NCM THEORIES Nightingale Roy
NCM THEORIES Nightingale Roy
NCM THEORIES Nightingale Roy
METAPARADIGM • Note that the client, the nurse, and the major
environment concepts are in balance; that is; the
“The act of utilizing the environment of the patient nurse can manipulate the environment to
to assist him in his recovery.” compensate for the client’s response to it. The goal
“It involves the nurse’s initiative to configure of the nurse is to assist the patient in staying in
environmental settings appropriate for the gradual balance. If the environment of a client is out of
restoration of the patient’s health and that external balance, the client expends unnecessary energy.
factors associated with the patient’s surroundings NIGHTINGALE’S ENVIRONMENTAL MODEL
affect the life or biologic and physiologic processes
and his development.” NIGHTINGALE’S NURSING PROCESS AND THOUGHT
CANON
Major concepts: (Nightingale,
1969)
• Person: Nightingale viewed the essence of Ventilation & • Client’s body temperature, room
person as a client. “The recipient of care” She warmth temperature, ventilation and foul
believed that nurses should perform tasks to odors
and for the client as well as control the clients • Create a plan to keep the room
well-ventilated and free of odor
environment to facilitate recovery easily.
while maintaining the client’s body
• Health: According to Nightingale, health is temp.
“being well and using every power that the Light • Check room for adequate light,
person has to the fullest extent.” sunlight is essential
• Create and implement adequate o Pure fresh air – “to keep the air he breathes
light in the room without placing as pure as the external air without chilling
the client in direct light him.”
Cleanliness of • Check room for and keep it free
o Pure water – “well water of a very impure
rooms and from dust, dampness and dirt
walls kind is used for domestic purposes. And
Health of • Check for fresh air, pure water, when the epidemic disease shows itself,
houses drainage, cleanliness and light persons using such water are almost sure to
• Remove garbage, stagnant water, suffer.”
and ensure clean water and fresh o Effective drainage – “all the while the sewer
air
may be nothing but a laboratory from which
Noise • Check noise level in the room and
surroundings epidemic disease and ill health are being
• Attempt to keep noise level in installed into the house.”
minimum o Cleanliness – “the greater part of nursing
Bed and • Check bed and bedding for consists in preserving cleanliness.”
bedding dampness, wrinkles and soiling o Light (especially direct sunlight) – “the
• Keep the bed dry, wrinkle-free and usefulness of light in treating disease is very
at its lowest height to ensure
comfort
important.”
Personal • Attempt to keep the client dry and • The factors posed great significance during
cleanliness clean at all times Nightingale’s time when health institutions had
• Frequent assessment of the client’s poor sanitation, and health workers had little
skin is essential to maintain good education and training and were frequently
skin integrity incompetent and unreliable in attending to the
Chattering • Avoid talking without giving advice
patients’ needs.
hopes and that is without a fact
advices • Respect the client as a person and • Also emphasized in her environmental theory is
avoid personal talk providing a quiet or noise-free and warm
Variety • Attempt to accomplish variety in environment, attending to patient’s dietary needs
the room and with the client by assessment, documentation of time of food
• Done with cards, flowers, pictures, intake, and evaluating its effects on the patient.
and books
• Encourage friends and relatives to ANALYSIS OF NIGHTINGALE’S THEORY
engage in stimulating activities
Food intake • Check the diet of the client. Note • In the era that we are in today, we are faced
the amount of food and fluid with environmental conditions beyond what
ingested by the client at every meal ought to be natural and nurturing. Some of the
Petty • Ensures continuity of care global environmental issues we have now are
management • Document the plan of care and global warming, nuclear radiation threats,
evaluate the outcomes that ensure
continuity
human-made environmental calamities, and
Observation of • Observe and record anything about pollution. From these occurrences, Nightingale’s
the sick the client model seemed to be ideal. Her concept of
• Continue observation in the client’s providing fresh air to patients is in question with
environment and make changes in today’s industrialization effects.
the plan of care if needed • In addition to the analysis of the concept of
ventilation, it is not always beneficial for all
clients to have fresh air. Natural air has its
ENVIRONMENTAL FACTORS
impurities which in turn may infect open wounds
• In Florence Nightingale’s Environmental Theory, and drainages such as in burns.
she identified five (5) environmental factors: fresh
air, pure water, efficient drainage, cleanliness or
sanitation, and light or direct sunlight.
APPLICATION OF ENVIRONMENTAL THEORY METAPARADIGM
“The Science of Unitary Human Beings (SUHB) does not According to Rogers, the Science of Unitary Human
directly identify testable empirical indicators. Instead, Beings contains two dimensions: the science of nursing,
the theory specifies a worldview and philosophy used to which is the knowledge specific to the field of nursing
identify the phenomena concerning nursing.” that comes from scientific research; and the art of
nursing, which involves using the science of nursing
• Person: A unitary human being is an open creatively to help better the lives of the patient.
system which continuously interact with the
environment. A person’s aspects cannot be
Assumptions of Rogers’ Science of Unitary Human iii. Rhythms of the life and process
Beings iv. Supplementary data
v. Categorical disease entities
1. WHOLENESS: Man is a unified whole possessing his
vi. Subsystem pathology
own integrity and manifesting characteristics that
vii. Pattern appraisal
are more than and different from the sum of his
parts. Mutual Patterning: patterning can be done by
2. OPENNESS: Men and the environment are suggesting the various alternatives such as empowering,
continuously exchanging matter and energy with encouraging, etc. depending on the client’s condition
one another. and needs.
3. UNDIRECTIONALITY: The life process evolves
Mutual patterning of human and
irreversibly and unidirectionally along the space-
environmental field:
time continuum.
