TEST BANK FOR NURSING THEORIES AND NURSING PRACTICE 4TH EDITION BY PARKER SMITH

Chapter 1 TEST BANK FOR NURSING THEORIES AND NURSING PRACTICE 4TH EDITION BY PARKER SMITH Chapter 1 Statement of Intent The intent of this chapter is to offer an approach to understanding nursing theory within the context of the discipline of nursing, define the discipline of nursing and theory, describe the purpose of theory for the discipline of nursing, identify the structure of the discipline of nursing, and speculate on the future of nursing theory. Chapter 1 Key Terms Nursing Community of scholars Nursing knowledge Discipline Professional practice Theory Paradigm Worldviews Framework Metaparadigm Philosophy Conceptual model Grand theory Middle-range theory Nursing practice theory Clinical scholarship Empirical indicators Domain Caring Environment Persons Health Syntactical structure Conceptual structure Specialized language Tradition Values and beliefs Practice-level theory Nursing process Chapter 1 Objectives On completion of this chapter, students will be able to: 1. Compare and contrast definitions of nursing. 2. Describe the usefulness of theory to everyday practice. 3. Identify four phenomena of interest to nursing. 4. Name the primary purpose of nursing theory. 5. Describe characteristics of nursing as a discipline. 6. Discuss the importance of conceptualizing nursing as a discipline of knowledge. 7. Compare and contrast definitions of nursing theory. Chapter 1 Outline What Is Nursing? Problems with Defining Nursing by Process, Functions, or Activities The Discipline of Nursing Expression of Human Imagination Domain Syntactical and Conceptual Structures Specialized Language and Symbols Heritage of Literature and Networks of Communication Tradition Values and Beliefs Systems of Education Definitions of Nursing Theory As a General Term As an Organizing Structure Definitions from Other Disciplines Definitions Used in Nursing Practice, Education, Administration, or Research The Purpose of Theory in a Professional Discipline Structure Further Development and Understanding of Nursing Practice Multidisciplinary Collaboration The Structure of Knowledge in the Discipline of Nursing Paradigm Grand Theories and Conceptual Models Middle-Range Theories Practice-Level Theories Nursing Theory and the Future Continuing Evolution of the Discipline of Nursing Use in Education Use in Health Care Organizations Expanded Use of Theory Summary References Chapter 1 Questions for Classroom Discussion 1. Before taking this class, what was your definition of nursing? 2. How does knowledge become ―nursing knowledge‖? 3. What does the term ―language of nursing‖ mean to you? Identify practice examples in which use of the ―language of nursing‖ can be explicated. 4. What is your understanding of the statement ―Nursing is a discipline‖? Chapter 1 Multiple-Choice Questions (Answers appear in bold) 1. Every discipline has a unique focus that directs inquiry and distinguishes it from other fields of study. A. True B. False 2. The purpose of theory is to: A. Explain experience B. Describe relationships C. Project outcomes D. All of the above 3. Members of a community of scholars share a commitment to all of the following except: A. Values B. Knowledge C. Geographic location D. Processes 4. and structures are essential to any discipline and are inherent in nursing theories. A. Paradigm and metaparadigm B. Syntactical and conceptual C. Middle and grand D. Language and symbol 5. Books and periodicals are examples of . A. Communication networks B. Heritage of literature C. Nursing organizations D. Nursing discipline 6. Theories are not discovered in nature but are human inventions A. True B. False 7. The basic building blocks of theories are: A. Concepts and their definitions B. Statements of relationships C. Concepts and statements of relationships D. Empirical indicators 8. Nursing theories: A. Are discovered in nature. B. Serve as exact representations of reality. C. Are invented by humans. D. Cannot be modified. 9. A paradigm is defined as a: A. Worldview B. General framework C. Shared perspectives held by members of a discipline D. All of the above 10. Science generally evolves as a smooth, regular, continuing path of knowledge development over time. A. True B. False 11. The dependence of nursing theory development on human imagination is an attribute of nursing as a(n): A. Occupation B. Discipline C. Vocation D. Profession 12. The primary purpose of nursing theory is to: A. Structure nursing knowledge. B. Demonstrate creativity in nursing. C. Guide the thinking about, being, and doing of nursing. D. Organize nursing curricula. 13. The first nursing theorist who identified the importance of theory in nursing was: A. Virginia Henderson B. Hildegard Peplau C. Lydia Hall D. Florence Nightingale 14. Early nursing theorists relied on definitions of theory from nursing practice to guide the development of theories within nursing. A. True B. False 15. The most abstract level of knowledge is: A. Paradigm B. Metaparadigm C. Theory D. Concept 16. Statements of enduring values or beliefs are considered: A. Conceptual Models B. Philosophies C. Grand Theories D. Practice Theories 17. Theories that include specific concepts, are broad enough to be useful in complex situations, and can be empirically tested are called: A. Grand Theories B. Middle-Range Theories C. Practice-Level Theories D. Nursing Theories 18. Theories that have the most limited scope and level of abstraction that are useful in within a specific range of nursing situations are called: A. Grand Theories B. Middle-Range Theories C. Practice-Level Theories D. Nursing Theories 19. The name for the boundaries or focus of a discipline is: A. Imagination B. Domain C. Tradition D. Value 20. The best test of any nursing theory is its usefulness in professional practice. A. True B. False Chapter 2 Statement of Intent The intent of this chapter is to offer a guide to a disciplined approach for the study of nursing theory. A set of questions is provided intended to facilitate reflection and exploration leading to a selection of a nursing theory for use in practice. Chapter 2 Key Terms Studying nursing theory Guiding questions Scope of nursing Theory analysis and evaluation Theory-based practice Analysis and evaluation Values and beliefs Preparation, judgment, and justification Boundaries Nursing situation Chapter 2 Objectives On completion of this chapter, students will be able to: 1. Discuss the importance of guiding questions for the study of nursing theory. 2. Identify and discuss four specific issues important to nurses who consider the study of nursing theory. Chapter 2 Outline Study of Theory for Nursing Practice Importance of Guiding Questions Guide for the Study of Nursing Theory in Practice How is nursing conceptualized? Is the focus stated? What is the purpose of nursing? What are the boundaries of nursing? How can nursing situations be described? What is the context of the theory development? Who is the nurse theorist as person and as a nurse? What are major theoretical influences on this theory? What were major external influences on development of the theory? Who are authoritative sources for information about development, evaluation and use of this theory? Who are the nursing authorities who speak about, write about, and use the theory? What major resources are authoritative sources on the theory? How can the overall significance of the nursing theory be described? What is the importance of the nursing theory over time? What is the experience of nurses who report consistent use of the theory? What are projected influences of the theory on nursing‘s future? Summary References Chapter 2 Questions for Classroom Discussion 1. Who controls the practice of nursing? How is your personal practice controlled day-to-day? Think of an exemplar in which you felt strongly in control of your practice. Write it down and reflect on the image portrayed in your narrative. How might nursing theory influence your practice of nursing? 