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Application of theories in nursing process 2nd
1. Application of Theories inApplication of Theories in
Nursing ProcessNursing Process
By,By,
ARUN.MARUN.M
2. THEORY MAIN CONCEPT APPLICATIONS
Madeleine
Leininger
Cultural
Care
Diversity
and
Universali
ty Theory
Components of
holistic assessment-
following factors:
• Technological
• Religious &
physical
• Kinship & social
• Cultural values &
life ways
• Political & Legal
• Economic
• Educational
Nursing care
depends on holistic
assessment
These factors to
be considered for
patient
assessment in
clinical practice.
used to do the
assessment of
individuals,
families, groups &
communities in
diverse health
system to compare
the factors related,
that is to findout
the similarities and
differences.
3. Application of Theories inApplication of Theories in
Nursing ProcessNursing Process
By,By,
Mrs.V. Selvanayaki M.Sc. (N),Mrs.V. Selvanayaki M.Sc. (N),
Lecturer,Lecturer,
V.M.A.C.O.N,V.M.A.C.O.N,
Salem.Salem.
4. Level ILevel I
Viewed as havingViewed as having
four level:four level:
It is the world view &It is the world view &
social system levelsocial system level
Leads to the study ofLeads to the study of
nature, meaning andnature, meaning and
attribute of care fromattribute of care from
three perspectives-three perspectives-
Help us to findHelp us to find
interrelationshipinterrelationship
between factors forbetween factors for
effective planningeffective planning
for better outcomefor better outcome
Specific factorSpecific factor
can also becan also be
identified for specialidentified for special
need assessmentneed assessment
for planning carefor planning care
5. • Micro perspectivesMicro perspectives
studies individuals withinstudies individuals within
carecare
• Middle perspectivesMiddle perspectives
focuses on more complexfocuses on more complex
factors in one specificfactors in one specific
cultureculture
• Macro perspectivesMacro perspectives
investigates phenomenainvestigates phenomena
across several culturesacross several cultures
When we need toWhen we need to
assess anything inassess anything in
micro or large scale ormicro or large scale or
when we try to assesswhen we try to assess
the complexity of thethe complexity of the
factors or when wefactors or when we
want to investigate awant to investigate a
single phenomena withsingle phenomena with
regard to individual,regard to individual,
families groups andfamilies groups and
institutions this theoryinstitutions this theory
can be used.can be used.
8. Level IIILevel III
Focuses on folkFocuses on folk
systems,systems,
professional systemprofessional system
and nursing.and nursing.
IncludesIncludes
characteristics andcharacteristics and
specific care featuresspecific care features
of each system -of each system -
allows to identifyallows to identify
similarities andsimilarities and
differences ofdifferences of
culture.culture.
Can be used forCan be used for
planning in whichplanning in which
the nursing care willthe nursing care will
be plannedbe planned
according to theaccording to the
folk systems andfolk systems and
professionalprofessional
system.system.
Nursing care may
be planned based
on the holistic
components and
professional system
9. LevelLevel
IVIV
Nursing careNursing care
decisiondecision
& actions& actions
At this level,At this level,
nursing care isnursing care is
delivereddelivered
Influences nursingInfluences nursing
care and based on thatcare and based on that
actions to be taken.actions to be taken.
Level I through IIILevel I through III
provide knowledgeprovide knowledge
base needed forbase needed for
planning & delivery ofplanning & delivery of
culture congruent careculture congruent care
Used for planning andUsed for planning and
implementationimplementation
10. Along with these factors, the folk system –
common practices which are followed in that
area and professional system will help the nurses
to assess the needs and problems of the person.
According to that assessment planning will be
made and on the basis of the planning nursing
care will be given.
11. Any single factor or more than one factors or
all the above factors may influence the holistic
health of individual.
E.g.. Person with mental health disorder
Further, this theory can be applied in nursing
care. However, nursing care also consider
professional system that is the role of
professional nurse to plan to repattern or
restructure the individual’s health.
12.
13. This model is mainly focusing the socio-This model is mainly focusing the socio-
cultural dimensions of individuals, families,cultural dimensions of individuals, families,
groups, communities and institutions.groups, communities and institutions.
