Organizing Frameworks applied
to Community Health Nursing
Community Assessment and
Nursing Diagnosis, Data
Collection, Analysis and Synthesis
By the end of this lecture you
will be able to:
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explain what is meant by a theory and a
model of nursing
understand the main features of at least
two models of nursing
understand how to critically review a
model
Identify how the application of models
to practice influences the activity of the
nurse and the experience for the
patient or client
Additional References………….
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Models of nursing practice. McGee P.
Stanley Thornes 1998
Conceptual bases of professional
nursing. Leddy S. Pepper J. Lippincott
4th ed.. 1998
Foundations of nursing practice.
Hogston R & Simpson P. Macmillan
1999 (Ch 14)
Nature of theory:
“represent a scientist’s best
effort to describe and explain
phenomena”
Pollitt & Hungler 1997
Theory……
“…is a general statement that summarizes
and organizes knowledge by proposing a
general relationship between events - if it
is a good one it will cover a large number
of events and predict events that have not
yet occurred or been observed”
Robson C.
“an internally consistent group of relational
statements (concepts, definitions & propositions)
that present a systematic view about phenomenon
and that is useful for description, explanation,
prediction and control. A theory ….is the primary
means of meeting the goals of the nursing
profession concerned with a clearly defined body
of knowledge”
Walker & Avant 1996 (cited by Jasper M in
Hogston & Simpson))
Purpose of theory
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Support the development of knowledge
through thesis and contestability
Explains and predicts outcomes
Supports decision making
Embeds goals and outcomes for the
client and by implication for the nurse
Supports modeling of processes of
nursing
Classifying theories
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Meta-theory (Theory building - values etc)
Grand theory (Broad conceptual frameworks not testable e.g. Leininger theory of
transcultural care)
Middle range theory (Narrower and testable
e.g. Peplau)
Practice Theory (situational theory - focuses
on the way in which nursing is practised e.g.
Norton’s theory of nursing elderly people)
Typology:
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Descriptive theory: Explains through
describing relationships and patterns
within the framework (e.g. Roper et al)
Predictive Theories: Address the
consequences of interventions (e.g.
Noddings theory of care)
The medical model
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Bio-reductionist
Differential diagnosis: signs &
symptoms
Provision of treatment
Scientific theory - testable and not
contestable
Goals - cure and therapy
Evaluation of treatment efficacy
Nursing models
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Located in social science
Constructed
Contestable knowledge
Capable of change and development
Embed values and culture
What sort of theories would
you use?
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Tony Archer (18 years) underwent
surgery to have a below knee
amputation of his left leg
Peggy Mountford is 82 years old, lives
alone with no family and is becoming
increasingly confused and depressed
What sort of theories did you
identify?
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Physiology
Psychology
Sociological theory
Nursing theories
Descriptive theory
Predictive theory
Metaparadigm: constructs in
all nursing theories
The person
 the environment
 health
 nursing
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Commonly used models
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Roper, Logan & Tierney (ADL)
Peplau (interpersonal communication)
Orem (Self-Care)
Roy (adaptation model)
Wolfensberger (social role valorisation)
Carper (personal explanations)
Roper, Logan & Tierney
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Developmental model - emphasises
growth & development
Person oriented
Focus on change
Sees process over time
Sees a range of activities of daily living
changing with maturation
Supporting and enabling
Draws on Henderson’s work strongly
Callister Roy’s model
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Systems model - person is made up of
systems
Systems interact with the environment
Health is equilibrium and managed
systems
Nursing is supporting adaptation to
environment
Is holist, purposeful and unifying
Adaptive modes: physiologic, self
concept, role function, interdependence
Health is a process of responding
positively to environmental changes
Model and Nursing Model
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A conceptual model
A nursing model is a representation of
nursing, not a reality.
A nursing model is an abstract of reality
from the nursing perspective.
The purpose of nursing model
(1)
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Provide a map for the nursing process
*Guide assessment (What do you
assess?)
*Guides analysis
*Dictates nursing diagnoses
*Assists in planning
*Facilitates evaluation
The purpose of nursing model
(2)
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Provide a curriculum outline for
education
Represents a framework for research
Provides a basis for development of
theory
A model not only describe what is but
also provides a framework for making
decisions about what would be.
Community-as-partner model
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Neuman’s model of a total-person approach
Community-as-client model: public health and
nursing
Community-as-partner model: primary health care
with two central factors
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The first factor the focus on the community as partner
represented by the community assessment wheel at the top.
The second factor is the use of nursing process.
The core of assessment
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People who make up the community
*Demographic data
*Values, beliefs, and history
Lines of defense
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Normal line of defense: level of health
of a community
Eight subsystems
Flexible line of defense: a buffer zone of
a community
The selection of eight
subsystem
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Examining the selection of subsystems
that have been identified. Can you
think of any that have been omitted?
Line of resistance
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Line of resistance: community’s strength
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Stressors: tension-producing stimuli
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The degree of reaction: the amount of
disequilibrium or disruption that results from
stressors impinging on the community’s lines
of defense.
Analyze data
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Compare and contrast your data with
the neighbor areas and the national
data.
Compare and contrast your data for 3
to 5 years.
Interpret your data
Nursing diagnosis
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Stressors and degree of reaction
become part of the community
nursing/health diagnosis (health
problem).
Example: the increased rate of
respiratory illness (a degree of reaction)
related to air pollution (a stressor)
Stressors leading to??
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The outcome of a stressor impinging on
a community is not always negative.
Can you think of an example that
stressors may lead to positive outcomes?
Community health diagnosis
(1)
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Comparing nursing diagnosis and
community health diagnosis (see
handout)
Community health diagnosis is preferred
over community nursing diagnosis
Community health diagnosis
(2)
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The community health diagnosis gives direction to
both nursing goals and its interventions.
The goal is derived from the stressors
The goal may include
* the elimination or alleviation of the stressor
* strengthening of the community’s resistance
through strengthening the lines of defense.
Community health diagnosis
(3)
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The goal should state the degree of
reaction
Intervention
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Three modes of prevention: primary
prevention, secondary prevention, and
tertiary prevention
Primary vs. tertiary prevention
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In the case of 921 earthquake will you
give an example of primary vs. tertiary
prevention?
Evaluation
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Feedback from the community
Final note
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Health may not be a primary goal of the
community, It is, however, an important
resource for the community to meet its goals.
The consequences intended in this model
include a strengthened normal line of defense,
increased resistance to stressors, and a
diminished degree of reaction to stressors by
the community.