contrast nursing models
For this , in four to five paragraphs, contrast two nursing models and theories found in your reading. Discuss how they are similar or different in the way the define/discuss health and wellness, illness, the client, the environment, and nursing. Summarize by selecting the one model or theory that aligns best with your beliefs and then describe how this would affect the way in which you would practice nursing. https://ambassadored.vitalsource.com/#/books/97808…
Developing a framework of practice early in your career is essential and very helpful. A practice framework is developed when you select a reference point for how you believe care should be delivered. This is considered theory based practice. It usually emerges from the values you now have and those that will develop as you deliver nursing care first hand. Fortunately we have many nurses who have developed frames of reference from their values and beliefs about health, wellness, caring, science and many other concepts. These are available to us to review and see if they align with what we believe. Some are considered philosophies, some are models, and others are considered theories. In your textbook reading you were able to review these. For example, we know that Dorothea Orem defined health as the ability to live to the fullest through self-care. Jean Watson’s more contemporary philosophy focuses on transpersonal caring and her “10 caritas” provide us with a perspective on how the “art of nursing” can be practiced. Callista Roy offers even another view of alteration in health by discussing adaptation and coping within an environment. Several others are detailed in your reading.
All of these are important to know and learn as you will use these to begin to develop your own approach and philosophy (an assignment in this module). It is also helpful to become familiar with these as you will see others work from a theory base and by understanding the different possibilities you will find it helpful when working with them. Many healthcare settings are also selecting nursing models and theories as their basis for practice.
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REQUIREMENTS
school composition school nursing school anatomy
book:
Joseph T. Catalano
Learning Objectives
After completing this chapter, the reader will be able to:
• Explain why theories and models are important to the profession of nursing
• Analyze the four key concepts found in nursing theories and models
• Interrelate systems theory as an important element in understanding nursing theories and models
• Evaluate how the four parts of all systems interact
• Synthesize three nursing theories, identifying how the different nursing theorists define the key concepts in their theories
• Compare and contrast a middle-range theory with a major nursing theory
CARING FOR REAL PEOPLE
For many nurses, and for most nursing students, the terms theory and model evoke images of textbooks filled with abstract, obscure words and convoluted sentences. The visceral response is often, “Why is this important? I want to take care of real people!” The simple answer is that understanding and using nursing theories or models will help you be a better nurse and provide better care to real people.
DIFFERENCES BETWEEN THEORIES AND MODELS
What Is a Theory?
Although the terms theory and model are not synonymous, in nursing practice they are often used interchangeably. Strictly speaking, a theory refers to a speculative statement involving some element of reality that has not been proved. For example, the theory of relativity has never been proved, although the results have often been observed.
The nursing profession tends to use the term theory when attempting to explain apparent relationships between observed behaviors and their effects on a client’s health. In this nursing context, the goal of a theory is to describe and explain a particular nursing action to make a hypothesis, which predicts the effect on a client’s outcome, such as improved health or recovery from illness. For example, the action of turning an unresponsive client from side to side every 2 hours should help to prevent skin breakdown and improve respiratory function.
In recent years, nursing has been moving toward using research findings to guide nursing practice. This approach, called evidence-based practice, is an important element in improving nursing care and proving many of the long-standing theories that the nursing profession has developed over the years.1
What Is a Model?
A model is a 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. For example, a hospital organizational chart is a model that attempts to demonstrate the interrelationships of the various levels of the hospital’s administration.
What Do You Think?
Do you consider yourself to be healthy? What factors make you healthy? What factors are indicators of illness?
What Do Nurses Do?
Although a model tends to be more concrete than a theory, they both help explain and direct nursing actions. This ability, using a systematic and structured approach, is one of the key elements that raises nursing from a task-oriented job to the level of a profession that uses judgment and knowledge to make informed decisions about client care. With the use of a conceptual model, nurses can provide intelligent and thoughtful answers to the question, “What do nurses do?” Consider the quoted scenario above.
“Mr. X had surgery for intestinal cancer 4 days ago. He has a colostomy and needs to learn how to take care of it at home because he is going to be discharged from the hospital in 2 days. When the nurses attempt to teach him colostomy care, he looks away, makes sarcastic personal comments about the nurses, and generally displays a belligerent and hostile attitude.”
Without an understanding of the underlying dynamics involved, the nurses might themselves become sarcastic and scold the client about his behavior or simply minimize their contact with him. This type of response will not improve Mr. X’s health status. If, however, the nurses knew about and understood the dynamics of grief theory, they would realize that Mr. X was probably in the anger stage of the grief process. This understanding would direct the nurses to allow, or even to encourage, Mr. X to express his anger and aggressiveness without condemnation and to help him deal with his feelings in a constructive manner. Once Mr. X gets past the anger stage, he can move on to taking a more active part in his care and thus improve his health status. The client goals would then be achieved.