2. As a discipline, what knowledge and/or technology would you like to see nursing claim? Chapter 2 Multiple-Choice Questions (Answers appear in bold) 1. The guide for the selection of nursing theory presented in your text is a set of questions that facilitate reflection and exploration in the study of nursing theory that can lead to the selection of a nursing theory for use in your practice. A. True B. False 2. One criterion for hospitals seeking magnet hospital status is selection of a theoretical model for nursing practice. A. True B. False 3. It is not necessary or desirable for the study and use of nursing theory to have roots in the everyday practice of nursing. A. True B. False 4. The scope of nursing practice is: A. Known and static B. Continually being expanded C. Determined only by individual researchers D. Important only to nurses with advanced degrees 5. The question ―What does the nurse attend to when practicing nursing?‖ relates to which of the following areas of the theory guide? A. How nursing is conceptualized B. The context of theory development C. Authoritative sources D. Overall theory significance 6. Nursing theorists and nurses in practice: A. Are interested in related but different phenomena. B. Do not see nursing in the same context. C. Think and work with the same phenomena. D. Require the same knowledge and skills. 7. Key ways to study nursing include analysis and evaluation. A. True B. False 8. The study of nursing theory: A. Is a simple, short-term endeavor. B. Can be easily undertaken. C. Requires a continuing commitment. D. Is not essential for expert nursing practice. 9. The question ―What nursing societies share and support work of the theory?‖ relates to which of the following areas of the theory guide? A. How nursing is conceptualized B. The context of theory development C. Authoritative sources D. Overall theory significance 10. The question ―Is the theory used to guide programs of nursing education?‖ relates to which of the following areas of the theory guide? A. How nursing is conceptualized B. The context of theory development C. Authoritative sources D. Overall theory significance Chapter 3 Statement of Intent The intent of this chapter is to describe the processes leading to implementation of nursing theory-guided practice models. Processes include choosing possible theories of use in practice, analyzing and evaluating these theories, and implementing theory in practice. Chapter 3 Key Terms Scope of nursing practice Choosing Values and beliefs Nursing situations Theory-guided practice Connecting values Creative nursing practice Ways of knowing Theoretical frames of reference Theory evaluation guides Empirical knowing Personal knowing Ethical knowing Esthetic knowing Chapter 3 Objectives On completion of this chapter, students will be able to: 1. Describe the significance of nursing theory for nursing practice. 2. Identify questions from practicing nurses about using nursing theory. 3. Compare and contrast five approaches to evaluating nursing theory. 4. Demonstrate the use of study guides to direct the analysis and evaluation of selected nursing theorists. 5. Articulate a process for implementing theory-guided practice. Chapter 3 Outline Significance of Nursing Theory for Nursing Practice Nursing Practice as Essential for Developing, Testing, and Refining Nursing Theory Creative Nursing Practice Theoretical Frames of Reference Depth and Scope of Nursing Practice Responses to Questions from Practicing Nurses About Using Nursing Theory My Nursing Practice My Personal Interests, Abilities, and Experiences Resources and Support The Theorist, Evidence, and Opinion Choosing a Nursing Theory to Study Importance and Significance of Choosing Hope and Anxiety A Reflective Exercise for Choosing a Nursing Theory for Practice Enduring Values Nursing Situations Connecting Values and the Nursing Situation Verifying Awareness and Appreciation Multiple Ways of Knowing and Reflecting on Nursing Theory Empirical Knowing Personal Knowing Ethical Knowing Esthetic Knowing Using Insights to Choose Theory Evaluation of Nursing Theory Process of Making a Determination About the Value, Worth, and Significance of a Theory Addressing the Whole Theory Level and Scope Theory Evaluation Guides Johnson (1974) Chinn and Kramer (2004) Fawcett (2000) Melesis (1997) Smith (2008) Implementing Theory-Guided Practice Gaining Administrative Support Selecting a Model or Theory to Be Used in Practice Launching the Imitative Creating a Plan for Evaluation Consistent and Constant Support and Education Periodic Feedback Re-visioning of the Theory-Guided Practice Model Summary References Chapter 3 Questions for Classroom Discussion 1. Form small classroom groups (two or three students). After you have completed the Reflective Exercise described in your text, identify a value that you believe strongly influences your understanding of nursing. Draw a picture or take a photograph that you believe demonstrates that value as it is lived in nursing. Share the artwork/photograph with your groupmates and ask them: What do you think/see when you look at this? After they have shared their thoughts, discuss the value you were trying to portray. Discuss any shared values that were depicted within the group. 2. In small groups, share a brief description of a nursing situation. As a group, list as many values guiding nursing that you can. Write down whatever comes to mind (the goal is to generate as many listings as you can—do not edit responses at this point). Discuss the responses and edit the list to consolidate those listings that seem to convey a similar value. Have each group member individually rate the values in order of their importance with a numerical score. Share your priorities with the group. Discuss the commonalities and differences. How might practice be influenced from a set of hierarchical values? Chapter 3 Multiple-Choice Questions (Answers appear in bold) 1. The primary purpose of nursing theory is to: A. Improve nursing practice. B. Control health care costs. C. Justify nursing costs. D. Establish nursing as a discipline. 2. One of the most urgent issues facing the discipline of nursing is the artificial separation of theory and practice. A. True B. False 3. Theories of any professional discipline are useless if they do not have an impact on practice. A. True B. False 4. Nursing practice is essential for all of the following except: A. Developing nursing theory B. Testing nursing theory C. Refining nursing theory D. Discovering nursing theory 5. Historically, nursing has always been distinctly separate from the medical model. A. True B. False 6. Nurses working together as colleagues often realize that: A. Their views of nursing are not compatible. B. They share the same values and beliefs. C. The study of nursing theory does not enhance their work. D. None of the above 7. Responses to guiding questions about theory in practice can be found in the following resources: A. Nursing literature B. Audiovisual sources C. Electronic sources D. All of the above 8. How we come to know the science of nursing and other disciplines that are used in nursing practice was described by Carper as: A. Empirical knowing B. Personal knowing C. Ethical knowing D. Esthetic knowing 9. How we come to know the moral component guiding choices within the complexity of health care that guide day-to-day actions in nursing practice was described by Carper as: A. Empirical knowing B. Personal knowing C. Ethical knowing D. Esthetic knowing 10. Striving to know the self and to actualize authentic relationships between the nurse and the one nursed was described by Carper as: A. Empirical knowing B. Personal knowing C. Ethical knowing D. Esthetic knowing Chapter 4 Statement of Intent This chapter explores the life of Florence Nightingale and her contributions to nursing. A biographical account is provided that addresses her education, travel, spiritual background, and Crimean War experiences. The medical environment of the 1800s and her views of women during that time are also presented. An overview is provided for the foundations of Nightingale‘s model of nursing and how it is interpreted today. Chapter 4 Key Terms Spirituality Crimean War Moral Authority Atmosphere Environment Sickness Contagionism Feminism Expressions of Caring Laws of Nursing Laws of Health Health of Houses Observation Personal Cleanliness Petty Management Light Cleanliness of Rooms Ventilation and Warming Bed and Bedding Taking Food What Food? Noise Chattering Hopes and Advices Variety Chapter 4 Objectives On completion of this chapter, students will be able to: 1. Summarize significant events in Nightingale‘s life that led her to nursing and influenced the development of her model of nursing. 