This can be mainly used in transculturalThis can be mainly used in transcultural
nursing care aspects.nursing care aspects.
Assessment of referral patients from otherAssessment of referral patients from other
sectors of health or different parts of thesectors of health or different parts of the
country or outside country needs holisticcountry or outside country needs holistic
assessment through this theory.assessment through this theory.
15. THEORYTHEORY MAIN CONCEPTMAIN CONCEPT APPLICATIONAPPLICATION
FlorenceFlorence
NightingaleNightingale
Theory (AnTheory (An
EnvironmentalEnvironmental
adaptationadaptation
theory)theory)
Environment is coreEnvironment is core
concept - Environmentconcept - Environment
could be altered in suchcould be altered in such
a way as to improvea way as to improve
condition so that naturecondition so that nature
could act to cure thecould act to cure the
patientpatient
Most importantMost important
environmental concernsenvironmental concerns
are ventilation and cleanare ventilation and clean
air followed by cleanair followed by clean
waterwater
This model isThis model is
mainlymainly
focusing onfocusing on
infectioninfection
control whichcontrol which
will be suitablewill be suitable
for wardfor ward
management.management.
16. Additional needs areAdditional needs are
warmth, control of noise,warmth, control of noise,
provision for light andprovision for light and
adequate management ofadequate management of
wastes and odors.wastes and odors.
According to theAccording to the
theorist, if environment istheorist, if environment is
clean, the survival abilityclean, the survival ability
and recovery will beand recovery will be
improvedimproved
According to her,According to her,
nursing is a nurturing artnursing is a nurturing art
that requires knowledgethat requires knowledge
of sanitary procedureof sanitary procedure
For individualFor individual
care it is applicablecare it is applicable
to prevent theto prevent the
infection or controlinfection or control
the infectionthe infection
BasicBasic
principles ofprinciples of
environmentenvironment
manipulation canmanipulation can
be applied withbe applied with
modification inmodification in
manymany
contemporarycontemporary
nursing settingsnursing settings
17. The author says that onlyThe author says that only
environment related to patientenvironment related to patient
to be altered to reduce orto be altered to reduce or
prevent infection in order toprevent infection in order to
improve patient’s health.improve patient’s health.
As per the theorist, theAs per the theorist, the
holistic health of a personholistic health of a person
includes biological,includes biological,
psychological and socialpsychological and social
components in which thecomponents in which the
biological and psychologicalbiological and psychological
components are mostlycomponents are mostly
dominating than socialdominating than social
components.components.
There is noThere is no
direct patientdirect patient
carecare
WardWard
management,management,
infectioninfection
controlcontrol
(nosocomial(nosocomial
infection)infection)
asepticaseptic
techniquestechniques
18. These holisticThese holistic
health of a personhealth of a person
can be maintainedcan be maintained
by altering theby altering the
environment only.environment only.
Thus, this theoryThus, this theory
can be used forcan be used for
assessment of aassessment of a
patientspatients
environment inenvironment in
clinical practiceclinical practice
21. THEORYTHEORY MAIN CONCEPTMAIN CONCEPT APPLICATIONAPPLICATION
Ida JeanIda Jean
OrlandoOrlando
NursingNursing
ProcessProcess
TheoryTheory
Inadequate patientInadequate patient
care- caused by thecare- caused by the
profession’s lack ofprofession’s lack of
clearly articulatedclearly articulated
nursing functionnursing function
Identification ofIdentification of
patient need in thepatient need in the
foundation of the nurse-foundation of the nurse-
patient relationship,patient relationship,
nurses must developnurses must develop
skills in exploring withskills in exploring with
patients the meaning ofpatients the meaning of
their verbal and non-their verbal and non-
verbal behavior.verbal behavior.
Can be usedCan be used
when there is anwhen there is an
interactioninteraction
between healthbetween health
personnels andpersonnels and
client, nurse andclient, nurse and
client, andclient, and
between client tobetween client to
assess the patientassess the patient
need for anneed for an
effectiveeffective
communication tocommunication to
provide qualityprovide quality
care.care.