If a researcher were to stop 10 people at random on the street and ask the question, “What do nurses do,” he or she would likely get 10 different answers, but the confusion about nurses’ activities extends far beyond the public at large. What if the researcher asked 10 hospital administrators, 10 physicians, or even 10 nurses the same question? The answers would probably vary almost as much as the answers from laypersons.
The Iowa Project
In an attempt to identify what exactly it is that nurses do, J. C. McCloskey and G. M. Bulechek, two nurse researchers at the University of Iowa, have been conducting a research project since 1990 to develop a taxonomy of the interventions that nurses use in their practice (Box 3.1). This research has been called Nursing Interventions Classification (NIC), the Iowa Interventions Project, or simply the Iowa Project.2–5
A Classification System
The Iowa Project addresses an ongoing need for nurses to be able to identify and quantify what they do. In the current era of concern for high-quality health care, this need has become even more acute. The first results, published in 1994, categorized and ranked 336 interventions that nurses use when they provide care to clients. A follow-up study was conducted about 2 years after the original study categorized and ranked 433 interventions used by nurses. McCloskey and Bulechek6 also investigated which nursing interventions were commonly used by nurses in specialty settings. Forty specialty areas responded, and the researchers were able to develop a table that lists what core skills are used by each organization. In 2008, the list was again updated. It now contains 542 interventions within a taxonomy of seven domains (i.e., physiological: basic; physiological: complex; behavioral; safety; family; health systems; and community) and 30 classes of interventions.
Research into nursing intervention classification systems is ongoing and has served as the foundation of new methods to define nursing practice and measure the outcomes of client care. The need to increase client satisfaction and achieve successful outcomes of nursing care is a key element in the Affordable Care Act (ACA), which was passed in 2010. Even more than in the past, these elements will be the basis of reimbursement for health-care providers.
Box 3.1 What Constitutes Care?
At first glance, it would seem that everybody knows that nurses take care of clients. But what constitutes care? A study conducted by the faculty of the University of Iowa, called the Nursing Interventions Classification (NIC) or simply the Iowa Project, has identified 336 tasks or interventions for which nurses are responsible in their care of patients. Not all nurses carry out all 336 of these tasks all the time, but during an average career, a nurse would likely be involved in the majority of these tasks. Although this project was undertaken in the mid-1990s, it remains the benchmark study. Since the original study, several additional studies have been conducted that reaffirm the findings of the Iowa Project, and several researchers have undertaken projects to use the data generated by the Iowa Project in actual client-care situations.
This project is an excellent example of how a nursing theory led to a research project that developed information that can be used by nurses in their daily practice. On the principle that nursing interventions are specific actions that a nurse can perform to bring about the resolution of a potential or actual health-care problem, the NIC attempted to identify and classify nursing interventions. It also attempted to rank those interventions according to the number of times a nurse was likely to perform one during a working day. The goal of the project was to develop a nursing information system that could be incorporated into the current information systems of all clinical facilities. By using the NIC system, hospital administrators, physicians, nurses, and even the public should be better able to recognize and evaluate the multiple interventions that nurses are responsible for in their daily work.
It is a generally acknowledged fact that nurses, as the largest single group of health-care providers, are essential to the welfare and care of most clients. Yet, in an age of health-care reform, nurses are finding it increasingly difficult to delineate the specific contributions they make to health care. If nurses are unable to define the care they provide, how are the reformers, politicians, and public going to be able to identify the unique contribution made by nursing?
Unfortunately, many of the contributions that nurses make to health care are currently invisible because there is no method of classification for them in the computerized database systems now in use. Commonly used nursing interventions such as active listening, emotional support, touch, skin surveillance, and even family support cannot be measured and quantified by most current information systems.
The large number of interventions used daily by nurses demonstrates the complex and demanding nature of the profession. The breadth and depth of knowledge and skills demanded of nurses on a daily basis are much greater than are found in many other health-care professions. One study found that nurses working in general medical-surgical units during a 6-month period were likely to care for 500 clients with more than 600 individual diagnoses (many clients have multiple diagnoses). These researchers also found that the physical demands of the work were actually less difficult and tiring than dealing with the emotional and technical demands of handling the huge amounts of information generated by the care given.