2. Discuss the influence of Nightingale‘s spirituality on her practice of nursing. 3. Compare and contrast the medical milieu of the 1800s with the medical milieu of today. 4. Discuss the impact of Nightingale‘s feminist view within the context of her work. 5. Discuss Nightingale‘s conception of nursing and analyze the elements of Nightingale‘s Theory of Nursing. 6. Identify the expressions of caring that are essential components of Nightingale‘s Theory of Nursing. 7. Discuss Nightingale‘s assumptions and their relevance and application to nursing today. 8. Identify ways to apply Nightingale‘s Environmental Model to the current practice of nursing. 9. Identify and discuss the application of the four major factors that influenced Nightingale‘s Model (Environmental Model) to current nursing practice. Chapter 4 Outline Introduction the Theorist Foundation of Nursing Practice Call to Serve Justice-Making Early Life and Education Family Travel Kaiserworth Spirituality Science and Spirituality Truth Seeking War Crimean War Experience Breaking Gender Barriers Battle Front Innovations Introduction to the Theory Role of Observation Defining Disease The Medical Milieu 19th Century Medicine Paradigm Shift Origins of Disease The Feminist Context of Nightingale‘s Caring Respectable Profession Moral Role Cultural Feminism Ideas About Nursing Notes on Nursing: What It Is; What It Is Not Nursing as a Science Statistics Nightingale‘s Assumptions Goal of Nursing Education Environment Nightingale‘s Legacy for 21st-Century Nursing Practice Caring Activism Applications: Nightingale‘s Legacy of Caring Chapter 4 Questions for Classroom Discussion 1. In Nightingale‘s mind a specific function of nursing was to ―put the patient in the best condition for nature to act upon him. What was the meaning of this perpsective? What can nurses do in contemporary nursing practice to implement this function of patient care? 2. How does Nightingale‘s legacy for 21st-century nursing practice create an environment for evidence-based practice in the current hospital or community setting? Discuss nursing situations that would validate your thoughts. 3. Discuss how Nightingale‘s concepts might decrease hospital-acquired infections and the impact on patient recovery. Develop one hypothesis statement clarifying the relationship beween envrionmentally and hospital-acquired infections. Chapter 4 Multiple-Choice Questions (Answers appear in bold) 1. Nightingale proposed nursing as: A. An extension of the environment B. An art and a science C. Empirical science D. Physician‘s handmaiden 2. Nightingale defined a nurse as any woman who had ―charge of the personal health of somebody‖ whether well, as in caring for babies and children, or sick, as an ―invalid‖ (Nightingale, 1860/1969). It was assumed that all women: A. One time or another in their lives, would nurse B. Needed to know the laws of health C. Nursing proper, or ―sick‖ nursing, was both an art and a science and required organized, formal education to care for those suffering from disease. D. All of the above 3. The goal of nursing as described by Nightingale is: A. Work collaboratively with the physician to implement the medical orders. B. Take care of the patient‘s environment by maintaining cooking, cleaning, and scrubbing the floors. C. Assisting the patient in his or her retention of ―vital powers‖ by meeting his or her needs, thus putting the patient in the best condition for nature to act upon. D. Giving the patient medicine when the medicine is due. 4. Nightingale isolated five environmental components essential to an individual‘s health. Select the correct grouping from the following: A. Calming colors, quiet, comfortable temperature, clean air, pure water B. Clean air, pure water, efficient drainage, cleanliness, and light C. Light, color, sound, smell, temperature D. Pure food, clean water, cleanliness, quiet, calming color 5. In Nightingale‘s mind, the specific ―scientific‖ activity of nursing that was the central element in health care, without which medicine and surgery would be ineffective is which of the following: A. Preparing nutritious meals B. Maintaining an aesthetic environment C. Maintaining hygiene D. Sustaining a quiet environment 6. In the mid-19th century , there were two competing theories regarding the nature and origin of disease. These competing thoeries were: A. Localization and specificity B. Contagionism and quarantine C. Vectorism and pollution D. Atmosphere and environment 7. According to Nightingale, a nurse is defined as: A. The handmaiden of the physician B. A member of the moral majority C. Any woman who had charge of the personal health of somebody, whether well or sick. D. An individual who felt a calling to take charge of the sick 8. The patient is at the center of the Nightingale model and incorporates: A. A holistic view of the person B. Psychological, intellectual, and spiritual components C. A unique individual filled with chttering hopes and advice D. A & B E. All of the above. 9. According to Nightingale, health is viewed as: A. An additive process B. The result of environmental, physical, and psychological factors C. The absence of illness D. A & B E. All of the above 10. Cultural feminism is defined as: A. Women are a product of the culture. B. A belief in inherent gender differences C. The emancipation of women as a cultural fad. D. The corruption of women by masculine politics . Chapter 4: Florence Nightingale‘s Legacy of Caring and Its Applications Instructions: Read the case study and answer the questions that follow. The Community Health Nurse knocked softly before entering Isabel‘s bedroom. On this home visit Isabel was holding her 3-week-old baby girl, Pearl, while 2-year-old Jerry was sitting on the floor playing with a cat. In one corner, a full litter box sat on the floor next to the changing table. The nurse noted two half- empty 4-oz formula bottles on the changing table, an empty box of baby wipes, and three soiled cloth diapers. Looking into Pearl‘s sleeping face, Isabel said ―She‘s finally fell asleep…I am so tired…Jerry stop teasing Freckles (the cat) and come over here and hold Pearl while I get something to drink…do you want something to drink?‖ The nurse quickly scanned the room, seeing an unmade bed with a bassinet wedged against the wall. Jerry‘s bed, also unmade, was in the corner opposite the litter box. The small bedroom was stifling hot, the ceiling fan was not on, and the windows were closed. A table in the middle of the room had plates with partially eaten sandwiches and half-finished cans of soda. 1. Based on this case study how would the nurse practicing from Nightingale‘s theory begin her home visit? What would be the priority for the nurse in this situation? 2. How might Nightingale‘s understanding of sanitation and environment guide the nurse in her home visit? 