Joan May's Blog

If Only Words Could Describe..

2008-12-20T04:22:00.000-08:00

If only words could describe the way I feel I wouldn't have such a hard time everyday Trying to subside the pain when I think of you Missing you for all that you were

You left me for someone who doesn't care A person that only feels for herself Yet when she hurts your heart The only thing you do is go back to her

I've always have been here caring for you Though you've never really seen We may be from two different worlds But we both shared something complicated

You know you had loved me but you turned away For someone who could higher your popularity status I may not be high in ranks but I feel for you Even though you never look at me the way you did

Maybe I shouldn't have lied and told you to take a chance Then you would have told her no But I deceived my heart to let you be happy And here you are all broken apart

Now we can't be friends because of who you are And I regret everything in the past But you let a friendship of years go for a girl I hope she loves you in the end the way I do

My heart told me no, but I had to move away Far from you and her and everyone Now we are thousands of miles apart and you don't care That I'm gone far away, and still missing you

One day you'll find out the way I really felt But right now I will just close my eyes and breathe Thinking of you just hurts me so bad And I can never go through it again

Even if I love you with my entire heart Yours is no longer the same I'd still give anything just to hold your hand But everything is forever changed

Who You Really Are

2008-12-20T04:00:00.000-08:00

I'm glad i finally see who you really are I'm glad i see the real you Who you are inside sweet and nice such an act I believed you as you went behind my back Act like friends what a joke Use your hands watch me choke Watch your lies grow and grow What you're doing is so so low

------by: sammy------

YOU ARE WHO YOU ARE

2008-12-14T02:32:00.000-08:00

You are who you are for a reason.
You're part of an intricate plan.
You're precious and perfect unique design,
Called God's special woman or man.

You look like you look for a reason.
Our God made no mistake.
He knit you together within the womb,
You're just what he wanted to be.

The parents you had were the ones He chose,
And no matter how you feel,
They were costumed-designed with God's plan in mind,
And they bear the Master's seal.

No, that trauma you faced was not easy.
And God wept that it hurt you so;
But it was allowed to shape your heart
So that into His likeness you'd grow.

You are who you are for a reason,
You've been formed by the Master's rod.
You are who you are, beloved,
Because there is God!

-----by: Russell Kelfer-----

2008-10-19T02:51:00.000-07:00

The Common Defense Mechanisms

Most notably used by Freud in his psychoanalytic theory, a defense mechanism is a tactic developed by the ego to protect against anxiety. Defense mechanisms are thought to safeguard the mind against feelings and thoughts that are too difficult for the conscious mind to cope with. In some instances, defense mechanisms are thought to keep inappropriate or unwanted thoughts and impulses from entering the conscious mind.

For example, if you are faced with a particularly unpleasant task, your mind may choose to forget your responsibility in order to avoid the dreaded assignment.

Although we may knowingly use these mechanisms, in many cases these defenses occur unconsciously and work to distort reality.

While many defense mechanisms can be unhealthy, they can also be adaptive and allow us to cope and function normally. The greatest problems arise when defense mechanisms are overused in order to avoid dealing with problems.
Compensation – Overachieving in one area to compensate for failures in another. An example might be someone who has a chronic illness and is not physically able to compete with other students at school instead becomes the “best” student in the class. Another example: if you think you are an dumb you may work at becoming more physically fit than others to make up for this shortcoming.

Denial - is the refusal to accept reality to a painful event. Denial may be a subconscious or conscious process of blinding yourself to negative self-concepts that you believe exist, but that you do not want to deal with. It is "closing your eyes" to the negative self-concepts about people, places, or things that you find too severe to deal with. For example, a family may pretend and act as if the father is only sick when it is obvious that he is an alcoholic.
Displacement - is the redirecting emotions to a safer, substitute target. Example: Being angry at your teacher then taking out your feelings on a younger sibling when you get home. –or- Your parent makes you angry so you go in your room and throw something or punch the wall.

