Definition of Nursing, Health and Environment Nursing is a human interaction designed to promote "wholeness" through adaptation.

it course at the interface between the open and fluid boundaries of the person and his environment. nursing care is seen as both supportive and therapeutic. the supportive aspect is designed to maintain a state of wholeness in the face o a client's failing health. Nursing

"Nursing is a profession as well as an academic discipline, always practiced and studied in concert with all of the disciplines that together from the health sciences" The human interaction relying on communication ,rooted in the organic dependency of the individual human being in his relationships with other human beings Nursing involves engaging in "human interactions"

Goal of Nursing

A theory of nursing must recognized the importance of detail of care for a single patient with in an empiric framework that successfully describe the requirement of the all patient A human being is a social animal A human being is an constant interaction with an ever changing society To promote wholeness, realizing that every individual requires a unique and separate cluster of activities The individual integrity is his abiding concern and it is the nurses re sponsibility to assist him to defend and to seek its realization Human being make decision through prioritizing course of action Human being must be aware and able to contemplate objects, condition and situation Human being are agents who act deliberately to attain goal Adaptive changes involve the whole individual A human being has unity in his response to the environment Every person possesses a unique adaptive ability based on ones life experience which creates a unique message There is an order and continuity to life change is not random A human being respond organismically in an ever changing manner Change is inevitable in life Nursing needs existing and emerging demands of self care and dependant care Nursing is associated with condition of regulation of exercise or development of capabilities of providing care

Nursing Process I. Assessment

Collection of provocative facts through observation and interview of challenges to the internal and external environment using four conservation principles Nurses observes patient for organismic responses to illness, reads medical reports. talks to patient and family Assesses factors which challenges the individual

II. Trophicognosis

Nursing diagnosis-gives provocative facts meaning A nursing care judgment arrived at through the use of the scientific process Judgment is made about patients needs for assistance

III. Hypothesis

Planning Nurse proposes hypothesis about the problems and the solutions which becomes the plan of care Goal is to maintain wholeness and promoting adaptation

IV. Interventions

Testing the hypothesis Interventions are designed based on the conservation principles Mutually acceptable

Goal is to maintain wholeness and promoting adaptation

V. Evaluation

Observation of organismic response to interventions It is assesses whether hypothesis is supported or not supported If not supported, plan is revised, new hypothesis is proposed

Definition of Health Health is a state of being "whole" and just not the absence of a disease. health is socially determined and modified by person's interaction or relationship with other people, particularly family and peers. Health

Health is a wholeness and successful adaptation It is not merely healing of an afflicted part ,it is return to daily activities, selfhood and the ability of the individual to pursue once more his or her own interest without constraints Disease: It is unregulated and undisciplined change and must be stopped or death will ensue

Definition of Environment The environment is where a person is constantly and actively involved. each individual has his own environment, both internal and external. the internal environment involves the physiologic element, while the external includes three levels: Perception, Operation, and conceptual I. Internal Environment

Homeostasis: A state of energy sparing that also provide the necessary baselines for a multitude of synchronized physiological and psychological factors A state of conservation Homeorrhesis: A stabilized flow rather than a static state Emphasis the fluidity of change within a space-time continuum Describe the pattern of adaptation, which permit the individuals body to sustain its well being with the vast changes which encroach upon it from the environment

II. External Environment

Preconceptual: Aspect of the world that individual are able to intercept Operational: Elements that may physically affects individuals but not perceived by hem: radiation, micro-organism and pollution Conceptual: Part of person's environment including cultural patterns characterized by spiritual existence, ideas, values, beliefs and tradition

Person and the Environment Adaptation

Historicity: Adaptations are grounded in history and await the challenges to which they respond Specificity: Individual responses and their adaptive pattern varies on the base of specific genetic structure Redundancy: Safe and fail options available to the individual to ensure continued adaptation

Organismic Response

A change in behavior of an individual during an attempt to adapt to the environment Help individual to protect and maintain their integrity They co-exist There are four types:

