Grand Theory

Middle Range Theory

Descriptive Theory

Prescriptive Theory

Nursing Paradigm

Orem

Think Self-care

Theory of self-care deficits-Nursing clients are incapable of continuous self care due to health related limitations.

Theory of self-care-A relationship exists b/t deliberate self-care actions (learned behaviors) et the development et functioning of individuals et groups.

Theory of Nursing Systems-Form when nurses prescribe, design et provide nursing that regulates the individual's self care capabilities et meets therapeutic self-care requirements.

Self-Care activities-maintain life, health et well-being, requisistes-common human, needs, developmental et health deviation; agency learned ability et is deliberate action; nursing agency-develops pt self-care agency et ability to meet therapeutic self-care demand.

Lineger

Think CARE et CULTURE

Caring is central et unifying domain.

Diverse factors influence patterns of care et health or well-being.

Caring includes-assistive, supportive, et facilitative acts for a client w/needs.

Neuman

Think SYSTEMS

5 interacting variables

Physiological, Psychological, Sociocultural, Developmental, Spiritual, Function harmoniously, Stable to internal et external environment, Concepts of stress et reaction to stress.

GOAL:facilitate optimal wellness-through retention, atttainment or maintenance of client system stability.

Sister Colista Roy

ADAPTATION

Physiologic, role function, self-concept, interdependent.

Martha Rogers

UNITARY HUMAN BEING

Washburn's main theorist

Therapeutic touch.

Swanson

CARING

5 dimensions of Caring

Knowing, being with, doing for, Enabling, Maintaining belief.

Jean Watson

CARING

Metaphysical, spiritual dimension, transpersonal caring

Carative factors:Humanistic-alturist system of values

Faith, hope, sensitivity, helping, trusting

Expressing positive et negative feelings

Supportive, Protective, et Corrective

Spiritual

Transpersonal Caring Relationships

Caring Occasions or Moment

Sister Simone Roach

CARING

Expresssion of our humanity

5-C's

Compassion, Confidence, Competence, Conscience, Commitment.

Parse

EVOLVING HUMAN

Transistion state, always changing, human-universe mutual process.

Florence Nightingale

ENVIROMENTAL CONTROL

                                                              i.      Notes on Nursing (1860)

                                                            ii.      First organized programs to train nurses

                                                          iii.      Served in Crimea War (1853-1856)

                                                          iv.      Major reforms – hygiene and environmental sanitation

                                                            v.      Reduced mortality from 42.7% to 2.2% in 6 months

                                                          vi.      “lady with the lamp”

                                                        vii.      First nurse theorist, researcher, epidemiologist

Clara Barton

i.      Served in the Civil War (1860-1865)

                                                            ii.      Founded the Red Cross in 1881

                                                          iii.      Distributed supplies to wounded soldiers; provided care to both sides

Isabella Hampton Robb

                                                              i.      First superintendent of Johns Hopkins Training School

                                                            ii.      Founded the ANA

                                                          iii.      Author of many textbooks

Mary Adelaid Nutting

                                                              i.      First professor of nursing - Columbia Teachers College - 1907

                                                            ii.      Brought nursing education to the university setting

Lillian Wald

                                                              i.      Founded Henry Street Settlement

                                                            ii.      Founder of American Public Health Nursing

                                                          iii.      Responds to at-risk populations

                                                          iv.      Decreased infectious disease and improved infant well-being

                                                            v.      Wrote House on Henry Street – published 1915

Mary Breckinridge

                                                              i.      Established the Frontier Nursing Service in 1925 in Appalachian Mountains of KY

                                                            ii.      Trained nurse midwives

                                                          iii.      In FNS first 50 years, delivered 17,053 babies with only 11 maternal deaths (in early 1900s, 800 maternal deaths per 100,000 live births vs approximately 7.7 per 100,000 today).

Samuel Crumbine

Sanitary guy w/don't spit on the sidewalk

Fly Swatter

Kansas Man of Honor

Community

People who share one or more characteristics

Location, social system w/members who interact

(Ex: Baker Nursing Students)

Population

A group of individuals who share one common Characteristic

NOT a social sytem, no shared interaction.

