THEORETICAL FOUNDATION OF NURSINGClick to edit the outline text format Second Outline LevelThird Outline Level Fourth Outline LevelFifth Outline LevelSixth Outline LevelSeventh Outline LevelEighth Outline LevelNinth Outline LevelClick to edit Master text stylesSecond levelThird levelFourth levelFifth levelLydia HallIntroduced the model on Nursing !hat is It"# Consists of three tenets The $rst is that nursing functions differently in the three interlocking circles that constitute as%ects of the %atient &The ' circles areC()E * The %atients +ody,C-)E *The disease affecting the +ody'CO)E *The %erson of the %atient .hich is +eing affected +y each of the other circles/Types of theories0rand theoriesThese theories that have a very +road sco%eEach of thegrand theories shares the common ground offering a structure that ena+les descri%tion and ex%lanation of essential conce%tuali1ation of nursingExam%lesLeningerNe.man2arse Middle )ange Theories(s those 3that lie +et.een the minor +ut necessary .orking hy%otheses that evolve in a+undance during day to day research and all 4 inclusive systematic efforts to develo% uni$ed theory2rinci%le ideas of middle range theories are relatively sim%leMeans rudimentary straight for.ard ideas that sum from the factors of disci%lineThus# middle range theories is +asic# usa+le structure of ideas# less a+stract than grand theories and more a+stract than em%erical generali1ations or micro*range theoriesExam%les Orlando# 2e%lau# !atson# Modelling and Mercer5sMicro 4 )ange TheorySituation s%eci$cFocus on s%eci$c nursing %henomenon that re6ect clinical %ractice and that are limited to s%eci$c %o%ulations or to %articular $eld of %racticeThese theories offer a +lue %rint that is more readily o%erational and or less has more accessi+le utili1ation clinical situationExam%le 7orean immigrant .omen learned to ado%t to chronic illness8NURSING PARADIGMNursing has a model or %aradigm that ex%lains the linkages of science# %hiloso%hy# and theory that is acce%ted and a%%lied +y the disci%line8The elements of Nursing %aradigm direct the activity of the nursing %rofession# including kno.ledgedevelo%ment# %hiloso%hy# theory# educational ex%erience# research# %ractice and literature identi$ed .ith the %rofession Nursing identi$ed its domain in a %aradigm that includes four linkages the %erson# health# environment9 situation# and nursing N-)SIN0 2E)SON:E(LT:EN;I)ONMENT For Ma!or Co"#epts of Nrsi"$ Theories &8 2E)SON 4 )efers to all human +eings&,8 EN;I)ONMENT 4 Include factors that affect individuals internally and externally,'8 :E(LT: 4 (ddresses the %erson5s state of .ell 4 +eing /8 N-)SIN0 4 is central to all nursing theories8 (N(# &??@A8'Click to edit the outline text format Second Outline LevelThird Outline Level Fourth Outline LevelFifth Outline LevelSixth Outline LevelSeventh Outline LevelEighth Outline LevelNinth Outline LevelClick to edit Master text stylesSecond levelThird levelFourth levelFifth levelFlore"#e Ni$hti"$alenursing the sickA# 3general nursing= >health %romotionA# and 3mid.ifery nursing=Nightingale vie.ed nursing the 3Science of environmental management=Nurses .ere to use common sense# o+servation# and ingenuity to allo. nature to effectively re%air the %atientNightingale +elieved# 3o+servation may al.ays +e im%roved .ith training 4 seldom +e %resent .ithout trainingE for other.ise the nurse does not kno. .hat to look forAppli#atio"Miss angel gon1aga is a ,@ year old female .ho had +een admitted to the medical unit .ith the chief com%laint of freFuent# .atery stool since last night8 This is accom%anied +y a+dominal cram%s# NG;8 her ;S are as follo.s TB'H8I# 2B?H# )),'# D2B&JJ9KJ8 she com%lains of .eakness# thirst# dryness of mouth8 :er skin is .arm# 