Assignment #2



How Can I think Differently? Nursing Theories Applied to Practice ScenarioAssignment #2Edna M. Grajalesfor Dr. R. KohrMHST/NURS 608Athabasca UniversityJuly 2, 2019AbstractA classic and contemporary nursing theory will be presented to assist a nurse in understanding events depicted in a presented practice scenario. Betty Neuman’s classic Systems Model focuses on stressors in the environment, an individual’s response to these stressors, and how an individual recovers from these adversities. Nola J. Pender’s Health Promotion Model focuses on an individual’s behavior in promoting health. Both theories incorporate a holistic approach by considering the biological, psychological, and sociological aspects of an individual.Keywords: nursing theorists, classic theory, contemporary theory, Betty Neuman’s Systems Model, Nola J. Pender’s Health Promotion ModelIn this paper, Betty Neuman’s classic Systems Model (SM) and Nola J. Pender’s contemporary Health Promotion Model (HPM) will be described. Presenting the two nursing theories will provide understanding of a presented practice scenario.Betty Neuman’s Systems ModelBetty Neuman’s Systems Model was developed as a method to teach new nursing students about the holistic perspective of nursing that included physiological, psychological, sociological, and developmental aspects. This model is based on the client’s relationship with stress, how they react to it, and the dynamics used to recover from these stressors (Petiprin, 2016). The basic assumptions of the model are:“Each patient system is a unique composite of factors and characteristics within a range of responses contained in a basic structure.Many known, unknown, and universal stressors exist. Each differ in their potential for upsetting a client's usual stability level.Each patient has evolved a normal range of responses to the environment referred to as the normal line of defense. It can be used as a standard by which to measure health deviation.The particular inter-relationships of patient variables can, at any point in time, affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors.When the flexible line of defense is incapable of protecting the patient against an environmental stressor, that stressor breaks through the line of defense.The client is a dynamic composite of the inter-relationships of the variables, whether in a state of illness or wellness. Wellness is on a continuum of available energy to support the system in a state of stability.Each patient has implicit internal resistance factors, which function to stabilize and realign the patient to the usual state of wellness.Primary prevention is applied in patient assessment and intervention, in identification and reduction of possible or actual risk factors.Secondary prevention relates to symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects.Tertiary prevention relates to adjustive processes taking place as reconstitution begins, and maintenance factors move them back in a cycle toward primary prevention.The patient is in dynamic, constant energy exchange with the environment” (Petiprin, 2016a).Nola J. Pender’s Health Promotion ModelNola J. Pender’s Health Promotion Model assists nurses in understanding the dominant determinants of health behaviours used as the basis of behavioural counseling to promote healthy lifestyles (Pender, 2011). It serves as a framework to guide nurses in exploring the biopsychosocial process that encourages individuals to participate in health improving behaviours (Pender, 2006). It includes four assumptions:“Individuals seek to actively regulate their own behavior.Individuals, in all their biopsychosocial complexity, interact with the environment, progressively transforming the environment as well as being transformed over time.Health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people through their life span.Self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior” (Petiprin, 2016b).Practice ScenarioTaylor is 32 years old and has a long-term partner named Pat. They have a 2-year-old child named Sam. After Sam’s birth, Taylor experienced difficulties with postpartum adjustment for approximately six weeks, with bouts of sadness, being teary and crying for no apparent reason. Taylor sought help at three weeks postpartum from a Public Health Nurse (PHN) and incorporated many health promoting strategies suggested by the PHN, such as increased rest, physical activity, and good nutrition. Since having Sam, Taylor has felt socially isolated since no immediate family lived nearby and Pat worked full-time. During this maternity leave, Taylor sought out supports and was referred by the Public Health Nurse to many parenting programs in the community. Along with Pat, Taylor made some strong connections with other parents. After thirteen months of leave, Taylor decided not to return to work but has been contemplating searching for work again to alleviate some financial stressors. This has been put on hold after recently confirming a multiple pregnancy of 8 weeks gestation. Taylor has been experiencing extreme nausea, vomiting, and fatigue and feels these physical symptoms are impeding the ability to care for Sam when Pat is at work. Taylor has been able to reach out to some reliable parents in the neighbourhood to help with Sam during the day. At the most recent Public Health Nurse visit, although accepting of the pregnancy, Taylor discloses feeling stressed and worried about being pregnant and unwell. Taylor is also beginning to experience signs of anxiety and is terrified that this will lead to postpartum depression after the arrival of the twins.Nursing Theories Applied to Practice ScenarioIn this practice scenario, both Neuman’s SM and Pender’s HPM can be used to guide the nurse’s understanding of the client’s situation. Although Neuman’s SM focuses on stressors and Pender’s HPM focuses on behaviour, both models use a holistic perspective in viewing the client by examining the physiological, psychological, and social aspects. Using Neuman’s SM, the nurse can determine that the client adequately managed difficulties with postpartum adjustment due to previous responses to other stressors known as the normal line of defense. The nurse is aware that the client’s flexible line of defense adapts to stressors, in this case social isolation, finances and feeling unwell during pregnancy. The nurse will also understand that a client seeking support and assistance when experiencing stressors helps the client to realign self to a previous state of wellness. In primary prevention aimed to prevent illness, the nurse assesses history of difficulties with postpartum adjustment and is aware that this is a risk factor for postpartum depression. Thus, the nurse’s intervention would be to build on current client supports, and help the client build and strengthen new support systems. In secondary prevention aimed to reduce the impact of illness, the nurse determines past positive coping mechanisms used with difficulties in postpartum adjustment and pregnancy discomforts. The nurse reinforces these coping strategies with the onset of anxiety and feeling unwell during pregnancy. In tertiary prevention aimed at reducing the impacts of ongoing illness, the nurse could work on new strategies based on the client’s current coping abilities to address ongoing signs and symptoms of anxiety. Using Pender’s HPM, the nurse is aware that the client attempts to self-regulate behaviour during difficulties with postpartum adjustment by integrating increased rest, physical activity, and optimal nutrition into daily life. The nurse can assist in the client’s experience of social isolation by supporting the client to seek reliable supports within the community. By building reliable support systems, the client seeks to change their environment of being socially isolated. It is important that the nurse understands that all behavioural changes to improve health status is client led. Thus, the client’s receptiveness to a Public Health Nurse allows the nurse to have a positive influence on the client’s life. ConclusionIn presenting a classic and contemporary nursing theory, it is seen here that two differing theories can help a nurse to explore and understand a presented practice scenario. Despite the focus of each theory, one being on a client’s reaction to stressors in the environment and the other on client behaviours to improve health, both theories can assist the nurse in understanding the client’s situation and interventions used.ReferencesNeuman, B. (1982). The Neuman Systems Model: Application to nursing education and practice. Connecticut: Appleton-Century-CroftsPender, N.J. (2011). Health Promotion Model Manual. Retrieved from Petiprin, A. (2016a). Nursing Theory: Systems Model. Retrieved from , A. (2016b). Nursing Theory: Health Promotion Model. Retrieved from ................
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