Sources: Bulechek GM, Butcher HK, Dochterman JM. Nursing Interventions Classification (NIC) (5th ed.). St. Louis, MO: Mosby Elsevier, 2008; Moorhead S, et al. Nursing Outcomes Classification (NOC): Iowa Outcomes Project (3rd ed.). St. Louis, MO: Mosby, 2004; Scherb CA, Weydt AP. Work complexity assessment, nursing interventions classification, and nursing outcomes classification: Making connections. Creative Nursing, 15(1):16–22, 2009.
Using the NIC as a starting point, the Work Complexity Assessment (WCA) was developed so that nurses could identify specific interventions they routinely perform for various client populations. Taking the process one step further, the Nursing Outcomes Classification system closes the loop by providing a means for nurses to evaluate whether the outcomes were achieved.2
Although initially used primarily to help nurses with the delegation of duties to unlicensed personnel by linking skills with performance requirements, WCA is now an important tool in the improvement of the quality of nursing care. When nurses analyze the care they provide and actually look at the various interventions they use, they increase their understanding of both the methods and rationales for care. WCA also fits nicely into the use of evidence-based practice when nurses share with other nurses what they have learned about improving care.
This type of research helps identify the important contributions made by nursing to the health and well-being of clients. It also demonstrates the complex and demanding nature of the nursing profession. Much of the public, and even many physicians and nurses, do not really understand what nurses do for clients on a daily basis. Using classification systems aids in clarifying what nurses bring to client care, makes what they do measurable, and validates the importance of the nursing profession.
Nursing Competencies
One way in which the nursing profession identifies what nurses do is by looking at competencies. In nursing, the word competence is often defined as the combination of skills, knowledge, attitudes, values, and abilities that support the safe and effective practice of the nurse. A nurse practices competently when he or she has mastered a range of skills and decision-making processes demonstrated in the care of clients. All the major nursing organizations have developed lists of competencies for nurses. These are usually general, broad statements rather than catalogues of specific skills. (See “Issues Now: The Pew Commission Final Report” in this chapter.)
“The need to increase client satisfaction and achieve successful outcomes of nursing care is a key element in the Health Care Reform Act, which was passed in 2010. Even more than in the past, these elements will be a basis of reimbursement for health-care providers.”
Nursing competencies are currently under close scrutiny due to the large number of medication and other types of errors in the health-care setting that have led to numerous clients being injured or killed. The Institute of Medicine’s (IOM) document on the future of nursing contains recommendations and lists of competencies for nursing school graduates to help improve the quality of care. The Quality and Safe Education for Nurses (QSEN) project, built upon the IOM recommendations, is in the process of developing a framework for nursing schools’ curricula (see IOM and QSEN in Chapter 4).
Nursing researchers have attempted to develop specific lists of skills based on the general competency statements from the various nursing organizations. These skills lists help differentiate the various levels of nursing practice. One such list of skills is presented in Table 3.1.
KEY CONCEPTS COMMON TO NURSING MODELS
Although nursing models vary in terminology and approach to health care, four concepts are common to almost all of them: Client or patient (individual or collective), health, environment, and nursing. Each nursing model has its own specific definition of these terms, but the underlying definitions of the concepts are similar.
Client
The concept of client (or patient) is central to all nursing models because it is the client who is the primary recipient of nursing care. Although the term client usually refers to a single individual, it can also refer to small groups or to a large collective of individuals (e.g., for community health nurses, the community is the client).
A Complex Relationship
The concept of client has changed over the years as knowledge and understanding of human nature have developed and increased. A client constitutes more than a person who simply needs restorative care and comes to a health-care facility with a disease to be cured. Clients are now seen as complex entities affected by various interrelating factors, such as the mind and body, the individual and the environment, and the person and the person’s family. When nurses talk about clients, the term biopsychosocial is often used to express the complex relationship between the body, mind, and environment. These elements are at the heart of preventive care that has been an emphasis of professional nursing since the time of Florence Nightingale. The prevention of disease and promotion of health are key provisions in the health-care reform bill passed in 2010 and open the door for nurses to practice what has always been a part of their educational history.
Table 3.1 Competencies for Nursing Skills
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Contrasting Nursing Models
Even though nursing theories have fallen out of practice, they play a role in determining the process of care delivery. These concepts require knowledge that is helpful in supporting nursing practices. Nursing theories and concepts help nurses to develop a framework that guides their operations through assessing, planning and implementing patient care. The paper compares and contrasts Orem’s Self-Care Deficit Nursing Theory and Watson’s Theory of Caring and gives an outline of the model that aligns with the patients’ beliefs.
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