3. How could the nurse develop a relationship with Isabel and return as a welcomed visitor in Isabel‘s ―home‖? Guided Response (Answer) for Instructors: 1. Nightingale focuses on the concepts of the patient in relationship with the environment, sanitation or hygiene, observation skills, and empirical knowledge. The priority for the nurse would be the safety of the patient in this environment. This requires the nurse to draw upon empirical knowledge and experience to place the patient ―in the best condition for nature to act upon‖ (Nightingale, 1860/1969). 2. According to Nightingale, important things to consider include: Sanitation—litter box, formula bottles, soiled diapers, food and drink left in the open Environment—the above with the addition of ventilation, light, pleasant surroundings Empirical knowledge a. Isabel—postpartum health, hydration, nutrition and personal cleanliness, and follow-up health care provider visits b. Pearl—hydration, weight gain, number of diapers soiled per day, color of skin, stool and urine. Physical evaluation for reflexes/responses c. Jerry—general health, mental and physical development and nutrition 3. Nightingale reminds us the nurse is a guest in someone else‘s environment. Consistent with Nightingale‘s assertion of nurse as guest, the community nurse might begin the visit with a simple question such as ―How may I help you?‖ This question opens the door for communication and would give Isabel an opportunity to begin the visit by expressing her needs first. Ask students to consider how Isabel might respond to this open-ended question, what follow-up questions they might ask, and what nursing activities might be useful from Nightingale‘s perspective. Chapter 5 Statement of Intent This chapter provides a brief overview of each of three important 20th century nursing theorists: Wiedenbach, Henderson, and Hall. The content of the chapter has been taken from that written by scholars who have studied or worked with these theorists and who wrote chapters about each for the first edition of Nursing Theories and Nursing Practice. For a wealth of additional information on these nurses, scholars, researchers, thinkers, writers, practitioners, and educators, please consult the separate reference and bibliography sections at the end of the chapter. Chapter 5 Key Terms Focus on patient Definitions of nursing Important influences on nursing theory development Professional practice Prescriptive theory Nursing practice theory Goal-directed care Dynamic nursing Motivating factors Care Cure Core Trade vs. profession Therapeutic effect Definition of nursing Nursing functions Caring based Basic nursing care Chapter 5 Objectives On completion of this chapter, students will be able to: 1. Describe the historical, educational, and career trajectories of each theorist. 2. Describe the impact that Wiedenbach, Henderson, and Hall had on the development of nursing knowledge. 3. Discuss the relevance of the basic principles proposed by these theorists to the current practice of nursing. 4. Identify the major contribution that each theorist to the development of nursing knowledge. 5. Explore and describe each theorist‘s unique approach and process of developing a theoretical framework for nursing practice. 6. Examine the theoretical perspectives of each theory and identify commonalities and differences among the theories. Chapter 5 Outline Introducing the Theorists Ernestine Wiedenbach Virginia Henderson Lydia Hall Introducing the Theories Ernestine Wiedenbach Prescriptive Theory Central Purpose Nurse‘s Goals Virginia Henderson Function of Nursing Definition of Nursing Fourteen Components of Basic Nursing Care Lydia Hall Hall‘s Care, Cure, and Core Model Care Cure Core Practice Applications Ernestine Wiedenbach A Concept of Dynamic Nursing Virginia Henderson Basic Principles of Nursing Care (1960) The Nature of Nursing (1966) Functions Pertaining to the Care of Patients Definition of Nursing Lydia Hall Practice Exemplars Practice Exemplar Wiedenbach Practice Exemplar Henderson Practice Exemplar Hall Summary References Chapter 5 Questions for Classroom Discussion 1. Virginia Henderson has been referred to as the modern-day Florence Nightingale. Examining Henderson‘s 14 components of basic nursing care, identify parallels in her theoretical structure that are consistent with Nightingale‘s theory of nursing. 2. Wiedenbach emphasized that the nurse‘s goals are grounded in the nurse‘s philosophy, or ―those beliefs and values that shape one‘s attitude toward life, toward fellow human beings, and toward herself.‖ Write a paragraph for each of the following philosophic considerations that are relevant for nursing practice: a. What is the nature of human beings? b. What is the nature of nursing? c. What is the focus of nursing? Chapter 5 Multiple-Choice Questions (Answers appear in bold) 1. Wiedenbach explains her prescriptive theory in her book, Meeting the Realities in Clinical Teaching (1969). Select the answer that represents the BEST explanation of her perspective theory. A. Nursing process allows the nurse to employ a standard process in selecting appropriate interventions. B. Account must be taken of the motivating factors that influence the nurse not only in doing what she does but also in doing it the way she does it with the realities that exist in the situation in which she is functioning. C. This theory proposes 14 functional components of basic nursing care. D. Nursing entails the diagnosis and treatment of illness. 2. Weidenbach proposes that there are three ingredients essential to the prescriptive theory. Select the ONE answer that is NOT one of these essential ingredients. A. The nurse‘s central purpose in nursing is the nurse‘s professional commitment. B. The prescription indicates the broad general action that the nurse deems appropriate to fulfillment of her central purpose. C. The reality of nursing is that the charge of the nurse is to implement the orders prescribed by the physician. D. The realities are the aspects of the immediate nursing situation that influence the results the nurse achieves through what she does. 3. Which of the following theorists coined the term ―basic nursing care‖? A. Wiedenbach B. Henderson C. Hall D. None of the above. 4. Which of the following theorists founded the Loeb Center? A. Wiedenbach B. Henderson C. Hall D. None of the above. 5. Based on the assumption that nursing has a unique function, Henderson believed which of the following? A. Nursing functions to follow and implement the prescribed regimen of the physician. B. Nursing independently initiates and controls activities related to basic nursing care. C. It is not necessary to limit nursing activities to nursing care because nurses should be responsive to all patient needs. D. All of the above 6. Henderson identified 14 components of basic nursing care that reflect needs pertaining to personal hygiene and healthful living. These components of basic nursing care include all of the following EXCEPT: A. Move and maintain desirable postures. B. Communicate with others in expressing emotions, needs, fears, or opinions. C. Do not involve the patient in decisions of care so that the patient may get better rest. D. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. 