Determining Care through Ideologies, Policy
and Practice in order to sustain health and
The Role of the Nurse
• To identify a client's health status, actual or potential
health care problems or needs
• To establish plans to meet the identified needs,
• To deliver specific nursing interventions to meet those
• The role of the Nurse is currently shaped by the NMC
competencies demanding professional behaviour to
safeguard patients with the aim to deliver care that
promotes health and wellbeing
• The first stage of any care is based on Assessment
• Scenario Therefore what does the role of the nurse
require to carry out a comprehensive assessment?
Revealing through critical analysis the role
of the nurse and the profession
• Thus we are interested in how nursing relate to the
philosophical understanding of scientific method,
epistemology and the search for truth…….therefore
encouraging you to ask searching questions about the
development of practices such as how far they provide
more adequate truths or epistomologies as a means to
• The nursing process is a series of organized steps
designed for nurses to provide excellent care.
• The five phases, include assessing, diagnosing, planning,
implementing, and evaluating.
• Purpose of Nursing Process is to determine the potential,
actual and percieved problems
• Nursing assessment is the gathering of information about
a patient's physiological, psychological, sociological, and
• Is the systematic and continuous collection, organisation,
validation and documentation of information
• Cornerstone for individualised care
• Provides a baseline of the “Normal”
• “The nursing process is described as being cyclical, made up
of four interconnecting elements and having a dynamic nature
(Pearson et al, 1996). It has long been a feature of nursing
care in the UK and when used in conjunction with a nursing
model it facilitates consistent, evidenced-based nursing care,
and necessitates accurate, up-to-date care documentation. The
nursing process consists of four distinct phases, each having a
discreet role in the process, whilst also being interdependent
upon each other. The phases of the process are” (RCN 2015)
• To determine the needs of the patients through determining the
Health Status/Position of the patient.
• Deficit Model
• Determine the Health Need
• Health needs (Wright et al 1998)
• incorporate the wider social and environmental determinants of
health, such as deprivation, housing, diet, education,
employment. This wider definition allows us to look beyond the
confines of the medical model based on health services, to the
wider influences on health (box).
• Biomedicine: Dominant Paradigm
• Coined by R.D. Laing (1971)
• So illness is due to dysfunction in the individual
• Cartesian Dualism (Body Mind split)
• Its critique Ivan Illich 1974
• Medical Iatrogenisis
• Therapeutic Nihilism
Andrews and Boyle (2008)
• The first is determinism which states that a cause and
effect relationships exists for all natural phenomena
• The second relates to life to the structure and function of
machines which is possible to control life processes
through mechanical, genetic and other engineered
• The third is reductionism according to which all life can be
reduced or divided into smaller parts; study of these
isolated parts is thought to reveal aspects/properties of
• Biomedical model guides nurses to perceive an individual
as a physicochemical machine or a disease diagnosis
where emphasis is on body’s structure and malfunction.
• Mind and body separation was not suitable with holistic
• As a result, nurses ignored patient’s individual
characteristics and needs and limited themselves in the
frame of treatment.
• Practicing with biomedical model leaded nurses to
uncertainty between treatment and care, where nurses
would decide on whether to be dependent to physicians
or be independent from physicians.
• Biomedical model, as a traditional model where the
nursing practice has been based, is important for its
contributions in the past. However, it is a widespread idea
within the nurses that this model is not suitable to provide
a base for nursing practice. For a different nursing care,
existence of various alternatives is very crucial
Traditional: George Castledine (2005)
• The difference between nursing and medicine has often been
expressed as the nurse ‘cares’ and the doctor ‘cures’.
• Some observers would see it as a difference between models
of health care, or the way each profession approaches the
• The predominant model used by doctors in the UK is a
biomedical one, emphasizing diagnosis and treatment based
on scientific evidence. It is important to acknowledge, however,
that there are those doctors who reject this approach and use a
much more holistic and alternative Eastern model.
