new trends in nursing

1. Nursing Theory

2. Outlines:
Defintion of cocept, phenomena and theory
Common concepts in nursing theories
Types of the theory
Most common theories and their applications

3. Most common theories:
Environmental theory
Roper-Logan-Tierney Model of Living
self care deficit theory
Peplau's interpersonal relations model
 Roy Adaptation Model

4. Enviromental theory
As the founder of modern nursing, Florence Nightingale's
Environment Theory changed the face of nursing practice. The
model of nursing that developed from Nightingale, who is
considered the first nursing theorist, contains elements that
have not changed since the establishment of the modern
nursing profession. Though this theory was pioneering at the
time it was created, the principles it applies are timeless.

5. The Environment Theory of nursing is a patient-care theory. That is, it
focuses on the care of the patient rather than the nursing process, the
relationship between patient and nurse, or the individual nurse. In this
way, the model must be adapted to fit the needs of individual patients
The ten major concepts of the Environment Theory, also identified
as Nightingale's Canons, are:
1. Ventilation and warming
2. Light and noise
3. Cleanliness of area
4. Bed and bedding

6. 6. Personal cleanlines
7. Variety
8. Offering hope and advice
9. Food
10. Observation
According to Nightingale, nursing is separate from medicine.
The goal of nursing is to put the patient in the best possible
condition in order for nature to act. Nursing is "the activities

8. Roper-Logan-Tierney Model of Living
• The Roper-Logan-Tierney Model for Nursing is a theory of
nursing care based on activities of daily living, which are
often abbreviated ADLs or ALs. It is often used to assess how
the life of a patient has changed due to illness, injury, or
admission to a hospital rather than as a way of planning for
increasing independence and quality of life.

9. The activities of living listed in the Roper-Logan-Tierney
Model of Nursing are:
- maintaining a safe environment. - communication.
- breathing. - eating and drinking.
- elimination. - washing and dressing.
- controlling temperature. - mobilization.
- working and playing. - sleeping.
The list also includes death and sexuality as activities of daily
living, but these are often disregarded depending on the setting
and situation for the individual patient.

10. • According to the model, there are five factors that influence the
activities of living. They are used to determine the individual
patient's relative independence in regards to the activities of daily
living.
• They are: biological, psychological, sociocultural, environmental,
and politicoeconomic. The biological factor addresses the impact
of the overall health, of current injury and illness, and the scope
of the patient's anatomy and physiology. The psychological
factor addresses the impact of emotion, cognition, spiritual
beliefs, and the ability to understand. According to Roper, this is
about "knowing, thinking,' hoping, feeling and believing."

11. • The sociocultural factor is the impact of society and culture
as experienced by the individual patient. This includes
expectations and values based on class and status, and culture
within the sociocultural factor relates to the beliefs,
expectations, and values held by the individual patient for
him or herself, as well as by others pertaining to
independence in and ability to carry out the activities of daily
living.

12. • The environmental factor in Roper's theory of nursing makes
it a "green" model. The theory takes into consideration the
impact of the environment on the activities of daily living, but
also examines the impact of the activities of daily living on
the environment. The politicoeconomic factor is the impact of
the government, politics, and economy on the activities of
daily living. This factor addresses issues such as funding,
government policies and programs, war or conflict,
availability to benefits, political reforms, interest rates, and
availability of public and private funding, among others.

18. Self Care Deficit Theory
• developed as a result of Dorothea E. Orem working toward
her goal of improving the quality of nursing in general
hospitals in her state.
• The theory is relatively simple, but generalizable to apply to a
wide variety of patients. It can be used by nurses to guide and
improve practice.
• Orem's theory is comprised of three related parts: theory of
self-care; theory of self-care deficit; and theory of nursing
system.

19. The major assumptions of Orem's Self-Care Deficit
Theory are:
1. People should be self-reliant, and responsible for their care,
as well as others in their family who need care.
2. People are distinct individuals
3. Nursing is a form of action it is an interaction between two
or more people
4. A person’s knowledge of potential health problems is needed
for promoting self-care behaviors
5. Self-care and dependant care are behaviours learned within
a socio-cultural context .

20. • The theory of self-care includes self-care, which is the
practice of activities that an individual initiates and performs
on his or her own behalf to maintain life, health, and well-
being; self-care agency, which is a human ability that is "the
ability for engaging in self-care," conditioned by age,
developmental state, life experience, socio-cultural
orientation, health, and available resources; therapeutic self-
care demand, which is the total self-care actions to be
performed over a specific duration to meet self-care requisites
by using valid methods and related sets of operations and
actions; and self-care requisites, which include the categories
of universal, developmental, and health deviation self-care
requisites.

21. Universal self-care requisites are associated with life processes,
as well as the maintenance of the integrity of human structure
and functioning. Orem identifies these requisites, also called
activities of daily living, or ADLs, as:
1. the maintenance of sufficient intake of air, food, and water
2. provision of care associated with the elimination process
3. a balance between activities and rest, as well as between
solitude and social interaction
4. the prevention of hazards to human life and well-being
5. the promotion of human functioning

22. • The second part of the theory, self-care deficit, specifies when
nursing is needed. According to Orem, nursing is required when
an adult is incapable or limited in the provision of continuous,
effective self-care. The theory identifies five methods of helping:
acting for and doing for others; guiding others; supporting another;
providing an environment promoting personal development in
relation to meet future demands; and teaching another.
• The theory of nursing systems describes how the patient's self-care
needs will be met by the nurse, the patient, or by both. Orem
identifies three classifications of nursing system to meet the self-
care requisites of the patient: wholly compensatory system, partly
compensatory system, and supportive-educative system.

