NURSNG 601: Introduction to Advanced Practice Nursing: Knowledge for Practice in the Global Community

The Roy Adaptation Model sees man as having four modes of adaptation--basic physiological needs, self-concept, role function, and interdependence. The study described tests the feasibility of the Model for nursing practice in both episodic and distributive settings.

An exploration of the Roy Adaptation Model is undertaken to determine its usefulness in multicultural studies related to nursing and nursing care. The elements and development of the theory are presented along with philosophical principles. The concepts related to the theory are examined to see if they fit into a multicutural perspective. Examples are given of multicultural research that has been done using Roy's model as theoretical underpinning.

The authors present an overview of Dorothea Oremʼs conceptual framework, discuss its impact upon practice in a nursing home, and give clinical illustrations of nurse and patient reactions. Implementation of the sell-care concept was found to be growth producing for nurse and patient and has a potential for cost effectiveness.

Dorothea Orem and Madeleine Leininger are two nursing scholars who are contributing significantly to the body of nursing knowledge. This paper contrasts their backgrounds, the origins of their theories, their views of the nature of nursing, use of thoery development strategies, and contributions to nursing science. The concepts of Leininger's care and Orem's self-care will be compared as these relate to their theories with the examination of similarities and differences.

Open access version: https://bura.brunel.ac.uk/bitstream/2438/612/1/Gobet-Chassy-Expert-Intuition-in-Nursing-BURA.pdf

This article is based on an invited challenge address at the 1989 National Doctoral Forum related to future directions for substantive knowledge development. The focus is on the inclusion of caring knowledge into nursing's metaparadigm. Art and metaphor are used to make a case for caring knowledge and caring ontology as a metaphorical landscape for diverse epistemological "set pieces," all converging on a Commons Room of caring knowledge within a broader human and natural landscape. Such a framework links ontology and epistemology as both substance and form, and allows matter and spirit to be of a piece, but distinguishable; human caring knowledge then becomes Annie Dillard's "Absolute base" and "Holy the Firm."

Peplau and Orlando have had a great impact on the past and current practice of mental health nursing. Their works represent some of the first attempts at theory development in nursing. This article compares and critiques the works of these two theorists. The emphasis on the interpersonal relationship is a major focus of both theorists. Peplau has a greater emphasis on the development of the individual, while Orlando focuses on the immediate needs of the client. They both contribute greatly to the development of nursing science. Appreciating their work only for its historical significance would be a major oversight.

The perioperative nursing role has evolved from that of task-oriented specialists to patient-centered professionals. The concept of caring is significant to perioperative nurses and is manifested by the many caring behaviors perioperative nurses demonstrate toward surgical patients. This article describes how the element of caring is an essential function of perioperative nursing and relates the perioperative nursing role to the work of three nursing theorists (le, Florence Nightingale; Virginia Henderson, RN, AM; Carol L. Montgomery, RN, PhD).

This article describes the development and initial psychometric evaluation of an instrument to measure health-promoting life-style. Based on responses from 952 adults in midwestern communities, the Health-Promoting Lifestyle Profile was evaluated using item analysis, factor analysis, and reliability measures. Factor analysis isolated six dimensions: Self-Actualization, Health Responsibility, Exercise, Nutrition, Interpersonal Support, and Stress Management. These six factors accounted for 47.1% of the variance in the 48-item measure. Second-order factor analysis yielded a single factor, interpreted as Health-Promoting Lifestyle. The alpha reliability coefficient for the total scale is .922; alpha coefficients for the subscales range from .702 to .904. Further evaluation of the measure with different populations appears warranted. This instrument will enable researchers to investigate patterns and determinants of health-promoting life-style, as well as the effects of interventions to alter life-style.