Fantasy - involves creating an inner world when the real world becomes too painful, difficult, or stressful. Example: A nursing student feels unsure and inadequate in the hospital arena. She fantasies about someone having a cardiac arrest in the lobby and she will come to their aid and save their life with CPR.
Intellectualization - involves removing the emotion from emotional experiences, and discussing painful events in detached, uncaring ways. Someone who intellectualizes becomes very distant from their feelings. An example: An individual who when told they had a life threatening disease focuses exclusively on the statistical percentages of recovery and is unable to cope with their fear and sadness.

Projection - is the attribution to others of your own negative self-concepts. This occurs when people want to avoid facing negative self-concepts about their behaviors or intentions and do so by seeing them, instead, in other people. Example: An chronically angry individual accuses their friend of hostility. –or- a cheating boyfriend accuses his girlfriend of cheating

Rationalization - is creating false but credible justifications. Example: The officer position you may have wished for and didn't get becomes "a dumb job for nerds.

Reaction Formation - occurs when we have a reaction that is too painful or threatening to feel (such as intense hate for someone with power over us), we turn it into the opposite (intense liking for that person). That way, we aren't threatened by the feeling. For example, you may hate your parents, but you go out of your way to show care and concern for them. –or- A woman who is furious at her sister’s child and wishes her harm might become overly concerned and protective of the child's health; an individual who has feelings for the same sex verbally chastises homosexual relationships.

Regression - is the retreating to behavior appropriate for an earlier stage of development. Example: A child who is overwhelmed with fear or anger when a new sibling is born might become clinging and begin thumb sucking or bed wetting.

Repression - involves putting painful thoughts and memories out of our minds and forgetting them. Example: Might not acknowledge hurtful things that parent(s) say. Instead, ignore and repress these situations. Sometimes called “stuffing”.

Undoing - is the attempt to take back behavior or thoughts that are unacceptable. For example, a millionaire might give to charities for the poor to make up for profiting from the poor. Or, a parent may buy their child a lot of gifts to make up for not spending time with them. Another example of undoing would be excessively praising someone after having insulted them.
Other Defense Mechanisms

Since Freud first described the original defense mechanisms, other researchers have continued to describe other methods of reducing anxiety. Some of these defense mechanisms include:

• Acting out – The individual copes with stress by engaging in attention-seeking behavior to try and get notice that they crave. (school children trying to be class clown)
• Affiliation – Involves turning to other people for support. (co-dependent behavior when one feels he/she can’t cope by self)
• Passive-aggression – Indirectly expressing anger. (teen silently resents chores; puts dishes in washer, but does sloppy job and bangs plates around—easier for parent to take charge of chore)
• Avoidance – Refusing to deal with or encounter unpleasant objects or situations. (dislike certain people at school and doesn’t join a club they’re in order to avoid contact with them)
• Altruism – Satisfying internal needs through helping others.
• Humor – Pointing out the funny or ironic aspects of a situation.
While defense mechanisms are often thought of as negative reactions, some of these defenses can be helpful.

For example, utilizing humor to overcome a stressful, anxiety-provoking situation can actually be an adaptive defense mechanism

