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Theoritical Foundation and Nursing- Reports

This file contains lectures about Theoretical Foundation and Nursing
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bs nursing

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INTERPERSONAL THEORY

Hildegard E. Peplau

OVERVIEW OF THE NURSE SCHOLAR

 Hildegard E. Peplau, first published nursing theorist in a century, since Nightingale  Created the nursing middle-range theory of Interpersonal Relations  Helped revolutionize the scholarly work of nurses  Contributor to mental health laws/reform

BACKGROUND – BIRTH AND CHILDHOOD

 Hildegard E. Peplau -- born September 1, 1909 in Reading, PA to immigrant parents of German decent  Illiterate, work-a-holic father  Oppressive, perfectionist mother  Raised in a paternalistic family and a paternalistic society  Though higher education was never discussed at home, Hilda was strong-willed, with motivation and vision to grow beyond traditional women’s roles  She wanted more out of life and knew nursing was one of few career choices for women in her day

HISTORICAL EVENTS OF HILDA'S YOUTH

 WW I ended in 1918, along with the great flu epidemic the same year  It was a man’s world in both business and education

NURSING EDUCATION OF PEPLAU'S TIME

 The autonomous, nursing- controlled Nightingale era schools came to an end – schools controlled by hospitals now and formal book learning was discouraged  Hospitals and physicians saw women in nursing as a source of free or inexpensive labor  Exploitation was not uncommon of nurse’s employers, physicians and educational providers  Nursing practice was controlled by medicine

NURSING EDUCATION & MILITARY SERVICE

 Peplau pushed forward beating the odds:  Graduate Pottstown, PA Hospital School of Nursing in 1931  BA Psychology: Bennington College, VT 1943  World War II: Army Nurse Corps -- worked in a neuropsychiatric hospital in London, England  MA Psychiatric Nursing: 1947; Ed. Nursing Education: 1953, both graduate degrees from Teachers’ College, Columbia University  Certification in Psychoanalysis for Teachers: William Alanson White Institute, New York City, 1954

FOUNDATION OF PEPLAU’S FRAMEWORK

 Hilda witnessed injustices in life, being determined to push past them for social justice  First exposure to Interpersonal Theory at Bennington  Attended lectures by Harold Stack Sullivan on Interpersonal Relations  She had vision to bring the Sullivanian theory to interactions with her patients – they needed:  Humane treatment

Hildegard Peplau Army Nurse Corps 1943-

 Dignity & respect  Healing discussion

“.. a time when there was none to be found...”

 Teachers’ College: Director of Advanced Program in Psychiatric Nursing  She created nursing curriculum  Included study of nurse-patient interactions through “Process Recordings”  Her book, or conceptual framework, was completed by 1948, entitled Interpersonal Relations in Nursing

PURPOSE

 To improve the interpersonal relationship between the nurses and patients and quality nursing education.

INTERPERSONAL RELATIONSHIP

 Nurse-patient  It is important that Nurse must have the ability to understand their own behaviors to help and understand the patients perceived difficulties.  Four phases of the nurse-patient relationship are identified

RELATIONSHIPS HAVE FOUR PHASES:

ORIENTATION PHASE

 Get acquainted phase of the nurse-patient relationship  It is important that a professional relationship is established  Parameters and boundaries are established and met  Early levels of trust are developed

IDENTIFICATION PHASE

 The client begins to identify problems to be worked on within relationship  The goal of the nurse: o Help the patient to recognize his/her participation role and promote responsibility for self

EXPLOITATION PHASE or Working phase

 Client’s trust of nurse reached full potential  Client making full use of nursing services  Solving immediate problems  Nurse and the patient work towards discharge and termination goals.  Interventions of the problems are done

RESOLUTION PHASE/ TERMINATION PHASE

 Final phase of nurse-patient relationship  Client met needs  Mutual termination of relationship  Client has increased self-reliance to deal with his/her problem

METAPARADIGMS

 Hesistate  Unable to decide  What would nurse do?  Your role is to listen to patient  Your interpretation of the issue  Will be perceived as a barrier

 Unexplained Discomfort  Manifestions?  Frustrations  Anxiety  Needs  Conflict  SELF Awareness is necessary to identify the cause of discomfort and plan to achieve the goals.

STRENGHTS  Applicability

 Essential to a strong nurse- patient relationship

WEAKNESS

 Personal space not considered

 Health promotion not emphasized  Difficult with patient who does not recognize the “ need”

TRAVEL BEE’S HUMAN TO HUMAN RELATIONSHIP

AUTHOR

Joyce Travelbee (1926-1973) developed the Human-to-Human Relationship Model presented in her book “Interpersonal Aspects of Nursing (1966, 1971)”.

 She dealt with the interpersonal aspects of nursing.

