Application of theories, models and conceptual frameworks into family health care

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Application of theories, models and conceptual frameworks into family health care

  1. 1. Application of Theories,Application of Theories,Models and ConceptualModels and ConceptualFrameworks into FamilyFrameworks into FamilyHealth CareHealth CareBy,By,ARUN.MARUN.M
  2. 2. FAMILY NURSINGFAMILY NURSINGPRACTICE THEORIESPRACTICE THEORIES Nursing theories are to predict the phenomenaNursing theories are to predict the phenomenaessential for evidence based practice. Theessential for evidence based practice. Therelationship of theory to practice is dynamic.relationship of theory to practice is dynamic. Family nursing theory informs practice andFamily nursing theory informs practice andpractice facilitate development of new theory.practice facilitate development of new theory. Conceptual models provide a distinct frame toConceptual models provide a distinct frame tothink about nursing. The family is an example ofthink about nursing. The family is an example ofa concept which can form any conceptual modela concept which can form any conceptual modelfor family nursing.for family nursing.
  3. 3. Functions of Family NursingFunctions of Family NursingTheoriesTheoriesTo provide knowledge to improve nursing careTo provide knowledge to improve nursing careto family.to family.Goals of Theories in Family CareGoals of Theories in Family Care Assisting in Accumulation and organization of researchAssisting in Accumulation and organization of researchfindingsfindings Articulate ideas more clearly and specifically.Articulate ideas more clearly and specifically. Direct researchers to develop and test hypothesis.Direct researchers to develop and test hypothesis. Demonstrate inter relationship between theories.Demonstrate inter relationship between theories. Helps to make sense about how the phenomena isHelps to make sense about how the phenomena isaddressed.addressed. Predict the future of the phenomena.Predict the future of the phenomena. Provide answer to why and how questions.Provide answer to why and how questions.
  4. 4. According to ANA (1995),According to ANA (1995),Nursing began with the focus on the individual.Nursing began with the focus on the individual.However to stay current with the nursing education systemHowever to stay current with the nursing education systemthe concept of client should be broadened to include thethe concept of client should be broadened to include theindividual, family and community.individual, family and community.According to Whall and Fawcett (1991),According to Whall and Fawcett (1991),Family nursing concerned with –Family nursing concerned with – Principles and laws that governs family process, familyPrinciples and laws that governs family process, familywell being and optimum functions during illness andwell being and optimum functions during illness andwellness.wellness. Patterning the family behavior in interaction with thePatterning the family behavior in interaction with theenvironment in normal life events and critical lifeenvironment in normal life events and critical lifesituations .situations . Processes by which positive changes in family healthProcesses by which positive changes in family healthstatus may be effected.status may be effected.
  5. 5. Criteria For Evaluating Family TheoriesCriteria For Evaluating Family Theories Internal consistencyInternal consistency Clarity or explicitnessClarity or explicitness Explanatory power.Explanatory power. CoherenceCoherence UnderstandingUnderstanding Empirical fitEmpirical fit TestabilityTestability Heuristic valueHeuristic value GroundednessGroundedness ContextualizationContextualization Interpretive sensitivityInterpretive sensitivity Predictive powerPredictive power Practical utilityPractical utility
  6. 6. NursingModels/TheoriesFamily SocialScienceTheoriesEmerging FamilyNursingTheoriesFamily TherapyTheoriesConceptual source / Classification of FamilyConceptual source / Classification of FamilyNursing TheoriesNursing Theories
  7. 7. Nursing Theories /ConceptualNursing Theories /ConceptualModelsModelsI.I. System orientationSystem orientation Neumanns System conceptual modelNeumanns System conceptual modelI.I. Developmental orientationDevelopmental orientation Orem’s self care modelOrem’s self care modelI.I. Systems and instructional orientationSystems and instructional orientation Roys adaptation modelRoys adaptation model Kings interacting systems modelsKings interacting systems modelsI.I. Systems and developmental orientationSystems and developmental orientation Roger’s life process modelRoger’s life process modelI.I. OthersOthers NightingaleNightingale
  8. 8. I.I. System orientationSystem orientationHealth Care Systems ModelHealth Care Systems ModelBetty NeumannBetty NeumannMain focus-Main focus- Family as a client. Family is a group ofFamily as a client. Family is a group oftwo or more persons who create andtwo or more persons who create andmaintain common culture.maintain common culture. Family as a system- composed of familyFamily as a system- composed of familymembers sub systemsmembers sub systems It is a prime relationshipIt is a prime relationship Any stressor affects the stability of theAny stressor affects the stability of thefamily and produces stressfamily and produces stress
  9. 9. Goal of familyGoal of familyMaintain stability by preserving integrity ofMaintain stability by preserving integrity ofthe basic structure.the basic structure.Each family responds to stress events based onEach family responds to stress events based onits perception of the situation and families abilityits perception of the situation and families abilityto adjust and restore the impaired family functionto adjust and restore the impaired family functioncreated by the stressor.created by the stressor.Nursing intervention:Nursing intervention:It has three levels of prevention ,i.e., Primary ,It has three levels of prevention ,i.e., Primary ,secondary and tertiary ,applicable to family healthsecondary and tertiary ,applicable to family healthcare .care .Family has a basic structure and energy whichFamily has a basic structure and energy whichis protected by flexible line of defense andis protected by flexible line of defense andresistance.resistance.