2008-10-16T05:15:00.000-07:00

Choosing the Right Hospice for End of Life Care

Choosing the right Hospice Care is a difficult personal decision. Know what questions to consider before making an informed choice.
Choosing hospice care and the right hospice to serve you is a personal decision. If contemplating hospice care, you or your loved one must have been diagnosed by a physician with a "terminal illness”. No one is ever prepared for such a pronouncement.
To be "certified” for hospice care, the doctor must state that statistically, the illness may cause death within six months or less. Some patients live longer than six months, some for years. The bottom line when faced with a terminal illness is to live life as fully as possible for every day and every hour is precious. That is where hospice care comes in.
Hospice is not a place, it's a way of caring.
Quality hospice care can make the difference between unbearable pain symptoms, overwhelming stress and living peacefully and as pain free as possible to the very end. Hospice is about living, dignity and caring for one another. Hospice is a way of caring; not a place. Hospice serves the family as well as the patient.
A decision to use hospice services does not mean that you are giving up; it is an affirmation of the meaning of your life. It allows you to optimize the time you have, control symptoms, and do the necessary things you need to do. For families and caregivers, hospice provides the support and training to deal with the unknown and the crisis that often accompanies the approach of death.
Dealing with symptoms related to a terminal illness involves unique applications of medications and ways of administering medications that provide for the patient’s comfort and well-being. Many physicians and nurses, who are not experienced in hospice care, do not know how to deal with these symptoms and pain management.
Hospice care is a special kind of care that accepts dying as a natural part of life. When death is inevitable, hospice seeks neither to hasten nor postpone it. Choosing hospice care means choosing to optimize the quality of life, it is not a curative treatment but serves to promote the comfort and peace of the patient and the family. Hospice is a team approach to support the patient and family throughout the course of the illness in a holistic manner.
Once a decision has been made to seek hospice assistance, a positive step has been made to make the last days of life more meaningful and comfortable for all. Because there are many hospices in each state, research the hospices in your area. Hospice services are covered by Medicare, Medicaid and most private insurance plans. You many want to check with your insurance carrier in reference to hospice benefits.
Questions to ask when choosing a hospice program:
• What services are provided by the hospice team?
• Is the program licensed by the state?
• How many years has the agency served the community? Can the agency provide references from professionals?
• Does the agency create a plan of care for each patient?
• How does the agency handle payment and billing?
• Who owns the hospice?
• What kind of support is available to the family and caregiver?
• What roles do the attending physician and the hospice play?
• What does hospice provide to keep the patient comfortable?
• What does the hospice volunteer do?
• How are services provided after hours?
• How and where does hospice provide short-term inpatient care?
• Is the hospice contracted with local nursing home?
• Is the hospice accredited?
Also speak with others who have recently used hospice services and seek their opinions. A recent personal experience with a hospice is perhaps the best indicator of the type of care provided.

The Community Focus of Mercy Hospice Care
Mercy Hospice, which serves Horry, Marion and Georgetown Counties in South Carolina, offers all the services necessary to help patients function to their unique capacity. Mercy provides comfort and guidance to caregivers, family members and friends of the hospice patient.
The focus of Mercy’s care is in the home setting but hospitalization is available for short term stays during periods of crisis. Mercy is contracted with all major hospitals and nursing facilities. The Mercy team consists of the patient’s doctor, Mercy’s medical director, certified hospice nurses, medical social workers, chaplains, bereavement counselors, certified nursing assistants and trained volunteers.
Mercy hospice is a non-profit community–based hospice founded in 1981 and is accredited with commendation by Community Health Accreditation Program (CHAP).

Article provided with reprint permission by:
Carole Bowdre - Director of Development
Mercy Hospice and Palliative Care
Conway, S.C.
www.Hospice.sc
If you live in the State of South Carolina and need Hospice Care, you may also be interested in seeking information and reading articles on www.Cancer.sc , www.Pain.sc and www.FamilyDoctor.sc. There you will find many other valuable, free resources in your area.

2008-10-14T09:48:00.000-07:00

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

Steps in the IMCI Case Management Process:

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)Steps in the IMCI Case Management Process:
1. Assess and Classify
2. Identify Treatment
3. Treat
4. Counsel the Mother
5. Follow-Up

A. Assess and Classify Sick Children 2 months up to 5 Years

1. Determine which age group the child belongs:
1 week up to 2 months
2 months up to 5 years
2. Record the child’s data : Name, Age in months, Weight in kg., temperature, etc.