 She explains “human-to-human relationship is the means through which the purpose of nursing if fulfilled”

 A psychiatric nurse, educator and writer born in 1926.

 1956, she completed her BSN degree at Louisiana State University

 1959, she completed her Master of Science Degree in Nursing at Yale University.

 1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans.

 Later in Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi.

 Travelbee died at age 47.

THEORY

THE HUMAN-TO-HUMAN RELATIONSHIP MODEL

Purpose

Health is defined as being both subjective and objective. Human beings perceive and relate their own sense of health and illness. To be human is to experience illness. Travelbee (1971) wrote: "A basic assumption is that illness and suffering are spiritual encounters as well as emotional-physical experiences" (p 61). Humans may see illness as having merit or as unavoidable. The presence of distress may not cause one to seek help (Travelbee, 1971, 2013).

Environment is not well defined, which one might relate to the timing of Travelbee’s writing, the 1960s. Instead, Travelbee relates that the nurse must be observant of the patient in the place where the patient is present in order to ascertain that the patient is in need. She speaks of experiences encountered by all humans: suffering, pain, illness, and hope. Her work with psychiatric patients and community as well as hospitalized individuals encompasses an awareness of differing environments (Travelbee, 1971, 2013; Doona, 1979).

Nursing is better defined. Foremost, the assumption of nursing is to establish a human-to-human relationship. Doona (1979) explained: "A relationship is established only when each participant perceives the other as a unique human being" (p 149). It is within the paradigm of nursing that the nurse/human facilitates the individual, family, or community to prevent or cope with illness and suffering. The nurse also assists with trying to find meaning in these experiences (Travelbee, 1971, 2013; Pokorny, 2010). All contact with ill persons helps fulfill the purpose of nursing. Travelbee (1971) insisted: "The final measure of nursing competency is always in terms of the extent to which individuals and families have been assisted with the problems of illness and suffering" (p 119).

Lydia Hall’s Nursing Theory—Core, Care and Cure Model

Lydia Hall’s nursing theory—Core, Care and Cure Model—is client-centered (Anonuevo et al., 2000). Hall’s metaparadigm centers on the following: on person as the Core, body as the Care and disease is for the Cure (Pearson, 2007; Tomey & Alligood, 2002; Parker, 2001; Anonuevo et al., 2000). In an editorial (Pearson, 2007), nurses primarily function within three realms: core, where nurses use their selves to relate with the patient; care, using hands on caring for the body: and, cure, in the nurses’ application of medical know-how.

The Core of nursing focuses on the recipient of care—who can be an individual, family or community. Core of nursing encompasses various fields of study, including the biological, social and behavioral sciences and humanities (Pearson, 2007). It is the application of social sciences that focuses on the personal knowing, therapeutic use of self (Octaviano & Balita, 2008; Tomey & Alligood, 2002; Parker, 2001). The nurse uses relationships for therapeutic effect and emphasizes the social, emotional, spiritual and intellectual needs of the patient in relation to family, institution, community and the world—the core (Parker, 2001).

Hall’s Care pertains to the knowledge and activities of nursing (Pearson, 2007). The Body, from the inference of phenomena of natural and biological sciences, concerns the intimate bodily care (Tomey & Alligood, 2002). Nursing is required when people are not capable of performing intimate bodily care for themselves (Parker, 2001). Nursing care is the focus of the Care Model of Hall.

Cure involves the pathological and therapeutic sciences, focusing on the patient and family through the medical care (Tomey & Alligood, 2002). Cure provides the treatment of the disease by utilizing the nursing process in conjunction with medicine (Pearson, 2007; Parker, 2001).Cure is the medical side in the care of patients.

Geriatric syndromes are conditions experienced by older frail individuals that occur intermittently rather than either continuously or as single episodes. It may be triggered by acute insults, and often are linked to subsequent functional decline. More recently, geriatric syndromes have been viewed as conditions in which symptoms are assumed to result not only from discrete diseases but also from accumulated impairments in multiple systems and develop when the accumulated effect of these impairments in multiple domains compromise compensatory ability (Flacker, 2003). Geriatric or the stage of ageing is the period of multiple impairments that predisposes to falling, incontinence and functional dependence which includes slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment) (Tinetti et al., 1995).

The Care. The type of care a nurse will render in any case of altered health pattern can be in the form of promotive, preventive, curative, rehabilitative and palliative aspects of care. Promotive care focus on health promotion which is categorized with no source of health information, visits to well-clinic/centers or oriented to health programs and practicing a healthy lifestyle and with good environment. Prevention is the end of health promotion. Promotive and preventive care works together. When these fail, the curative aspect of care is given to a sick individual. In curative care, the nurse will assess if the patient is capable for self-care and can participate in the nursing interventions. Minimal care is given if the patient needs assistance. Total care is given to the patient who cannot participate to the nursing interventions but with the support system (e., family) in doing the nursing care. The complete total care is given to patients without support system, who need a “change agent”—the nurse—in providing complete total nursing care. Rehabilitative care is given to restore the patient’s health after the convalescence stage. Palliative is the last sort of care when all else failed, this stage prolonged life without treatment, care is given only to minimize suffering or lessen the depth of present condition but does not promise long term relief or recovery.

