You are on page 1of 12

1.

Introduction Nursing is a human interaction designed to promote "wholeness" through adaptation. It

course at the interface between the open and fluid boundaries of the person and his environment. Nursing care is seen as both supportive and therapeutic. The supportive aspect is designed to maintain a state of wholeness in the face o a client's failing health. Nursing is a profession as well as an academic discipline, always practiced and studied in concert with all of the disciplines that together from the health sciences. The human interaction relying on communication, rooted in the organic dependency of the individual human being in his relationships with other human beings. Nursing involves engaging in "human interactions". Some goals of nursing are as below:

A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient A human being is a social animal A human being is an constant interaction with an ever changing society To promote wholeness, realizing that every individual requires a unique and separate cluster of activities The individual integrity is his abiding concern and it is the nurses responsibility to assist him to defend and to seek its realization Human being make decision through prioritizing course of action Human being must be aware and able to contemplate objects, condition and situation Human being are agents who act deliberately to attain goal Adaptive changes involve the whole individual A human being has unity in his response to the environment Every person possesses a unique adaptive ability based on ones life experience which creates a unique message There is an order and continuity to life change is not random A human being respond organismically in an ever changing manner Change is inevitable in life Nursing needs existing and emerging demands of self care and dependent care Nursing is associated with condition of regulation of exercise or development of capabilities of providing care

2.0 2.1

Nursing Theory The Modeling and Role Modeling Theory The Modeling and Role Modeling Theory was developed by Helen C. Erickson, Evelyn

M. Tomlin, and Mary Anne P. Swain. It was first published in 1983 in their book Modeling and Role Modeling: a Theory and Paradigm for Nursing. The theory enables nurses to care for and nurture each patient with an awareness of and respect for the individual patient's uniqueness. This exemplifies theory-based clinical practice that focuses on the patient's needs. The theory draws concepts from a variety of sources. Included in the sources are Maslow's Theory of Hierarchy of Needs, Erikson's Theory of Psychosocial Stages, Piaget's Theory of Cognitive Development, and Seyle and Lazarus's General Adaptation Syndrome. The Modeling and Role Modeling Theory explains some commonalities and differences among people. The commonalities among people include:

Holism, which is the belief that people are more than the sum of their parts. Instead, mind, body, emotion, and spirit function as one unit, affecting and controlling the parts in dynamic interaction with one another. This means conscious and unconscious processes are equally important.

Basic needs, which drive behavior. Basic needs are only met when the patient perceives they are met. According to Maslow, whose hierarchical ordering of basic and growth needs is the basis for basic needs in the Modeling and Role Modeling Theory, when a need is met, it no longer exists, and growth can occur. When needs are left unmet, a situation may be perceived as a threat, leading to distress and illness. Lack of growthneed satisfaction usually provides challenging anxiety and stimulates growth. Need to know and fear of knowing are associated with meeting safety and security needs.

Affiliated Individuation is a concept unique to the Modeling and Role Modeling Theory, based on the belief that all people have an instinctual drive to be accepted and dependent on support systems throughout life, while also maintaining a sense of independence and freedom. This differs from the concept of interdependence.

Attachment and Loss addresses the idea that people have an innate drive to attach to objects that meet their needs repeatedly. They also grieve the loss of any of these objects. The loss can be real, as well as perceived or threatened. Unresolved loss leads to a lack of

resources to cope with daily stressors, which results in morbid grief and chronic need deficits.

Psychosocial Stages, based on Erikson's theory, say that task resolution depends on the degree of need satisfaction. Resolution of stage-critical tasks lead to growth-promoting or growth-impeding residual attributes that affect one's ability to be fully functional and able to respond in a healthy way to daily stressors. As each age-specific task is negotiated, the person gains enduring character-building strengths and virtues.

Cognitive Stages are based on Piaget's theory, and are the thinking abilities that develop in a sequential order. It is useful to understand the stages to determine what developmental stage the patient may have had difficulty with.

The differences among people include:

Inherent Endowment, which is genetic as well as prenatal and perinatal influences that affect health status. Model of the World is the patient's perspective of his or her own environment based on past experiences, knowledge, state in life, etc. Adaptation is the way a patient responds to stressors that are health- and growth-directed. Adaptation Potential is the individual patient's ability to cope with a stressor. This can be predicted with an assessment model that delineates three categories of coping: arousal, equilibrium, and impoverishment.