3. Ask the mother what the child’s problems are.
4. Determine if this is an initial or follow – up visit:
Initial visit – 1st visit for this episode of an illness or problem
Follow-up visit- the child has been seen a few days ago for the same illness
- if the child’s condition improved, still the same or is getting better

4. Check for general danger signs:
a. not able to drink or breastfeed
• too weak to drink and is not able to suck or swallow when offered a drink or
Breast-feed
• if not sure: ask mother to offer child a drink of clean water or breast milk
• A child may have difficulty sucking when his nose is blocked. If the nose is blocked, clean it.
b. vomits everything
• a child is not able to hold anything down at all
• if in doubt, offer the child water
c. convulsions (during this illness)
• arms and legs stiffen because muscles are contracting
• the child may lose consciousness or not be able to respond to spoken directions or handling, even if eyes are open
• “fits” or “spasms” or “jerky movements”
Note: Shiver is not convulsion. There is no loss of consciousness.
d. abnormally sleepy or difficult to awaken
• drowsy and does not show interest in what is happening around him
• stare blankly and appear no to notice what is going on around him
• does not respond when touched, shaken or spoken to
Note: 1. If the child is asleep and has cough or difficult breathing, count the number
of breaths first before you try to wake the child.
2. If there is any general danger sign, complete the assessment and any
pre-referral treatment immediately so referral is not delayed.

5. Assess and classify cough or difficult breathing
• 2 Common Causes of Pneumonia
1. Stretococcus pnemoniae
2. Hemophilus influenzae
• 2 Causes of Death
1. hypoxia – too little oxygen
2. sepsis – generalized infection

• Health workers can identify almost all causes of pneumonia by checking for 2 clinical signs: 1. fast breathing – body’s response to stiff lungs and hypoxia
2. chest indrawing

Assess cough or difficult breathing:

Does the child have cough or difficult breathing? “fast” or “noisy” or “interrupted”?
* If the answer is NO, look back to see if you think the child has cough or difficult breathing.
• how long?
chronic cough – more than 30 days
- may be sign of tuberculosis, asthma, whooping cough or another
problem
• fast breathing
a. count the breaths in one minute
1. child must be quiet and calm
2. no feeding, crying or angry
 Ask the mother to lift the child’s shirt. If you are not sure about the number of breaths you counted, repeat the count.

b. cut-off for fast breathing:
if the child is: fast breathing is:
2 months up to 12 months 50 breaths/ minute or more
12 months up to 5 years 40 breaths/ minute or more

Determine if the child is breathing IN or breathing OUT
• chest indrawing – the lower chest wall goes IN when the child breaths IN
NORMAL: the whole chest wall and abdomen move OUT when the child breaths
IN
Best position : lying down
Conditions : clearly visible
Note: intercostals indrawing or intercostals retractions and subcostal indrawing are not chest indrawing.

• Look or listen for stridor.
Stridor – harsh noise made when the child breaths IN
- happens when there is swelling of the larynx, trachea, or epiglottis
Put your ear near the child’s mouth and look at the movement of the abdomen to determine if child is breathing IN or OUT
wet noise - blocked nose
wheezing - harsh noise while breathing OUT; not stridor

CLASSIFY COUGH OR DIFFICULT BREATHING

6. Assess and classify diarrhea
diarrhea – loose or watery stool
- defined as 3 or more loose or watery stools in a 24 – hour period

Assess:
• how long?
• blood in stool
• signs of dehydration

If YES, asses for:
• dehydration
• persistent diarrhea – 14 days or more
• Dysentery
Asses for dehydration:
• Abnormally sleepy or difficult to awaken
• Restless and irritable: (all the time)
• Sunken eyes: If not sure, ask the mother if the child’s eyes look unusual.
• Offer the child fluid :
Not able to drink - if he is not able to take fluid in his mouth and swallow it
Drinking poorly – if the child is weak and cannot drink without help.
Drinking eagerly, thirsty – reaches out for the cup or spoon when you offer water.
• Pinch the skin of the abdomen:
Goes back very slowly – longer than 2 seconds
Goes back slowly – the skin stays up for even a brief time after release.

CLASSIFY DIARRHEA FOR ;: DEHYDRATION
PERSISTENT DIARRHEA
DYSENTERY

7. Assess Fever:

A child has the main symptom fever if:
- the child has history of fever – no fever now but had fever within 72 hours or
- the child feels hot or
- the child has an axillary temperature of 37.5 C or above

Decide malaria risk:

- child lives in malarious area or
- has been in a malaria risk area in the past 4 weeks.

