Dimensions Final Exam Study Guide Nursing Theories

Dimensions Final Exam Study Guide Nursing Theories: A Theory- refers to a speculative statement involving some element of reality that has not been proved. The goal of a theory is to describe and explain a nursing action to make a hypothesis. Ex: such as improved health or recovery from illness. A Model- hypothetical representation of something that exists in reality. The purpose of a model is to explain a complex reality in a systematic and organized manner. Ex: hospital organizational chart to be able to see the relationships between hospital admins. (conceptual model) - Roy Adaptation Model: o Client: Human being- a dynamic system with input and output o Health: A continuum with the ability to adapt successfully to illness o Environment: Both internal and external stimuli that affect behavior. o Nursing: Multistep process that helps client adapt and reach the highest level of functioning. - Orem Self-Care Model: o Client: Human being- biological, psychological, social being with the ability for self-care. o Health: Able to live life to the fullest through self-care o Environment: The medium through which the client moves. o Nursing: Assistance in self-care activities to help the client achieve health. - King Model of Goal Attainment: o Client: Person- exchanges energy and information with the environment to meet needs. o Health: Dynamic process to achieve the highest level of functioning. o Environment: Personal, interpersonal, and social systems and the external physical world. o Nursing: Dynamic process that identifies and meets the client’s health-care needs. - Watson Model of Human Caring: o Client: Individual- has needs, grows, and develops to reach a state of inner harmony. o Health: Dynamic state of growth and development leading to full potential as a human being. o Environment: The client must overcome certain factors to achieve health. o Nursing: Science of caring that helps clients reach their greatest potential. - Johnson Behavioral System Model: o Client: Person- a behavioral system; an organized, integrated whole composed of seven subsystems. o Health: A behavioral system able to achieve a balanced, steady state. o Environment: All the internal and external elements that affect client behavior. o Nursing: Activities that manipulate the environment and help clients achieve the balanced state of health. - Neuman Health-Care Systems Model: o Client: An open system that constantly interacts with internal and external environments. o Health: An individual with relatedly stable internal functioning of a high state of wellness (stability). o Environment: Internal and external stressors that produce change in the client. o Nursing: Identifies boundary disruption and helps clients in activities to restore stability.  Orem Self Care: What is self-care? What are the two levels of self-care? What is wholly compensated care? What is partially compensated care? What is supportive developmental care? - Orem Self Care: (CHEN) - What is self-care? o 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. - What are the two levels of self-care? o 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 commonly found in everyday life that support and encourage normal human growth, development, and functioning. Individuals who are healthy, according to the Orem model, carry out the activities listed in order to maintain a state of health. To some degree, all of these elements are necessary activities in maintaining health through self-care. The second type of self-care comes into play when the individual is unable to conduct one or more of the six self-care activities. This second type of self-care is called health deviation self-care. Health deviation self-care includes those activities carried out by individuals who have diseases, injuries, physiological or psychological stress, or other health-care concerns. Activities such as seeking health care at an emergency department or clinic, entering a drug rehabilitation unit, joining a health club or weightcontrol program, or going to a physician's office fall into this category. - What is wholly compensated care? o A person who is able to carry out few or no self-care activities falls into the wholly compensated nursing care category. - What is partially compensated care? o Clients in the partially compensated category of nursing care can meet some to most of their self-care needs but still have certain self-care deficits that require nursing intervention. - What is supportive developmental care? o Clients who are able to meet all of their basic self-care needs require very few or no nursing interventions. Neuman Health-Care Systems Model: What are the three levels of interventions as described by this theory? Primary, secondary, tertiary. - Nursing's main concern in this model is either to identify stressors that will disrupt a defensive boundary in the future (prevention) or to identify a stressor that has already disrupted a defensive boundary, thereby producing instability (illness) The Neuman model is based on the nursing process and identifies three levels of intervention: primary, secondary, and tertiary. - The main goal of a primary intervention is to prevent possible symptoms that could be caused by environmental stressors. Teaching clients about stress management, giving immunizations, and encouraging aerobic exercise to prevent heart disease are examples of primary interventions. - A secondary intervention is aimed at treating symptoms that have already been produced by stressors. Many of the actions that nurses perform in the hospital or clinic (e.g., giving pain medications or teaching a client with cardiac disease about the benefits of a low-sodium diet) fall into this secondary intervention category. - A tertiary intervention seeks to restore the client's system to an optimal state of balance by adapting to negative environmental stressors. Teaching a client how to care for a colostomy bag at home after discharge from the hospital is an example of a nursing activity at the tertiary level. It occurs after the client has received a secondary intervention and offers support to the client so that he or she can continue to recover or prevent further deterioration in health. MIDDLE-RANGE THEORIES AND MODELS A set of relatively concrete concepts or propositions that lie between a minor working hypothesis found in everyday nursing research and a well-developed major nursing theory. More focused on the nursing theory 1987, Dr. Nola Pender's Health Promotion Model - The goal of the individual is to move toward a balanced state of positive health and well-being. Health is up to the individual, not the healthcare system; although the health-care system can be an important part, it will always be secondary to the individual. Swanson's Theory of Caring, first published in 1991- The role of the nurse in the Theory of Caring so they believe that their problems are understood by the nurse, being kept informed with key information, their needs are being met, their lives are being validated, and the nurse believes in the client's ability to move toward wellness Nursing Process: assessment, analysis, planning, intervention and implementation, and evaluation. - Assessment- is to collect subject and objective data about the client, significant history, history of the present illness, signs and symptoms, environmental elements, laboratory values, and vital signs. Ex: Ability to perform aerobic exercises for 15 minutes - Analysis/ Diagnose- Developing and using a nursing diagnosis. Ex: Anxiety related to fear of hospitalization. - Planning- Set goals for the clients, determining expected outcome, set priorities for goals, anticipating client’s needs based on the assessment. Ex: Walk the length of the hall twice during a nurse's shift. - Intervention and implementation- Identify nursing actions required to meet the goal. Ex: Providing care based on the client’s goals. - Evaluation- Determines whether the goals stated during the planning process were met through the interventions. Ex: “I can stop taking this medication when I feel better.” QSEN- Built upon Florence Nightingale, Pew, IOM Principles. Guides what’s being taught in Nursing school. Robert Wood Johnson Foundation undertook a three-phase project to improve the quality and safety of client care by focusing nursing education on student competency. Phase I- Developing student competencies; the knowledge, skills, and abilities (KSAs) necessary to maintain a safe health-care system; and measurable outcomes for graduates of nursing programs. Phase II- kicked off in 2007 with the goals of developing KSAs for graduate students and developing QSEN-based curricula in 15 selected schools. Phase III- Some of the pilot schools are beginning to publish information about their experiences implementing QSEN as their curricular model. Scope of Practice- Nurse Practice Act- defines nursing practice and establishes standards for nurses in each state. most definitive legal statute or legislative act regulating nursing practice. STANDRAD OF CARE! Nurse practice acts identify grounds for disciplinary actions such as suspension and revocation of a nursing license. Ex: the term Nursing Diagnosis- Broadens the role of nurses. Insurance- - PPO- Preferred Provider Organization. One that limits an enrollee's choice to a list of “preferred” hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list. - Medicare- Federally funded national health insurance program in the US for people older than 65 years. Part A provides basic protection for medical, surgical, and psychiatric care costs based on diagnosis-related groups (DRGs). Part B is a voluntary medical insurance plan that covers physician and certain outpatient services. Part D is an unfunded insurance for medications.