1. Flight or fight: An instantaneous response to real or imagined threat, most primitive response 2. Inflammatory: response intended to provide for structural integrity and the promotion of healing 3. Stress: Response developed over time and influenced by each stressful experience encountered by person 4. Perceptual: Involves gathering information from the environment and converting it in to a meaningful experience Nine Models of Guided Assessment 1. 2. 3. 4. 5. 6. 7. 8. 9. Vitals signs Body movement and positioning Ministration of personal hygiene needs Pressure gradient system in nursing interventions Nursing determination in provision of nutritional needs Pressure gradient system in nursing Local application of heat and cold Administration of medicine Establishing an aseptic environment

Assumption The nurse creates an environment in which healing could occur

A human being is more than the sum of the part Human being respond in a predictable way Human being are unique in their responses Human being know and appraise objects ,condition and situation Human being sense ,reflects, reason and understand Human being action are self determined even when emotional Human being are capable of prolonging reflection through such strategists raising questions

Key Concepts Conservational Principle 1. Conservation of Energy Each person requires a balance of energy but there are factors within the person and the external environment that may cause depletion of energy. Refers to balancing energy input and output to avoid excessive fatigue and includes adequate rest, nutrition and exercise. Example:

Availability of adequate rest Maintenance of adequate nutrition

2. Conservation of Structural Integrity For a person to function he has to cover his structural integrity. this is preserving the anatomical structure of the body. Refers to maintaining or restoring the structure of body preventing physical breakdown And promoting healing Example:

Assist patient in ROM exercise Maintenance of patients personal hygiene

3. Conservation of Personal Integrity Each person has his own sense of identity and self worth. how do you value yourself. Recognizes the individual as one who strives for recognition, respect, self awareness, selfhood and self determination Example:

Recognize and protect patients space needs

4. Conservation of Social Integrity Involves the presence and recognition of the human interaction, particularly with the client's significant others who comprise his support system. An individual is recognized as some one who resides with in a family, a community ,a religious group, an ethnic group, a political system and a nation

Example:

Position patient in bed to foster social interaction with other patients Avoid sensory deprivation Promote patients use of news paper, magazines, radio, and TV Provide support and assistance to family

Theoretical Assumptions and Uses 1. Conservational Models Conservational model provides the basis for development of two theories

Theory of redundancy Theory of therapeutic intention

Theory of Redundancy

Untested ,speculative theory that redefined aging and everything else that has to do with human life Aging is diminished availability of redundant system necessary for effective maintenance of physical and social well being

Theory of Therapeutic Intention Goal: To seek a way of organizing nursing interventions out of the biological realities which the nurse has to confront. Therapeutic regimens should support the following goals:

2. Uses

Facilitate healing through natural response to disease Provide support for a failing auto regulatory portion of the integrated system Restore individual integrity and well being Theory of therapeutic intention Provide supportive measure to ensures comfort Balance a toxic risk against the threat of disease Manipulate diet and activity to correct metabolic imbalance and stimulate physiological process Reinforce usual response to create a therapeutic changes

Critical, acute or long term care unit Neonates, infant and young children, pregnant young adult and elderly care unit Primary health care OT Community setting

3. Utility of Theory

Nursing research Nursing education Nursing administration Nursing practice

Nursing Research

Principles of conservation have been used for data collection in various researches Conservational model was used by Hanson et al.in their study of incidence and prevalence of pressure ulcers in hospice patient Newport used principle of conservation of energy and social integrity for comparing the body temperature of infants who had been placed on mothers chest immediately after birth with those who were placed in warmer

Nursing Education

Conservational model was used as guidelines for curriculum development It was used to develop nursing undergraduate program at Allentown college of St.Francis de sales, Pennsylvania Used in nursing education program sponsored by Kapat Holim in Israel

Nursing Administration

Taylor described an assessment guide for data collection of neurological patients which forms basis for development of comprehensive nursing care plan and thus evaluate nursing care McCall developed an assessment tool for data collection on the basis of four conservational principles to identify nursing care needs of epileptic patients Family assessment tool was designed by Lynn-Mchale and Smith for families of patient in critical care setting