6ushed# and dry8 :er urine is dark yello. in colorShe claims# she had eaten oysters for dinner8 She lives in a cro.ded community close to land$ll and shares toilet .ith / other families8 Their source of drinking is from %um% .ell in the community8 She does not %ractice good hand.ashing after using the toilet8 SE revealed salmonellosisShe is tearful8 She ex%ress great concern over her a+sence from her Co+ in a garment factory and over her health and ex%ense for hos%itali1ation A' Nrsi"$ the Si#( A' Assess)e"t&8 Fluid and electrolyte losses related to freFuent# .atery stools# nausea and vomiting as manifested +y changes in the ;SE .eaknessE dryness of mouthE .armth# 6ushed# dry skinE dark*colored urine8,8 2ain related to a+dominal cram%s '8 InadeFuate food intake related to nausea and vomiting/8 Fever >TB'H8I5CA related to infection >salmonellosisA and dehydration *' Pla" &8 Fluid and electrolyte losses2rovide 6uid and electrolyte re%lacement(dminister medications to relieve freFuent # .atery stools and nausea and vomiting as %rescri+ed2rovide good oral care for dryness of mouth2romote rest to relieve .eaknessMonitor intake and out%ut8 To assess 6uid +alance status 2rovide good %erianal care &8 2ain related to a+dominal cram%s 2rovide lo. $+er diet L to reduce %eristalsis 2romote rest L to reduce %eristalsis and to %romote comfort(void gas forming foods L 6atulence .orseness a+dominal %ain(dminister anticholinergic as %rescri+ed L to relieve a+dominal cram%s '8 InadeFuate food intake 2rovide small freFuent feeding8 This +etter tolerated +y %atients .ith nausea2rovide ice chi%s to relieve nauses(dminister antiemitic as %rescri+ed L relieve nausea and vomiting '8 Fever related to infection and dehydration 2rovide adeFuate room ventilation7ee% the room airy and free of odor8Increase 6uid intake(dminister anti+iotic and anti%yretic as %rescri+ed)ender TSD7ee% skin clean and dryChange go.ns and +edding*' Physi#al E"+iro")e"t A' Ho)e, Co))"ity- Nei$h.orhood a"d /or(pla#e Assess)e"t &8 2ure .ater8 (ssess for adeFuate .orking .ater system and storage that is free from contamination,8 Cleanliness8 (ssess for sanitation conditions of food sources and %re%aration and hygienic %ractices(ssess for the means to maintain sanitation conditions of toilets8 To kee% food and .ater su%%ly free from contamination Ho)e, Co))"ity-Nei$h.orhood a"d /or(pla#e Pla" &8 !ater:ave .ater checked for contamination in coordination .ith local kno. ho.A through research and the characteri1ation and understanding of the Pkno. ho.P of clinical ex%erience8She conce%tuali1es in her .riting a+out nursing skills as ex%erience is a %rereFuisite for +ecoming an ex%ert8*e""er9s Sta$es of #li"i#al #o)pete"#eStage & NoviceDeginnershavehadnoex%erienceofthesituationsin .hich they are ex%ected to %erform8 Novices are taught rules to hel% them %erform8 Therulesarecontext*freeandinde%endentofs%eci$c casesE hence the rules tend to +e a%%lied universally8 Therule*governed+ehaviorty%icalofthenoviceis extremely limited and in6exi+le8 (ssuch#noviceshavenoPlifeex%eriencePinthe a%%licationofrules8POusttellme.hatIneedtodoand IQll do it8PStage , (dvanced Deginner(dvanced +eginners are those .ho can demonstrate marginally acce%ta+le %erformance# those .ho have co%ed .ith enough real situations to note# or to have %ointed out to them +y a mentor# the recurring meaningful situational com%onents8 These com%onents reFuire %rior ex%erience in actual situations for recognition8 2rinci%les to guide actions +egin to +e formulated8 The %rinci%les are +ased on ex%erience8Stage ' Com%etentCom%etence# ty%i$ed +y the nurse .ho has +een on the Co+ in the same or similar situations t.o or three years# develo%s .hen the nurse +egins to see his or her