22. A nursing situation is composedA nursing situation is composed
of the patients behavior, theof the patients behavior, the
nurse’s reaction and the nurse’snurse’s reaction and the nurse’s
action. The interaction of these isaction. The interaction of these is
called the nursing processcalled the nursing process
Orlando identified four phases inOrlando identified four phases in
action process:action process:
• The person perceives with anyone ofThe person perceives with anyone of
his five sense organs an object orhis five sense organs an object or
objects.objects.
• The perception stimulate automaticThe perception stimulate automatic
thought.thought.
• Each thought stimulate an automaticEach thought stimulate an automatic
feeling and then the person acts.feeling and then the person acts.
• ReactionReaction
It can beIt can be
used whenused when
there is anthere is an
interactioninteraction
between abetween a
nurse and anurse and a
patient in anpatient in an
immediateimmediate
situation tosituation to
meetmeet
patientspatients
needs.needs.
23. First, nurse must take theFirst, nurse must take the
initiative in helping theinitiative in helping the
patient express the specificpatient express the specific
meaning of his behavior inmeaning of his behavior in
order to ascertain hisorder to ascertain his
distress. Second, she mustdistress. Second, she must
help the patient explore thehelp the patient explore the
distress in order to ascertaindistress in order to ascertain
the help he requires for histhe help he requires for his
(immediate) need (for help)(immediate) need (for help)
to be met.to be met.
It can be usedIt can be used
to emphasizeto emphasize
immediate careimmediate care
as there is aas there is a
positivepositive
correlationcorrelation
between thebetween the
length of time thelength of time the
patientpatient
experiences theexperiences the
unmet needs andunmet needs and
the degree ofthe degree of
distress.distress.
24. Because, the patients behavior stimulates theBecause, the patients behavior stimulates the
nursing perception, it becomes the starting pointnursing perception, it becomes the starting point
of the nurse’s investigation. According toof the nurse’s investigation. According to
Orlando, the nurses perception and the patientsOrlando, the nurses perception and the patients
presenting behavior forms the basis of thepresenting behavior forms the basis of the
nurse’s thoughts and feelings.nurse’s thoughts and feelings.
25. Automatic personal response
PERSON – A PERSON – B
Reaction Secret Reaction Secret
ACTION ACTION
PERCEPTION PERCEPTION
THOUGHT THOUGHT
FEELING FEELING
Re
action
Re
action
ACTION ACTION
PERCEPTION PERCEPTION
THOUGHT THOUGHT
Re
action
FEELING FEELING Re
action
26. When the action
process in a person to
person contact
functioning secret, the
perceptions, thoughts
and feelings in each
individual are not
directly available to the
perception of other
individual through the
observable action.
It can be
used to
increase the
care
effectiveness
in patients
needs.
27. Deliberate Nursing Process
PERSON – A PERSON – B
Reaction Explicit Reaction Explicit
ACTION ACTION
PERCEPTION PERCEPTION
THOUGHT THOUGHT
FEELING FEELING
Re
action
Re
action
ACTION ACTION
PERCEPTION PERCEPTION
THOUGHT THOUGHT
Re
action FEELING FEELING
Re
action
28. The nurse’s expression
of his or her reaction
minimizes the opportunity
for the nurse to make
assumptions and
increases the chance to
correct or verify the
nurse’s private
interpretation of the
patient action.
Finally, if the patients
behavior does not change,
the nursing functions has
not been met.
In clinical
practice it
may guide
to make
the
person’s
actions
and
reactions
are
positive
29. It can be used at patient care
level, management level and
nursing division level
It may improve decision –
making skills – more effective
conflict resolution among staff
nurses, between staff and
physicians and unity among
staff.
It can be used in guidance
and counseling for the patients
and for psychoanalysis and to
assess the mental health
status of a person.
It can be
used to
increase the
care
effectiveness
in patients
needs.
30. Eg.: Counseling
NURSE CLIENT
Explicit
Action Action
Understands Understanding the problem
Approachable Analysis
Problem can be solved How much to be done
to solve the
problem/ what to be done
31. Can be used at patient care,
management and nursing
division level
May improve decision – making
skills – more effective conflict
resolution among staff nurses,
between staff and physicians
and unity among staff.
