Chapter 12: Conceptual and Philosophical Bases for Nursing

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Chapter 12 Conceptual and Philosophical Bases
for Nursing

• Bonnie M. Wivell, MS, RN, CNS

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Systems

• System theoristvon Bertalanffy (1936) described
  a system as a set of interrelated parts that come
  together to form a whole that performs a
  function. Each part is a necessary
  componentthese parts are
• Input raw material that enters a system and is
  changed by it
• Throughput process used to convert raw material
  into something useful
• Output end result or product
• Evaluation measuring the success or failure of
  the output or the effectiveness of the system
• Feedback information given back into the system
  to determine if purpose or end result was achieved

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Systems Continued

• Suprasystem the environment outside the system
• Open promotes the exchange of matter, energy
  information with other systems whole is greater
  than sum of parts
• Closed doesnt interact with other systems
• Synergy subsystems collaborate
• Dynamic Nature of Systems dynamic balance
  maintains homeostasis or internal stability
• Application to Nursing Nurses work in systems
  every day

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Person as a System

• Physiological subsystems of person circulatory,
  musculoskeletal, respiratory, GI, GU,
  neurological
• Psychological, social, cultural and spiritual
  subsystems also exist
• Holistic nursing care combines all these
  subsystems
• Genes and environmental factors influence how a
  person develops
• Maslow Human Needs Theory
• Basic needs food, air, water
• Safety needs physical safety and psychological
  security
• Love and belonging intimacy and relationships
• Esteem needs self-esteem, self-respect,
  self-reliance
• Self-actualization attaining maximum potential
• Assumption basic needs must be at least
  partially satisfied before higher-order needs can
  become relevant to the individual

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Carl Rogers

• Theory of personhood
• People are constantly adapting, discovering and
  rediscovering themselves
• Human potential to grow and develop can be used
  by nurses to assist patients to change unhealthy
  behaviors and to reach the highest level of
  wellness possible
• The concept of adaptation is helpful because when
  people are moved from their home environment to
  the hospital, anxiety often occurs

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Homeostasis

• When needs are not met, it is threatened
• Balance between internal and external forces must
  be maintained
• Balance achieved healthy, resistant to disease
• Persons attempt to adapt to change
• If adaptation unsuccessful, disequilibrium occurs
  and disease or illness can result
• How one responds to stress is a major factor in
  the development of illness

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Environment

• Family Systems nuclear family (mom, dad,
  children) extended family single parent
• Cultural Systems attitudes, beliefs, behaviors
  of social ethnic groups
• Social Systems neighborhoods, churches schools,
  civic recreational groupsHolmes Rahe (1967)
  studied social change as related to illness
  changes require social readjustment
• WHO now recognizes poverty as the most
  influential determinant of health
• Community, National, World Systems

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Health

• WHO defines health as a state of complete
  physical, mental, and social well-being and not
  merely the absence of disease or infirmity.
• Holism Interrelationship of all parts make up
  whole of the person (Smuts, 1926)
• High-level Wellness functioning at a maximum
  potential in an integrated way with the
  environment (Dunn, 1961)

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Health Beliefs Health Behaviors

• Healthy People 2010 an effort designed to
  stimulate a national disease prevention and
  health promotion agenda to improve significantly
  the health of all Americans
• Convincing individuals to change their
  lifestyles, however, even when to do so would
  result in improved health, remains a challenge
• Health behaviors include those choices and
  habitual actions that promote or diminish health
• Rosenstocks health beliefs model
• An evaluation of ones vulnerability to a
  condition and the seriousness of that condition
• An evaluation of how effective the health
  maintenance behavior might be
• The presence of a trigger event that precipitates
  the health maintenance behavior

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Albert Bandura

• Banduras (1997) model of self-efficacy high
  belief in ones self-efficacy lead to efforts to
  change four components
• Information
• Skill development
• Skill enhancement through guided practice and
  feedback
• Creating social supports for change

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Locus of Control

• Locus of control concept proposed that people
  tend to be influenced by either an internal or
  external view of control
• Internal what they themselves do
• External is determined by outside factors
• Influence of Internet on healthreliance for
  health information validity see page 289 in
  text for ideas on how to assess sites

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Nurses and Health Beliefs Models

• Health is relative, ever changing, and affected
  by genetics, environment, personal beliefs and
  cultural beliefs
• Health affects the entire person
• Individuals health beliefs are powerful and
  influence how they respond to efforts to change
  their behaviors
• Individuals needing or desiring change may lack
  knowledge, motivation, and support
• Various models of health beliefs can be used to
  assess individual, family, and group readiness to
  change
• The burden of action is mutually shared by
  patient, health care providers, and
  population-focused entities such as public health
  programs

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High-Level Wellness

• Developing a personal plan for High-level
  wellness see page 311 in text
• The personal health practices of nurses play a
  direct role in their effectiveness in counseling
  patients on health-related matters
• Patients more likely to adopt healthy behaviors
  if caregiver engages in them
• Nurses have a professional responsibility to
  model positive health behaviors in their own
  lives, but nurses are individuals too.

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Concepts Basic to Nursing

• Person
• Unique
• Capable of adaptation
• Motivated by needs
• Environment
• Promotes or interferes with well-being
• Physical and Nonphysical
• Health
• Dynamic
• A continuum

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Beliefs

• A belief represents the intellectual acceptance
  of something as true.
• A nurse with a non-judgmental attitude makes
  every effort to convey neither approval nor
  disapproval of a patients beliefs and respects
  each persons rights to his or her beliefs.
• Categories
• Descriptive show true or false
• Evaluative judge as good or bad
• Prescriptive judged desirable or undesirable

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Values

• Values are the freely chosen principles, ideals
  or standards held by an individual, class or
  group that give meaning and direction to life.
• Professional nursing values on page 316
• Clarifying your values on page 296

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Philosophies

• Philosophy is defined as the study of the
  principles underlying conduct, thought, and the
  nature of the universe.
• Branches of Philosophies
  
• Epistemology tries to determine how we know
  whether our beliefs about the world are true
• Logic study of proper improper methods of
  reasoning (such as the nursing process)
• Aesthetics study of what is beautiful
• Ethics study of standards of conduct
• Politics deals with regulation control of
  people living in society
• Metaphysics ultimate nature of existence,
  reality, human experience the universe

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Philosophy of Nursing

• Philosophies of Nursing are statements of beliefs
  and expressions of values in nursing that are
  used as bases for thinking and acting guide
  practice.
• Individual philosophies
• Collective philosophies hospitals, schools of
  nursing
• Your personal philosophy of nursing