CLO 20: Integrate / Utilize concepts and principles of the different theoretical perspectives in the

family and community health situations

The concept of community is defined as "a group of people who share some important feature of their
lives and use some common agencies and institutions."
• The concept of health is defined as "a balanced state of well-being resulting from harmonious
interactions of body, mind, and spirit."
• The term community health is defined by meeting the needs of a community by identifying problems
and managing interactions within the community

THEORETICAL PERSPECTIVES IN THE FAMILY AND COMMUNITY HEALTH SITUATIONS

 Nightingale’s theory of environment

 Orem’s Self care model
 Neuman’s health care system model
 Roger’s model of the science and unitary man
 Pender’s health promotion model
 Roy’s adaptation model
 Milio’s Framework of prevention
 Salmon White’s Construct for Public health nursing
 Block and Josten’s Ethical Theory of population focused nursing

1. FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY

Canons: Major Concepts
• Ventilation and warming
• Light, Noise
• Cleanliness of rooms/walls
• Health of houses
• Bed and bedding
• Personal cleanliness
• Variety
• Chattering hopes and advices
• Taking food. What food?
• Petty management/observation
NURSING PARADIGMS:
Nursing
• Nursing is different from medicine and the goal of nursing is to place the patient in the best
POSSIBLE
condition for nature to act.
• Nursing is the "activities that promote health (asoutlined in canons) which occur in any
caregiving
situation. They can be done by anyone."
Person
 • People are multidimensional, composed of biological, psychological, social and spiritual
components.
Health
• Health is “not only to be well, but to be able to use well every power we have”.
• Disease is considered as dys-ease or the absence of comfort.
Environment
• "Poor or difficult environments led to poor health and disease".
• "Environment could be altered to improve conditions so that the natural laws would allow
healing to occur."

2. DOROTHEA OREM’S SELF CARE DEFICIT THEORY

• People should be self-reliant and responsible for their own care and others in their family
needing care
• People are distinct individuals
• Nursing is a form of action – interaction between two or more persons
• Successfully meeting universal and development selfcare requisites is an important
component of primary care prevention and ill health
• A person’s knowledge of potential health problems is necessary for promoting self-car
behaviors
• Self care and dependent care are behaviors learned within a socio-cultural context

3. BETTY NEUMAN'S SYSTEM MODEL

MAJOR CONCEPTS (Neuman, 2002) Content
• the variables of the person in interaction with the internal and external environment comprise
the whole client system
Basic structure/Central core
• The common client survival factors in unique individual characteristics representing basic
system energy resources.
• The basis structure, or central core, is made up of the basic survival factors which include:
normal temp. range, genetic structure.- response pattern. organ strength or weakness, ego
structure. Stability, occurs when the amount of energy that is available exceeds that being used
by the system.
• A homeostatic body system is constantly in a dynamic process of input, output, feedback, and
compensation, which leads to a state of balance

4. NOLA J. PENDER HEALTH PROMOTION MODEL

The health promotion model notes that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavioral specific
knowledge and affect have important motivational significance. These variables can be modified
through nursing actions. Health promoting behavior is the desired behavioral outcome and is
the end point in the HPM. Health promoting behaviors should result in improved health,
enhanced functional ability and better quality of life at all stages of development. The final
behavioral demand is also influenced by the immediate competing demand and preferences,
which can derail an intended health promoting actions
5. SISTER CALISTA ROY ADAPTATION MODEL
• The person is a bio-psycho-social being.
• The person is in constant interaction with a changing environment.
• To cope with a changing world, person uses both innate and acquired mechanisms
which are biological, psychological and social in origin.
• Health and illness are inevitable dimensions of the person’s life.
• To respond positively to environmental changes, the person must adapt.
• The person’s adaptation is a function of the stimulus he is exposed to and his adaptation
level
• The person’s adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.
• The person has 4 modes of adaptation: physiologic needs, self- concept, role function
and inter-dependence.
• "Nursing accepts the humanistic approach of valuing other persons’ opinions, and view
points" Interpersonal relations are an integral part of nursing
• There is a dynamic objective for existence with ultimate goal of achieving dignity and
integrity.
Implicit assumptions
• A person can be reduced to parts for study and care.
• Nursing is based on causality.
• Patient’s values and opinions are to be considered and respected.
• A state of adaptation frees an individual’s energy to respond to other stimuli.

6. MARTHA E. ROGERS' THEORY OF UNITARY HUMAN BEINGS

-views nursing as both a science and an art. The uniqueness of nursing, like any other science, is
in the phenomenon central to its focus. The purpose of nurses is to promote health and well-
being for all persons wherever they are. The development of Rogers' abstract system was
strongly influenced by an early grounding in arts, as well as a background in science and interest
in space. The science of unitary human beings began as a synthesis of ideas and facts.

7. SALMON WHITE’S CONSTRUCT FOR PUBLIC HEALTH NURSING

Mark Salmon White (1982) describes a public health as an organized societal effort to protect,
promote and restore the health of people and public health nursing as focused on achieving and
maintaining public health.
• He gave 3 practice priorities i.e.; prevention of disease and poor health, protection against
disease and external agents and promotion of health.

8. Milio’s Framework of prevention

• Nancy Milio a nurse and leader in public health policy and public health education developed a
framework for prevention that includes concepts of
community-oriented, population focused care.(1976,1981).
• The basic treatise is that behavioral patterns of populations and individuals who make up
populations are a result of habitual selection from limited choices.
• She challenged the common notion that a main determinant for unhealthful behavioral choice is
lack of knowledge.
Governmental and institutional policies, she said set the range of options for personal choice
making.
• It neglected the role of community health nursing, examining the determinants of communit
health and attempting to influence those determinants through public policy.
For these 3 general categories of nursing intervention have also been put forward, they Are:
1.education directed toward voluntary change in the attitude and behaviour of the subjects
2.engineering directed at managing risk-related variables
3.enforcement directed at mandatory regulation to achieve better health.

9. BLOCK AND JOSTEN’S ETHICAL THEORY OF POPULATION FOCUSED NURSING

• Derryl Block and Lavohn Josten, public health educators proposed this based on intersecting fields
of public health and nursing. They have given 3 essential elements of population focused nursing
that stem from these 2 fields:
1.an obligation to population
2.the primacy of prevention
3.centrality of relationship- based care the first two are from public health and the third element
from nursing. Hence it implies to nursing that relation-based care is very important in population
focused care.