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Application of Theories inApplication of Theories inNursing ProcessNursing ProcessBy,By,ARUN.MARUN.M
THEORY MAIN CONCEPT APPLICATIONSMadeleineLeiningerCulturalCareDiversityandUniversality TheoryComponents ofholistic assessment-following factors:• Technological• Religious &physical• Kinship & social• Cultural values &life ways• Political & Legal• Economic• EducationalNursing caredepends on holisticassessmentThese factors tobe considered forpatientassessment inclinical practice. used to do theassessment ofindividuals,families, groups &communities indiverse healthsystem to comparethe factors related,that is to findoutthe similarities anddifferences.
Application of Theories inApplication of Theories inNursing ProcessNursing ProcessBy,By,Mrs.V. Selvanayaki M.Sc. (N),Mrs.V. Selvanayaki M.Sc. (N),Lecturer,Lecturer,V.M.A.C.O.N,V.M.A.C.O.N,Salem.Salem.
Level ILevel IViewed as havingViewed as havingfour level:four level:It is the world view &It is the world view &social system levelsocial system levelLeads to the study ofLeads to the study ofnature, meaning andnature, meaning andattribute of care fromattribute of care fromthree perspectives-three perspectives-Help us to findHelp us to findinterrelationshipinterrelationshipbetween factors forbetween factors foreffective planningeffective planningfor better outcomefor better outcomeSpecific factorSpecific factorcan also becan also beidentified for specialidentified for specialneed assessmentneed assessmentfor planning carefor planning care
• Micro perspectivesMicro perspectives studies individuals withinstudies individuals withincarecare• Middle perspectivesMiddle perspectives focuses on more complexfocuses on more complexfactors in one specificfactors in one specificcultureculture• Macro perspectivesMacro perspectives investigates phenomenainvestigates phenomenaacross several culturesacross several culturesWhen we need toWhen we need toassess anything inassess anything inmicro or large scale ormicro or large scale orwhen we try to assesswhen we try to assessthe complexity of thethe complexity of thefactors or when wefactors or when wewant to investigate awant to investigate asingle phenomena withsingle phenomena withregard to individual,regard to individual,families groups andfamilies groups andinstitutions this theoryinstitutions this theorycan be used.can be used.
Level IILevel IIProvidesProvidesknowledgeknowledgeaboutaboutindividuals,individuals,families,families,groups &groups &institutions ininstitutions indiversediversehealthhealthsystemsystemLevel II provides culturallyLevel II provides culturallyspecific meanings andspecific meanings andexpressions in relation toexpressions in relation tocare and healthcare and health
Level IIILevel IIIFocuses on folkFocuses on folksystems,systems,professional systemprofessional systemand nursing.and nursing.IncludesIncludescharacteristics andcharacteristics andspecific care featuresspecific care featuresof each system -of each system -allows to identifyallows to identifysimilarities andsimilarities anddifferences ofdifferences ofculture.culture.Can be used forCan be used forplanning in whichplanning in whichthe nursing care willthe nursing care willbe plannedbe plannedaccording to theaccording to thefolk systems andfolk systems andprofessionalprofessionalsystem.system.Nursing care maybe planned basedon the holisticcomponents andprofessional system
LevelLevelIVIVNursing careNursing caredecisiondecision& actions& actionsAt this level,At this level,nursing care isnursing care isdelivereddeliveredInfluences nursingInfluences nursingcare and based on thatcare and based on thatactions to be taken.actions to be taken.Level I through IIILevel I through IIIprovide knowledgeprovide knowledgebase needed forbase needed forplanning & delivery ofplanning & delivery ofculture congruent careculture congruent careUsed for planning andUsed for planning andimplementationimplementation
Along with these factors, the folk system –common practices which are followed in thatarea and professional system will help the nursesto assess the needs and problems of the person.According to that assessment planning will bemade and on the basis of the planning nursingcare will be given.
Any single factor or more than one factors orall the above factors may influence the holistichealth of individual.E.g.. Person with mental health disorder Further, this theory can be applied in nursingcare. However, nursing care also considerprofessional system that is the role ofprofessional nurse to plan to repattern orrestructure the individual’s health.
