Theoretical Framework in Nursing

By:

May Vallerie V. Sarmiento RN

Prof. Erlinda E. Domingo RN., MPH., CESO IV

Professor III

Henderson called her definition of

nursing her “concept” and emphasized

the importance of increasing the patient’s

independence so that progress after

hospitalization would not be delayed. She

categorized nursing activities into

fourteen components, based on human

needs

Case Scenario

Ms.X 25 years old female client was admitted

in the surgical unit, with attempted suicide. Two

weeks ago, she ingested toilet cleaner because

of a family dispute.

Upon history taking, her mother informed that

her marriage was planned two days before the

incident. She was reluctant to share the reason

for her suicide but stated that she was stressed

out and tried to kill herself

Cont…

Later on, her mother reported that

she was impulsive and emotional

person and was in live with someone

but the family was willing for her

marriage.

Table Nursing ASSESSMENT of Ms. X

Henderson's 14 Components Assessment Findings

1 Breathing normally She was experiencing difficulty in breathing; Respiratory

rate-16 irregular, Oxygen saturation 87%

2 Eat and drink adequately. Height 153 cm; weight 45kg; skin turgor good, She was

Advised liquid diet but she resisted taking any liquid.

3 Elimination of body wastes Foley's catheter was in placed

4 Movement and Posturing Reports fatigue , Feeble to walk, Gait imbalance

5 Sleep and Rest Experiencing insomnia for three days, Dark circles around

Eyes

6 Select suitable clothes-dress and undress Wearing loose fitted dirty dress.

7 Maintain body temperature No signs of hyperthermia or hypothermia; Temperature 37

C

8 Keep the body clean and well groomed Mother reported that she was very conscious of her physical

appearance and hygiene but was not well groomed at that

time.

9 Avoid dangers in the environment Fatigue, feeble walk and history of attempted suicide.

10 Communication She had damaged larynx and had speech difficulty

11 Worship according to one’s faith Religion; Islam, mother reported that she was not spiritual.

12 Work accomplishment Lost interest in self-care and inability to perform ADLs

since her marriage was planned as reported by mother

13 Play or participate in various forms of

recreation

Mother reported that she used to spend time with family but

had lost active participation in home activities

14 Learn, discover, or satisfy the curiosity Finding difficult to cope with her stress and present illness

The Nursing Process, when used

systematically, could very well facilitate the

application of this theory. The self care

deficit is identified by the nurse through

assessment of the patient. Dorothea Orem

portrayed one of the very crucial skills of

the nurses in the nursing practice and that is

skilled observation, both of the patient and

other elements of the nursing situation.

PATIENT DETAILS

Name

Age

Sex

Education

Occupation

Marital status

Religion

Diagnosis

Theory applied

Mrs.X

56years

Female

No formal education

Household

Married

Hindu

Rheumatoid arthritis

Orem’s theory of self

care deficit.

Age 56 year

Gender Female

Health state Disability due to health

condition, therapeutic self

care demand

Development state Ego integrity vs despair

Sociocultural orientation No formal education, Indian,

Hindu

Health care system Institutional health care

Family system Married, husband working

Patterns of living At home with partner

Environment Rural area, items for ADL not

in easy reach, no special

precautions to prevent injuries

resources Husband, daughter, sister’s

son

Basic Conditioning Factors

Air Breaths without difficulty, no pallor cyanosis

Water Fluid intake is sufficient. Edema present over

ankles.

Turgor normal for the age

Food Hb – 9.6gm%, BMI = 14.Food intake is not

adequate or the diet is not nutritious.

Elimination Voids and eliminates bowel without difficulty.

Activity/ rest Frequent rest is required due to pain.

Pain not completely relieved,

Activity level ha s come down.

Deformity of the joint secondary to the disease

process and use of the joints.

Social interaction Communicates well with neighbors and calls the

daughter by phone Need for medical care is

communicated to the daughter.

Prevention of hazards Need instruction on care of joints and prevention

of falls. Need instruction on improvement of

nutritional status. Prefer to walk bare foot.

Promotion of normalcy Has good relation with daughter

Universal Self-care Requisites

Maintenance

of

developmenta

l environment

Able to feed self ,

Difficult to perform the dressing,

toileting etc

Prevention/

management

of the

conditions

threatening the

normal

development

Feels that the problems

are due to her own behaviours and

discusses the problems with

husband and daughter.

Developmental Self-care

Requisites

Adherence to medical

regimen

Reports the problems to the physician when in the

hospital. Cooperates with the medication, Not

much aware about the use and side effects of

medicines

Awareness of potential

problem associated with the

regimen

Not aware about the actual disease process.

Not compliant with the diet and prevention of

hazards. Not aware about the side effects of the

medications

Modification of self image

to incorporates changes in

health status

Has adapted to limitation in mobility.

The adoption of new ways for activities leads to

deformities and progression of the disease.

Adjustment of lifestyle to

accommodate changes in the

health status and medical

regimen.

Adjusted with the deformities.

Pain tolerance not achieved

Health Deviation Self-care Requisites

The Adaptation Model of Nursing is a

prominent nursing theory aiming to explain

or define the provision of nursing science.

In her theory, Sister Calista Roy’s model

sees the individual as a set of interrelated

systems who strives to maintain balance

between various stimuli.