  10. 10. II.II. Developmental orientationDevelopmental orientationOrems Self Care ModelOrems Self Care ModelDorothea Orem’s Model of self care can be usedDorothea Orem’s Model of self care can be usedfrom individual to family although she has notfrom individual to family although she has notaddressed it. She has described the family as a basicaddressed it. She has described the family as a basicconditioning unit in which individual learn culture,conditioning unit in which individual learn culture,roles and responsibility.roles and responsibility.Her assumption can be used for family nursing.Her assumption can be used for family nursing.The assumptions are,The assumptions are,1.1. Self care can be evaluated in variety of situation toSelf care can be evaluated in variety of situation toassess the family self care abilityassess the family self care ability2.2. It relates to the personal values and health beliefs ofIt relates to the personal values and health beliefs ofthe family. Self care can be implemented by selfthe family. Self care can be implemented by selfcare agent to promote health of the family andcare agent to promote health of the family andevaluate whose health care is diminished.evaluate whose health care is diminished.
  11. 11. III.III. Systems and instructionalSystems and instructionalorientationorientationRoy’s Adaptation ModelRoy’s Adaptation ModelSister Callista Roy’s adaptation model of 1976Sister Callista Roy’s adaptation model of 1976viewed the individual as an adaptive system whichviewed the individual as an adaptive system whichresponse to environment stimuli by four modes:response to environment stimuli by four modes:physiological, self concept, role function andphysiological, self concept, role function andinterdependence.interdependence.She has viewed family on context to theShe has viewed family on context to theindividual. However, in 1981, Roy and Rabertsindividual. However, in 1981, Roy and Rabertsaltered this to family as an adaptive system. Thealtered this to family as an adaptive system. Thecharacteristics of the system includes, inputs,characteristics of the system includes, inputs,internal control and feedback processes and output.internal control and feedback processes and output.
  12. 12. The integrity of the person is to express theThe integrity of the person is to express theability to meet the goals of survival, growth,ability to meet the goals of survival, growth,reproduction and mastery.reproduction and mastery.Roy’s theory of adaptation can be broaden toRoy’s theory of adaptation can be broaden tothe family unit where ineffective family copingthe family unit where ineffective family copingpattern leads to family functioning problem. Shepattern leads to family functioning problem. Shehas stated that manipulating significant elements ofhas stated that manipulating significant elements ofenvironment of the family nursing can be given toenvironment of the family nursing can be given topromote the health.promote the health.Nurse seeks to reduce ineffective response andNurse seeks to reduce ineffective response andpromote adaptive response as output behaviorpromote adaptive response as output behaviorthrough strengthening the coping modes of thethrough strengthening the coping modes of thefamily towards the stressor.family towards the stressor.
  13. 13. Kings Interacting System ModelKings Interacting System ModelImogene King (1981-1987) developed an interactive systemsImogene King (1981-1987) developed an interactive systemsconceptual framework and a middle range theory “Theoryconceptual framework and a middle range theory “Theoryof Goal attainment”. She has used family-as-contextof Goal attainment”. She has used family-as-contextapproach. According to her,approach. According to her, family is a small group of individuals bonded together forfamily is a small group of individuals bonded together forsocialization.socialization. Family as a social system transmit values and norms ofFamily as a social system transmit values and norms ofbehavior across the lifespan.behavior across the lifespan. The individual has personal, interpersonal, and socialThe individual has personal, interpersonal, and socialsystem which are interacting with each other and aresystem which are interacting with each other and aredynamic.dynamic. The individual cannot be isolated from the family.The individual cannot be isolated from the family.This model can be used for socializing the individual in theThis model can be used for socializing the individual in thefamily and developing socially approved behaviors.family and developing socially approved behaviors.