This model is mainly focusing the socio-This model is mainly focusing the socio-cultural dimensions of individuals, families,cultural dimensions of individuals, families,groups, communities and institutions.groups, communities and institutions. This can be mainly used in transculturalThis can be mainly used in transculturalnursing care aspects.nursing care aspects. Assessment of referral patients from otherAssessment of referral patients from othersectors of health or different parts of thesectors of health or different parts of thecountry or outside country needs holisticcountry or outside country needs holisticassessment through this theory.assessment through this theory.
THEORYTHEORY MAIN CONCEPTMAIN CONCEPT APPLICATIONAPPLICATIONFlorenceFlorenceNightingaleNightingaleTheory (AnTheory (AnEnvironmentalEnvironmentaladaptationadaptationtheory)theory) Environment is coreEnvironment is coreconcept - Environmentconcept - Environmentcould be altered in suchcould be altered in sucha way as to improvea way as to improvecondition so that naturecondition so that naturecould act to cure thecould act to cure thepatientpatient Most importantMost importantenvironmental concernsenvironmental concernsare ventilation and cleanare ventilation and cleanair followed by cleanair followed by cleanwaterwaterThis model isThis model ismainlymainlyfocusing onfocusing oninfectioninfectioncontrol whichcontrol whichwill be suitablewill be suitablefor wardfor wardmanagement.management.
Additional needs areAdditional needs arewarmth, control of noise,warmth, control of noise,provision for light andprovision for light andadequate management ofadequate management ofwastes and odors.wastes and odors. According to theAccording to thetheorist, if environment istheorist, if environment isclean, the survival abilityclean, the survival abilityand recovery will beand recovery will beimprovedimproved According to her,According to her,nursing is a nurturing artnursing is a nurturing artthat requires knowledgethat requires knowledgeof sanitary procedureof sanitary procedure For individualFor individualcare it is applicablecare it is applicableto prevent theto prevent theinfection or controlinfection or controlthe infectionthe infection BasicBasicprinciples ofprinciples ofenvironmentenvironmentmanipulation canmanipulation canbe applied withbe applied withmodification inmodification inmanymanycontemporarycontemporarynursing settingsnursing settings
The author says that onlyThe author says that onlyenvironment related to patientenvironment related to patientto be altered to reduce orto be altered to reduce orprevent infection in order toprevent infection in order toimprove patient’s health.improve patient’s health. As per the theorist, theAs per the theorist, theholistic health of a personholistic health of a personincludes biological,includes biological,psychological and socialpsychological and socialcomponents in which thecomponents in which thebiological and psychologicalbiological and psychologicalcomponents are mostlycomponents are mostlydominating than socialdominating than socialcomponents.components. There is noThere is nodirect patientdirect patientcarecare WardWardmanagement,management,infectioninfectioncontrolcontrol(nosocomial(nosocomialinfection)infection)asepticaseptictechniquestechniques
These holisticThese holistichealth of a personhealth of a personcan be maintainedcan be maintainedby altering theby altering theenvironment only.environment only.Thus, this theoryThus, this theorycan be used forcan be used forassessment of aassessment of apatientspatientsenvironment inenvironment inclinical practiceclinical practice
InfectionaftersurgeryBeddingVentilationCleanlinessHealth ofHouses(Hospital)AirVentilationHealthofHousesCleanliness EnvironmentApplication of Nightingale’s theory in nursing processEg-1NutritionNutrition
NursingObservationDocumentationEnvironmentalAlterationHEALTHSTATEPERSONNURSING PROCESSApplication of Nightingale’s theory in nursing practice
THEORYTHEORY MAIN CONCEPTMAIN CONCEPT APPLICATIONAPPLICATIONIda JeanIda JeanOrlandoOrlandoNursingNursingProcessProcessTheoryTheoryInadequate patientInadequate patientcare- caused by thecare- caused by theprofession’s lack ofprofession’s lack ofclearly articulatedclearly articulatednursing functionnursing functionIdentification ofIdentification ofpatient need in thepatient need in thefoundation of the nurse-foundation of the nurse-patient relationship,patient relationship,nurses must developnurses must developskills in exploring withskills in exploring withpatients the meaning ofpatients the meaning oftheir verbal and non-their verbal and non-verbal behavior.verbal behavior. Can be usedCan be usedwhen there is anwhen there is aninteractioninteractionbetween healthbetween healthpersonnels andpersonnels andclient, nurse andclient, nurse andclient, andclient, andbetween client tobetween client toassess the patientassess the patientneed for anneed for aneffectiveeffectivecommunication tocommunication toprovide qualityprovide qualitycare.care.
