Dimensions Final Study Guide

Dimensions Final Study Guide Nursing Theories To analyze and understand any nursing model, it is important to look for these four key concepts: client, health, environment, and nursing. These concepts should be clearly defined, closely interrelated, and mutually supportive. Depending on the particular nursing model, one element may be emphasized more than another. The resultant role and function of the nurse depend on which element is given greater emphasis. MAJOR NURSING THEORIES AND MODELS At least 15 published nursing models (or theories) have been used to direct nursing education and nursing care.12 The six nursing models discussed here (Table 3.2) have been selected because they are the most widely accepted and are good examples of how the concepts of client, health, environment, and nursing are used to explain and guide nursing actions. Discussion of these theories is not intended to be extensive but rather to provide an overview of the main concepts of the nurse theorist. It is important to understand the terms used in the theories as defined by their authors and to see the interrelationship between the elements in each theory as well as the similarities and differences among the various models. The Roy Adaptation Model As developed by Sister Callista Roy, the Roy Adaptation Model of nursing is very closely related to systems theory.13 The main goal of this model is to allow the client to reach his or her highest level of functioning through adaptation. Client The central element in the Roy Adaptation Model is man (a generic term referring to humans in general, or the client in particular, collectively or individually). Man is viewed as a dynamic entity with both input and output. As derived from the context of the four modes in the Roy Adaptation Model, the client is defined as a biopsychosocial being who is affected by various stimuli and displays behaviors to help adapt to the stimuli. Because the client is constantly being affected by stimuli, adaptation is a continual process.13 Inputs are called stimuli and include internal stimuli that arise from within the client's environment and stimuli coming from external environmental factors such as physical surroundings, family, and society. The output in the Roy Adaptation Model is the behavior that the client demonstrates as a result of stimuli that are affecting him or her. Output, or behavior, is a very important element in the Roy Adaptation Model because it provides the baseline data about the client that the nurse obtains through assessment techniques. In this model, the output (behavior) is always modified by the client's internal attempts to adapt to the input, or stimuli. Roy has identified four internal adaptational activities that clients use and has called them the four adaptation modes: 1. The physiological mode (using internal physiological process) 2. The self-concept mode (developed throughout life by experience) 3. The role function mode (dependent on the client's relative place in society) 4. The interdependence mode (indicating how the client relates to others) Health In the Roy Adaptation Model, the concept of health is defined as the location of the client along a continuum between perfect health and complete illness. In this model, health is rarely an absolute. Rather, “a person's ability to adapt to stimuli, such as injury, disease, or even psychological stress, determines the level of that person's health status.”13 For example, a client who broke her neck in an automobile accident and was paralyzed but who eventually went back to college, obtained a law degree, and became a practicing lawyer would, in the Roy Adaptation Model, be considered to have a high degree of health because of the ability to adapt to the stimuli imposed. Environment The Roy Adaptation Model's definition of environment is synonymous with the concept of stimuli. The environment consists of all those factors that influence the client's behavior, either internally or externally. This model categorizes these environmental elements, or stimuli, into three groups: (1) focal, (2) contextual, and (3) residual. Focal stimuli are environmental factors that most directly affect the client's behavior and require most of his or her attention. Contextual stimuli form the general physical, social, and psychological environment from which the client emerges. Residual stimuli are factors in the client's past, such as personality characteristics, past experiences, religious beliefs, and social norms, that have an indirect effect on the client's health status. Residual stimuli are often very difficult to identify because they may remain hidden in the person's memory or may be an integral part of the client's personality. Nursing In the Roy Adaptation Model, nursing becomes a multistep process, similar to the nursing process, to aid and support the client's attempt to adapt to stimuli in one or more of the four adaptive modes. To determine what type of help is required to promote adaptation, the nurse must first assess the client. Assessment The primary nursing assessments are of the client's behavior (output). Basically, the nurse should try to determine whether the client's behavior is adaptive or maladaptive in each of the four adaptational modes previously defined. Some first-level assessments of the client with pneumonia might include a temperature of 104°F, a cough productive of thick green sputum, chest pain on inspiration, and signs of weakness or physical debility, such as the inability to bring in wood for the fireplace or to visit friends. A second-level assessment should also be made to determine what type of stimuli (input) is affecting the client's health-care status. In the case of the pneumonia client, this might include a culture and sensitivity test of the sputum to identify the invasive bacteria, assessment of the client's clothes to determine whether they were adequate for the weather outside, and an investigation to find out whether any neighbors could help the client upon discharge from the hospital. Analysis After performing the assessment, the nurse analyzes the data and arranges them in such a way as to be able to make a statement about the client's adaptive or maladaptive behaviors—that is, the nurse identifies the problem. In current terminology, this identification of the problem is called a nursing diagnosis. The problem statement is the first part of the three-part PES (problem–etiology–signs and symptoms) formulation that completes the nursing diagnosis (Fig. 3.1). Setting Goals After the problem has been identified, goals for optimal adaptation are established. Ideally, these goals should be a collaborative effort between the nurse and the client. A determination of the actions needed to achieve the goals is the next step in the process. The focus should be on manipulation of the stimuli to promote optimal adaptation. Finally, an evaluation is made of the whole process to determine whether the goals have been met. If the goals have not been met, the nurse must determine why, not how, the activities should be modified to achieve the goals.11 The Orem Self-Care Model Dorothea E. Orem's model of nursing is based on the belief that health care is each individual's own responsibility. The aim of this model is to help clients direct and carry out activities that maintain or improve their health.14 Client As with most other nursing models, the central element of the Orem model is the client, who is a biological, psychological, and social being with the capacity for self-care. Self-care is defined as the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. Self-care is a requirement for maintenance of life and for optimal functioning. Health In the Orem Self-Care Model, health is defined as the person's ability to live fully within a particular physical, biological, and social environment, achieving a higher level of functioning that distinguishes the person from lower life-forms. Quality of life is an extremely important element in this model of nursing. A person who is healthy is living life to the fullest and has the capacity to continue that life through self-care. An unhealthy person is an individual who has a self-care deficit. This group of unhealthy individuals also includes adults with diseases and injuries, young and dependent children, elderly people, and disabled people. This deficit is indicated by the inability to carry out one or more of the key health-care activities. These activities have been categorized into six groups: • Air, water, and food • Excretion of waste • Activity and rest • Solitude and social interactions • Avoiding hazards to life and well-being • Being normal mentally under universal self-care Self-Care In the Orem model, self-care is a two-part concept. The first type of self-care is called universal self-care and includes those elements ………………………..CONTINUED……………………………