NursingModelsandTheoriesinCommunityHealthNursing

SethoHadisuyatmana,S.Kep.Ns

NursingTheoriesHistory

Era Event BasicCurriculum ImpactonNursing

CrimeanWar Nigh<ngalefoundabodyofeducatedwomen

Studytolearnhowtonurse InMid‐1930’sstandardizedcurriculumpublished

Changesfromhospitalbasedtouniversitybasedcurriculum

Mid1970’s Lackedconceptualconnec<onsandtheore<calframeworksrevealed(Batey,1977)

Standardiza<oncurriculaandDoctoralDegreeinNursingwasfirstinisiated

Changesfromvoca<onaltoprofesional

1980’s DevelopmentofNursingtheories Theore<calandBodyofKnowledgeevolved

Significantchangesinintelectualskillandnursingapproach

Theore<calWorksPhilosophies ConceptualModelsand

GrandTheoriesTheories MidRangeNursing

Theories

Nigh<ngaleWatsonRayBennerMar<nsenEriksson

LevineRogersOremKingNeumanRoyJohnsonBoykinandSchoenhofer

OrlandoPenderLeiningerNeumanParseErickson,TomlinandSwainHustedandHusted

MercerMishelReedWienerandDoddEakes,Burke,andHainsworthBarkerKolcabaBeckSwansonRulandandMoore

SELFCAREDEFICITNURSINGTHEORY

DorotheaE.Orem

MainFeatures

Oremdefinedhertheoryconsistofthreerelatedtheories:

•  Selfcarewhyandhowpeoplemaintainthemselves.

•  Selfcaredeficitwhypeopleneednurses’helps.

•  Nursingsystemsexplainsaboutmaintainingnursingsystemstobebrought.

SelfCarevsSelfCareRequisites

•  SelfCareonbehalfoftheirowninteresttomaintainfunc<ons

•  SelfCareRequisitesFactorsthatneedtobecontrolled,andNatureofpurposedonselfcare.

ConceptualFramework

Self‐care

SCdemandsSCagency

NsAgency

Deficit

Cond

i<on

ingFactors

Cond

i<on

ingFactors

CULTURECARETHEORYOFDIVERSITYANDUNIVERSALITY

MadeleineLeininger’s

BriefReview

•  1960’sbecametheintroduc<onyeartotheterms:”transculturalnursing,ethnonursing,andcross‐culturalnursing”

•  Firstlyintroducedasfieldexperience.•  However,Leiningerassumedthatdifferentculturemeansofitspercep<on,language,norms,life,value,buts<llhavecommonali<estocareamongmembers.

Dis<nctfeatures

•  Focusedexplicitlyondiscoveringholis<candcomprehensiveculturecare

• MajorConcepts:– Humancareandcaring(enabling)– Culture(materialandnon‐material)

– CultureCare(SynthesizesCulture)– Culturecarediversity

con<nued

•  Culturecareuniversality(commonali<esonseveralaspects)

• Worldview(howpeopleperceivedworldbasedtotheirculturalview)

•  CulturalandSocialstructuredimensions

•  Environmentalcontext

•  Ethnohistory

Cont.

•  Emic(howcomm.Reacttophenomenon)•  E<c(howoutsiderreacttophenomenon)

•  Health(localdefini<on)•  TransculturalNursing

ApproachingMethod

•  CulturecarePreserva<onorMaintenance– Assis<veuptoenablingtocomm.CDM.

•  CulturecareAccommoda<onorNego<a<on– Toadaptnewvalueneededintermsofhealth

•  CulturecareRepaaerningorRestructuring– Modify,reordernewlifepaaern

•  CulturallyCompetentnursingcare– Tofitgenerallifeways

Leininger’sSunriseTheory:allculturesareunique,buttheyalsohavesimilari<es.

HEALTHPROMOTIONMODELNolaJ.Pender

AccordingtoPender

•  Healthpromo<onanddiseasepreven<onshouldbeinthefirstlineofhealthcare,howeverifthatfail,caringtheillnessbecomesthenextpriority.(Pender,2006).