The Cure. This identifies the level of care to be given to a person in case of altered health pattern. Level 1 Cure covers promotive and preventive care are indications for primary health care management. The major purposes of this level are to promote wellness and prevent illness or disability. This level occurs at home or community and the participants in the care of geriatrics is the private/family/community nurse, family and patient’s self that will emphasize the development of healthy lifestyle and environment. Level 2, or early stage of curative phase, is an indication for secondary health care management. This level aims to provide early intervention to alleviate disease and prevent further disability. Acute treatment center or hospital is advised for diagnostic and therapeutic services. Health team includes the nurses, doctors, diagnostic centers and the support system. Level 3 includes late stage of curative, rehabilitative and palliative care, which is an indication for tertiary health care management. This aims to minimize the effects and permanent disability of chronic irreversible condition. Aggressive curative interventions occur at this level including medical-surgical procedures. This level seeks to restore an individual to the state that existed before the development of an illness or promote the maximum potential of wellness after the disease. Palliative management is given when all the interventions failed. The health team in this level includes nurses, physicians/surgeons, diagnostic centers, rehabilitation centers and other auxillary services. Clergy services, support system and family are also very vital part in this level.

The main responsibility of the nurse is to care for the patient’s health. Both holistic and anatomic in nature, care respects man as a whole so as to improve quality of life and provide health. Quality of life is akin to health and will always be a part of man’s basic needs—and every need has its hierarchy and level to attain the highest level of health continuum. The search for the health of the patient is the primary method to provide one of man’s basic needs. To care is to provide what man needs, and such needs must be included in the nursing process.

—TO CARE IS TO NURSE AND TO NURSE IS TO GIVE YOURSELF WHEN YOU CARE.

21 NURSING PROBLEMS

Faye Abdellah

BACKGROUND

 Born –March 13,  Nursing Diploma from Fitkin Memorial Hospital  Columbia University  Bachelor’s Degree in Nursing 1945  Master’s Degree in Physiology 1947  Doctorate in Education 1955  May 6, 1937  German hydrogen-fueled airship Hindenburg exploded in Lakehurst, New Jersey  "I could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would learn nursing."  Faye was 18 years old when she and her brother witnessed the explosion of this airship in Lakehurst where her family resided. Together with her brother, they ran to help the injured people.

ACHIEVEMENTS

 U. Public Health Service (Branch of Military)  Chief Nurse Officer  First Deputy U. Surgeon General  Uniformed Services University of Health Sciences  Founder and First Dean, Graduate School of Nursing  Yale University School of Nursing  Nursing Instructor  Nursing researcher and theorist  “First woman to become a surgeon general as a nurse”  Originated from nursing practice & desire to promote patient-centered comprehensive care

FAYE ABDELLAH’S THEORY

Abdellah’s theory, “Nursing is based on an art and science that moulds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs.”

 Remedial care needs  Restorative care needs.

TWENTY-ONE NURSING PROBLEMS

 Serve as a knowledge base for nursing (categorized according to needs)

ABDELLAH'S TYPOLOGY OF 21 NURSING PROBLEMS

BASIC TO ALL PATIENTS

  1. To maintain good hygiene and physical comfort –

 After colonoscopy, patients are usually soiled from the procedure. It is therefore important to clean them properly.  Physical comfort through proper positioning in bed.

  1. To promote optimal activity: exercise, rest, and sleep –

 Patients who were sedated during the procedure stay in the unit until the effect of the sedation has decreased to a safe level.  As a nurse, make sure the patients are able to rest and sleep well by providing a conducive environment for rest, such as decreasing environmental noise and dimming the light if necessary.

  1. To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection –

 One way we prevent the spread of infection is through proper disinfection of the equipment.  Bed alarm, call light at all times

  1. To maintain good body mechanics and prevent and correct deformity –

 Positioning the patient properly, allowing for the normal anatomical position of body parts.

SUSTENAL CARE NEEDS

  1. Facilitate the maintenance of a supply of oxygen to all body cells –

 When patients manifest breathing problems, oxygen is attached to them. Sedated patients are attached to cardiac monitor and pulse oxi meter while having the oxygen delivered. When the oxygen saturation falls below the normal levels, the rate of oxygen is increased accordingly, as per physician's order.

  1. To facilitate the maintenance of nutrition of all body cells –

 Patients undergoing endoscopic procedures are on NPO. For this reason it is important to monitor the blood glucose level. When the patient's blood glucose falls from the normal value, we inject D50W to the patient or we change the patient's IVF to a dextrose containing fluid.