7. In 1990 the Sigma Theta Tau (International Honor Society of Nursing) library was named in honor of which of the following nursing theorists? A. Nightingale B. Weidenbach C. Orlando D. Henderson 8. Weidenbach, Henderson, and Hall made a significant impact on nursing theory in the 20th Century because they each: A. Examined nursing practice and explored nurse–patient interactions. B. Used nursing practice as the basis for their theory development. C. Defined ways nursing is thought about, practiced, and research. D. A & C E. All of the above 9. Lydia Hall drew on her expertise of which of the following practice areas in developing her Care, Cure, and Core Model? A. Critical care B. Pediatrics C. Rehabilitation D. Gerontology 10. A significant value of the contributions of Wiedenbach, Henderson, and Hall is that each of them was concerned with the unique aspects of nursing‘s supportive role to physician medical practice. A. True B. False 11. Lydia Hall believed CARE was the sole function of nurses, whereas CORE and CURE were shared with other members of the health team. A. True B. False Chapter 5: Twentieth-Century Nursing Case Study: Ernestine Weidenbach, Virginia Henderson, and Lydia Hall‘s Contributions to Nursing Theory and Their Use in Practice Instruction: Read the case study and answer the questions that follow. Janice went to see her urologist because she was experiencing burning when she urinated. She felt an urgent need to go and frequently ran to the bathroom only to discover her bladder held very little fluid. The morning of her appointment, Janice saw blood in her urine. She was becoming increasingly uncomfortable and anxious. When she arrived at the doctor‘s office, the nurse spoke with her about how she was feeling and the symptoms she was experiencing. While waiting for the doctor, Janice shared with the nurse that her mother had died at the age of 50 from complications of bladder cancer and that she was afraid she was genetically programmed to die young from the same type of cancer. 1. Weidenbach guides us to explore each patient‗s unique perception of his or her condition or situation. What is the unique way in which Janice perceives her bladder problems? 2. From Henderson‘s perspective, how might the nurse address Janice‘s anxiety? 3. Develop a plan of care for Janice from the perspective of Weidenbach, Henderson, and/or Hall. Guided Response (Answer) for Instructors: 1. For Weidenbach, the focus of practice is the experiencing individual, that is, the individual for whom the nurse is caring, and the way he and only he perceived his condition or situation. 2. Henderson conceptualized the nurse as a substitute for the patient‘s lack of necessary will, strength, or knowledge to attain good health and to complete or make the patient whole. 3. Hall believed during the rehabilitation phase of an illness experience, professional nurses were the best prepared to foster the rehabilitation process, decrease complications and recurrences, and promote health and prevent new illnesses. 4. Encourage students to compare and contrast questions each theory might guide the nurse to ask. Weidenbach: Compare situations identifying where there are differences, assist the patient to articulate concerns discuss genetic links to bladder cancer with the doctor, and provide education regarding common causes of the symptoms the patient is experiencing. Henderson: Review 14 components of basic nursing care. The components Eat and Drink adequately and Eliminate body wastes are particularly relevant in this case study. Hall: How might the nurse help Janice prevent complications and promote healing? . Chapter 6 Statement of Intent This chapter provides a brief overview of each of these early scholars and their conceptualization of nursing and the nurse–patient relationship. Their work situated the focus of nursing from performance of tasks to engagement in a therapeutic relationship designed to facilitate health and healing. Chapter 6 Key Terms Nurse–patient relationship Interpersonal process Therapeutic communication Self awareness Supervision Phases of the nurse patient relationship Interpersonal Subjects Human-to-Human Relationship Model Therapeutic use of self Hope Motivation Empathy Rapport Dehumanization Illness Dynamic nurse–patient relationship Helplessness Directive assistance Nursing process Value Independent role of nursing Chapter 6 Objectives On completion of this chapter, students will be able to: 1. Describe the historical, educational, and career paths of each theorist. 2. Discuss the impact Peplau, Travelbee, and Orlando had on the practice of nursing. 3. Describe the basic components of each theorist‘s model. 4. Identify the commonalities and differences between the theories 5. Discuss the application of each theoretical model to clinical research Chapter 6 Outline Part One: Peplau’s Nurse–Patient Relationship Introducing the Theorist Overview of Theory: Nurse–Patient Relationship Components Central to All Nursing Care Goal Key Components Nurse: Acceptance Therapeutic Communication (Verbal and Nonverbal) Self-awareness via Supervision Relationship: Interpersonal Objective and Focused on Need of Patient Growth Promoting, Forward Movement Time Limited Phases of the Nurse–Patient Relationship Orientation Phase Working Phase Resolutions Phase Applications Research Practice Exemplar Part Two: Travelbee’s Human-to-Human Relationship Model Introducing the Theorist: Travelbee Overview of Theory: Human-to-Human Relationhsip Model Mid-range Theory Components Nursing Care: Five Stages Observation Interpretation Decision-making Action (nursing intervention) Appraisal (evaluation) Phases of Progression of Spiritual and Emotional Needs Original Encounter Emerging Identities Empathy Sympathy Rapport Practice Application Phase Three: Orlando’s Theory of Dynamic Nurse–Patient Relationship Introducing the Theorist: Orlando Overview of Theory: Dynamic Nurse–Patient Relationship Purpose of Nursing Components of Theory Practice Application Chapter 6 Questions for Classroom Discussion 1. Orlando‘s theory can serve as a philosophy as well as a theory. Describe how you would use this theory /philosophy in your nursing practice. 2. What modifications or refinement do you suggest that would make Travelbee‘s theory more applicable and useful to contemporary nursing practice? Chapter 6 Multiple-Choice Questions (Answers appear in bold) 1. Peplau‘s publication, in 1952, Interpersonal Relations in Nursing, presented her framework for the practice of psychiatric nursing. The publication: A. Resulted in a paradigm shift in this field of nursing. B. Presented revolutionary ideas. C. Was not well received when it was first published. D. All of the above. 2. Peplau‘s goal for her input into nursing knowledge and practice was to: A. Prepare nurse psychotherapists, referring to this training as ―talking to patients.‖ B. Demonstrate to the medical community that nurses could practice independently. C. Develop a method for theory development. D. Link psychosocial and medical nursing. 3. Peplau viewed nursing interventions as those that: A. Supported the implementation of physician medical orders. B. Reflected the wants and desires of the patient. C. Are soundly based on bio-medical knowledge. D. Assisted patients in gaining interpersonal and intellectual competencies evolved through the nurse–patient relationship. 4. Peplau required her students to engage in unflinching self-scrutiny, examining their own verbal and nonverbal communication and its effect on the nurse–patient relationship. A. True B. False 5. Forchuk‘s research of Peplau‘s nurse–patient relationship was focused on which phase of the nurse–patient relationship? A. Orientation Phase B. Working Phase C. Resolution Phase 6. Travelbee‘s model uses the word ―patient‖ to describe the individual in need of nursing care. A. True B. False 7. According to Travelbee, dehumanization occurs when: A. The ill person is left alone to find meaning to his illness experience. B. The term patient is used to label or categorize a person. C. One treats the ill person with an emotional detachment. D. All of the above 8. The nursing tasks of hope and motivation are key assumptions to which of the following theorists? A. Peplau B. Orlando C. Travelbee D. Forchuk 9. According to Orlando, professional nurses function in an independent role from physicians and other health care providers. A. True B. False 10. One of the most important contributions of Orlando‘s work is: A. The values of the human transaction B. The enormous research based on her theory C. The phases of the nurse–patient relationship D. The instillation