Stress is a general response to stressful stimuli in a pattern of changes involving the endocrine, GI, and lymphatic systems. Self-Care is the process of managing responses to stressors. It includes what the patient knows about him or herself, his or her resources, and his or her behaviors. Self-Care Knowledge is the information about the self that a person has concerning what promotes or interferes with his or her own health, growth, and development. This includes mind-body data.

Self-Care Resources are internal and external sources of help for coping with stressors. They develop over time as basic needs are met and developmental tasks are achieved. Self-Care Action is the development and utilization of self-care knowledge and resources to promote optimum health. This includes all conscious and unconscious behaviors directed toward health, growth, development, and adaptation.

In the theory, modeling is the process by which the nurse seeks to know and understand the patient's personal model of his or her own world, as well as learns to appreciate its value and significance. Modeling recognizes that each patient has a unique perspective of his or her own world. These perspectives are called models. The nurse uses the process to develop an image and understanding of the patient's world from that patient's unique perspective. Role modeling is the process by which the nurse facilitates and nurtures the individual in attaining, maintaining, and promoting health. It accepts the patient as he or she is unconditionally, and allows the planning of unique interventions. According to this concept, the patient is the expert in his or her own care, and knows best how he or she needs to be helped. This model gives the nurse three main roles. They are facilitation, nurturance, and unconditional acceptance. As a facilitator, the nurse helps the patient take steps toward health, including providing necessary resources and information. As a nurturer, the nurse provides care and comfort to the patient. In unconditional acceptance, the nurse accepts each patient just as he or she is without any conditions. The basic theoretical linkages used in nursing practice for this model are: developmental task resolution (residual) and need satisfaction are related; basic need status, object attachment and loss, growth and development are all interrelated; and adaptive potential and need status are related. According to the theory, the five goals of nursing intervention are to build trust, promote the patient's positive orientation, promote the patient's control, affirm and promote the patient's strengths, and set mutual, health-directed goals. Modeling refers to the development of an understanding of the patient's world, while role modeling is the nursing intervention, or nurturance, that requires unconditional acceptance. This model considers nursing as a self-care model based on the patient's perception of the world, as well as his or her adaptation to stressors. 2.2 The Theory of Goal Attainment The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. The theory explains that factors which can affect the attainment of goals are roles, stress, space, and time. The model has three interacting systems: personal, interpersonal, and social. Each of these systems has its own set of concepts. The concepts for the personal

system are perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are interaction, communication, transaction, role, and stress. The concepts for the social system are organization, authority, power, status, and decision-making. The following propositions are made in the Theory of Goal Attainment:

If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur. If the nurse and patient make transaction, the goal or goals will be achieved. If the goal or goals are achieved, satisfaction will occur. If transactions are made in nurse-patient interactions, growth and development will be enhanced. If role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur. If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur. If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement will occur.

There are also assumptions made in the model. They are:


The focus of nursing is the care of the human being (patient). The goal of nursing is the health care of both individuals and groups. Human beings are open systems interacting with their environments constantly. The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process. Patients perceive the world as a complete person making transactions with individuals and things in the environment. Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.

According to King, a human being refers to a social being that is rational and sentient. He or she has the ability to perceive, think, feel, choose, set goals, select means to achieve goals, and make decisions. He or she has three fundamental needs: the need for health information when it

is needed and can be used; the need for care that seeks to prevent illness; and the need for care when he or she is unable to help him or herself. Health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of resources to achieve maximum potential for daily living. Environment is the background for human interaction. It involves the internal and external environments. The internal environment transforms energy to enable a person to adjust to continuous external environment changes. The external environment involves formal and informal organizations. In this model, the nurse is part of the patient's environment. The Theory of Goal Attainment defines nursing as "a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation" and "a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals." In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse "includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying." The function of a professional nurse is "to interpret information in the nursing process to plan, implement, and evaluate nursing care." 2.3 Orlando's Nursing Process Discipline Theory The Dynamic Nurse-Patient Relationship, published in 1961 and written by Ida Jean Orlando, described Orlando's Nursing Process Discipline Theory. The major dimensions of the model explain that the role of the nurse is to find out and meet the patient's immediate needs for help. The patient's presenting behavior might be a cry for help. However, the help the patient needs may not be what it appears to be. Because of this, nurses have to use their own perception, thoughts about perception, or the feeling engendered from their thoughts to explore the meaning of the patient's behavior. This process helps nurses find out the nature of the patient's distress and provide the help he or she needs. The concepts of the theory are: function of professional nursing, presenting behavior, immediate reaction, nursing process discipline, and improvement. The function of professional nursing is the organizing principle. This means finding out and