23. • The nursing process in this model has three parts. First is the
assessment, which collects data to determine the problem or
concern that needs to be addressed. The next step is the
diagnosis and creation of a nursing care plan. The third and
final step of the nursing process is implementation and
evaluation. The nurse sets the health care plan into motion to
meet the goals set by the patient and his or her health care
team, and, when finished, evaluate the nursing care by
interpreting the results of the implementation of the plan

24. Peplau's interpersonal relations model
• (Interpersonal communication)
• Hildegard peplau, introduced her interpersonal concepts in
1952 as one of
• the first model of psychiatric nursing care. Nurses enter into a
personal
• relationship with an individual when a need is present. The
nurse-patient

25. Relationship evolves in four phases:
1. Orientation:
• During this phase, the individual has a felt need and seeks
professional assistance.
• The nurse helps the individual to recognize and understand
his/ her problem and determine the need for help.
2. Identification
• The patient identifies with those who can help him/ her.
• The nurse permits exploration of feelings to aid the patient in
undergoing illness as an experience that reorients feelings and
strengthens positive forces in the personality and provides
needed satisfaction.

26. 3. Exploitation
• During this phase, the patient attempts to derive full value
from what he/ she are offered through the relationship.
• The nurse can project new goals to be achieved through
personal effort and power shifts from the nurse to the patient
as the patient delays gratification to achieve the newly
formed goals.
4. Resolution
• The patient gradually puts aside old goals and adopts new
goals. This is a process in which the patient frees himself
from identification with the nurse.

27. • The nurse has a variety of roles in Hildegard Peplau's nursing
theory:
• As a stranger, the nurse receives the patient in the same way
the patient meets a stranger in other life situations. The nurse
should create an environment that builds trust.
• As a teacher, the nurse imparts knowledge in reference to the
needs or interests of the patient. In this way, the nurse is also
a resource person, providing specific information needed by
the patient that helps the patient understand a problem or
situation.

28. • The nurse's role as a counselor helps the patient understand and
integrate the meaning of current life situations, as well as provide
guidance and encouragement in order to make changes.
• As a surrogate, the nurse helps the patient clarify the domains of
dependence, interdependence, and independence, and acts as an
advocate for the patient.
• As a leader, the nurse helps the patient take on maximum
responsibility for meeting his or her treatment goals.
• Additional roles of a nurse include technical expert, consultant,
tutor, socializing and safety agent, environment manager, mediator,
administrator, record observer, and researcher.

37. Roy Adaptation Model
• The Adaptation Model of Nursing was developed by Sister
Callista Roy in 1976. After working with Dorothy E. Johnson,
Roy became convinced of the importance of describing the
nature of nursing as a service to society.
• Roy's model asks the questions:
• Who is the focus of nursing care?
• What is the target of nursing care?
• When is nursing care indicated?

38. • Roy explained that adaptation occurs when people respond
positively to environmental changes, and it is the process and
outcome of individuals and groups who use conscious
awareness, self-reflection, and choice to create human and
environmental integration.
• The key concepts of Roy's Adaptation Model are made up of
four components: person, health, environment, and nursing.

39. • According to Roy's model, a person is a bio-psycho-social
being in constant interaction with a changing environment.
He or she uses innate and acquired mechanisms to adapt. The
model includes people as individuals, as well as in groups
such as families, organizations, and communities. This also
includes society as a whole.
• The Adaptation Model states that health is an inevitable
dimension of a person's life, and is represented by a health-
illness continuum. Health is also described as a state and
process of being and becoming integrated and whole.

40. • The environment has three components: focal, which is
internal or external and immediately confronts the person;
contextual, which is all stimuli present in the situation that all
contribute to the effect of the focal stimulus; and residual,
whose effects in the current situation are unclear. All
conditions, circumstances, and influences surrounding and
affecting the development and behavior of people and groups
with particular consideration of mutuality of person and earth
resources, including focal, contextual, and residual stimuli.

41. There are also four implicit assumptions which state:
1. A person can be reduced to parts for study and care.
2. Nursing is based on causality.
3. A patient's values and opinions should be considered and
respected.
4. A state of adaptation frees a person's energy to respond to
other stimuli.

42. • The goal of nursing is to promote adaptation in the four
adaptive modes. Nurses also promote adaptation for
individuals and groups in the four adaptive modes, thus
contributing to health, quality of life, and dying with dignity
by assessing behaviors and factors that influence adaptive
abilities and by intervening to enhance environmental
interactions. The Four Adaptive Modes of Roy's Adaptation
Model are physiologic needs, self-concept, role function, and
interdependence.

43. The Adaptation Model includes a six-step nursing process.
1. The first level of assessment, which addresses the patient's behavior
2. The second level of assessment, which addresses the patient's stimul
3. Diagnosis of the patient
4. Setting goals for the patient's health
5. Intervention to take actions in order to meet those goals
6. Evaluation of the result to determine if goals were met
• Throughout the nursing process, the nurse and other health care
professionals should make adaptations to the nursing care plan based
on the patient's progress toward health.