Can be used in guidance and
counseling for the patients and
for psychoanalysis -to assess
the mental health status of a
person.
It can be
used to
increase the
care
effectiveness
in patients
needs.
32. THEORY MAJOR CONCEPTS APPLICATIONS
Dorothea
Orem’s
self-care
deficit
theory
a. Theory
of self-
care
b. Theory
of self-
care
deficit
Composed three
related theories:
Describes why and
how people care for
themselves.
Describes and explains
why people can be
helped through nursing.
Continuous
assessment
of the patient
will help the
nurse to find
out his needs
and
problems
33. c. Theory of
nursing
system
Every individual has certain
capacity of to be independent.
Sometimes he also need some
assistant for any activity to be
completed and in sudden cases
he is fully depend on others.
Describes and explains
relationships that must be
brought about and maintained
for nursing to be produced.
35. Accomplishes patient’s
therapeutic self- care
Compensates for patients inability
to engage in self care
Supports and protects patient
Nurse’s
Action
Wholly compensatory system
36. Performs some self-care
measures for patient
Compensates for self-
care limitations of
patient
Assists patient as
required
Performs some self-care
Regulates self-care
agency
Accepts care and
assistance from nurse
Nurse
Action
Patient
Action
Partly compensatory system
37. Accomplishes patient’s
therapeutic self- care
Regulates the exercise
and development of self-
care agency
Nurse
Action
Patient
Action
Supportive Educative System
38. Described & explain
relationships that must be
brought about and maintained for
nursing to be produced.
Self – care activities to maintain
life, healthful functioning,
continuing personal development
and well being for functional and
developmental regulations.
Self care agency ability to know
and meet their own human
functioning and development
As per
the ability
of the
patient the
nursing
care can
be
planned to
implement
the care
39. Self care deficit – Self care
capabilities are in adequate for
meeting some or all components of
therapeutic self care demand.
Self-care demand – summation of
care measures necessary at times
or over duration of time for meeting
all of an individuals needs.
Nursing agency – Nurses to act, to
know and to help persons in such
relationship to meet their
therapeutic self-care demands and
to regulate the development of
their self-care agency.
As per
the
planning
the care
can be
impleme
nted on
the
patient.
40. Hygienic needs
Nutritional needs
Elimination needs
New born care
Safety and Security
needs
Mother –
unable to
perform her
activity
due to
surgery
Fluid &
electrolyte
imbalance
Infection control
Nutritional
needs
Deficit
Personal Hygiene
Dressing
Medication
Maintaining fluid
balance
Perennial care
Feeding baby
R R
R
R
R
41. Accomplishes the patient
therapeutic self care
Administration of IV fluids,
ambulation, medications, dressing,
new born care
Compensates for patient’s inability
to engage in self care
Personal hygiene, helping the
patient to turn in the bed
Supports & Protects Patient
Bedside railing prevent fall,
measures to prevent infection,
psychological support, observe the
operated site for infection
Nurse
Action
Patient
Action
Limited
NURSING SYSTEM
Wholly Compensatory System
1st
Post operative day
42. Performs some self care
measures to patient
Personal hygiene, dressing
Compensates some self care
limitations of patient
Help the patient to turn in the
bed, change the dress
Assist patient as required
Help the patient to turn in the
bed
Nurse
Action
Partly Compensatory System
2nd
Post operative day
43. Performs some self care
measures-
Brushing, turning from one
position to another position,
mobility with assistance
Regulates self care agency
Able to perform his activity to
certain extent
Accepts care and assistance from
nurse
Accepts the medication given by
the nurse
Patient
Action
44. Accomplishes self care
Able to take bath, eats alone,
ambulate alone
Regulates the exercise and
development of self care agency
- Teach about new born care,
feeding etc.
- Prevention of infection
- Dietary requirements
- Psychological support
- Need for regular follow-up.
Patient
Action
Nurse
Action
Supportive Educative System
During discharge