(Ex: all nursing students)

Culture

Public Health

What we as a society, do collectively to assure the conditions in which people can be healthy.

Assesment-data collection (incident rates for cancer, flu, STD's)

Assurance-Making sure essential community-wide health services are available (prenatal care, emphasis on disease prevention, health protection et promotion)

Policy Development-developing policies that support population health (seat-belt laws, smoking policies)

Community Health Nursing (CHN)

Broader focus on that of public health; focus on high risks, provide indirect/direct services locally, state, federally, et globally.

GOAL is to preserve/protect health

Community is client

Emphasis on high risk

Direct et indirect service

Community-Based Nursing (CBN)

acute/chronic care of individuals et families that enhances their capacity for self-care et promotes autonomy in decision making.

Management of acute/chronic conditions of individuals or families, promote autonomy of individual/family across a lifespan, provide direct care to the local community.

Individual et family is client

Goal is to manage acute or chronic conditions

Works across the entire lifespan

Direct service

Individual et family autonomy

Roles of Community Health Nurses

Case Manager

Collaborator

Educator

Counselor

Client Advocate

Change agents

Community Assessment

Structure-name of community, geographic boundaries, water et sanitation, housing, economy.

Population-age/sex distribution, growth trends, density (rural), cultural groups, education level, religious groups.

Social System-Education, transportation, government, communication, welfare, volunteer programs, health.

Vulnerable Groups

Homeless et poor

Immigrant

Abused Clients

Clients who abuse Substances

Older clients

Primary et Preventative Care Services of Health Care Agencies

School Health

Occupational

Physician's office

Clinics

Nursing Centers

Block et parish Nursing

Volunteer Agencies

Secondary et Tertiary Health Care Agencies

Hospitals

Intensive Care

Subacute

Psychiatric facilities

Rural hospitals

Restorative Care

Home health care

Rehabilitation

Extended care facilities

Continuing Care

Nursing facilities

Assisted Living

Respite Care

Adult daycare centers

Health

State of complete, physical, mental, et social well being

-not simply the absence of disease or infirmity

Wellness

Disease

Illness

Health Promotion

process of enabling people to increase control over, et to improve, their health

Enhance Well-being

Actualize human potential

Approach-motivated

Disease prevention-Avoidance motivated-don't do things->exercise to be more healthy or exercise to prevent disease; action toward disease process; illness/injury specific.

Clinical Preventative Services

Screening recommendation (BP, PAP, mammograms, PSA, colonoscopy)

Screening Test Criteria

Effectiveness or early detection, detect target condition earlier than w/o screening.

Counseling (substance abuse, sexual behavior, diet, exercise, dental health)

Immunizations.

Criteria for Preventative Services

Sensitivity:True positive rate;% of people w/o the disease who have a positive test.

Specificity:True negative rate; % of people w/o the disease who have a negative test.

Don't screen for everthing...that's TOO Much!

 Healthy People 2010 Goals

Eliminate health disparities-gender, income, education, geographic location, race et ethnicity, disability, et sexual orientation.

Increase Quality et Years of Life-Will be a test question->MC choose all that apply

Primary Prevention of Health

Health Belief Model

Percieved susceptibility

Perceived seriousness

Transtheoretical Model

Precontemplation

Contemplation

Preparation

Action

Maintenance Stage

Leading Health Indicators

Physical activity

Overweight et obesity

Tobacco use

Substance abuse

Immunization

Access to health care

Responsible sexual behavior

Internal Variables influencing Health Beliefs et Practices

Developmental Stage

Intellectual background

Perception of functioning

Emotional factors

Spiritual factors

External Variable Influencing Health Beliefs et Patterns

Family practice

Socioeconomic factors

Cultural background

Racism

Institutional Racism

Interpersonal Racism

Internalized Racism

Prejudice

Discrimination

Nursing Process

Assessment

Subjective-pt history, what pt tells you

Objective-anything measurable/observable, what you see.

Comprehensive-Gordon's functional Health Patterns

Focused-already have complete history, focus on current problem/issue, reason for the visit.

