not in balance, disease occurs
Used primarily in predicting illness rather than promoting wellness
Model is composed of three dynamic, interactive elements By Leavell and Clark
Useful for examining causes of disease in an individual
The agent, host and environment interact in ways that create risk factors and
understanding these are important for the promotion and maintenance of health
An agent is an environmental factor or stressor that must be present or absent for an
illness to occur
A host is a living organism capable of being infected or affected by an agent
The host reaction is influenced by family history age, and health habits
The environment is the situation of circumstances where host live.
Holistic Health Model
I. A comprehensive view of the person as a bio psychosocial and spiritual being and sometime
holistic health model is said to be alternative medicine
II. The holistic health care model comes from a variety of scientific philosophical, social bases that
describe similar phenomenon
III. The model empower the patients to engage in their own healing power which comprises of
concepts of energy, holism, the mind body connection, and balance in order to expand the
definition of health
IV. The holistic health model uses the different techniques that in the past the health community
viewed as experimental or alternative
V. Alone it is realized that personal health choice has intensive and powerful impact of an individual
VI. Some of widely used holistic interventions include aromatherapy, meditation, music therapy, and
relation therapy, therapeutic touch, applied in health care setting such as meditation, breathing
Health Promotion Model
a) Model is proposed by Pender (1996)
b) It define health as a positive, dynamic state,not merely the absence of disease
c) The model was proposed as a framework for integrating the perspectives of nursing and
behavioural science and the factors that influence health behaviour
d) Health promotion is desire to increase well-being and actualize human health potential,
whereas health protection is behaviour that is motivates by a desire to avoid illness,
detect it early or maintain function within the constraints of an illness
e) The model describe the multidimensional nature of people as they interact in their
environment to pursue health
f) The model emphasize on the three function of patient’s cognitive perceptual, Individual
characteristics experiences ,Behaviour specific cognitions and affect , Behavioural
FACTS OF HOLISM
I. Personal/ inner resources are as important as external ones Link between the body and the
mind. Personal/ inner resources are as important as externalones Link between the body and
What is holistic nursing ?????
Holistic nursing focuses on promoting health and wellness, assisting healing and preventing
or alleviating suffering.
A philosophy of nursing practice that takes into account total patient care,considering the
physical, emotional, social, economic, and spiritual needs of patients, their response to their
illnesses, and the effect of illness on patients' abilities to meet self-care needs.
Uses medical knowledge complementary, alternative and integrative methods to care for the
patient as a whole.
Insists that total good health and well being can be achieved by understanding the whole
person in a perspective that includes his physical, mental, emotional, social and spiritual
GOAL OF HOLISTIC NURSING
The goal of holistic nursing is the "enhancement of healing the whole person from birth to
death" (American Holistic Nurses Association [AHNA],2004).
Involves the harmonious balance of body, mind, emotions, and spirit within an everchanging
“Considers the whole person, including physical, mental, emotional, and spiritual aspects.
Body, Mind and Spirit Relationship
The individual according to Indian scriptures is ‘Prakriti’ and ‘Purusha’. Nature (Prakriti) is said to be
the formation of body and ‘Purusha’ the soul.
Spirit is the cause of expression of pleasure and pain guided by mind, intellect, ego etc.
Mental Conditions Affecting Bodily Functions . Our emotions and strong feeling affect the body
inwardly and outwardly. Unpleasant emotions such as fear,anger, worry cause headache,insomnia,
indigestion and various neurotic diseases. Deep thinking and concentration can cause physical
fatigue. Mind motivates all physical and motor activities. Emotional conflicts are responsible to
cause various illnesses such as hysteria, gastrointestinal troubles like peptic ulcer, ulcerative colitis,
a) Based on Florence nightingale work 1970- nurse scholars start concerned with
concept of “whole person” Dossey developed a theory builds upon a solid holistic,
integrated, and multidimensional theoretical nursing foundation.
b) 1980- American Holistic Nurses Association was founded 1993-94 Steps towards
certification for holistic nursing
c) 1995- Revised standards of holistic nursing 1997 development of basic core
d) 1997- American Holistic Nurses Certification Corporation (AHNCC) was founded
2003-development of core curriculum for advanced holistic nursing 2006-
recognition as a specialty area in nursing practice in ANA 2007- revision of basic and
advance practice standards
PRINCIPLES OF HOLISTICCARE
a) All people have innate healing powers.
b) The patient is a person, not a disease.
c) Healing takes a team approach involving the patient and doctor, and addresses all aspects of
a person's life using a variety of health care practices.
d) Treatment involves fixing the cause of the condition, not just alleviating the symptoms.
DIFFRENCE BETWEENTRADITIONALAND HOLISTIC NURSING
TRADITIONAL VS HOLISTIC
• Have knowledge related to nursing
• Limited methods of care
• Treats all patients
• Uni level care to patient Holistic
• Needs additional knowledge
• Creativity and unlimited methods of care
• Usually treat patients with severe conditions
• Tri level care to patient
• Found at every health care facility
• Easy to get job as traditional nurse Holistic
• Found at more specialized health care facilities
• Need special areas to provide care
CORE VALUES OF HOLISTIC CARE PRACTICE
1 Holistic Philosophy: develop and expand overall philosophy in the art and science of holistic
nursing Holistic Education: acquire and maintain current knowledge and competency in holistic
2 Holistic Ethics: hold to a professional ethic of caring and healing that seeks to preserve wholeness
and dignity of self, students, colleagues, and the person who is receiving care
3 Holistic Nurse Self-Care : engage in self-care and further develop their own personal awareness of
being an instrument of healing to better serve self and others
4 Holistic Communication: engage in communication to ensure that each person experiences the
presence of the nurse as authentic and sincere;
Therapeutic Environment: recognize that each person’s environment includes everything that
surrounds the individual, both the external and the internal (physical, mental, emotional, social, and
spiritual) as well as patterns not yet understood. Cultural Diversity: recognize each person as a whole
body-mind-spirit and mutually create a plan of care consistent with cultural background, health
beliefs, sexual orientation, values, and preferences
5 Holistic Caring Process Assessment:Each client is assessed holistically using appropriate
traditional and holistic methods while the uniqueness of the client is honored
DIMENSIONS OF HOLISTIC HEALTH CARE :
a) Nutritional awareness
b) Over eating
c) Physical fitness
d) Stress awareness and management
e) Bring variety in daily living/routine
f) Environmental sensitivity
HEALTH CARE SETTINGS FOR HOLISTIC NURSING PRACTICE
• Seeking cost effective ways to deliver an ever increasing range of services
• Demand of greater accessibility to quality health care services at affordable costs.
• Nursing need to be theoretically and practically equipped with use of technological advances,
biomedical research and state-of-the-art clinical equipment and facilities.
• Nursing preparation needed to work within health care delivery system that is complex, involving
myriad providers such as organization, institutions, groups and individuals, ,consumers and settings.