Conceptual Bases for Nursing: Systems, Adaptation, and Health Beliefs

1. Chapter 12: Conceptual and Philosophical Bases for Nursing Bonnie M. Wivell, MS, RN, CNS

2. Systems • System theorist—von Bertalanffy (1936) described a system as a set of interrelated parts that come together to form a whole that performs a function. Each part is a necessary component—these parts are: • Input: raw material that enters a system and is changed by it • Throughput: process used to convert raw material into something useful • Output: end result or product • Evaluation: measuring the success or failure of the output or the effectiveness of the system • Feedback: information given back into the system to determine if purpose or end result was achieved

3. Systems Continued • Suprasystem: the environment outside the system • Open: promotes the exchange of matter, energy & information with other systems; whole is greater than sum of parts • Closed: doesn’t interact with other systems • Synergy: subsystems collaborate • Dynamic Nature of Systems: dynamic balance maintains homeostasis or internal stability • Application to Nursing: Nurses work in systems every day

4. Person as a System • Physiological subsystems of person: circulatory, musculoskeletal, respiratory, GI, GU, neurological • Psychological, social, cultural and spiritual subsystems also exist • Holistic nursing care combines all these subsystems • Genes and environmental factors influence how a person develops • Maslow Human Needs Theory • Basic needs: food, air, water • Safety needs: physical safety and psychological security • Love and belonging: intimacy and relationships • Esteem needs: self-esteem, self-respect, self-reliance • Self-actualization: attaining maximum potential • Assumption: basic needs must be at least partially satisfied before higher-order needs can become relevant to the individual

5. Carl Rogers • Theory of personhood • People are constantly adapting, discovering and rediscovering themselves • Human potential to grow and develop can be used by nurses to assist patients to change unhealthy behaviors and to reach the highest level of wellness possible • The concept of adaptation is helpful because when people are moved from their home environment to the hospital, anxiety often occurs

6. Homeostasis • When needs are not met, it is threatened • Balance between internal and external forces must be maintained • Balance achieved = healthy, resistant to disease • Persons attempt to adapt to change • If adaptation unsuccessful, disequilibrium occurs and disease or illness can result • How one responds to stress is a major factor in the development of illness

7. Environment • Family Systems: nuclear family (mom, dad, children); extended family; single parent • Cultural Systems: attitudes, beliefs, & behaviors of social & ethnic groups • Social Systems: neighborhoods, churches schools, civic & recreational groups—Holmes & Rahe (1967) studied social change as related to illness; changes require social readjustment • WHO now recognizes poverty as the most influential determinant of health • Community, National, World Systems

8. Health • WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” • Holism: Interrelationship of all parts make up whole of the person (Smuts, 1926) • High-level Wellness: functioning at a maximum potential in an integrated way with the environment (Dunn, 1961)

9. Health Beliefs & Health Behaviors • Healthy People 2010: an effort designed to stimulate a national disease prevention and health promotion agenda to improve significantly the health of all Americans • Convincing individuals to change their lifestyles, however, even when to do so would result in improved health, remains a challenge • Health behaviors include those choices and habitual actions that promote or diminish health • Rosenstock’s health beliefs model: • An evaluation of one’s vulnerability to a condition and the seriousness of that condition • An evaluation of how effective the health maintenance behavior might be • The presence of a trigger event that precipitates the health maintenance behavior

10. Albert Bandura • Bandura’s (1997) model of self-efficacy: high belief in one’s self-efficacy lead to efforts to change; four components • Information • Skill development • Skill enhancement through guided practice and feedback • Creating social supports for change

11. Locus of Control • Locus of control concept proposed that people tend to be influenced by either an internal or external view of control • Internal: what they themselves do • External: is determined by outside factors • Influence of Internet on health—reliance for health information; validity; see page 289 in text for ideas on how to assess sites

12. Nurses and Health Beliefs Models • Health is relative, ever changing, and affected by genetics, environment, personal beliefs and cultural beliefs • Health affects the entire person • Individual’s health beliefs are powerful and influence how they respond to efforts to change their behaviors • Individuals needing or desiring change may lack knowledge, motivation, and support • Various models of health beliefs can be used to assess individual, family, and group readiness to change • The burden of action is mutually shared by patient, health care providers, and population-focused entities such as public health programs

13. High-Level Wellness • Developing a personal plan for High-level wellness; see page 311 in text • The personal health practices of nurses play a direct role in their effectiveness in counseling patients on health-related matters • Patients more likely to adopt healthy behaviors if caregiver engages in them • Nurses have a professional responsibility to model positive health behaviors in their own lives, but nurses are individuals too.

14. Concepts Basic to Nursing • Person • Unique • Capable of adaptation • Motivated by needs • Environment • Promotes or interferes with well-being • Physical and Nonphysical • Health • Dynamic • A continuum

15. Beliefs • A belief represents the intellectual acceptance of something as true. • A nurse with a non-judgmental attitude makes every effort to convey neither approval nor disapproval of a patient’s beliefs and respects each person’s rights to his or her beliefs. • Categories: • Descriptive: show true or false • Evaluative: judge as good or bad • Prescriptive: judged desirable or undesirable

16. Values • Values are the freely chosen principles, ideals or standards held by an individual, class or group that give meaning and direction to life. • Professional nursing values on page 316 • Clarifying your values on page 296

17. Philosophies • Philosophy is defined as the study of the principles underlying conduct, thought, and the nature of the universe. • Branches of Philosophies: • Epistemology: tries to determine how we know whether our beliefs about the world are true • Logic: study of proper & improper methods of reasoning (such as the nursing process) • Aesthetics: study of what is beautiful • Ethics: study of standards of conduct • Politics: deals with regulation & control of people living in society • Metaphysics: ultimate nature of existence, reality, human experience & the universe

18. Philosophy of Nursing • Philosophies of Nursing are statements of beliefs and expressions of values in nursing that are used as bases for thinking and acting – guide practice. • Individual philosophies • Collective philosophies: hospitals, schools of nursing • Your personal philosophy of nursing