of hope and motivation Chapter 6: Nurse–Patient Relationship Theories: Hildegard Peplau, Joyce Travelbee, and Ida Jean Orlando Instructions: Read the case study and answer the questions that follow. Ann, a community nurse, made an afternoon home visit with Susan and her father. After the death of her mother, Susan had growing concerns about her father living alone. ―I worry about my father all the time. He is becoming more forgetful and he has trouble seeing. Mom used to take of him. I am not sleeping and I am irritable around him. Yesterday I shouted at him because he wouldn‘t let me help him with his laundry. I felt terrible! I am at my wits‘ end! My brothers and sisters do not want to put dad in a nursing home but they are not willing to help out. As usual, they have left me with all the responsibility. I work part time and have two small children to care for. Susan‘s father, Sam, sat quietly with tears filling his eyes. He was well nourished and well groomed but would not make eye contact. Nurse Ann noticed that the house was clean and orderly. A tray in front of the TV had the remains of a ham sandwich and glass of ice tea. Mail was piled up, unopened on a small table near the front door. There was only one car in the driveway and the yard was in need of attention. 1. What questions do the theories of Peplau, Travelbee, and Orlando guide the nurse to consider in caring for Susan and Sam? 2. How might Peplau‘s concepts of participant–observer, spectator–observer, and random observer guide the nurse in this case study? From Travlebee‘s perspective, how might Ann prevent dehumanizing Susan and Sam? How might Orlando‘s focus on alleviating helplessness inform Ann‘s approach to Susan and Sam? 3. Develop a family plan of care from the perspective of Peplau, Travelbee, and/or Orlando. Guided Response (Answer) for Instructors: 1. Peplau, Travelbee, and Orlando explicated the nature and importance of the nurse–patient relationship. Their work moved the focus of nursing from the performance of a set of tasks to engagement in a therapeutic nurse–patient relationship designed to facilitate patient health and healing. Each theorist has a unique definition of nursing that informs a nursing focus. 2. Peplau‘s primary focus is to assist patients in gaining interpersonal and intellectual competencies that evolved through the nurse–patient relationship. She required her students to engage in unflinching self-scrutiny, examining their own verbal and nonverbal communication and its effect on the nurse–patient relationship which was an early form of reflective practice. Ask students to reflect on the case study and identify assumptions that they immediately make about the situations and then using the concepts of participant–observer, spectator–observer, and random observer guide them in exploring those assumptions. 3. Travelbee asserts that through the therapeutic use of self and the integration of evidence-based knowledge, the nurse provides quality patient care that can foster the patient‘s trust and confidence in the nurse (Travelbee, 1971). She sees the role of the nurse as assisting persons to experience hope in order to cope with the stress of illness and suffering (Travelbee, 1971). Orlando defines the focus of nursing as responding to individuals who suffer or anticipate a sense of helplessness; it is focused on the process of care in an immediate experience; it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing, or curing the individual‘s sense of helplessness. (Orlando, 1972). Encourage students to identify concepts of importance in the case study from the perspective of each theorist and explore the literature using these key concepts to develop a sense of the variety of approaches to the nursing care of this family. Chapter 7 Statement of Intent The intent of this chapter is to provide an introduction to the historical, educational, and career pathway of nursing theorist Myra Levine and an overview of her Conservation Model. The goal of the Conservation Model is to promote adaptation and maintain wholeness using the principles of conservation. Chapter 7 Key Terms Conservation Adaptation Wholeness Redundancy Environmental Challenges Organismic Organismic Responses Environmental Fit Internal and External Environment Therapeutic Intervention Chapter 7 Objectives On completion of this chapter, students will be able to: 1. Discuss the historical, educational, and career pathway of nursing theorist Myra Levine. 2. Identify the basic components of the Conservation Model. 3. Discuss the application of the Conservation Model to nursing practice. 4. Compare and contrast Levine‘s use of the concepts: structural, social, and personal integrity. 5. Explore and discuss the impact of the Conversation Model to provide a foundation for the future of nursing practice. Chapter 7 Outline Part One Introducing the Theorist Introducing the Theory Foundations of Clinical Nursing The Composition of the Conservation Model Goal Components Adaptation Conservation Wholeness Health, Person, Environment, Nursing The Model Philosophical Assumptions and Values of the Conservation Model Values Part Two Applications to Nursing Practice Case Study Using the Levine Conservation Model, the nurse‘s goal is to promote wholeness in the context of Missy‘s pregnancy. Assessment Structural and Integrity Social Integrity Trophigcognoses Hypothesis Nursing Interventions Organismic Responses Use of Conservation Model in the 21st Century The Model Modified for Use in Community-Based Care Summary Chapter 7 Questions for Classroom Discussion 1. Levine stated that unless the ―theory can be interpreted by the how nurse who reaches the patient wherever nursing is practiced, theory will remain a questionable entity ... theory should teach nurses what they are.‖ Divide in to small groups and discuss how you think Levine‘s theory can be interpreted into nursing practice. Identify the barriers you perceive to utilizing the theory in current nursing practice. 2. Levine proposes a major proposition of the conservation principles as: ―The individual is always within an environment milieu, and the consequences of his awareness of his environment persistently influence his behavior at any given moment.‖ Provide a clinical example/senerio that demonstrates this proposition. 3. Divide students into small groups. Provide groups with a clinical case study. Have groups then address and develop strategies for applying Levine‘s steps in the nursing process: Assessment, trophicognosis, hypothesis, interventions, and evaluation. Chapter 7 Multiple-Choice Questions (Answers appear in bold) 1. Levine identified two concepts critical to the use of her model: A. Back and forth B. Dynamic and static C. Adaptation and Wholeness D. Risk and risk management 2. As an organizing framework for nursing practice, the goal of the Conservation Model is to: A. Guide the nurse to focus on the influences and responses at the organismic level. B. Promote adaptation and maintain wholeness using the principles of conservation. C. Provide a framework for nursing interventions to improve the patient‘s condition (therapeutic) or to promote comfort (supportive) when change in the patient‘s condition is not possible. D. All of the above E. None of the above 3. Levine defines adaptation as: A. The process whereby the patient maintains integrity within the realities of the environment B. The process of change with conservation being the outcome of adaptation C. The process of making the best of a bad situation D. A and B E. All of the above 4. Levine proposes that health and disease are patterns of: A. Internal and external mitigating factors B. Adaptive change C. An individual response that may change over time in response to new situations, new life challenges, aging; or social, political, economic, and spiritual factors D. B and C E. A and B 5. The interventions of the Conservation Model