A nursing situation is composedA nursing situation is composedof the patients behavior, theof the patients behavior, thenurse’s reaction and the nurse’snurse’s reaction and the nurse’saction. The interaction of these isaction. The interaction of these iscalled the nursing processcalled the nursing processOrlando identified four phases inOrlando identified four phases inaction process:action process:• The person perceives with anyone ofThe person perceives with anyone ofhis five sense organs an object orhis five sense organs an object orobjects.objects.• The perception stimulate automaticThe perception stimulate automaticthought.thought.• Each thought stimulate an automaticEach thought stimulate an automaticfeeling and then the person acts.feeling and then the person acts.• ReactionReactionIt can beIt can beused whenused whenthere is anthere is aninteractioninteractionbetween abetween anurse and anurse and apatient in anpatient in animmediateimmediatesituation tosituation tomeetmeetpatientspatientsneeds.needs.
First, nurse must take theFirst, nurse must take theinitiative in helping theinitiative in helping thepatient express the specificpatient express the specificmeaning of his behavior inmeaning of his behavior inorder to ascertain hisorder to ascertain hisdistress. Second, she mustdistress. Second, she musthelp the patient explore thehelp the patient explore thedistress in order to ascertaindistress in order to ascertainthe help he requires for histhe help he requires for his(immediate) need (for help)(immediate) need (for help)to be met.to be met.It can be usedIt can be usedto emphasizeto emphasizeimmediate careimmediate careas there is aas there is apositivepositivecorrelationcorrelationbetween thebetween thelength of time thelength of time thepatientpatientexperiences theexperiences theunmet needs andunmet needs andthe degree ofthe degree ofdistress.distress.
Because, the patients behavior stimulates theBecause, the patients behavior stimulates thenursing perception, it becomes the starting pointnursing perception, it becomes the starting pointof the nurse’s investigation. According toof the nurse’s investigation. According toOrlando, the nurses perception and the patientsOrlando, the nurses perception and the patientspresenting behavior forms the basis of thepresenting behavior forms the basis of thenurse’s thoughts and feelings.nurse’s thoughts and feelings.
Automatic personal responsePERSON – A PERSON – BReaction Secret Reaction SecretACTION ACTIONPERCEPTION PERCEPTIONTHOUGHT THOUGHTFEELING FEELINGReactionReactionACTION ACTIONPERCEPTION PERCEPTIONTHOUGHT THOUGHTReactionFEELING FEELING Reaction
When the actionprocess in a person toperson contactfunctioning secret, theperceptions, thoughtsand feelings in eachindividual are notdirectly available to theperception of otherindividual through theobservable action. It can beused toincrease thecareeffectivenessin patientsneeds.
The nurse’s expressionof his or her reactionminimizes the opportunityfor the nurse to makeassumptions andincreases the chance tocorrect or verify thenurse’s privateinterpretation of thepatient action. Finally, if the patientsbehavior does not change,the nursing functions hasnot been met. In clinicalpractice itmay guideto maketheperson’sactionsandreactionsarepositive
It can be used at patient carelevel, management level andnursing division level It may improve decision –making skills – more effectiveconflict resolution among staffnurses, between staff andphysicians and unity amongstaff. It can be used in guidanceand counseling for the patientsand for psychoanalysis and toassess the mental healthstatus of a person. It can beused toincrease thecareeffectivenessin patientsneeds.
