2. By the end of this lecture the student you will be able to: Explain what is meant by a theory and a model of nursing Explain what is meant by a theory and a model of nursing Discuss the main features of at least two theories of nursing: Discuss the main features of at least two theories of nursing: – Orem’s Theory – Roper, Logan & Tierney – Callister Roy’s model Characterize the conceptual models: Characterize the conceptual models: – the Omaha System, – Neuman System Model

3. Community – oriented,population focused care: Community orientation : Is a process that is actively shaped by the unique experiences,knowledge,concern,value and cultures.

4. Community – oriented,population focused care Employs population based skills and is shaped by the characteristics and needs of a given community

5. Relation ship-based care Incorporate the value of establishing and maintaining a reciprocal,caring relationship with the community

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. Theories and models for community health nursing in a General Sense (Philosophies) Florence Nightingale Virginia Henderson Ernestine Wiedenbach

8. Theories about Broad Nursing Practice Areas: Grand Theories Myra Estrin Levine's Conservation Model Betty Neuman's Systems Model Sister Callista Roy's Adaptation Model Dorthea Orem's Self-Care Model

9. Theories about Specific Nursing Actions, Processes, or Concepts: Middle-Range Theories Katharine Kolcaba's Theory of Comfort Sister Callista Roy's Adaptation Model Nola Pender's Health-Promotion Model Hildegard Peplau's Interpersonal Relations in Nursing

10. Theories that Defy Classification Martha Rogers's Unitary Human Beings Margaret Newman's Health as Expanding Consciousness

11. A conceptual model … is the synthesis of a set of concepts and the statements that integrate those concepts into a whole.

12. Nightingale's theory of environment Florence Nightingale's environmental theory has great significance to nursing in general and to community health nursing specifically because focus on preventive care for population.

13. Theory of Nursing Systems = Orem’s Theory This is the unifying theory that “subsumes the theory of self-care deficit which subsumes the theory of self-care” Concept of Self care learned goal oriented actions to preserve and promote life.

14. Orem’s Theory Orem identified three types of nursing systems: – wholly compensatory, – partly compensatory, and – supportive-educative.

15. Neuman's health care systems model… is based on the individual's relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. is a unique, open systems-based perspective that provides a unifying focus for approaching a wide range of international health concerns. Being universal in nature, it is open to creative interpretation and is widely used throughout the world as a multidisciplinary, wholistic, and comprehensive guide for excellence in nursing practice, education, research, and administration.

16. Betty Neuman Betty Neuman is a community health nurse and clinical psychologist who has developed this theory. Betty M. Neuman, R.N., B.S.N., M.S., Ph.D., PLC., FAAN

17. Neuman's systems model… The model's basic central core 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.

18. Neuman's systems model… 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 The flexible line of defense depicts the dynamic nature that can rapidly alter over a short period of time.

19. The Omaha System The Omaha System is a research-based, comprehensive practice and documentation standardized classification; it can be used by multidisciplinary health care practitioners in any setting from the time of client admission to discharge.

20. The Omaha System Consists of three relational, reliable, and valid components designed to be used together: Problem Classification Scheme (client assessment) Problem Classification Scheme Intervention Scheme (service delivery) Intervention Scheme Problem Rating Scale for Outcomes (client change/evaluation) Problem Rating Scale for Outcomes

21. The Omaha System Problem Classification Scheme Four levels: Four domains appear at the first level and represent priority areas of practitioner and client health-related concerns. Forty-two terms (concepts), referred to as client problems or areas of client needs and strengths, appear at the second level. The third level consists of two sets of problem modifiers: health promotion, potential, and actual as well as individual, family, and community. Clusters of signs and symptoms describe actual problems at the fourth level.

22. Roy's Model Of Nursing Sister Callista Roy developed the Adaptation Model Definition – Roy's model of nursing sees an individual as a set of interrelated systems, biological, psychological, and social. The individual tries to maintain a balance between each of these systems and the outside world. However, there is no absolute level of balance. According to Roy we all strive to live within a band where we can cope adequately. This band will be unique to an individual. The adaptation level is the range of adaptability within which the individual can deal effectively with new experiences.

23. Roy's Model Of Nursing This model comprises the four domain concepts of – person, – health, – environment, and – nursing and involves a six step nursing process.

24. Roy's Model Of Nursing – Roy's models sees the person as "a biopsychosocial being in constant interaction with a changing environment" (Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with stressors. – Roy sees the environment as "all conditions, circumstances and influences that surround and affect the development and behaviour of the person" (Andrews & Roy, 1991). – Roy describes stressors as stimuli and uses the term 'residual stimuli' to describe those stressors whose influence on the person is not clear

25. Roy's Model Of Nursing Roy employs a six-step nursing process which includes: – assessment of behaviour, – assessment of stimuli, – nursing diagnosis, – goal setting, – intervention and evaluation.

26. Roy's Model Of Nursing In the first step, the person's behaviour in each of the four modes is observed. This behaviour is then compared with norms and is deemed either adaptive or ineffective. The second step is concerned with factors that influence behaviour. Stimuli are classified as – focal, – contextual or – residual

27. Roy's Model Of Nursing The nursing diagnosis is the statement of the ineffective behaviours along with the identification of the probable cause. In the fourth step, goal setting is the focus. – Goals need to be realistic and attainable and are set in collaboration with the person (Andrews & Roy, 1991). Intervention occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the 'doing phase' (Rambo). In the final stage, evaluation takes place. The degree of change as evidenced by change in behaviour, is determined. Ineffective behaviours would be reassessed, and the interventions would be revised

28. Social influence on community oriented,population –focused nursing Communication technology Genetics Global economy Migration Climate changes