Diagnosis

Short Term Goal

Part of the identification of outcomes

may be achieved in less than a week.

Long Term Goal

Part of identification of outcomes in nursing process

may be achieved in weeks or months.

Client Centered Goals

Part of the outcome indentification process in the nursing process

What a pt will be able to do

Outcome Requirments

Measureable criteria to evaluate goal achievement

Stepping stones to achieve goal

Typical short-term

 Components of Goals et Objectives

Subject:Patient Centered.

Verb:Single behavior such as Cognitive, Affective, Psychomotor.

Qualifiers:observable/measurable

Reasonable

Realistic

Time bound-by time of discharge, throughtout hospitalization, by the end of the teaching session, weeks or months.

Mutual

Indications

Planning

Part of the nursing process

Plans of care

Care Plans

Critical Pathways-set outcomes, certain expectations for special injuries, plan for all departments, hospitals.

Kardex

Implementation

Part of the nursing process

Reassessing the client

Review et revise current care plan

Implment nursing interventions

Organize resources et care delivery-equipment, personnel->know level of skill->get help if needed, environment, client.

Evaluation

Part of the nursing process that measures clients responce to nursing actions et clients progress toward achieving goals.

Ongoing et continuous

Evaluate-clietns status et progress toward goal acheivement, care plan status, measures:gather data, compare client status to outcome criteria, determine if client is making progress.

Documentation-goal met AEB, Goal partially, Not met.

Factors contributing to success of failure in goal attainment-client variables, nurse variables, health care system variable->money, no help in area, problems w/the nursing process.

Family

A family is who they say they are

:Or 2 or more persons who are joined together by bonds of sharing et emotional closeness et who identify themselves as being part of the family.

Purpose of Family

Characteristics of Healthy Family

Good Communication

Clear, open, et spontaneous w/feelings, beliefs et differences.

Respect one another

Encourage autonomy

Demonstrate warmth et closeness to one another

Optimistic, enjoy eachother

Structure theory that guide family nursing.

Relationships/roles-what they value, organization of family.

Power

Boundaries-sharing in/out of family

5 functions that guide family nursing

Health Care

Reproductive

Affective-feelings/emotions

Economic

Socialization et social placement

Developmental Stages Theory that Guide Nursing

Single young Adult-Accepting parent-offspring separation

Newly married couple-commitment to new system

Family w/young children-Accepting new generation of members into system

Family w/adolescents-increasing fexibility of family boundaries to include children's independence

Launching frown children-Accepting multitude of exists from et entries into family

Later Life-Accepting shifting of generational roles.

Extended Family

Family containing immediate family et other family members.

Parents, their children, et a aunt et cousin.

Disabled Family Coping

Family Resiliency Model

Resiliency-ability to recover from adverse events

How well family responds to hardship

Assumptions:Families face hardship et changes

Families develop basic strenghts et capabilities to protect, develop et promote adaptation.

Families benefit from et contribute to network or relationships in community.

Nuclear Family

Extended Family

Blended Family

Stress

Disruptive forces operating within or on any system.

Can lead to illness-increased hormones, unhealthy coping strtegies, neglect s/s

Reaction-perception of event.

Appraisal

General Adaptation Syndrome

Alarm reaction stage-flight or flight initiated

Stage of Resistance-Body stabilized, if stressor persists et no adaptation.

Stage of Exhaustion-Prolonged exposure to stressor, immunological responce.

Pimary appraisal Reaction to Stress

Secondary Appraisal reaction to Stress

Problem Focused (Task Oriented) Coping Strategies

Emotion Focused Coping Strageties

Talk to someone

Don not alter the situation but make the person feel better

Ego defense mechanism

Actions such as joking, exercising, etc.

Newman's System Theory et Stressors

Situational-finance, finals

Maturational-health, insurance, separation, menopause

Sociocultural-race, sexuality, sexism, povery, neighborhood violence

Interventions: Primary-promotion/prevention; secondary-early detection/treatment; tertiary-restoration/rehab

Adaptive Coping Strategies

Maladaptive Coping

Dysfunctional Family Coping

Medicare

Medicaid

low income people

*can have both Midicaid et Medicare.