  14. 14. DYNAMIC INTERACTING SYSTEMSOCIAL SYSTEMS(Society)PERSONAL SYSTEMS(Individual)INTERPERSONAL SYSTEMS(Groups)
  15. 15. IV. Systems and developmentalIV. Systems and developmentalorientationorientationRoger’s Life Process ModelRoger’s Life Process ModelMartha Roger’s view human body as a unitaryMartha Roger’s view human body as a unitarymultidimensional energy field that is engaged in a continuousmultidimensional energy field that is engaged in a continuousmutual process with environment. Her theory reflects family as amutual process with environment. Her theory reflects family as aconstant open system energy field i.e., ever changing in responseconstant open system energy field i.e., ever changing in responseto its interaction with environment.to its interaction with environment.Five assumptions of Roger’s theory are –Five assumptions of Roger’s theory are –1. Family wholeness composed of interdependent subs system.1. Family wholeness composed of interdependent subs system.2. Family interact with environment continuously.2. Family interact with environment continuously.3. Family is subject to change.3. Family is subject to change.4. The changes observed in the form of matter and energy4. The changes observed in the form of matter and energytowards a growing a level of complexity.towards a growing a level of complexity.5. Family has a capacity of feeling, knowing, comprehending and5. Family has a capacity of feeling, knowing, comprehending andusing this process.using this process.Her conceptual framework is basis for researcher in guidingHer conceptual framework is basis for researcher in guidingtheory for family nursing practice.theory for family nursing practice.
  16. 16. V. OthersV. OthersA.A. Nightingale’s ModelNightingale’s ModelFlorence Nightingale actually notFlorence Nightingale actually notpresented the theory of Family Nursing.presented the theory of Family Nursing.However, she acknowledged family in herHowever, she acknowledged family in hernursing practice.nursing practice.According to her-According to her-Family is too narrow a field as familyFamily is too narrow a field as familyuses people not for what they are, not foruses people not for what they are, not forwhat they are intended to be but for what itwhat they are intended to be but for what itwants them for.wants them for.
  17. 17. Nightingale believed-Nightingale believed- Family induced constraints however is aFamily induced constraints however is asupportive institution which follows the memberssupportive institution which follows the membersfrom cradle to grave.from cradle to grave. She supported helping woman and children forShe supported helping woman and children forgood health.good health. Nursing in home environment is necessary forNursing in home environment is necessary forboth sick and healthy person as it is an unit ofboth sick and healthy person as it is an unit ofhealth service.health service. Home health nurse can protect the whole family.Home health nurse can protect the whole family.Hence her model on client and environment can beHence her model on client and environment can beapplied to family health nursing as ventilation,applied to family health nursing as ventilation,light, noise, air, variety, bedding, cleanliness arelight, noise, air, variety, bedding, cleanliness arenecessary for the client health.necessary for the client health.Her theory can be applied in improving the familyHer theory can be applied in improving the familyand clientand client
  18. 18. BB.. Friedman Framework of SystemicFriedman Framework of SystemicOrganizationOrganizationMorze-luise Friedman (1995) developed aMorze-luise Friedman (1995) developed aframework of systemic organization. She viewedframework of systemic organization. She viewedfamily as a social process which has goals offamily as a social process which has goals oftransmitting culture to its members. Her assumptionstransmitting culture to its members. Her assumptionsof families are –of families are –-- It transmits culture, the total of human systemIt transmits culture, the total of human systempatterns and values.patterns and values.- As a civil system and environment at a large- As a civil system and environment at a largeshares the responsibility to provide physicalshares the responsibility to provide physicalnecessities and safety, teach social skills to itsnecessities and safety, teach social skills to itsmembers,members,- Provide for personal growth and development,- Provide for personal growth and development,allows emotional bonding of family members andallows emotional bonding of family members andpromote a purpose for life and meaning throughpromote a purpose for life and meaning throughspiritually.spiritually.
  19. 19. - Family satisfied and guides the members in- Family satisfied and guides the members inthe network system through spirituality.the network system through spirituality.- All family processes include collectively- All family processes include collectivelyaccepted and coordinated behavior of strategy toaccepted and coordinated behavior of strategy toregulate space, time, energy and matter inregulate space, time, energy and matter inpursuing four system targets. They are familypursuing four system targets. They are familystability, growth, control and spirituality.stability, growth, control and spirituality.- Family has four process i.e., dimension of- Family has four process i.e., dimension ofsystem, maintenance, system change andsystem, maintenance, system change andcoherence and individualization.coherence and individualization.- She has also stated four elements such as- She has also stated four elements such asfamily stability, family growth, family controlfamily stability, family growth, family controland family spiritualityand family spirituality..
  20. 20. Conclusion:Conclusion:These are a few major nursing frameworksThese are a few major nursing frameworkswhich can be used. However, when morewhich can be used. However, when morenursing theories will be established the nursesnursing theories will be established the nurseswill explore their application in the familywill explore their application in the familynursing practice.nursing practice.
  21. 21. ThankThankYou !!!You !!!

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