conceptual model & nursing theory

CONCEPTUAL MODEL CONCEPTUAL MODEL AND NURSING THEORYAND NURSING THEORY

PRESENTED BY:PRESENTED BY:33th th GROUPGROUP

AMIR SYAMAMIR SYAMEDYEDY

HAPSAHHAPSAHNIANIA

ROSAMEYROSAMEYWARDIYAHWARDIYAH

The Holarchy of Contemporary Nursing The Holarchy of Contemporary Nursing Knowledge:Knowledge:

Five ComponentsFive Components MetaparadigmMetaparadigm

PhilosophiesPhilosophies

Conceptual ModelsConceptual Models

TheoriesTheories

Methodologies for inquiry and practiceMethodologies for inquiry and practice

Jacqueline Fawcett, PhD, RN, FAANProfessor, 2006

CONCEPTUAL MODELCONCEPTUAL MODEL

NURSING THEORY

&

ConceptConcept

Definition:Definition: – an abstraction an abstraction – creates an image of an idea we want to creates an image of an idea we want to

shareshare– representations of particular aspects of representations of particular aspects of

human behavior and characteristicshuman behavior and characteristicsPainPainCopingCopingGriefGriefResilienceResilience

Alexis Morgan, WWF Canada, Oct 2005

Conceptual ModelConceptual Model

A visual method (diagram) of A visual method (diagram) of representing a set of causal representing a set of causal

relationships between factors that relationships between factors that believed to impact one or more believed to impact one or more

biodiversity targets.biodiversity targets.

Alexis Morgan, WWF Canada, Oct 2005

TheoryTheory“…is a general statement that “…is a general statement that

summarizes and organizes knowledge summarizes and organizes knowledge by proposing a general relationship by proposing a general relationship

between events - if it is a good one it between events - if it is a good one it will cover a large number of events will cover a large number of events and predict events that have not yet and predict events that have not yet

occurred or been observed”occurred or been observed”

Robson C.Robson C.

The Holarchy of Contemporary The Holarchy of Contemporary Nursing Knowledge:Nursing Knowledge:

TheoriesTheories

One or more relatively concrete and specific One or more relatively concrete and specific concepts that are derived from a conceptual concepts that are derived from a conceptual model, the propositions that narrowly describe model, the propositions that narrowly describe those concepts, and the propositions that state those concepts, and the propositions that state relatively concrete and specific relations relatively concrete and specific relations between two or more of the conceptsbetween two or more of the concepts

Jacqueline Fawcett, PhD, RN, FAANProfessor, May, 2006.

NURSING THEORYNURSING THEORY

Creates a conceptual framework for Creates a conceptual framework for nursing assessment and interventionnursing assessment and intervention

Means of interpreting nurses Means of interpreting nurses observationsobservations

Comprises the core content of NursingComprises the core content of Nursing

Nursing TheoriesNursing Theories Conceptual structure that organizes Conceptual structure that organizes

practice and research into ideas practice and research into ideas central to the disciplinecentral to the discipline

““Nursing theories are reservoirs in Nursing theories are reservoirs in which findings related to nursing which findings related to nursing concepts, such as comfort, healing, concepts, such as comfort, healing, recovering, mobility, rest, caring, recovering, mobility, rest, caring, enabling, fatigue, and family care, enabling, fatigue, and family care, are stored.”are stored.”

Meleis, 1997Meleis, 1997

““an internally consistent group of relational an internally consistent group of relational statements (concepts, definitions & statements (concepts, definitions & propositions) that present a systematic view propositions) that present a systematic view about phenomenon and that is useful for about phenomenon and that is useful for description, explanation, prediction and description, explanation, prediction and control. A theory ….is the primary means of control. A theory ….is the primary means of meeting the goals of the nursing profession meeting the goals of the nursing profession concerned with a clearly defined body of concerned with a clearly defined body of knowledge”knowledge”Walker & Avant 1996 (cited by Jasper M in Walker & Avant 1996 (cited by Jasper M in Hogston & Simpson))Hogston & Simpson))

How may How may it be different ?it be different ?