Nursing Practice

Conservational model has been used for nursing practice in different settings Bayley discussed the care of a severely burned teenagers on the basis of four conservational principles and discussed patients perceptual, operational and conceptual environment Pond used conservation model for guiding the nursing care of homeless at a clinic, shelters or streets

Nursing Management Utilizing Myra Levine's Conservation Model CASE 1 Mrs. RL is a 47-year-old female rushed to the emergency room due to onset of sudden severe chest pain radiating to the left arm and left angle of the jaw associated with diaphoresis, nausea, vomiting, and shortness of breath. Initial vital signs as follows: T=37.0 C, CR=110 bpm, RR=30 rpm, BP=140/90 mmHg. Oxygen was administered at 2-4 lpm via nasal cannula. Morphine 4mg was administered intravenously as ordered. 12-lead ECG shows ST-elevation consequently a medical diagnosis of Acute Coronary Syndrome ST-segment elevation Myocardial Infarction was made. Intravenous fluid resuscitation was initiated with PNSS 1L at KVO regulation. Metoclopramide 1 ampule was administered intravenously for nausea and vomiting. She was instructed nothing per orem temporarily. Aside from the chief complaint, a non-healing wound was noticed on Mrs. RLs right foot. Medical history confirms Diabetes Mellitus Type II. Capillary blood glucose reads 314 mg/dl and a rescue dose of Humulin R 10 units was administered intravenously as ordered. Nursing Management: Conservation of Energy Energy must be conserved to prevent precipitation of the clinical distress brought about by the medical condition of Mrs. RL. Our client is prone to activity intolerance therefore provision of complete bed rest with commode privileges for 24 to 48 hours may address this problem. The goal is to prevent further myocardial tissue injury, maximize tissue perfusion, and reduce tissue demands. Energy is conserved to promote oxygenation and tissue perfusion. Instructions must be given to the patient regarding avoidance of over fatigue. Oxygen therapy must be ensured at appropriate regulation and tolerance. Position the client in Semi-Fowlers to allow greater diaphragm expansion thereby lung expansion and better carbon dioxide-oxygen exchange. Assist the client in feeding and performing self-hygiene to minimize the efforts provided by the patient in such activities. Most importantly, anticipate the needs of the client. Conservation of Structural Integrity Daily wound care must be rendered over the non-healing wound of Mrs. RL on her right foot. Prevention of infection is the goal to minimize further damage. Healing should be promoted as soon as possible. Cleanse the wound properly and apply prescribed topical medications by the physician. Keep wound dressing intact over the affected area. Administer prescribed antibiotics ordered. Aside from focusing on the wound per se, capillary blood glucose levels must be under tight controls. Determine the signs and symptoms of hypoglycemia and hyperglycemia and respond accordingly with appropriate insulin therapy Conservation of Personal Integrity Hospitalization is a great stressor to the well-being of an individual. Promote relief of anxiety and well-being by providing an opportunity for Mrs. RL to explore concerns and to identify alternative methods of coping as necessary. Promote a positive attitude and active participation of Mrs. RL in her care during her stay in the hospital. Build up a constructive nurse-patient relationship. Use an emphatic approach when caring. Deal with the Mrs. RL as a person with specific needs rather than a patient requiring merely medical help. Make her feel more comfortable with the nurse by calling her by her name rather than bed number. Help her feel that she is respected and treated with dignity. Provide privacy through proper draping and screening when performing commode activities such as perineal hygiene, diaper change, changing of hospital gown, bed bath, and the like. Promote independence and autonomy in the course of her hospitalization. In short, put yourself into the shoes of your client to maintain effectively his/ her personal integrity. Conservation of Social Integrity Encourage friends and relatives to visit the patient during visiting hours. This provides Mrs. RL of a sense of security in an unfamiliar environment and would relieve the anxiety brought about by present hospitalization.