THEORETICAL FOUNDATIONS OF NURSING

1. THEORETICAL FOUNDATIONS OF NURSING Ns. HeniDwiWindarwati, M.Kep., SpKepJ

2. INTERPERSONAL RELATIONS THEORY HILDEGARD PEPLAU’S

3. HILDEGARD PEPLAU • Born on September 1, 1909 @ Reading, Pennsylvania • 1931- Graduated from Pottstown, Pennsylvania Hospital School of Nursing • Worked as an Operating Room Supervisor@ Pottstown Hospital • 1943- received Bachelor of Arts in Interpersonal Psychology- Bennington College, Vermont

4. HILDEGARD PEPLAU • 1947- Received a Master of Arts in Psychiatric Nursing- Teacher’s College, Columbia, New York • 1953- received a Doctor of Education in Curriculum Development @ Columbia • Became a member of the Army Nurse Corps & worked in a neuropsychiatric hospital in London, UK- WORLD WAR II

5. HILDEGARD PEPLAU • Worked with psychiatrists Freida Fromm-Riechman and Harry Stack Sullivan. • March 7, 1999- she died @ her home in Sherman Oaks, California @ the age of 89.

6. MAJOR INFLUENCES • She had her first exposure on INTERPERSONAL THEORY @ Bennington • She attended lectures on INTERPERSONAL RELATIONS by Harold Stack Sullivan • She was influenced by the Sullivanian theory (psychoanalysis) and she aimed to bring this to the patients.

7. MAJOR CONCEPTS: • PERSON:man is an organism that lives in an unstable balance of a given system 2. HEALTH:movement of the personality & other ongoing human processes that directs the person towards creative, constructive. Productive and community living.- needs must also be met (physiologic demands & interpersonal process)

8. 3. ENV’T:forces outside the organism & in the context of the socially- approved way of living- social processes (norms. Customs, beliefs) 4. NURSING:significant, therapeutic interpersonal process

9. KEY AND SUB-CONCEPTS • PSYCHODYNAMIC NURSING: • Being able to understand one’s own behavior to help others identify felt difficulties & to apply principles of human relations to the problem

10. B. NURSE- PATIENT RELATIONSHIP * PHASES * • ORIENTATION- Initial interaction between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional help.

11. 2. IDENTIFICATION- patient and nurse explore the experience & the needs of the patient- leads to relatedness 3. EXPLOITATION- patient derives the full value of the relationship as he moves on from dependent role- independent one. 4. RESOLUTION- patient earns independence over his care.

12. C. NURSING ROLES • Nurse assumes several roles w/c are used in empowering in meeting the needs of the patient.

13. 1. ROLE OF THE STRANGER • Nurse must treat the patient with outmost courtesy- accepts the patient and respects the patient’s individuality

14. 2. ROLE OF THE RESOURCE PERSON • (Pt is in dependent role)- nurse provides answers to pt’s queries- providing health information, advices, and simple explanation of the course of care. • either straightforward answers or providing counseling

15. 3. TEACHING ROLE • Gives importance to self- care • Helping patient understand the teaching plan • develop discussions around the interest of the patient

16. 4. LEADERSHIP ROLE • Acts in behalf of the patient but also enables pt to make decisions (achieved through cooperation and active participation)

17. 5. SURROGATE ROLE • Also known as temporary care giver role- motherly role 6. COUNSELING ROLE • It has the greatest importance and emphasis in nursing

18. STRENGTHS OF THE THEORY • Useful in helping psychiatric pts become receptive for therapy • This theory is based on reality and it can be tested and observed using pure observation • It is used in every aspect of the nursing profession especially in dealing with patients.

19. LIMITATION OF THE THEORY • The use of this model/ theory is limited or impossible in working with senile, comatose or newborn patients. 2. Can only be used wherein a communication occurs between the nurse and the patient.

20. APPLICATION TO NURSING PRACTICE • In psychiatric nursing, Peplau’s interpersonal model is used in counselling women undergoing depression. Because of the strengthened nurse-pt relationship, women are able to describe patterns that resulted to negative thinking & independently found strategies to manage them. • Provides clear design for the practice of psychiatric nursing • Emphasized the development of interpersonal relationship between the patient and the nurse

21. APPLICATION TO NURSING EDUCATION • Peplau’s book, INTERPERSONAL RELATIONS IN NURSING, is being used as a manual to help graduate nurses and nursing students alike in creating a significant nurse- patient relationship. • Formulated effective psychotherapeutic methods.