Eg.: CounselingNURSE CLIENTExplicitAction ActionUnderstands Understanding the problemApproachable AnalysisProblem can be solved How much to be doneto solve theproblem/ what to be done
Can be used at patient care,management and nursingdivision level May improve decision – makingskills – more effective conflictresolution among staff nurses,between staff and physiciansand unity among staff. Can be used in guidance andcounseling for the patients andfor psychoanalysis -to assessthe mental health status of aperson. It can beused toincrease thecareeffectivenessin patientsneeds.
THEORY MAJOR CONCEPTS APPLICATIONSDorotheaOrem’sself-caredeficittheorya. Theoryof self-careb. Theoryof self-caredeficit Composed threerelated theories: Describes why andhow people care forthemselves. Describes and explainswhy people can behelped through nursing. Continuousassessmentof the patientwill help thenurse to findout his needsandproblems
c. Theory ofnursingsystemEvery individual has certaincapacity of to be independent.Sometimes he also need someassistant for any activity to becompleted and in sudden caseshe is fully depend on others.Describes and explainsrelationships that must bebrought about and maintainedfor nursing to be produced.
DeficitNursingAgencySelf CareSelf CareAgencySelf CareDemandRR RRROrem’s self-care model
Accomplishes patient’stherapeutic self- careCompensates for patients inabilityto engage in self careSupports and protects patientNurse’sActionWholly compensatory system
Performs some self-caremeasures for patientCompensates for self-care limitations ofpatientAssists patient asrequiredPerforms some self-careRegulates self-careagencyAccepts care andassistance from nurseNurseActionPatientActionPartly compensatory system
Accomplishes patient’stherapeutic self- careRegulates the exerciseand development of self-care agencyNurseActionPatientActionSupportive Educative System
Described & explainrelationships that must bebrought about and maintained fornursing to be produced. Self – care activities to maintainlife, healthful functioning,continuing personal developmentand well being for functional anddevelopmental regulations. Self care agency ability to knowand meet their own humanfunctioning and development As perthe abilityof thepatient thenursingcare canbeplanned toimplementthe care
Self care deficit – Self carecapabilities are in adequate formeeting some or all components oftherapeutic self care demand. Self-care demand – summation ofcare measures necessary at timesor over duration of time for meetingall of an individuals needs. Nursing agency – Nurses to act, toknow and to help persons in suchrelationship to meet theirtherapeutic self-care demands andto regulate the development oftheir self-care agency. As pertheplanningthe carecan beimplemented onthepatient.
Hygienic needsNutritional needsElimination needsNew born careSafety and SecurityneedsMother –unable toperform heractivitydue tosurgeryFluid &electrolyteimbalanceInfection controlNutritionalneedsDeficitPersonal HygieneDressingMedicationMaintaining fluidbalancePerennial careFeeding babyR RRRR
Accomplishes the patienttherapeutic self careAdministration of IV fluids,ambulation, medications, dressing,new born careCompensates for patient’s inabilityto engage in self carePersonal hygiene, helping thepatient to turn in the bedSupports & Protects PatientBedside railing prevent fall,measures to prevent infection,psychological support, observe theoperated site for infectionNurseActionPatientActionLimitedNURSING SYSTEMWholly Compensatory System1stPost operative day
Performs some self caremeasures to patientPersonal hygiene, dressingCompensates some self carelimitations of patientHelp the patient to turn in thebed, change the dressAssist patient as requiredHelp the patient to turn in thebedNurseActionPartly Compensatory System2ndPost operative day
Performs some self caremeasures-Brushing, turning from oneposition to another position,mobility with assistanceRegulates self care agencyAble to perform his activity tocertain extentAccepts care and assistance fromnurseAccepts the medication given bythe nursePatientAction
Accomplishes self careAble to take bath, eats alone,ambulate aloneRegulates the exercise anddevelopment of self care agency- Teach about new born care,feeding etc.- Prevention of infection- Dietary requirements- Psychological support- Need for regular follow-up.PatientActionNurseActionSupportive Educative SystemDuring discharge