meeting the patient's immediate needs for help. According to Orlando, nursing is responsive to individuals who suffer, or who anticipate a sense of helplessness. It is focused on the process of care in an immediate experience, and is concerned with providing direct assistance to a patient in whatever setting they are found in for the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the patient. The Nursing Process Discipline Theory labels the purpose of nursing to supply the help a patient needs for his or her needs to be met. That is, if the patient has an immediate need for help, and the nurse discovers and meets that need, the purpose of nursing has been achieved. Presenting behavior is the patient's problematic situation. Through the presenting behavior, the nurse finds the patient's immediate need for help. To do this, the nurse must first recognize the situation as problematic. Regardless of how the presenting behavior appears, it may represent a cry for help from the patient. The presenting behavior of the patient, which is considered the stimulus, causes an automatic internal response in the nurse, which in turn causes a response in the patient. The immediate reaction is the internal response. The patient perceives objects with his or her five senses. These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act. These three items are the patient's immediate response. The immediate response reflects how the nurse experiences his or her participation in the nurse-patient relationship. The nursing process discipline is the investigation into the patient's needs. Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his or her need, or finding out he or she has no needs at that time. The nurse cannot assume that any aspect of his or her reaction to the patient is correct, helpful, or appropriate until he or she checks the validity of it by exploring it with the patient. The nurse initiates this exploration to determine how the patient is affected by what he or she says and does. Automatic reactions are ineffective because the nurse's action is determined for reasons other than the meaning of the patient's behavior or the patient's immediate need for help. When the nurse doesn't explore the patient's reaction with him or her, it is reasonably certain that effective communication between nurse and patient stops.

3.0

Chosen Theory Orlandos Model Improvement is the resolution to the patient's situation. In the resolution, the nurse's

actions are not evaluated. Instead, the result of his or her actions is evaluated to determine whether his or her actions served to help the patient communicate his or her need for help and how it was met. In each contact, the nurse repeats a process of learning how he or she can help the patient. The nurse's own individuality, as well as that of the patient, requires going through this each time the nurse is called upon to render service to those who need him or her. Orlando's model of nursing makes the following assumptions:

When patients are unable to cope with their needs on their own, they become distressed by feelings of helplessness. In its professional character, nursing adds to the distress of the patient. Patients are unique and individual in how they respond. Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child. The practice of nursing deals with people, environment, and health. Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs. People are able to be secretive or explicit about their needs, perceptions, thoughts, and feelings. The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient. People attach meanings to situations and actions that aren't apparent to others. Patients enter into nursing care through medicine. The patient is unable to state the nature and meaning of his or her distress without the help of the nurse, or without him or her first having established a helpful relationship with the patient.

Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or her need, or finding out that he or she is not in need at that time.

Nurses are concerned with the needs the patient is unable to meet on his or her own.

The nurse uses the standard nursing process in Orlando's Nursing Process Discipline Theory, which follows: assessment, diagnosis, planning, implementation, and evaluation. The theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was the definition of the function of nursing. The model provides a framework for nursing, but the use of her theory does not exclude nurses from using other nursing theories while caring for patients. 4.0 4.1 Integration of Nursing Theory in Nursing Process First King gives detailed information about the nursing process in her model of nursing. The steps of the nursing process are: assessment, nursing diagnosis, planning, implementations, and evaluation. 4.2 Assessment The theory explains that assessment occurs during interaction. The nurse brings special knowledge and skills whereas the patient brings knowledge of him or herself, as well as the perception of problems of concern to the interaction. During the assessment, the nurse collects data regarding the patient including his or her growth and development, the perception of self, and current health status. Perception is the base for the collection and interpretation of data. Communication is required to verify the accuracy of the perception, as well as for interaction and translation. The steps are:

Collection of provocative facts through observation and interview of challenges to the internal and external environment using four conservation principles Nurses observes patient for organismic responses to illness, reads medical reports. talks to patient and family Assesses factors which challenges the individual