22. APPLICATION TO RESEARCH • Formulated concepts of anxiety as a means to constructively resolve angry feelings through experiential learning within the nurse- patient relationship.

23. Florence Nightingale

24. Florence and the Patient • Nightingale believed that caring for the sick was a component of Christianity • Cures were not limited to medical acts but also acts of God • Patient’s needs should be prioritized according to Maslow’s Hierarchy

25. Florence and the Patient • Health Promotion occurred through providing a sanitary environment, adequate nutrition, patient comfort, and conservation of the patient’s energy • Considered a client to have the capability to be healthy, however, he/she did not have the power to control their unsanitary environment or poor access to essential nutrients

26. Florence’s Theory and Health • Although Florence Nightingale was bedridden, she continued to campaign toimprove the heath standards, publishing 200 books, reports and pamphlets. • She believed that infection arose spontaneously in dirty and poorly ventilated places • Her belief led to improvements in hygiene and healthier living and working environments • Florence Nightingale’s vision of health care included professional nursing for the sick and the poor

27. Florence’s Theory and Health • One of the first people to examine data on occupational health and safety • Systemic approach to health care with a major role for prevention, clean air, clean water, decent housing and good infant care • Promoted uniform hospital statistics so that results could be compared by country, institution and type of treatment

28. Florence and the Environment • Mother’s responsibility to teach her children cleanliness in mind, body, and spirit • This included waste management and tidiness in and around the home • Bad smells were to be considered a sign of danger

29. Florence and the Environment • In order for healing to occur, all environmental and sanitary conditions must improve • Ventilation/ Clean Air and light were considered key factors in hygiene

30. Florence and Nursing • Florence Nightingale is the reason why nursing is considered a profession today and recognized that educated nurses would be viewed by the public as professional. • First nursing school at St. Thomas Hospital in London • She believed that God called her to be a nurse and that He had natural laws that were to be followed

31. Florence and Nursing • According to Nightingale, the aim of nursing education was to train women to become nurses in order to serve society for the alleviation of the suffering of the sick, for the amendment of the living conditions of the poor, and for the improvement of the health of the population (Nightingale 1859).

32. The Effect on Nursing Practice • Stressed the importance of hygiene and believed that it aided in the prevention of disease spreading • Focused on a holistic caring perspective • Aseptic practices • Nursing is a continuous learning process because new and better practices are always being developed

33. What it is, or what it should be? • BOTH! • Maintaining a clean environment within the healthcare setting is essential to prevent nonsocomial infections • Gloves and other PPE, bed linens, handwashing • Keeping a clear path for fire safety

34. What it is, or what it should be? • However, not everyone always follows the rules: • Carts, etc. obstructing the hallways • Not everyone wears gloves when they are supposed to • Handwashing • Florence Nightingale’s Theory is one that every nurse should strive to achieve by maintaining a healthy environments not only for their patients, but also for themselves.

35. CULTURAL CARE DIVERSITY AND UNIVERSALITY THEORY MADELEINE M. LEININGER

36. MADELEINELEININGER • Born in Sutton, Nebraska July 13, 1925 • Received her Basic Nursing Education from St. Anthony’s School of Nursing in 1948 • Received her Bachelor of Science from Mount St. Scholastica College in 1950 • Received her Master of Science in Psychiatric-Mental Health Nursing from The Catholic University of America in 1954 • Received her Ph.D. in Cultural and Social Anthropology from the University of Washington in 1965

37. MADELEINELEININGER • Dr. Leininger is the founder of Transcultural Nursing • She is a fellow in the American Academy of Nursing • She was named a “Living Legend” by the American Academy of Nursing in 1998 • She is Professor Emeritus in the College of Nursing, Wayne State University and Adjunct Professor at the University of Nebraska Medical Center, College of Nursing, Omaha

39. DEFINITION OF TRANSCULTURAL NURSING • A substantive area of study and practice focused on comparative cultural care (caring) values, beliefs and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promotinghealth or well-being or to help people to face unfavorablehuman conditions, illness or death in culturallymeaningfulways.

40. DEFINITION OF ETHNONURSING • The study of nursing care beliefs, values and practices as cognitivelyperceived and known by a designated culture throughtheir direct experience, beliefs and value system.

41. TRANSCULTURAL NURSING • The termTranscultural Nursing isusedtoday to refer to the evolvingknowledge and practices related to this new field of study and practice. • Leininger stresses the importance of knowledgegainedfrom direct experience or directlyfromthosewho have experienced and labels suchknowledge as emic or people-centered. This is in contrastwitheticknowledge or professional perspective.

