Organizing Frameworks applied to Community Health Nursing

1. Organizing Frameworks applied to Community Health Nursing

2. Community Assessment and Nursing Diagnosis, Data Collection, Analysis and Synthesis

3. By the end of this lecture you will be able to: • explain what is meant by a theory and a model of nursing • understand the main features of at least two models of nursing • understand how to critically review a model • Identify how the application of models to practice influences the activity of the nurse and the experience for the patient or client

4. Additional References…………. • Models of nursing practice. McGee P. Stanley Thornes 1998 • Conceptual bases of professional nursing. Leddy S. Pepper J. Lippincott 4th ed.. 1998 • Foundations of nursing practice. Hogston R & Simpson P. Macmillan 1999 (Ch 14)

5. Nature of theory:“represent a scientist’s best effort to describe and explain phenomena”Pollitt & Hungler 1997

6. Theory…… “…is a general statement that summarizes and organizes knowledge by proposing a general relationship between events - if it is a good one it will cover a large number of events and predict events that have not yet occurred or been observed”Robson C.

7. “an internally consistent group of relational statements (concepts, definitions & propositions) that present a systematic view about phenomenon and that is useful for description, explanation, prediction and control. A theory ….is the primary means of meeting the goals of the nursing profession concerned with a clearly defined body of knowledge”Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))

8. Purpose of theory • Support the development of knowledge through thesis and contestability • Explains and predicts outcomes • Supports decision making • Embeds goals and outcomes for the client and by implication for the nurse • Supports modeling of processes of nursing

9. Classifying theories • Meta-theory (Theory building - values etc) • Grand theory (Broad conceptual frameworks - not testable e.g. Leininger theory of transcultural care) • Middle range theory (Narrower and testable e.g. Peplau) • Practice Theory (situational theory - focuses on the way in which nursing is practised e.g. Norton’s theory of nursing elderly people)

10. Typology: • Descriptive theory: Explains through describing relationships and patterns within the framework (e.g. Roper et al) • Predictive Theories: Address the consequences of interventions (e.g. Noddings theory of care)

11. The medical model • Bio-reductionist • Differential diagnosis: signs & symptoms • Provision of treatment • Scientific theory - testable and not contestable • Goals - cure and therapy • Evaluation of treatment efficacy

12. Nursing models • Located in social science • Constructed • Contestable knowledge • Capable of change and development • Embed values and culture

13. What sort of theories would you use? • Tony Archer (18 years) underwent surgery to have a below knee amputation of his left leg • Peggy Mountford is 82 years old, lives alone with no family and is becoming increasingly confused and depressed

14. What sort of theories did you identify? • Physiology • Psychology • Sociological theory • Nursing theories • Descriptive theory • Predictive theory

15. Metaparadigm: constructs in all nursing theories • The person • the environment • health • nursing

16. Commonly used models • Roper, Logan & Tierney (ADL) • Peplau (interpersonal communication) • Orem (Self-Care) • Roy (adaptation model) • Wolfensberger (social role valorisation) • Carper (personal explanations)

17. Roper, Logan & Tierney • Developmental model - emphasises growth & development • Person oriented • Focus on change • Sees process over time • Sees a range of activities of daily living changing with maturation • Supporting and enabling • Draws on Henderson’s work strongly

18. Callister Roy’s model • Systems model - person is made up of systems • Systems interact with the environment • Health is equilibrium and managed systems • Nursing is supporting adaptation to environment • Is holist, purposeful and unifying • Adaptive modes: physiologic, self concept, role function, interdependence • Health is a process of responding positively to environmental changes

19. Model and Nursing Model • A conceptual model • A nursing model is a representation of nursing, not a reality. • A nursing model is an abstract of reality from the nursing perspective.

20. The purpose of nursing model (1) • Provide a map for the nursing process *Guide assessment (What do you assess?) *Guides analysis *Dictates nursing diagnoses *Assists in planning *Facilitates evaluation

21. The purpose of nursing model (2) • Provide a curriculum outline for education • Represents a framework for research • Provides a basis for development of theory • A model not only describe what is but also provides a framework for making decisions about what would be.

22. Community-as-partner model • Neuman’s model of a total-person approach • Community-as-client model: public health and nursing • Community-as-partner model: primary health care with two central factors • The first factor the focus on the community as partner represented by the community assessment wheel at the top. • The second factor is the use of nursing process.

23. The core of assessment • People who make up the community *Demographic data *Values, beliefs, and history

24. Lines of defense • Normal line of defense: level of health of a community • Eight subsystems • Flexible line of defense: a buffer zone of a community

25. The selection of eight subsystem • Examining the selection of subsystems that have been identified. Can you think of any that have been omitted?

26. Line of resistance • Line of resistance: community’s strength • Stressors: tension-producing stimuli • The degree of reaction: the amount of disequilibrium or disruption that results from stressors impinging on the community’s lines of defense.

27. Analyze data • Compare and contrast your data with the neighbor areas and the national data. • Compare and contrast your data for 3 to 5 years. • Interpret your data

28. Nursing diagnosis • Stressors and degree of reaction become part of the community nursing/health diagnosis (health problem). • Example: the increased rate of respiratory illness (a degree of reaction) related to air pollution (a stressor)

29. Stressors leading to?? • The outcome of a stressor impinging on a community is not always negative. Can you think of an example that stressors may lead to positive outcomes?

30. Community health diagnosis (1) • Comparing nursing diagnosis and community health diagnosis (see handout) • Community health diagnosis is preferred over community nursing diagnosis

31. Community health diagnosis (2) • The community health diagnosis gives direction to both nursing goals and its interventions. • The goal is derived from the stressors • The goal may include * the elimination or alleviation of the stressor * strengthening of the community’s resistance through strengthening the lines of defense.

32. Community health diagnosis (3) • The goal should state the degree of reaction

33. Intervention • Three modes of prevention: primary prevention, secondary prevention, and tertiary prevention

34. Primary vs. tertiary prevention • In the case of 921 earthquake will you give an example of primary vs. tertiary prevention?

35. Evaluation • Feedback from the community

36. Final note • Health may not be a primary goal of the community, It is, however, an important resource for the community to meet its goals. • The consequences intended in this model include a strengthened normal line of defense, increased resistance to stressors, and a diminished degree of reaction to stressors by the community.