Question

12. What are Benner's domains and competencies? They were derived from what? 13. Be familiar with Neuman Systems model. Define the client system? 14. Be familiar with the goal(s) of Levine Conservation Model. 15. There are several questions regarding Orem -be familiar with entire chapter including the three related theories and what they each include 16. Be able to describe Ida Jean Orlando's and Margaret Newman's theory including a list of major concepts in a short answer question.

Answer 1

Domains of Nursing Practice

(Benner, 1984)

The Helping Role

The Healing Relationship: Creating a climate for and Establishing a Commitment to Healing.

Providing Comfort Measures and Preserving Personhood in the Face of Pain and Extreme Breakdown

Presencing: Being with a Patient Maximizing the Patient’s Participation and Control in His or Her Own Recovery.

Interpreting Kinds of Pain and Selecting Appropriate Strategies for Pain Management and Control

Providing Comfort and Communication Through Touch

Providing Emotional and Informational Support to Patients’ Families

Guiding Patients Through Emotional and Development Change

The Teaching – Coaching Function

Timing: Capturing a Patient’s Readiness to Learn

Assisting patients to Integrate the Implications of Illness and Recovery into Their Lifestyles

Eliciting and Understanding the Patient’s Interpretation of His Illness

Providing and Interpretation of the Patient’s Condition and Giving a Rationale for Procedures

The Coaching Function: Making Culturally Avoided Aspects of an Illness Approachable and Understandable.

The Diagnostic and Monitoring Function

Detection and Documentation of Significant Changes in a Patient’s Condition

Providing an Early Warning Signal: Anticipating Breakdown and Deterioration Prior to Explicit Confirming Diagnostic Signs

Anticipating Problems: Future Think Understanding the Particular

Demands and Experiences of an Illness: Anticipating Patient Care Needs

Assessing the Patient’s Potential for Wellness and for Responding to Various Treatment

Effective Management of Rapidly Changing Situations

Skilled Performance in Extreme Life-Threatening Emergencies: Rapid Grasp of a Problem

Contingency Management: Rapid Matching of Demands and Resources in Emergency Situations

Identifying and Managing a Patient Crisis Until Physician Assistance Is Available

Administering and Monitoring Therapeutic Interventions and Regimens

Starting and Maintaining Intravenous Therapy with Minimal Risk and Complications

Administering Medications Accurately and Safely

Combating the Hazards of Immobility

Creating a Wound-Management Strategy that Fosters Healing, Comfort, and Appropriate Drainage

Monitoring and Ensuring the Quality of Health Care Practices

Providing a Backup System to Ensure Safe Medical and Nursing Care

Assessing What Can Be Safely Omitted from or Added to Medical Orders

Getting Appropriate and Timely Responses from Physicians

Organizational and Work-role Competencies

Coordinating, Ordering, and Meeting Multiple Patient Needs and Requests: Setting Priorities

Building and Maintaining a Therapeutic Team to Provide Optimum Therapy

Coping with Staff Shortages and High Turnover

COMPETENCIES:

- The seven domains were identified inductively form Benner’s 31 competencies.

HELPING ROLE: 8 competencies

1. Creating a climate for and establishing a commitment to healing   
2. Providing comfort measures and preserving personhood in the face of pain and extreme breakdown
3. Presence (being with the patient)
4. Maximizing the patient’s participation and control in his or her own recovery
5. Interpreting kinds of pain and selecting appropriate strategies for pain management and control
6. Providing comfort and communication through touch
7. Providing emotional and informational support to patient’s families
8. Guiding a patient through emotional and developmental change

She has given nursing a unique way to understand that theory is derived from practice and practice is then altered or extended by theory. “Knowledge development in a practice discipline consists of extending practical knowledge (know-how) through theory-based scientific investigations and through the charting of the existent „knowhow‟ developed through clinical experience in the practice of that discipline” (Tomey, 1994, p. 164). Benner believes that nurses have failed to document their clinical experiences and observations and in turn this has deprived nursing theory from the unique knowledge embedded in expert practice

Neuman systems model

The Neuman systems model is a nursing theory based on the individual's relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature.^[1] The theory was developed by Betty Neuman, a community health nurse, professor and counselor. The central core of the model consists of energy resources (normal temperature range, genetic structure, response pattern, organ strength or weakness, ego structure, and knowns or commonalities) that are surrounded by several lines of resistance, the normal line of defense, and the flexible line of defense. The lines of resistance represent the internal factors that help the patient defend against a stressor, the normal line of defense represents the person's state of equilibrium, and the flexible line of defense depicts the dynamic nature that can rapidly alter over a short period of time.