4. PATTERN AND ORGANIZATION: Identifies the man i.Sharing knowledge
and reflect his innovative wholeness. ii.Offering choices
5. SENTENCE & THOUGHT: Man is characterized by iii. Empowering the patient
the capacity for abstraction and imagery, language iv. Fostering pattering
and thought sensation, and emotion. v. Evaluation
vi. Repeat pattern appraisal
PRINCIPLE OF HOMEODYNAMICS – dynamic version of
vii. Identify dissonance and harmony
homeostasis
viii. Validate appraisal with the
3 PRINCIPLES OF HOMEODYNAMICS: patients
ix. Self-reflection for the patients
Integrity – (synchrony + reciprocity) because of the
inseparability of human beings and environment, Evaluation: done by repeating the pattern appraisal
sequential changes in the life processes are continuous after the mutual patterning to determine the extents of
revisions occurring from the interactions between dissonance and harmony.
human beings and environment.
Areas of assessment:
Self-care agency: These are complex set of activities SUMMARY OF INTERRELATED THEORIES: The theory of
required to purposively regulate the actions needed for self-care delineates the demands of self-care requisites
planning a care plan for a client. that an individual needs to meet in order to stay healthy
or get better from illness. When a person cannot meet
Self-care Requisites or requirements can be defined as
these self-care demands, or when self-care requisites
actions directed toward the provision of self-care. It is
exceed self-care capabilities, nursing is needed. Nurses
presented in three categories.
can help patients meet their self-care needs by utilizing
• Universal Self-Care Requisites: Universal self- the 5 methods in the Theory of Self Care Deficit.
care requisites are associated with life However, the nurse must properly assess the level of
processes and the maintenance of the human self-care a patient requires so that the nurse can utilize
structure and functioning integrity. the nursing system (as stated in the Theory of Nursing
o The maintenance of a sufficient intake System) that best fits the patient's ability to perform
of air self-care. In the end, the nurse assists the patient in
o The maintenance of a sufficient intake meeting his/her self-care needs so that he/she is healthy
of water and free of illness.
o The maintenance of a sufficient intake
THERAPEUTIC SELF-CARE DEMAND
of food
o The provision of care associated with • Therapeutic Self-care Demand is the totality of
the elimination process and excrements “self-care actions to be performed for some
o The maintenance of a balance between duration to meet known self-care requisites by
activity and rest using valid methods and related sets of actions
o The maintenance of a balance between and operations.”
solitude and social interaction
• Developmental self-care requisites:
Developmental self-care requisites are “either
specialized expressions of universal self-care
requisites that have been particularized for
developmental processes or they are new
requisites derived from a condition or
associated with an event.”
o Provision of conditions that promote
development
o Engagement in self-development and;
o Prevention of the effects of human
conditions that threatens life
• Health deviation self-care requisites: Health
deviation self-care requisites are required in
Theory of self-care deficit:
conditions of illness, injury, or disease or may
result from medical measures required to This theory delineates when nursing is needed. Nursing
diagnose and correct the condition. is required when an adult (or in the case of a
o Modifying the self-concept (and self-image) dependent, the parent or guardian) is incapable of or
in accepting oneself as being in a particular limited in providing continuous effective self-care.
state of health
Orem identified 5 methods of helping:
• Acting for and doing for others • Design of a nursing system and plan for
• Guiding others delivery of care.
• Supporting another • Production and management of nursing
• Providing an environment promoting personal systems.
development about meet future demands
Step 1 – Collect Data in Six Areas
• Teaching another
• The person’s health status
Theory of nursing systems:
• The physician’s perspective of the person’s
This theory is the product of a series of relations health status
between the persons: legitimate nurse and legitimate • The person’s perspective of his or her health
client. This system is activated when the client’s • The health goals within the context of life
therapeutic self-care demand exceeds the available self- history, lifestyle, and health status.
care agency, leading to nursing. • The person’s requirements for self-care
• The person’s capacity to perform self-care
Systems that compose the nursing systems:
Nursing diagnosis and care plans
• Wholly compensatory - A situation in which
the individual is unable “to engage in those • The nurse designs a system that is wholly or
self-care actions requiring self-directed and partly compensatory or supportive-educative.
controlled ambulation and manipulative • Goals are to promote patient’s therapeutic
movement or the medical prescription to self-care demands and compensate or
refrain from such activity… Persons with these overcome patient’s self-care deficits
limitations are socially dependent on others for • Plans with scientific rationale
their continued existence and well-being.”
• Partially compensatory - A situation in which Step 2
“both nurse and perform care measures or (1) Bringing out a good organization of the components
other actions involving manipulative tasks or of patients’ therapeutic self-care demands.
ambulation [Either] the patient or the nurse
may have a major role in the performance of (2) Selection of a combination of helping methods will
care measures.” be effective and efficient in compensating
Example: Nurse can assist the postoperative for/overcoming the patient’s self-care deficits.
client in ambulating, Nurse can bring a meal Implementation and diagnosis
tray for a client who can feed himself
• Supportive-educative - This is also known as a • It is the production and management of nursing
supportive-developmental system. The person systems.
“can perform or can and should learn to
Step 3
perform required measures of externally or
internally oriented therapeutic self-care but • A nurse assists the patient or family in self-care
cannot do so without assistance.” matters to identify and describe health and
Example: Nurse guides a mother on how to health-related results.
breastfeed her baby, Counseling a psychiatric • Actions are guided by the rationale of nursing
client on more adaptive coping strategies. diagnosis.
• Evaluation of results achieved compared to
OREM’S SELF CARE THEORY AS A THEORITICAL
planned outcomes.
FRAMEWORK FOR NURSING PRACTICE:
Assessment
METAPARADIGM
ADAPTATION MODEL