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Copy of Four Key Concepts in Nursing's Metaparadigm: Person, Environ
Transcript of Copy of Four Key Concepts in Nursing's Metaparadigm: Person, Environ
Ramona T. Mercer
Four Key Concepts in Nursing Metaparadigm:
Nightingale’s Environmental Theory
Influence on Patient care
• Ventilation and warmth – Provide clean and fresh air. Adequate ventilation without foul odor. Maintain patient’s body temperature.
• Light – Provide sunlight or adequate light in the room but avoid placing the patient in direct light.
• Cleanliness of rooms and walls- Keep the room clean: free from dust, mildew, and dampness.
• Health of houses- Surrounding environment needs to be clean with pure air, pure water, drainage, and plenty of light.
• Noise- Keep the noise level to a minimum. Provide a quiet environment.
• Bed and bedding – Ensure comfort. Keep the bed at the lowest height, dry, and wrinkle free.
• Personal cleanliness- Patient needs to be clean and dry while maintaining adequate skin moisture.
• Variety- Provide stimulating room (ex. flowers and pictures). Encourage client to engage in stimulating conversation with family and friends.
• Chattering hopes and advices- Continue talking with patient to stimulate mind. However, avoid personal talk, false hopes, and advices without facts.
• Taking food- Recording the amount of food and fluid intake
• What food- Ensure availability of preferred types of food and drinks
• Petty management- Documenting plan of care and evaluation to ensure continuity of care.
• Observation of the sick- Record complete factual observation about the patient. Make changes in the plan of care as needed
Nursing Theories: Utilization and Application (4th ed.) Mercer’s
Becoming a Mother Theory in Nursing Practice.
Orlando's Metaparadigm and other concepts
Considered the 1st nurse theorist
Nightingale believed that the environment of the patient should be altered to allow nature to act on the patient (Alligood, 2010, p.98).
The theory focuses on patient and environment but the nurse and health are also included.
Knowledge and observation are part of caring for patients.
Patient centered care
Patient’s care is determined according to the patient’s immediate need and not just diagnosis.
The patient is active in the planning of their care.
Curing the patient’s sense of helplessness by resolving the need to decrease the anxiety level.
• Environment – Anything can be manipulated to place a patient in the best possible condition for nature to act (Alligood, 2010, p.98).
Physical components: ventilation, warmth, light, nutrition, medicine, stimulation, room temperature, and activity.
Psychological components: avoid chattering hopes and advices
• Person- Receiver of care. Consist of intellectual, emotional, social, and spiritual components.
Additional Key Concepts
• Health – To promote health and assist patient in preventing illness.
• Nursing- (A spiritual calling). Assist nature in healing the patient. Nurses were to use common sense, observation, and ingenuity to allow nature to effectively repair the patient (Alligood, 2010, p. 99).
Mercer's Paradigm and Key Concept
Person – is the “Mother to Be”. It is the woman who is becoming a mother for the first time.
Nursing – Nurses lead this transition by identifying and understanding maternal concerns in different stages. Nurses can have unique, positive, and long-term effects during this complex process.
Health – Maternal illness decreases self-esteem and brings fatigue which interferes with maternal role transition. Pre-term infants and early separation from infant decreases bonding and can cause stress related illness.
Environment – The living environments in this transition are: Family and Friends, Community, and Society at Large surrounding the nesting family.
Process of Becoming a Mother / Role identity – Identity is the woman’s view of herself as a mother, and role is the external behavior manifested as a mother.
• A - During the nursing assessment, determine both the health and the responses of mother, infant, father or (intimate partner) and the involvement of other immediate family members in the teaching of infant care. Whether the father is supportive, and actively involved with the mother and infant.
• D - Determining if couple attended prenatal classes, infant care information (Lack of knowledge). Assistance in providing care and nourishment for the infant, whether mother is showing commitment to her child and for the well-being of the child (Emotional well-being and Coping behaviors).
• P – Nurses are the immediate guide in postpartum care as the woman begins her journey toward role identity. The mother-to-be is heavily dependent on the nurses teaching. Helping the father or significant other understand the importance of his role as a caregiver after delivery of the infant, is another vital role of the nurse.