Conceptual model Theory ≠

Conceptual ModelConceptual Model TheoryTheory

abstract abstract impressions impressions organized into organized into symbols of realitysymbols of reality

Can be tested, Can be tested, changed, or used changed, or used to guide researchto guide research

An early of An early of development development theory processtheory process

group of concepts group of concepts that describe a that describe a pattern of realitypattern of reality

Research questions, study variables

Derived of Derived of conceptual modelsconceptual models

The Holarchy of Contemporary Nursing KnowledgeThe Holarchy of Contemporary Nursing Knowledge

Metaparadigm

Philosophies

Conceptual Models

Theories

Methodologies

Most abstract

Most concrete


The Holarchy of Contemporary Nursing Knowledge The Holarchy of Contemporary Nursing Knowledge Translated for Empirical Nursing Research Translated for Empirical Nursing Research

Metaparadigm

Philosophies

Conceptual Models

Theories

Empirical Research Methods

Study participantsSettingsHealth conditionsResearch process

Ethical conduct of researchApproaches to knowledgedevelopment

Research designsSamplesInstrumentsData analysis techniques

Research guidelines

Research questionsStudy variables


The Holarchy of Contemporary Nursing Knowledge The Holarchy of Contemporary Nursing Knowledge Translated for Nursing Practice Translated for Nursing Practice

Metaparadigm

Philosophies

Conceptual Models

Theories

Practice Methodologies

Nursing participantsSignificant othersPractice settingsHealth conditionsNursing process

Code of ethicsPatient’s RightsPhilosophy of nursing practice

Standards for PracticePractice ToolsIntervention protocols

Professional nursing perspectivePractice guidelines

Evidence


Theory developmentTheory development Starts with defining Starts with defining

concepts,concepts, Next suggests Next suggests

relationships bxn relationships bxn conceptsconcepts

Tests and evaluates Tests and evaluates the relationshipsthe relationships

Modifies theory based Modifies theory based on research findingson research findings

Theories develop and Theories develop and maturemature

Various stages with Various stages with increasing complexityincreasing complexity

SISTER CALLISTA ROYSISTER CALLISTA ROY6 Step Nursing Process :1.Assesses the behaviours manifested from the four adaptive modes2.Assess the stimuli, and categorize them into Assess the stimuli, and categorize them into type of stimuli type of stimuli3.Create a nursing diagnosis of the person’s s adaptive state adaptive state4.Set goals to improve adaptation5.Implement interventions to achieve goals Implement interventions to achieve goals6.Evaluate if goals have been met

Hildegard PeplauHildegard PeplauInterpersonal Relations ModelInterpersonal Relations Model

• Person An individual; a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium

• Environment- Not defined


HealthHealth

Implies forward Implies forward movement of the movement of the personality and personality and human processes human processes toward creative, toward creative, constructive, constructive, productive, personal, productive, personal, and community livingand community living


NursingNursing– A significant, A significant,

therapeutic, therapeutic, interpersonal process interpersonal process that functions that functions cooperatively with cooperatively with others to make health others to make health possiblepossible

– Involves problem-Involves problem-solvingsolving

Virginia HendersonVirginia Henderson The Nature of Nursing The Nature of Nursing

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge.

DorotheDorothea Orema Orem

Self-Self-Care Care ModelModel

the theory is useful in :

1. developing and guiding practice and research. 2. gives directions to nursing-specific outcomes3. related to knowing and meeting the therapeutic

self-care demands, regulating the development and exercise of self-care agency, establishing self-care and self-management systems, and others.

4. the design of curriculums for preservice, Graduate, and continuing nursing education.

5. gives direction to nursing administration. The development of theory-based computer systems, assessment forms, and the overall structuring of the delivery of care attests to the usefulness of the theory

(Tomey & Alligood,2002).

Jean WatsonJean WatsonPhilosophy and Science of CaringPhilosophy and Science of Caring

The nurse’s role is to:

1. Establish a caring relationship with patients

2. Treat patients as holistic beings (body, mind and spirit)

3. Display unconditional acceptance4. Treat patients with a positive regard5. Display unconditional acceptance6. Treat patients with a positive regard7. Promote health through knowledge

and intervention8. Spend uninterrupted time with

patients: “caring moments”

