Organizing Frameworks applied to Community Health Nursing

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Organizing Frameworks applied to Community Health
Nursing
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Community Assessment and Nursing Diagnosis, Data
Collection, Analysis and Synthesis
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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

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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)

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Nature of theoryrepresent a scientists best
effort to describe and explain phenomenaPollitt
Hungler 1997
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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
  observedRobson C.

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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 knowledgeWalker Avant 1996 (cited by
Jasper M in Hogston Simpson))
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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

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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.
  Nortons theory of nursing elderly people)

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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)

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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

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Nursing models

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

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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

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What sort of theories did you identify?

• Physiology
• Psychology
• Sociological theory
• Nursing theories
• Descriptive theory
• Predictive theory

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Metaparadigm constructs in all nursing theories

• The person
• the environment
• health
• nursing

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Commonly used models

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

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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 Hendersons work strongly

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Callister Roys 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

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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.

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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

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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.

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Community-as-partner model

• Neumans 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.

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The core of assessment

• People who make up the community
• Demographic data
• Values, beliefs, and history

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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

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The selection of eight subsystem

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

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Line of resistance

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

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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

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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)

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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?

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Community health diagnosis (1)

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

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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 communitys
  resistance
• through strengthening the lines of
  defense.

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Community health diagnosis (3)

• The goal should state the degree of reaction

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Intervention

• Three modes of prevention primary prevention,
  secondary prevention, and tertiary prevention

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Primary vs. tertiary prevention

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

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Evaluation

• Feedback from the community

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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.