• I – Home-care nurses, nurses in clinic, and pediatric settings, can have enormous influence toward integration of maternal identity. The importance of open dialogue, active listening and efforts to understand what mother’s mean by what they state play a unique role of nursing in supporting and boosting the confidence of new mothers in finding their identity. Referrals to local agencies, federal financial assistance, and follow-up programs sponsored by Health and Human Services are available.
• E - Maternal role identity is evaluated based on the outcome, whether woman’s feelings of confidence, competence, and satisfaction in the role have achieved, or her attachment to her child is manifested. Woman’s response to the unique needs of her infant and infant’s continued growth and development to her or his full capability can be measured.
Mercer's Influence On Patient - Care in the role transition
Professional nursing function- organizing principle.
“ Finding out and meeting the patient’s immediate needs for help.”(Alligood, 2010 p. 339)
Patient’s presenting behavior- problematic situation.
“The presenting behavior of the patient, regardless of the form, may be a plea for help.” (Alligood, 2010)
Immediate reaction – internal response.
When a nurse respond to a patient’s behavior according to knowledge and previous experiences, instead of asking the patient’s what is their immediate need.
Deliberative nursing process- reflective inquiry.
The nurse must focus on the individual patient’s needs. immediate to help reduce the patient’s distress rather than assuming patient’s needs according to their diagnosis.
When the patient’s immediate need is met it can be observed from the patient verbally and non- verbally.
Person, Environment, Health, and Nursing
form the foundation of nursing theories (Blais & Hayes, 2001, p. 98)
Alligood, M.R. (2010). Nursing Theory: Utilization and application (4th
ed.). Retrieved from The University of Phoenix eBook Collection database.
Developed in the late 1950’s from observations she recorded between a nurse and patient.
She categorized the observations as “good’ and “bad” nursing.
The role of the nurse is to find out and meet the needs of the patient.
The patient’s behavior could be a plea for help.
Relieving the need of the patient, diminishes their distress.
Potter, Mertie L, ARNP,N.D., C.S., & Bockenhauer, B. J. (2000). Implementing
orlando's nursing theory: A pilot study. Journal of Psychosocial Nursing & Mental Health Services, 38(3), 14-21. Retrieved from http://search.proquest.com/docview/225554520?accountid=458
Using One Model Vs several
Using a single model
Further the development of nursing as a profession.
Give all nurses a common framework, enhancing
communication and research.
Promote understanding about the nurse’s role in
nontraditional nursing settings,
Using several models
allow members to explore phenomena in
different ways and from different viewpoints.
increase an understanding of the nature of nursing and its scope.
foster development of the full scope
and potential of the discipline.
(Professional nursing practice (Blais & Hayes, 2001, p. 112)
Blais, K., & Hayes, J. S. (2001). Professional nursing practice, Concepts
and perspectives (6th ed.). Retrieved from The University of Phoenix eBook Collection database.
What needs to be adjusted in this environment to protect the patient? (Chitty & Black, 2010, p. 305)
How can I best figure out what
my patient needs through my
interaction with him? (Chitty & Black, 2010, p. 314)
Chitty, K. K., & Black, B. P. (2010). Professional nursing, Concepts and
challenges (6th ed.) Retrieved from The University of Phoenix eBook Collection database.
Explored and integrated several extrinsic factors to successfully assist in “Becoming a Mother”.
Each nurse theorist’s definition of these four concepts
vary in accordance with philosophy, scientific orientation,
experience, and view of nursing held by the theorist (Blais & Hayes, 2001, p. 99)
Meghan, H. (2013, April). Maternal Role Attainment Theory.
INTERNATIONAL JOURNAL OF CHILDBIRTH EDUCATION, 28(2), 46-48.
Mercer’s Becoming a Mother Theory - Overview
A) Mercer’s Theory is based on Reva Rubin research, Mercer’s professor and mentor. Later, Mercer changed the term “Maternal Role Attainment” to “Becoming a Mother” because role attainment explains an endpoint rather than a beginning of a continual evolving as a life-long commitment.
B) Four stages of the “Maternal Role Attainment” adapted from Thorton and Nardi are – (1) anticipatory (initial stage), (2) formal (role-taking), (3) informal (role making), and (4) personal (role identity) are part of Mercer’s theory.
C) The father’s role identity occurs with infant development and maternal role identity. The father’s or intimate partner’s interactions help reduce tension and facilitate maternal role identity.