Demographic Data

Name Mr. NR

Age 53 years old

Sex Male

Education Degree

Occupation Bank Clerk

Marital Status Married

Religion Hindu

Informants Patient and Wife

Date of Admission 02-23-16

Focal Stimulus: Non healing wound after amputation of great

and second toe of left leg. 4 week. A wound

first found on the junction between first and

second toe-4 month back. The wound was not

healing and gradually increased in size with pus

collected over the area

He first showed in local hospital, referred to

medical college; during hospital stay great and

second toe amputated. But surgical wound

turned to non-healing with pus and black color.

So the physician suggested for below knee

amputation. That made them to come to

hospital. He underwent plastic surgery 3 weeks

before.

Contextual Stimuli: Known case DM for past 10 years. Was on

oral hypoglycemic agent fr initial 2 years,

but switched to insulin and using it for 8

years now. Not wearing foot wear in the

house and premises.

Residual Stimuli: He had TB attack 10 years back and took

complete course treatment. Previously, he

admitted in Hospital for leg pain about 4 years

back. Mothers brother had DM. Mother has

history of PTB. He is a graduate in

humanities, no special knowledge on health

matters.

ASSESSME

NT OF

BEHAVIOR

ASSESSMENT

OF STIMULI

Nursing

Diagnosis

Goal Intervention

Ineffective

protection

and sense in

physiologica

l mode.

(No pain

sensation

from the

wound site.

Focal Stimuli:

Non Healing

wound after

amputation of

great and

second toe of

left leg- 4

weeks.

Impaired

skin

integrity

related to

fragility of

the skin

secondary to

vascular

insufficienc

y.

Long term:

Objective

1. Amputate

d area will

be

completel

y healed

by April

20, 2016

2. Skin will

remain

intact with

no

ongoing

ulceration.

Maintain the

wound area

clean as

contamination

affects the

healing

process.

Follow sterile

technique

while

providing

care to

prevent

infection and

delay in

healing.

Promotion Model Developed by Nola J.

Pender, first presented in 1982 The HPM aims

at predicting or explaining overall health-

promoting lifestyles and specific behaviors

A 36-year-old female patient who smokes

2 packs of cigarettes per day; her 9 months

old bottle-fed child has just been diagnosed

with his second episode of otitis media”

Problem Identified: Need for smoking

cessation with health promoting behavior.

ASSESSMENT

Prior Related Behavior Length of time patient has smoked Amount

patient smokes Previous attempts at smoking

cessation Personal Factors Perceived health

status Education Socioeconomic status Self-

motivation

Perceived Benefits of Action (provide education) Decreased risk of chronic

disease Improved health of child Financial

benefits Perceived Barriers-Address fears such

as weight gain, failure, etc Cost of

medications/nicotine replacement therapy

Assess personal capability of health-

promoting behavior Activity-Related Affect-

“modify cognitions, affect, and the

interpersonal and physical environment to

create incentives for health actions”

Interpersonal Influences Identify how family, peers, providers

influence patient behavior, support system

Situational Influences- What situations can

impede health promoting behavior Competing

Demands- job loss, death, stress

Intervention Develop a commitment to

a plan of action Provide

counseling (problem

solving/skills training)

and social support Provide

self-help educational

material Establish a quit

date Initiate

pharmacological treatment

as appropriate

Evaluation Continued assessment of

immediate competing

demands and preferences

is essential to the

continued health-

promoting behavior

Johnson’s Behavioral System Model is a

model of nursing care that advocates the

fostering of efficient and effective

behavioral functioning in the patient to

prevent illness. The patient is identified as a

behavioral system composed of seven

behavioral subsystems: affiliative,

dependency, ingestive, eliminative, sexual,

aggressive, and achievement.

Patient Profile

Name Mrs. B

Age 43 years old

Chief Complaint Nausea and Vomiting few

hours PTC

Decrease level of

Consciousness ; GCS:

Lethargic 13/15; Blurring

of vision, dysarthria, severe

right sided weakness

Patient Data Bp: 185/85, PR: 107bpm ,

RR: 20cpm, Temperature:

37.5C O2 sat: 87% Blood

sugar: 60mg/dl

According to her daughter, Mrs. “B” and her Husband having an argument and suddenly Mrs. “B” fell down on the ground so she was rushed to the nearby hospital within 15 minutes. She was immediately sent for CT scan and diagnosed with Acute Ischemic Attack.

Her past medical history revealed that the medication for her hypertension was not religiously complied due to budget constraints. She is 4 feet and 8 inches tall and weighs 70 kilos (154 lbs.). She had history of right nephrectomy five years ago, and rheumatic heart disease since she’s eighteen years old.

The patient has been compliant with her medications and dietary regimens until lately after her husband was out of work that all the stress came so overwhelmingly to her, that one morning she just woke up aphasic with severe weakness on the right limbs.

When Ms. “B” woke up in the middle of our interview, she burst into tears as you can obviously understand from her facial expression her worries for her family future.

Subsystem ASSESSMENT

Sub: Obj:

Affiliation “I don’t want

to see my

husband yet”.

Changing

topic when

husband was

mentioned

Dependency

“I don’t need

him right

now”

Changing

topic when

husband was

mentioned

Aggresion Please give me

something sweet

like leche flan or

cake

Show sign of

strong desire to

have something

to eat that is

sweet

Elimination I have difficulty

defecation

Straining during

defecation

Ingestion Pls give me

something sweet

like leche flan or

cake

Show sign of

strong desire to

have something

to eat that is

sweet

Achievement when I am

sad, I can’t

help it to eat

something just

to forget I am sad”

Begging for

food that is not

allowed like

sweet and

high

cholesterol,

unable to

finish hospital serve food

Restorative “I don’t think I

can return to

my usual way of living”

Show sign of

hopelessness

and not cooperating