The Health Promotion Model was tested as an explanatory framework for health-promoting lifestyle in a sample of 385 ambulatory cancer patients undergoing treatment in 13 clinical sites in the midwestern United States. The aim of this study was to determine the extent to which cognitive/perceptual and modifying variables identified in the Health Promotion Model explain the occurrence of health-promoting behaviors in adults with cancer. A secondary aim was to determine the potential of illness-specific cognitive/perceptual and modifying variables for further explaining the occurrence of health-promoting behaviors in adults with cancer. Multiple regression analyses revealed that 23.5% of the variance in health-promoting lifestyle was explained by the model cognitive/perceptual variables definition of health, perceived health status and perceived control of health and the modifying variables education, income, age and employment. When illness-specific variables were included in the analysis, initial reaction to the diagnosis of cancer was found to be a significant contributor to the regression. Study results support the importance of both general health-related and cancer-specific cognitive/perceptual factors in explaining the occurrence of health-enhancing behaviors among ambulatory cancer patients; these factors may therefore be suitable targets for interventions to encourage adoption of healthy lifestyles.

The determinants of health promotive-behavior are proposed by Pender in the HPM. The exact impact of the various variables on singular behaviors or a lifestyle index, however, is far from conclusive. All the proposed factors have been supported through research, at least in part, as either directly or indirectly influencing the intent to participate in different health behaviors. The difficulty in concluding which variables are most critical is perhaps due to the variety of definitions, theoretical approaches (from different disciplines), and research methods. Of primary concern to this author is the overlap of activities among different "patterns" of behavior and the various definitions of such behavioral patterns. Little evidence exists on how specific types of behaviors relate to one another. Thus, knowing the determinants of a lifestyle index, for example, may be insignificant if the goal of nursing is to target priority behaviors that may indeed be influenced by more significant variables. For example, a person's perception of control may be a significant predictor of lifestyle behaviors in general; however, this variable may not impact on the person's decision to engage in changes related to exercise or activity behavior. Hence, because the motives behind various behaviors may be different, it seems more prudent to invest our research efforts on the impact of various factors on singular behaviors rather than lifestyle patterns. Finally, the efforts of nursing research on health behavior have been directed primarily at explaining the impact of various individual perceptions on the likelihood of behavior. Such focus has revealed some evidence of the significance of these variables, yet much unexplained variance remains. Perhaps it would be more prudent to direct attention at those variables such as situational or environmental factors that may impede or act as a cue to healthy behavior. Because the explanation of behavior has been individually focused (perhaps due to an "individualizing" theme in nursing education), the impact of the ecological model of behavior tends to be dismissed or underrated in nursing research. Knowledge of the impact of societal factors on behavior may be more appropriate to planning strategies for various groups rather than the behavioristic approaches that separate people from their social, physical, and economic environments. Thus, personal lifestyles may not be a simple matter of informed choice, and attention to the complex processes of societal opportunities, cultural interpretations, and group-specific attitudes must be studied further.

A male-female stacked version of Pender's Health Promotion Model (HPM) was used to evaluate whether the causal mechanisms underlying health promotion behaviors are the same for men and women. Indicators of the conceptual variables in the HPM were obtained from the National Survey of Personal Health Practices and Consequences, 1979-1980--a telephone sample survey of 3,025 noninstitutionalized adults. All coefficients to be estimated were initially constrained to be equal for men and women, except for six direct effects originating from marital status. The estimates obtained via the LISREL VI program indicated that the stacked model did not fit the data and that additional gender interactions were required between gender and other concepts within the HPM. Based on model diagnostics and with the relaxation of some equality constraints, a modified stacked model was constructed that fit the data. The explanatory power of the model was poor, calling into question the validity of the HPM. Theorists and researchers of health promotion should not assume that the causal mechanisms underlying health promotion behaviors in men and women are identical, but must forge ahead with an exploration and clarification of possible differences.

The middle‐range nursing theory of uncertainty in illness is presented from both a theoretical and empirical perspective. The theory explains how persons construct meaning for illness events, with uncertainty indicating the absence of meaning. A model of the uncertainty theory displaying the concepts and their relationships forms the basis for the theoretical and empirical material. Discussion of the theory is organized around three major themes: the antecedents of uncertainty, the process of uncertainty appraisal and coping with uncertainty.