• There is a great deal of evidence to suggest that the
biomedical model has, and continues to be, the model on
which many nurses base their practice. Research studies in
nursing have frequently reported nurses viewing their patients
as physical beings with medical problems to solve, rather than
nursing and healing patients’ wider personal and individual
• WHO (2000) states that traditional medicine is the sum
total of knowledge, skills and practices based on the
theories, beliefs and experiences indigenous to different
cultures whether explicated or not, used in the
maintenance of health as well as in the prevention,
diagnosis, improvement or treatment of physical and
• The role of sociology in nursing continues to cast new
light on many aspects of health and illness.
• Over the last 20 years, nursing practice has seen
sociological theory become a valuable clinical tool, both in
the diagnosis and prognosis of a wide range of illnesses
and long-term conditions. Lifestyles, Environment,
• Nevertheless, of these, the sociological examination of
mental health problems and its impact upon nursing
practitioners has received little coverage, simply because,
as a discipline, mental health nursing has historically been
wedded to a biomedical model, one which continues to
embrace psychiatry/psychology as the driving force in the
diagnosis and treatment of psychopathology.
• The force of nature itself must be kept in natural balance
or harmony disturbance causes imbalance
• George Bateson’s double blind bind theory of
schizophrenia focuses on environmental causes rather
than physical brain dysfunction
Transcultural Concepts in Nursing Care
Andrews and Boyle (2008)
• Health and illness states are strongly influenced by
• 1950’s Dr Madelerine Leininger
• Florence Nightingale emphasised nursing’s control of the
environment so that patients could heal naturally ( was
viewed as holistic)
Folk Lore:Common Sense
• It is defined by McClean (2010) as stories customs and
beliefs in a culture that are unwritten and passed down
orally from generation
• Nursing: shares and preserves a common body of stories,
practices and beliefs and rights of passage that are not
shared or known by non nurses
• Traditions, Rituals, Practices handed down from previous
generations of nursing (Field) Customs of Nursing
• Can become “Common sense” views that are based upon
understandings within an expert nurse paradigm
Bio-psycholosocial Nassir Ghaemi (2009)
• Attributes disease causation or disease outcome to the
interaction of biological factors, genetics, biochemistry,
social and psychological factors
• Conceptual status quo devolved into mere eclecticism
• “We have made incredible advances in nursing science.
However, many of our practice remain focused on
procedures, principles underlying our procedures, and
• We have built care on nursing conceptual
frameworks/theories, only to return to medical models that
match the medically dominated clinical environments.
• But, is there a major shift is underway?
• Nursing is a microcosm of society it mirrors the biases
and prejudices found in the larger social order
• Is it realistic to expect respecting socio political economic
factors can reverse all inequalities
• It is realistic to expect more definitional conceptual and
theoretical clarity as well as expect nursing to become
increasingly active in influencing the political economic
and social policy agenda at various levels
Learning Outcome 4
• Relating to your field of practice construct a critical
evaluation of the current socio political and cultural
context of public health and social policy….
• 30mins to list as many policies that shape your practice in
order to shape the health of your patient (Scenario)
• The concept that nurses care for the sick and infirm is
contested as the focus is on sustaining health and well
• Bio medical model– the absence of illness and disease
• WHO aim is to improve global health (using health
determinants and health indicators)
Sustaining Health or Curing Disease?
• Introducing Prevention
• Epidemiology John Snow
• Broad Street Pump
• 1999 Project 2000 was introduced
• 16 Years of learning how to sustain health
• Public Health and Health Promotion 20 years young!
Helping people make healthy choices!
• Ottowa Charter - a process of enabling people to exert
control over, and to improve their health.
• Done with and for not on or to people
• Changing and improving health status
Lalonde Report (1974)
• “Health is maintained and improved not only through the
advancement and application of health science but also
through the efforts and intelligent lifestyle choices of the
individual and society”
Yet another role added…..
• Lifestyle behaviours causes illness and disease
• Public Domain v Private Domain
• Assessment to determine health risks
• Preventing disease
• Advising educating to enable self control!!
• Modifying behaviours
• Review the scenario
• Sustaining the health of the Evie/Julie/Jacob/
• Self Imposed risk behaviours
• What is she/he entitled to? Support
• How is she/he protected? Law
• Family centred care? Others
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