42. TRANSCULTURAL NURSING • Leiningercontendsthatemicallyderived care knowledgeis essential to establishnursing’sepistemological (the branch of philosophy that studies the nature of knowledge, in particular its foundations, scope, and validity)and ontological (the most general branch of metaphysics, concerned with the nature of being)base for practice.

43. TRANSCULTURAL NURSING • Leiningerbuilthertheory of transcultural nursing on the premisethat the peoples of each culture can not only know and define the ways in whichtheyexperience and perceivetheir nursing care world but also relate theseexperiences and perceptions to theirgeneralhealthbeliefs and practices.

44. MODEL KEPERAWATAN LEINEGER • Care. • ”Caring”, • Kebudayaan • Perawatan kultural • Cultural care diversity (perbedaan perawatan kultural) • Cultural care universality (Kesatuan perawatan kultural) • Keperawatan • Pandangan dunia • Dimensi struktur sosial dan budaya • Lingkungan • ”Etnohistory ” • Sistem perawatan profesional • Sistem perawatan pada masyarakat tradisional

45. CARING

46. 5 ASPEK CARING • MERUPAKAN SIFAT MANUSIA (HUMAN TRAIT) • PERILAKU CARING BERDASAR MORAL IMPERATIVE • DITUNJUKKAN DENGAN PENUH PERASAAN (AFFECT) • HUBUNGAN INTERPERSONAL PERAWAT-KLIEN • INTERVENSI TERAPEUTIK DALAM ASUHAN KEPERAWATAN

47. MODEL KEPERAWATAN Jean Watson • Mengunakan metode ilmiah dalam penyelesaian masalah . • Meningkatkan proses pembelajaran interpersonal untuk menumbuhkan tanggung jawab kesehatan klien . • Menciptakan suasana supportif, korektif dan protektif terhadap mental, fisik, sosiokultural dan spiritual. • Membantu memenuhi kebutuhan dasar manusia. • Menghargai kekuatan eksternal yang ada dalam kehidupan . 10 sifat dan karakter perawat profesional Membentuk Sistem nilai humanistik-altruistik Menanamkan keyakinan dan harapan Meningkatkan kepekaan terhadap diri sendiri dan orang lain Membina hubungan saling percaya Mengembangkan dan menerima ekspresi perasaan positif dan negatif.

48. SHARING JURNAL • Tujuan : • memberikankesempatankepadamahasiswauntukmemahamitentangteori model keperawatan • Prosedur: • Pilihlahsatuartikeldarijurnal professional yang menjelaskantentangteori model keperawatan. • Baca artikeltersebutsecaratelitidanlakukankritikjurnal (lampirkanartikel) • Bagaimanapenulismengaplikasikanteori model keperawatantersebut? • Apa relevance teori model keperawatantersebutdalampraktikkeperawatandi Indonesia? • Bagaimanasaudaramenggunakanteori model keperawatantersebutdalampraktikkliniksaudara? • Apa yang saudarapelajaridariartikeltersebut? • Diskusi • Dalamkelompokdiskusikanbersamakelompokhal-hal yang saudarapelajaridariartikeltersebutterkaitdenganrelevansiteori model keperawatanterhadapperanperawatprofessional

49. Referensi • Barnum, B.S. (1998). Nursing theory: analysis, application, evaluation. (5thed). Philadelphia: Lippincott. • Fawcett,Jacqueline (2005). Contemporary nursing knowledge:Analysis and evaluation of nursing models and theories. (2nded). Philadelphia: F.A. Davis Company.  • Higgins,Patricia.A & Moore,Shirley.M (2000). Perspective on nursing theory: Level of theoretical thinking. edited by Pamela G.Reed et.al (2004). (4thed). Philadelphia: Lippincott Williams & Wilkins. • Leddy.S & Pepper,J.M (1993). Conceptual bases of professional nursing. (3rded). Theoriticalnursing:Development and progress. (3rded). Philadelphia: Lippincott. • Meleis, Ibrahim.A. (1997). Theoritical nursing : development and progress. (3rded). Philadhelpia : Lippincott. • Peterson,Sandra.J & Bredow,Timothy.S (2004). Middle range theories; Aplication to nursing research. Philadelphia: Lippincott William & Wilkins. • Tomey, Ann Marriner. (1994). Nursing theorist and their work. (3rded). St.Louis: Mosby