Nursing focuses on the individual’s response to potential or actual health problems. Under the nursing model, human behavior is viewed from a holistic perspective.
Nursing View of Behavioral Deviations
- Behavior is viewed on a continuum from healthy adaptive responses to maladaptive responses that indicate illness.
- Each individual is predisposed to respond to life events in unique ways. These predispositions are biological, psychological, socio cultural, and the sum of the person’s heritage and past experiences.
- Behavior is the result of combining the predisposing factors with precipitating stressors. Stressors are life events that the individual perceives as challenging, threatening or demanding. The nature of the behavioral response depends on the person’s primary appraisal of the stressor and his secondary appraisal of the coping resources available to him.
- A stressor that has primary impact on physiological functioning also affects the person’s psychological and socio-cultural behavior. For instance, a man who has a myocardial infarction may also become severely depressed, because he fears he will lose his ability to work. On the other hand, the patient who enters the psychiatric inpatient unit with major depression may be suffering from malnutrition and dehydration because of his refusal to eat or drink. The holistic nature of nursing encompasses all of these facets of behavior and incorporated them into patient care planning.
Nursing intervention may take place at any point on the continuum. Nursing diagnosis may focus on behavior associated with a medical diagnosis or other health behavior that the patient wishes to change.
A nurse may practice primary prevention by intervening in a potential health problem, secondary prevention by intervening in an actual acute health problem or tertiary prevention by intervening to limit the disability caused by actual chronic health problem. The nursing assessment of the patient includes presenting complaints, past history, family history, personal history, occupational history, sexual history, physical examination and mental status examination. Additional data may be collected for significant others and by reviewing the systems. A nursing diagnosis is then formulated and based on this diagnosis; planning and interventions are carried out. Finally, evaluation will be done to find out the effectiveness of nursing interventions.
Providing nursing care is a collaborative effort, with both the nurse and the patient contributing ideas and energy to the therapeutic process.
Summary of Selected Nursing Theories
Peplau proposed an interpersonal theory applicable to nursing practice in general and to psychiatric-mental health nursing in particular. It focuses primarily on the nurse-patient relationship. Peplau’s theory describes, explains, predicts and to some extent, permits control of the sequence of events occurring in the nurse-patient relationship.
Peplau describes the interpersonal aspects of nursing as a process consisting of four phases. These are orientation, identification, exploitation and resolution phases.
While working with the patient through these phases, the nurse assumes six roles: resource person, technical expert, teacher, leader, surrogate parent and a counselor.
Peplau’s theory continues to apply to today’s nursing scene, especially with respect to long-term psychiatric care in outpatient and home health settings.
Dorothea E Orem’s theory is based on the premise that people need a composite of self-care actions to survive. Self-care actions consist of all behaviors performed by people to maintain life and health. The capacity of the patient and the patient’s family to perform self-care is called self-care agency. Orem states that a need for nursing care exists if the patient’s self –care demand exceeds the patient’s self-care agency. Thus, the goal of nursing is to meet the patient’s self-care demands until the patient and his family are able to do so.
Orem’s theory describes three types of self-care:
- Universal self-care behaviors, required to meet physiological and psychosocial needs.
- Developmental self-care behaviors, required to undergo normal human development.
- Health deviation self-care behaviors, required to meet patient’s needs during health deviations.
The classification of self-care behaviors in this manner helps to ensure complete assessment of the patient’s self-care agency.
Assessment focuses on the patient’s self-care demand, self-care agency and self-care deficits. A plan is formulated from the information obtained in the assessment that indicates the nursing approach needed to meet the patient’s needs. It can be categorized as follows:
- Wholly compensatory, in which the patient does not participate behaviorally in self- care.
- Partially compensatory, in which the patient and nurse participate behaviorally in meeting the patient’s self-care needs.
- Educative-developmental, in which the patient meets self-care needs with minimal nursing assistance.
To implement the required nursing approach, the nurse uses one of the five behaviors: acting or doing for the patient, guiding, supporting, providing and teaching.
Roger’s model focuses on the individual as a unified whole in constant interaction with the environment. The unitary person is viewed as an energy field that is more than as well as different from the sum of the biological, physical, social and psychological parts. In Roger’s model, nursing is concerned with the unitary person as a synergistic phenomenon.
Nursing science is devoted to the study of nature and direction of unitary human development. Nursing practice helps individuals achieve maximum well-being within their potential.
According to Callista Roy’s theory, the goal of nursing is to promote the patient’s adaptation in health and illness. This goal is achieved through the nurse’s efforts to change, manipulate or block stress-producing stimuli that may impinge on the patient. The theory assumes that this kind of nursing intervention assists the patient to cope more effectively through reducing stress.
Roy’s theory assumes that all human beings have adaptive systems and change in response to stimuli. If the change does not promote the person’s integrity then the change can be considered maladaptive.
The nursing process used in Roy’s theory involves two levels of assessment. The first level includes observation of behavior related to the four adaptive modes: Physiologic, self-concept, role function and interdependence. These four modes represent methods used by the patient to adapt. The second level of assessment consists of identifying focal, contextual and residual stimuli. The focal stimulus represents the immediate dominant stimulus affecting the patient, such as injury, stress or illness. Contextual stimuli include the environment, the patient’s family and all other background factors related to the focal stimulus. Residual stimuli consist of the patient’s previous background, beliefs, attitudes and traits.
According to Roy’s theory, a person’s adaptation level is a function of focal, contextual and residual stimuli. When a person encounters stresses form these stimuli that surpassinnate and acquired mechanisms to cope effectively, the person behaves ineffectively as demonstrated by one or more of the adaptive modes. At this point, nursing intervention is required. This emphasizes on the patient’s behavior, stimuli determining the patient’s behavior, stimuli determining the patient’s behavior, and the nurse intervening in some way to interfere with the stimuli.