The purpose of the nurse is to retain this system's stability through the three levels of prevention:

1. Primary prevention to protect the normal line and strengthen the flexible line of defense.
2. Secondary prevention to strengthen internal lines of resistance, reducing the reaction, and increasing resistance factors.
3. Tertiary prevention to readapt and stabilize and protect reconstitution or return to wellness following treatment.

Client System

A group of clients is usually called a client system. The members of a client system are usually related to one another in one or more aspects. In that respect,clients may depend upon one another and this my define the way their behaviour, their problems and the way they are guided by a social worke

Levin conservation model

Myra Levine (a major influence in the nursing profession) set out to find a new and effective method for teaching nursing degree students major concepts and patient care. Levine's goal was to provide individualized and responsive patient care, that was less focused on medical procedures, and more on the individual patient's context. This led to the creation of a new nursing theory and approach to patient care.

The main focus of Levine’s Conservation Model is to promote the physical and emotional well being of a patient, by addressing the four areas of conservation she set out. By aiming to address the conservation of energy, structure, and personal and social integrity, Levine's model helps guide nurses in provision of care that will help support the client's health.Though conservation of physical and emotional well being is the most vital part of attaining a successful outcome for patients, two additional concepts, adaptation and wholeness, are also extremely important in a patient's health;

• Adaptation- adaptation consists of how a patient adapts to the realities of their new health situation- the better a patient can adapt to changes in health, the better they are able to respond to treatment and care.
• Wholeness - the concept of wholeness maintains that a nurse must strive to address the client's external and internal environments. This allows the client to be viewed as a whole person, and not just an illness.
• Conservation -the product of adaptation; “Conservation describes the way complex systems are able to continue to function even when severely challenged”. Conservation allows individuals to effectively respond to the changes their body faces, while maintaining their uniqueness as a person.

Orem theory

Self Care Deficit Theory

The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve practice, but it must be consistent with other validated theories, laws and principles.

The major assumptions of Orem's Self-Care Deficit Theory are:

• People should be self-reliant, and responsible for their care, as well as others in their family who need care.
• People are distinct individuals.
• Nursing is a form of action. It is an interaction between two or more people.
• Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health.
• A person's knowledge of potential health problems is needed for promoting self-care behaviors.
• Self-care and dependent care are behaviors learned within a socio-cultural context.

Orem's theory is comprised of three related parts: theory of self-care; theory of self-care deficit; and theory of nursing system.

The theory of self-care includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is "the ability for engaging in self-care," conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand, which is the total self-care actions to be performed over a specific duration to meet self-care requisites by using valid methods and related sets of operations and actions; and self-care requisites, which include the categories of universal, developmental, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Orem identifies these requisites, also called activities of daily living, or ADLs, as:

1. the maintenance of sufficient intake of air, food, and water
2. provision of care associated with the elimination process
3. a balance between activities and rest, as well as between solitude and social interaction
4. the prevention of hazards to human life and well-being
5. the promotion of human functioning

Developmental self-care requisites are associated with developmental processes. They are generally derived from a condition or associated with an event.

Health deviation self-care is required in conditions of illness, injury, or disease. These include:

1. Seeking and securing appropriate medical assistance
2. Being aware of and attending to the effects and results of pathologic conditions
3. Effectively carrying out medically prescribed measures
4. Modifying self-concepts to accept onseself as being in a particular state of health and in specific forms of health care
5. Learning to live with the effects of pathologic conditions.