that are designed to return the patient to wholeness are based on the assumption the intervention must attend to: A. The conservation of energy B. Structural, personal, and social integrities C. Promote adaptation D. All of the above 6. Levine rejected the notion that energy can be manipulated and transferred from one human to another as in therapeutic touch. A. True B. False 7. According to Levine, the environment: A. Includes both the internal and external environment of the individual. B. Completes the wholeness of the individual. C. Includes those factors that impinge on and challenge the individual. D. A and B E. All of the above 8. The conservation of personal integrity acknowledges the individual as: A. One who strives for recognition, respect, self-awareness, humanness, self-hood, and selfdetermination B. A social being who functions in a society that helps to establish boundaries of the self C. Recognizing that the individual resides within a family, a community, a religious group, an ethnic group, a political system, and a nation D. Dependent on an intact defense system (immune system) that supports healing and repair 9. Levine viewed the person as a holistic being and proposed that the experience of wholeness is the foundation of all human enterprises. A. True B. False 10. An organismic response is a change in behavior or change in the level of functioning during an attempt to adapt to the environment. The organismic responses are intended to: A. Sustain social interaction B. Enhance the fight-or-flight response C. Maintain the patient’s integrity D. Maintain inflammation Chapter 7: Levine Case Study Instructions: Read the case study and answer the questions that follow. As a nurse working in a mental health facility, you are responsible for the care of Jane, a young woman in her mid-20s who has been admitted with a diagnosis of paranoid schizophrenia. Jane has a health history of repeated hospitalizations. Her first admission occurred when she was a young teenager. Jane tells you she was always very shy growing up, and that she did not have many friends. However, Jane did play the piano when she was an adolescent and found playing the piano comforting. It was the only engaged activity she participated in during her teenage years. Jane told the nurse that when her mother and father divorced, she became more withdrawn and preferred to remain alone. Further conversation revealed that she did not feel motivated to pursue goals or activities in school. She felt persecuted and interpreted events with no reference to reality. She eventually lost interest in the piano as the symptoms of the disease resulted in being unable to associate letters with the musical notes. She has recently stated she felt little purpose in her life. 1. The core or central concept of Levine‘s Theory is conservation. What might this mean for Jane? 2. How does Jane adapt to the internal and external environment? 3. What nursing interventions might ground the nurse in caring for Susan from Levine‘s perspective? Guided Response (Answer) for Instructors: 1. The nurse accomplishes the goals of the model through the conservation of energy, structure, personal, and social integrity. Conservation of energy: Adequate rest, nutrition, and exercise. Structural activity: A plan of care will promote specific interventions of self-care and maintenance of personal hygiene. Conservation of personal integrity: Recognize and protect the patient‘s space needs, includes patient respect and his or her self-determination. Conservation of social integrity: Help the individual to preserve his or her place in a family. 2. There is a continuous dynamic, open interaction between the internal and external environment. This interaction provides the basis for holistic thought and the view of the individual as whole. During the assessment process there may be a collection of challenging facts or in observation and interview there may be challenges to the internal and external environment … using the four conservation principles of energy, structure, personal, or social integrity. The nursing diagnosis gives the challenging facts meaning. Patients with schizophrenia have disturbed body temperature regulation; in the heat of summer, they may dress for winter. In the heat of summer they may dress for winter. Patients with schizophrenia may also have difficulty with personal hygiene. Weight gain may be a reason some patients do not take their medicines. 3. Historicity refers to the notion that adaptive responses are partially based on personal and genetic past history. Music therapy is a choice, by the nurse, as an adaptation response for the patient. This approach builds on Susan‘s past history of playing the piano before her illness. What is the meaning of playing the piano for Susan? Chapter 8 Statement of Intent The intent of this chapter is to offer a systems approach to nursing practice. Dorothy Johnson‘s theoretical model was the first to provide both a guide to understanding and a guide to action. These two ideas—understanding seen first as a holistic, behavioral system process mediated by a complex framework and second as an active process of encounter and response—are central to the work of other theorists who followed her lead and developed conceptual models for nursing practice. Chapter 8 Key Terms Systems Theory Developmental Theory Wholeness and Order Stabilization Reorganization Hierarchic Interaction Dialectical Contradiction Behavioral Subsystems Subsystem Structural Components Internal/External Environment Internal Structures Health Behavioral System Balance Structural and Functional Stresses Behavioral System Imbalance Regulatory and Control Measures Nursing Nursing Therapeutics Chapter 8 Objectives On completion of this chapter, students will be able to: 1. Discuss paradigmatic origins of Johnson‘s Model 2. Discuss the five core principles of Dorothy Johnson‘s Behavioral Systems Model. 3. Identify the eight subsystems of Dorothy Johnson‘s Behavioral Systems Model and discuss their interrelationship. 4. Describe Johnson‘s definition of person, environment, health, and nursing. 5. Discuss the role of the Behavioral Systems Model in nursing practice, administration, research, and education. Chapter 8 Outline Introducing the Theorist Overview of Dorothy Johnson‘s Behavioral System Model Five Core Principals Wholeness and Order Stabilization Reorganization Hierarchic Interaction Dialectical Contradiction Major Concepts of the Model Person Subsystems Health Nursing and Nursing Therapeutics Practice Applications Practice-Focused Research Education Nursing Practice and Administration The Practice Exemplar Subsystems Environmental Assessment Evaluation Summary Chapter 8 Questions for Classroom Discussion 1. Johnson viewed health as efficient and effective functioning of the system, and as behavioral system balance and stability. Behavioral system balance and stability are demonstrated by observed behavior that is purposeful, orderly, and predictable. Consider a clinical-practice situation that demonstrates Johnson‘s model of health. Describe the purposeful, orderly, and predictable behaviors that are utilized and how these behaviors contribute to establishing balance and stability. 2. Identify at least three ways in which Johnson‘s Behavioral Systems Model can inform current nursing practice. 