Recently Nursing Care Recently Nursing Care PhenomenonPhenomenon

X Hospital

Client Y

Nurses

Holistic need

Functio

nal syte

m

with

Case: Tn. Y, 67 thn. MRS X dengan KU: tidak bisa Tn. Y, 67 thn. MRS X dengan KU: tidak bisa

menggerakkan bagian kiri tubuhnya. Bibir menggerakkan bagian kiri tubuhnya. Bibir mencong ke kanan. Dialami sejak 2 jam SMRS. mencong ke kanan. Dialami sejak 2 jam SMRS. Riwayat penyakit hipertensi sejak usia 30 tahun. Riwayat penyakit hipertensi sejak usia 30 tahun. Riwayat merokok satu bungkus per hari sejak Riwayat merokok satu bungkus per hari sejak usia 12 tahun. Tn. Y adalah seorang pensiunan usia 12 tahun. Tn. Y adalah seorang pensiunan ABRI. TTV : TD : 200/140 mmHg, P : 36 x/menit, ABRI. TTV : TD : 200/140 mmHg, P : 36 x/menit, N : 115 x/menit, S: 37,4N : 115 x/menit, S: 37,4C. C.

Pertolongan pertama pada Tn. Y diberikan di unit Pertolongan pertama pada Tn. Y diberikan di unit gawat darurat RS X. Klien ditangani dengan gawat darurat RS X. Klien ditangani dengan pemberian dan pemberian cairan infus sebagai pemberian dan pemberian cairan infus sebagai jalur masuknya obat intravena serta pengawasan jalur masuknya obat intravena serta pengawasan terhadap tanda-tanda vitalnya. Sebagian besar terhadap tanda-tanda vitalnya. Sebagian besar tindakan ini dilakukan oleh perawat sesuai tindakan ini dilakukan oleh perawat sesuai dengan instruksi dokter.dengan instruksi dokter.

assess nurses

Medical order

documentation

Balanced fluid &

electrolit

In case :

Supervise Vital Sign

Give Medicine

client

suffer

Not satisfied Nothing change

Independent

Kondisi ruang perawatan: 1 perawat Kondisi ruang perawatan: 1 perawat menangani 5 – 10 orang pasien menangani 5 – 10 orang pasien tanpa melihat tingkat tanpa melihat tingkat ketergantungan pasien.ketergantungan pasien.

AnalysisAnalysis

Analisis terhadap pelayanan Analisis terhadap pelayanan perawat dalam kasus:perawat dalam kasus:

Askep tidak diterapkan dengan baikAskep tidak diterapkan dengan baik– Perencanaan tindakan hanya sekedar Perencanaan tindakan hanya sekedar

untuk pendokumentasian.untuk pendokumentasian.– Implementasi dilakukan tanpa Implementasi dilakukan tanpa

menganalisis masalah klien dan tidak menganalisis masalah klien dan tidak sesuai dengan perencanaan tindakan.sesuai dengan perencanaan tindakan.

– Jarang dilakukan evaluasi tindakan Jarang dilakukan evaluasi tindakan keperawatan.keperawatan.

Lanjutan…Lanjutan…

Perhatian perawat yang kurang tentang Perhatian perawat yang kurang tentang kemandirian & kepuasan klien.kemandirian & kepuasan klien.

Perawat tidak mengerti tentang model Perawat tidak mengerti tentang model keperawatan apa yang sedang keperawatan apa yang sedang dilaksanakannya.dilaksanakannya.

Komunikasi terapeutik yang kurang.Komunikasi terapeutik yang kurang.

Analisis kasusAnalisis kasus

Masalah keperawatan yang bisa muncul Masalah keperawatan yang bisa muncul pada klien:pada klien:– Nutrisi kurang dari kebutuhan tubuhNutrisi kurang dari kebutuhan tubuh– Gangguan rasa nyamanGangguan rasa nyaman– Gangguan pola tidurGangguan pola tidur– Defisit perawatan diriDefisit perawatan diri– Hambatan mobilitas fisikHambatan mobilitas fisik– Kelemahan Kelemahan – Ansietas Ansietas – Kurang pengetahuanKurang pengetahuan

Berdasarkan model HandersonBerdasarkan model Handerson

Kebutuhan klien yang terganggu/tdk Kebutuhan klien yang terganggu/tdk terpenuhi :terpenuhi :

Kebutuhan akan nutrisi Kebutuhan akan nutrisi Kebutuhan isthirahat dan tidurKebutuhan isthirahat dan tidur Kebutuhan akan personal hygiene Kebutuhan akan personal hygiene Kebutuhan rasa aman dan nyamanKebutuhan rasa aman dan nyaman Kebutuhan mobilitas, pengaturan posturKebutuhan mobilitas, pengaturan postur Berkomunikasi dengan orang lain dan Berkomunikasi dengan orang lain dan

mengekspresikan emosi, keinginan, rasa mengekspresikan emosi, keinginan, rasa takut dan pendapat.takut dan pendapat.