4.3

Diagnosis The nursing diagnosis is developed using the data collected in the assessment. In the

process of attaining goals, the nurse identifies problems, concerns, and disturbances about which the patient is seeking help. The steps are:

Nursing diagnosis-gives provocative facts meaning A nursing care judgment arrived at through the use of the scientific process Judgment is made about patients needs for assistance Implementation After the diagnosis, the nurse and other health care team members create a care plan of

4.4

interventions to solve the problems identified. The planning is represented by setting goals and making decisions about the means to achieve those goals. This part of transaction and the patient's participation is encouraged in making decisions on the means to achieve the goals. The implementation phase of the nursing process is the actual activities done to achieve the goals. In this model of nursing, it is the continuation of transaction. The steps are:

Planning Nurse proposes hypothesis about the problems and the solutions which becomes the plan of care Goal is to maintain wholeness and promoting adaptation Testing the hypothesis Interventions are designed based on the conservation principles Mutually acceptable Goal is to maintain wholeness and promoting adaptation Evaluation Evaluation involves determining whether or not goals were achieved. The explanation of

4.5

evaluation in King's theory addresses meeting goals and the effectiveness of nursing care. The steps are:

Observation of organismic response to interventions It is assesses whether hypothesis is supported or not supported. If not supported, plan is revised, new hypothesis is proposed Conclusion In conclusion, it appears that the definition of theory, nursing theory, and the criteria for

5.0

the evaluation of theory in nursing have changed over time, consistent with the expected philosophy of science. While there has been little theorizing in nursing as of late, this may be partially due to the limitations and confusion of which criteria to use to evaluate theory, or what are the characteristics of a good theory in the 90s. In addition, nurses in all roles will hopefully use these criteria proposed here to guide their choice of theory when using nursing theory in practice, education and research. While there has been a dearth of empirical testing of theories in nursing, testing is only one part of the evaluation of theory. Since there is a paucity of informed evaluation of nursing theory, a set of criteria for the evaluation of theory has been proposed here that includes: accuracy, consistency, fruitfulness, simplicity/complexity, scope, acceptability and socio-cultural utility. What has been suggested is that these criteria be seen as values, and that they can be differentially applied, individually and collectively by the profession in relationship to theory evaluation, in hopes of furthering the science of nursing (Kuhn, 1970). While the profession of nursing within each culture may be at a different phase of development, increasing the usage and development of nursing theories should be a top priority. An increase in the dialoging of theory development and its application should be encouraged. Evaluation of theory both within and among cultures should be a goal for the future for the nursing profession as a whole. It is hoped that through the use of this set of criteria new theories for and of nursing may emerge that are consistent with the 90s and beyond.

References Acton, G. J., Irvin, B. L. and Hopkins, B. A. (1991). Theory-testing research: building the science. Adv. Nuts. Sci. 14(l), 52-61. Barnum, B. J. S. (1990). Nursing Theory: Analysis, Application, Evaluation, 3rd Edn. Scott, Foreman and Co., Glenview, Illinois. Chin, P. L. and Jacobs, M. K. (1983). Theory and Nursing: A Systematic Approach. C.V. Mosby, St Louis, MO. Dickoff, J., James, P. and Wiedenbach, E. (1968). Theory in a practice discipline. Part 1: Practice oriented theories. Nurs. Res. 17(S), 415-435. Ellis, R. (1968). Characteristics of significant theories. Nurs. Res. 17(3), 217-222. Fawcett, J. (1989). Analysis and Evaluation of Conceptual Models of Nursing, 2nd Edn. F.A. Davis, Philadelphia, PA. Fitzpatrick, J. and Whall, A. (1983). Conceptual Models of Nursing: Analysis and Application. Robert J. Brady Co., Baltimore, MD. Hardy, M. E. (1974). Theories: Components, development, evaluation. In Perspectives on Nursing Theory (Nicoll, L., Ed.), pp. 342-351. Little, Brown and Co., Boston, 1986. (Reprinted from Theoretical Foundations for Nursing, NY: MSS Information Systems. Originally titled The nature of theories.) Jacox, A. K. (1974). Theory construction in nursing: an overview. Nurs. Res. 23(l), 4-13. Johnson, D. E. (1974). Development of theory: a requisite for nursing as a primary health profession.

You might also like