3. What do you consider to be the drawbacks with the application of Johnson‘s model to contemporary nursing practice? Chapter 8 Multiple-Choice Questions (Answers appear in bold) 1. Johnson integrated a complex knowledge set in the development of her Behavior System Model. Johnson has noted that her theory evolved from: A. Philosophical ideas B. Theory and research C. Her clinical background D. All of the above 2. A number of existing theories were integrated into Johnson‘s development of the Behavior System Model. The PRIMARY theoretical foundation for the model are: A. Transpersonal theory B. Florence Nightingale‘s theory of nursing C. Existential theory D. Systems theory and developmental theory 3. Johnson proposed five core principals of systems thinking. These core principals include which set of answers? A. Person, environment, health, nursing, nursing therapeutics B. Being, becoming, angst, choice, actualization C. Wholeness and order, stabilization, reorganization, hierarchic interaction, and dialectical contradiction D. Peace, harmony, balance, stability, perpetuation 4. Johnson proposes that each subsystem is composed of at least four structural components that interact in a specific pattern. These parts are: A. Person, environment, health, nursing B. Goal, set, choice, and action C. Preparation, readiness, action, review D. Approach. disorganization, orientation, engagement 5. Johnson viewed health as efficient and effective functioning of the system, and as behavioral system balance and stability. Behavioral system balance and stability are demonstrated by observed behavior that is: A. Chaotic, random, and unpredictable B. Permeable, malleable, and flexible C. Purposeful, orderly, and predictable D. Predetermined, fixed, sequential, and static 6. The overall representation of Johnson‘s model can be viewed as a behavioral system within an environment. A. True B. False 7. From a behavioral system perspective, homeorhesis is a more important stabilizing process than homeostasis. In homeorhesis the system stabilizes around: A. A trajectory rather than a set point B. Self-righting tendencies that can occur over time C. Development or adaptation of the behavioral system D. All of the above E. None of the above 8. Johnson conceptualized a nursing client as: A. An interpersonal–integrative system B. Independent of the environment C. A behavioral system D. Being comprised of mind–body–spirit 9. Two components of each subsystem include choice and action. Johnson refers to choice as the individuals‘s repertoire of alternative behaviors in a situation that will best meet the goal and attain the desired outcome. A. True B. False 10. According to Johnson, individuals are said to achieve efficient and effective behavioral functioning in all of the following, EXCEPT: A. Their behavior is commensurate with social demands. B. They are able to fit within the mainstream of society and follow the orders of the physician in order to regain their health. C. They are able to modify their behavior in ways that support biologic imperatives. D. They are able to benefit to the fullest extent during illness from the physician‘s knowledge and skill. Chapter 8: Dorothy Johnson‘s Behavioral System Model and Its Applications Instructions: Read the case study and answer the questions that follow. The preoperative area was busy. Five patients were waiting for their 7 A.M. surgeries. Over to one side was Angela, lying quietly on the stretcher holding her stuffed toy. The pink fluffy bunny was small enough to comfort a 5-year-old girl and snuggle next to her neck. As the circulating nurse for Angela‘s case came to take Angela back to the operating room she noticed the red heart that had been drawn on the plaster cast. The heart was in the center of the long leg cast and had the inscription ―daddy‘s big girl‖ in the center. The cast also had brightly colored flowers with smiling faces in the middle with the names Josey, Billy, Chelsea and Pepper taking up the remaining area. Angela hadn‘t looked at the nurse yet, but was petting her bunny with her left hand. This motion made the IV machine beep. The nurse glanced at Angela‘s toes— no swelling, pink, and since Angela was griping the edge of her cast with her toes the nurse knew that all toes were moving without difficulty. A noise cased the nurse to turn and see a tall woman with long red hair rush toward Angela. At this moment, Angela cried out ―Mommy, you came! Look at Bunny!‖ As the nurse looked from Angela and the bunny toward the woman, another stuffed animal peeped from the woman‘s hand. Angela was ecstatic ―Eeyore! You brought me Eeyore!‖ Angela turned to the nurse, saying, ―Now I can have my surgery. But they can‘t break my daddy‘s heart. I‘m sending it to him in Rock‖ Angela‘s mother turned to the nurse, winked, and said quietly ―Iraq.‖ Angela smiled and put her right thumb in her mouth but quickly stopped. Her eyes opened wider, ―Oh I‘m a big girl I don‘t suck my thumb anymore.‖ 1. Based on this case study, how would the nurse describe the holistic versus the particulate importance of Johnson‘ model? 2. How might Johnson‘s model guide the nurse in recognizing the importance of environment in this case study? 3. What would the homeorrhesis focus of this model provide in this case study? Guided Response (Answer) for Instructors: 1. Johnson‘s model is a holistic, behavioral system process mediated by a complex framework and is an active process of encounter and response. The model incorporates five core principles of system thinking: wholeness and order, stabilization, reorganization, hierarchic interaction, and dialectical contradiction. 2. The behavioral system and the environment are linked by interactions and transactions. We define the person (behavioral system) as comprised of subsystems and the environment as comprised of physical, interpersonal (e.g., father, friend, mother, sibling), and sociocultural (e.g., rules and mores of home, school, country, and other cultural contexts) components that supply the substantial imperatives (Grubbs, 1980; Holaday, 1997; Johnson, 1990; Meleis, 1991). 3. From a behavioral system perspective, homeorrhesis is a more important stabilizing process than is homeostasis. In homeorrhesis, the system stabilizes around a trajectory rather than a set point. Ask students to consider what actions the nurse would undertake to clarify the dialectical contradiction in this case study. Johnson emphasizes the importance of the principle of dialectical contradiction as the motivational force for behavioral change. Johnson (1980) described these as drives and noted that these responses are developed and modified over time through maturation, experience, and learning. A person‘s activities in the environment lead to knowledge and development. However, by acting on the world, each person is constantly changing it and his or her goals, and therefore changing what he or she needs to know. Chapter 9 Statement of Intent The intent of this chapter is to provide an overview of Orem‘s Theory of Self-Care Deficit. Insight into model building and theory development using exemplars from Orem‘s work are provided. Chapter 9 Key Terms Proper object of nursing Self Care Deficit Nursing Theory (SCDNT) Theory of self-care Theory of Self-Care Deficit Theory of nursing systems Dependent Care Deficit Legitimate nursing Therapeutic Self-Care Demand Product, structure, content Self-Care Agency (SCA) Nursing agency (NA) Deliberate Action Nursing systems Universal self-care requisites Nursing role Health deviation self-care requisite Dependent Care Professional–technological subsystem Patient Nursing systems Basic conditioning factors Wholly compensatory Situational variations Partially compensatory Agent Supportive–educative Dependent Care Agency (DCA) Therapeutic Self-Care Demand (TSCD) Developmental self-care requisites Societal–interpersonal subsystems Contractual operations Steps in Orem‘s process of nursing Chapter 9 Objectives On completion of this chapter, students will be able to: 1. Describe Orem‘s Theory of Self-Care Deficit. 2. Identify the proper object of nursing identified in Orem‘s Theory of Self-Care Deficit. 3. List the abilities of humans to affect their health as identified by Orem. 4. Compare and contrast self-care agency and dependent-care agency. 5. Identify and describe major constructs of the Self-Care Deficit Nursing Theory. 6. Describe the theoretical linkages between the Theory of Self-Care, Th