The second part of the theory, self-care deficit, specifies when nursing is needed. According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care. The theory identifies five methods of helping: acting for and doing for others; guiding others; supporting another; providing an environment promoting personal development in relation to meet future demands; and teaching another.

The theory of nursing systems describes how the patient's self-care needs will be met by the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet the self-care requisites of the patient: wholly compensatory system, partly compensatory system, and supportive-educative system.

Orem recognized that specialized technologies are usually developed by members of the health care industry. The theory identifies two categories of technologies.

The first is social or interpersonal. In this category, communication is adjusted to age and health status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination of efforts. The nurse should also maintain a therapeutic relationship in light of pscyhosocial modes of functioning in health and disease. In this category, human assistance adapted to human needs, actions, abilities, and limitations is given by the nurse.

The second is regulatory technologies, which maintain and promote life processes. This category regulates psycho- and physiological modes of functioning in health and disease. Nurses should promote human growth and development, as well as regulating position and movement in space.

Orem's approach to the nursing process provides a method to determine the self-care deficits and then to define the roles of patient or nurse to meet the self-care demands. The steps in the approach are thought of uas the technical component of the nursing process. Orem emphasizes that the technological component "must be coordinated with interpersonal and social pressures within nursing situations.

The nursing process in this model has three parts. First is the assessment, which collects data to determine the problem or concern that needs to be addressed. The next step is the diagnosis and creation of a nursing care plan. The third and final step of the nursing process is implementation and evaluation. The nurse sets the health care plan into motion to meet the goals set by the patient and his or her health care team, and, when finished, evaluate the nursing care by interpreting the results of the implementation of the plan.

Orlando's theory

About the Nursing Process Theory

The Nursing Process was based on a theory developed by nurse Ida Jean Orlando. This theory delves into the purpose of nurses and their requirements in the medical field.

Theory Assumptions

The theory assumes that a patient who cannot cope with their medical needs without assistance will become distressed and begin feeling helpless. At the base level, nursing can contribute to this distress. However, Orlando theorized that the nurse/patient relationship is one that is decided by both parties. The patient cannot appropriately convey their needs or fears without first establishing a close relationship with the nurse. As such, nurses exist to offer patients a motherly and nurturing presence to relieve distress.

The Role of the Nurse

This theory states that it is the expressed role of the nurse to find out what a patient's immediate needs for help are and fulfill them. Unfortunately, the patient will not always express their distress in a way that determines exactly what kind of help is needed. Therefore, it is the nurse's job to use insight, perception, and intuition to figure out what the patient's true needs are. This process of examining the patient's behavior and discovering its meaning assists nurses in finding out what a client really needs.

Major Dimensions

The nursing process theory dimensions can be summed up using some key terms. Distress is what a patient experiences when their needs have not been met. The Nursing Role is to learn what a patient's immediate needs are and meet them. Nursing Actions are direct or indirect approaches to providing for a patient's immediate need. An Outcome is a change in the patient's behavior that indicates either relief or an unmet need. Outcomes can be observed and interpreted in the patient both through verbal and non-verbal means.

Understanding Patient Needs

Before a nurse can take action, she must first recognize the present situation as a problematic one. In other words, the nurse must understand that the actions of the patient are communicating a plea for help, regardless of how they may appear. Eventually, these cues will become a stimulus for the nurse. Nurses who understand the theory will experience an automatic internal reaction to patient pleas and in turn exhibit behaviors that trigger a response of relief from the patient.

Interacting with a Patient

Nurses must understand that any observations shared and analyzed with a patient are relevant and useful then and there to determine whether or not the patient is in need of assistance. The nurse should also refrain from assuming that her actions and reactions are appropriate or helpful until the patient has confirmed as such. Additionally, she should fall into a pattern of exploring how a patient reacts to her actions. When the nurse stops identifying and deriving meaning from patient behaviors, the communication between nurse and patient immediately stops.

The nursing process theory is all about staying focused on the patient's needs. If you're studying to become a nurse, simply remember that the patient always comes before anything else.