Kebutuhan belajar.Kebutuhan belajar.

Handerson’s ModelHanderson’s Model

14 KDM

Manusia yg unik dan holistik

Terganggu

sakit

Perawat

Sbg central figure

Menolong klien mencapai

kemampuan memenuhi

kebutuhannya secara mandiriKlien

Penurunan kemandirian

Mandiri

Askep

profesional

Puas

Solusi menurut teori HandersonSolusi menurut teori Handerson Pada saat semua itu terjadi seharusnya, Pada saat semua itu terjadi seharusnya,

perawat ada di samping pasien, perawat ada di samping pasien, mendengarkan keluhannya, memberikan mendengarkan keluhannya, memberikan motivasi dan memberikan penjelasan motivasi dan memberikan penjelasan terkait penyakitnya. Seandainya para ahli-terkait penyakitnya. Seandainya para ahli-ahli keperawatan kita melihat langsung ahli keperawatan kita melihat langsung fenomena tersebut, dia akan sangat fenomena tersebut, dia akan sangat besedih. Konsep, teori, dan standar asuhan besedih. Konsep, teori, dan standar asuhan telah dibuat. Namun, implementasinya di telah dibuat. Namun, implementasinya di lapangan belum optimal.lapangan belum optimal.

Dorothea OremDorothea Orem

Menurut Orem, bila ditemukan Menurut Orem, bila ditemukan seorang pasien dengan defisit seorang pasien dengan defisit perawatan diri, maka seorang perawatan diri, maka seorang perawat seyogyanya bertindak perawat seyogyanya bertindak menuntun, membimbing, menuntun, membimbing, mendukung atau menyediakan mendukung atau menyediakan lingkungan yang akan meningkatkan lingkungan yang akan meningkatkan kemampuan pasien tersebut.kemampuan pasien tersebut.

KESIMPULANKESIMPULAN

Ada beberapa hal yang menjadi Ada beberapa hal yang menjadi kesimpulan dari makalah ini :kesimpulan dari makalah ini :

– Perbedaan yang mendasar antara model konseptual Perbedaan yang mendasar antara model konseptual dan teori keperawatan adalah bahwa sebuah konsep dan teori keperawatan adalah bahwa sebuah konsep bisa berkembang menjadi sebuah teori. Konsep lebih bisa berkembang menjadi sebuah teori. Konsep lebih menggambarkan simbol-simbol yang abstrak menggambarkan simbol-simbol yang abstrak sedangkan teori lebih menggambarkan tentang pola-sedangkan teori lebih menggambarkan tentang pola-pola realita.pola realita.

– Konsep model dan teori keperawatan yang terkait Konsep model dan teori keperawatan yang terkait dengan fenomena dalam makalah ini adalah yang dengan fenomena dalam makalah ini adalah yang dikemukakan oleh Virginia Henderson dan Dorothy E. dikemukakan oleh Virginia Henderson dan Dorothy E. Orem. Orem.

– Virginia Henderson mengembangkan keperawatan Virginia Henderson mengembangkan keperawatan berdasarkan 14 kebutuhan dasar manusia. berdasarkan 14 kebutuhan dasar manusia.

Lanjutan..Lanjutan..

– Menurut Henderson, di sinilah letak peran Menurut Henderson, di sinilah letak peran seorang perawat sebagai penolong pasien dalam seorang perawat sebagai penolong pasien dalam memenuhi kebutuhan-kebutuhan tersebutmemenuhi kebutuhan-kebutuhan tersebut

– Menurut Orem, bila perawat menemukan seorang Menurut Orem, bila perawat menemukan seorang individu mengalami defisit perawatan diri, individu mengalami defisit perawatan diri, perawat seharusnya menuntun, membimbing, perawat seharusnya menuntun, membimbing, mendukung atau menyediakan lingkungan yang mendukung atau menyediakan lingkungan yang akan meningkatkan kemampuan pasien tersebut.akan meningkatkan kemampuan pasien tersebut.

– konsep dan teori sangat berperan penting dalam konsep dan teori sangat berperan penting dalam perkembangan ilmu keperawatan menuju ke perkembangan ilmu keperawatan menuju ke profesi keperawatan yang lebih baik.profesi keperawatan yang lebih baik.

conceptual model & nursing theory

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