•  Thetwoconcept:• HealthPromo<on:increasewellbeing,while• HealthProtec<on:mo<vatedtoavoiddisease(Kozier,2004)

Theore<calFramework

CHNPrac<ceandAplica<on

•  AssessmentandInterven<on– PRB:Priorrelatedbehavior– PF :Bio=Physical,Psychosocial,&Cultural– PBA:Expectedoutcome– PBarA:Expectedbarrierstowardtheaaainment

– ARA:ControlledFeeling– SI,II,CPA,ICDP

CHNDiagnoses

•  RefertoNANDA2012‐2014

Implementa<on

•  HealthEduca<on•  IndependentAc<on=CommunityEmpowerment

•  Collabora<onAc<on=Partnership• MonitoringandEvalua<on

UNCERTAINTYINILLNESSTHEORYMerleH.Mishel

Dis<nc<on

•  Uncertaintyexistinillnesssitua<onsthatareambiguous,complex,unpredictableandwheninforma<onisunavailableorinconsistent.

•  Uncertaintyisdefinedastheinabilitytodeterminethemeaningodillnessrelatedsitua<on.

•  Merelyittalksaboutcogni<vestatewhensomeonecannotcategorizeanillnesseventbecauseofinsufficientcues.

con<nued

•  Itisabouthowpa<entcogni<velyinterpretstheuncertaintyofoutcomeandtreatment

•  TheThreemajorthemes:– Antecedentsofuncertainty– Appraisalofuncertainty– Copingwithuncertainty

Antecendents

•  S<muliFrame:Percep<ontowardsthes<muliwhichisthenstructuredintocogni<veschema(Mishel,1988).

•  Cogni<veScheme:Subjec<veinterpreta<onofillnessandtherapies

•  Cogni<vecapacity:Capacitytoprocessinforma<on

•  StructureProviders:Assis<veresourcetointerprettheS<muliFrame

Appraisal

•  Inference:Evalua<onofuncertaintybyrecallingmemories

•  Illusion:Beliefconstructed

Coping

•  Adapta<on:Biophysicalbehaviorthatappearinrangeofusualbehavior

“TheUITaimstoreachthestablepreviousstate,whereastheReconceptualisa<onUIT(RUIT)isa

valuablesystemtoreachthenewvalue”

Interven<onMethod

•  Itisdemonstratedeffec<velyinteachingtomanageuncertaintybybuildingcapacityincogni<vereframing,enhancecommunica<onbetweenclient‐provider,andpossibleeffectofchanges.

•  Itrequiresandfocusesinahighlyassis<vecapacity

CHNAssessment

•  S<muliFrame:–  SignandSymptom–  Previousevent–  Congruencypasteventsandexperiences

•  Cogni<veCapaci<es:–  Cogni<vebackground

•  StructureProviders:–  Localauthoritycapacitytosupportcommunity–  Socialsupportandappraisalandpar<cipa<on–  Educa<onresourceavailability

CHNAssessment

•  Illusion:– Localwisdomrelatedtovalueandbelief

•  Inference:– Gainingalterna<veeffortsthroughrecallingmemories.

Possibleassessmentmethod

•  Primaryandsecondaryassessmentfocusingonthemainproblemofcommunity,thatarefollowedsuchas:– FGD– WindshieldSurvey– Sampling– Resourcestudy– Etc.

Interven<on

•  However,theinterven<onthataremen<onedarealterna<vesrespec<velyregardingtotheCHNmethods,suchas:•  CommunityasClient(McFarlane)•  CommunityasPartner(McFarlane)•  SCDNT(Orem)•  SunriseModel(Leininger)•  HPM(Pender)

Bibliography

•  Alligood(2006).NursingTheoristandTheirWorks6thed.Mosby.•  Kozier,B.,Erb,G.,Berman,A.,Snyder,S.(2004).Fundamentalsof

Nursing:Concepts,Process,andPrac=ce.7thEdi=on.Philippines:PearsonEduca<onSouthAsiaPteLtd

•  Smith,MarryJaneandLiehr,Patricia(2008).MiddleRangeTheoryofNursing.SpringerPublishingCompany.