actions in terms of long*range goals or %lans of .hich he or she is consciously a.are8 For the com%etent nurse# a %lan esta+lishes a %ers%ective# and the %lan is +ased on considera+le conscious# a+stract# analytic contem%lation of the %ro+lem8 The conscious# deli+erate %lanning that is characteristic of this skill level hel%s achieve ef$ciency and organi1ation8 The com%etent nurse lacks the s%eed and 6exi+ility of the %ro$cient nurse +ut does have a feeling of mastery and the a+ility to co%e .ith and manage the many contingencies of clinical nursing8 The com%etent %erson does not yet have enough ex%erience to recogni1e a situation in terms of an overall %icture or in terms of .hich as%ects are most salient# most im%ortant8Stage / 2ro$cientThe %ro$cient %erformer %erceives situations as .holes rather than in terms of cho%%ed u% %arts or as%ects# and %erformance is guided +y maxims8 2ro$cient nurses understand a situation as a .hole +ecause they %erceive its meaning in terms of long*term goals8 The %ro$cient nurse learns from ex%erience .hat ty%ical events to ex%ect in a given situation and ho. %lans need to +e modi$ed in res%onse to these events8 The %ro$cient nurse can no. recogni1e .hen the ex%ected normal %icture does not materiali1e8 This holistic understanding im%roves the %ro$cient nurseQs decision makingE it +ecomes less la+ored +ecause the nurse no. has a %ers%ective on .hich of the many existing attri+utes and as%ects in the %resent situation are the im%ortant ones8 The %ro$cient nurse uses maxims as guides .hich re6ect .hat .ould a%%ear to the com%etent or novice %erformer as unintelligi+le nuances of the situationE they can mean one thing at one time and Fuite another thing later8 Once one has a dee% understanding of the situation overall# ho.ever# the maxim %rovides direction as to .hat must +e taken into account8 Maxims re6ect nuances of the situation8Stage @ The Ex%ertThe ex%ert %erformer no longer relies on an analytic %rinci%le >rule# guideline# maximA to connect her or his understanding of the situation to an a%%ro%riate action8 The ex%ert nurse# .ith an enormous +ackground of ex%erience# no. has an intuitive gras% of each situation and 1eroes in on the accurate region of the %ro+lem .ithout .asteful consideration of a large range of unfruitful# alternative diagnoses and solutions8 The ex%ert o%erates from a dee% understanding of the total situation8 The chess master# for instance# .hen asked .hy he or she made a %articularly masterful move# .ill Cust say PDecause it felt rightE it looked good8P The %erformer is no longer a.are of features and rulesEQ his9her %erformance +ecomes 6uid and 6exi+le and highly %ro$cient8 This is not to say that the ex%ert never uses analytic tools8 :ighly skilled analytic a+ility is necessary for those situations .ith .hich the nurse has had no %revious ex%erience8 (nalytic tools are also necessary for those times .hen the ex%ert gets a .rong gras% of the situation and then $nds that events and +ehaviors are not occurring as ex%ected !hen alternative %ers%ectives are not availa+le to the clinician# the only .ay out of a .rong gras% of the %ro+lem is +y using analytic %ro+lem solving8Click to edit the outline text format Second Outline LevelThird Outline Level Fourth Outline LevelFifth Outline LevelSixth Outline LevelSeventh Outline LevelEighth Outline LevelNinth Outline LevelClick to edit Master text stylesSecond levelThird levelFourth levelFifth levelRo88a"o Lo#si"Credentials2h< -niversity of the 2hili%%ines >&?HHA * Manila# 2hili%%inesM8(8 Nursing Silliman -niversity >&?KHA * &?KIA * F((NAFello.shi% 2hili%%ine*(merican (cademy Science G Engineering >2((SEATeaching2hiloso%hies of Science 0rounding NursingIntroduction to Nursing as