  1. To facilitate the maintenance of elimination –

 Providing bedpans or urinals to patients and at times, insertion of Foley catheter when the patient is not able to void

  1. To facilitate the maintenance of fluid and electrolyte balance –

 Proper regulation of the intravenous solutions.

  1. To recognize the physiological responses of the body to disease conditions—

 Pathological, Physiological, and Compensatory – ex. Pt. with DENGUE – it is important to check the patients for signs of bleeding by monitoring the BP, capillary refill.

  1. To facilitate the maintenance of regulatory mechanisms and functions –

 When a patient has a difficulty in breathing and is showing an increase respiratory rate, elevating the head part of the bed is done to facilitate the respiratory function.

  1. To facilitate the maintenance of sensory function –

 When a patient is admitted who is already deaf and mute, we communicate to them by body language to maintain their basic need despite of inadequacy to the sensory function.  Communicate to comatose patient

  1. To identify and accept interrelatedness of emotions and organic illness –

 Encourage patients to verbalize their feelings and allow them to cry when they have the need to do so will help them emotionally. Some patients are diagnosed with malignancy after the procedure and during this time the emotional needs of the patient is a priority.

  1. To identify and accept positive and negative expressions, feelings, and reactions –

 Most patients feel anxious before undergoing the procedures. It is necessary to listen to the patients' expressions and allow them to ask questions.  To decrease their anxiety.

  1. To facilitate the maintenance of effective verbal and nonverbal communication –

 When patients are not able to express themselves verbally, it is important to assess for nonverbal cues. For instance when patients are in pain, assessing for facial grimacing.

  1. To promote the development of productive interpersonal relationships –

 Allow the patient's significant others to stay with the patient before and after the procedure. This allows for bonding and promotes interpersonal relationship.

  1. To facilitate progress toward achievement of personal spiritual goals –

 Nurse usually visits the patients in the unit. Patients may benefit from this, allowing them time to practice their faith.

  1. To create and/or maintain a therapeutic environment –

 Providing proper lighting, proper room temperature, and a quiet environment are done to patients staying in the unit.

  1. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs –

 Care to patients varies according to their developmental needs.  Allowing the parents to stay during the procedure help the pediatric patients in their emotional and developmental needs.

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Theoritical Foundation and Nursing- Reports

Course: bs nursing

999+ Documents
Students shared 8659 documents in this course

University: Southwestern University PHINMA

Was this document helpful?
INTERPERSONAL THEORY
Hildegard E. Peplau
OVERVIEW OF THE NURSE SCHOLAR
Hildegard E. Peplau, first published nursing theorist in a century,
since Nightingale
Created the nursing middle-range theory of Interpersonal Relations
Helped revolutionize the scholarly work of nurses
Contributor to mental health laws/reform
BACKGROUND – BIRTH AND CHILDHOOD
Hildegard E. Peplau -- born September 1, 1909 in Reading, PA to
immigrant parents of German decent
Illiterate, work-a-holic father
Oppressive, perfectionist mother
Raised in a paternalistic family and a paternalistic society
Though higher education was never discussed at home, Hilda was strong-willed, with motivation
and vision to grow beyond traditional women’s roles
She wanted more out of life and knew nursing was one of few career choices for women in her
day
HISTORICAL EVENTS OF HILDA'S YOUTH
WW I ended in 1918, along with the great flu epidemic the same year
It was a man’s world in both business and education
NURSING EDUCATION OF PEPLAU'S TIME
The autonomous, nursing- controlled Nightingale era schools came to an end – schools
controlled by hospitals now and formal book learning was discouraged
Hospitals and physicians saw women in nursing as a source of free or inexpensive labor
Exploitation was not uncommon of nurse’s employers, physicians and educational providers
Nursing practice was controlled by medicine
NURSING EDUCATION & MILITARY SERVICE
Peplau pushed forward beating the odds:
Graduate Pottstown, PA Hospital School of Nursing in 1931
BA Psychology: Bennington College, VT 1943
World War II: Army Nurse Corps -- worked in a neuropsychiatric
hospital in London, England
MA Psychiatric Nursing: 1947; Ed.D. Nursing Education: 1953, both
graduate degrees from Teachers’ College, Columbia University
Certification in Psychoanalysis for Teachers: William Alanson White
Institute, New York City, 1954
FOUNDATION OF PEPLAU’S FRAMEWORK
Hilda witnessed injustices in life, being determined to push past them for social justice
First exposure to Interpersonal Theory at Bennington
Attended lectures by Harold Stack Sullivan on Interpersonal Relations
She had vision to bring the Sullivanian theory to interactions with her patients – they needed:
Humane treatment
Hildegard Peplau
Army Nurse Corps
1943-1945

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