Look or feel for stiff neck:
- look to see if the child moves and bends his neck easily as he looks around or
- draw the child’s attention to his toes or
- gently support his back and bend the head forward toward hid chest.

Look for runny nose ( not history of runny nose)

Look for signs of Measles: generalized rash and any one of the following: cough, runny nose, or red eyes. Measles rash: begins behind the ears and on the neck, spreads to the face, and to the rest of the body; does not have vesicles or pustules; does not itch.

If the child has measles now or within the last 3 months, assess for:
- mouth ulcers – painful open sore on the inside of the mouth and lips or tongue
- pus draining from the eye
- clouding of the cornea – hazy area in the cornea

Assess for Dengue Hemorrhagic Fever all children two months of age or older.-
Look and feel for signs of bleeding and shock:
- bleeding from the nose and gums
- skin petechiae – small hemorrhages in the skin; look like small dark red spots or patches in the skin; not raised, not tender; if you stretch the skin they do not lose their color.
- Cold and clammy extremities
- If with cold and clammy extremities, check for slow capillary refill ( longer than 3 seconds
- Perform the tourniquet test if: there are no signs in the ASK or LOOK and FEEL, the child is 6 months or older, and the fever is present for more than 3 days.

CLASSIFY FEVER

8. Assess Ear Problem
Assess the child for :
- Ear pain
- Ear discharge ; Present less than 2 weeks – Acute ear infection
Present 2 weeks or more – Chronic Ear Infection
- Tender swelling behind the ear

CLASSIFY EAR PROBLEM

9. Check for malnutrition and anemia:
Look for visible severe wasting – a child with visible severe wasting has marasmus, a form of severe malnutrition.. A child has this sign if he is thin, has no fat, and looks like skin and bones.

Look for palmar pallor – a sign of anemia
Some palmar pallor – the skin on the child’s palm is pale
Severe palmar pallor – the palm is very pale or so pale that it looks white

Look and feel for edema of both feet – the child may have kwashiorkor, a form of severe malnutrition.

Determine weight for age:

Very low weight for age – child’s weight is below the bottom curve of a weight for age chart.

CLASSIFY NUTRITIONAL STATUS

10. Check the child’s immunization status.

11. Check the child’s Vitamin A status.

12. Assess other Problems.

B. Management of the Sick Young Infant Age 1 Week Up to 2 Months

1. Assess the sick young infant

Check the young infant for possible bacterial infection.

1. Ask if the child had convulsion at any time after birth.
2. Count the number of breaths in one minute. Fast breathing is 60 breaths per minute or more.
3. Look for severe chest indrawing. Mild chest indrawing is normal in a young infant or young child. Severe chest indrawing is very deep and easy to see.
4. Look for nasal flaring – widening of the nostrils when the young infant breaths in.
5. Look and listen for grunting – soft, short sounds when breathing out.
6. ‘Look and feel for bulging fontanelle. Fontanelle is the soft spot on the top of the young infant’s head, where the bones of the head have not formed completely.
7. Look at the umbilicus – is it red or draining pus?
8. Measure temperature or feel for fever or low body temperature. Fever (axillary temperature 37.5 C or more; rectal temperature 38 C or more). Hypothermia ( axillary temperature below 35.5 C; rectal temperature below 36 C).
9. Look for skin pustules – red spots or blisters which contain pus. A severe pustule is large of has redness extending beyond the pustule.
10. LOOK: See if the child is abnormally sleepy or difficult to awaken.
11. LOOK at the young infant’s movement. Are they less that normal?

CLASSIFY ALL SICK YOUNG INFANT FOR BACTERIAL INFECTION

Assess Diarrhea

- For how long?
- Is there blood in the stool?
- Look at the young infant’s general condition. Is it “Abnormally sleepy or difficult to awaken” or “Restless and irritable”?
- Look for sunken eyes.
- Pinch the skin of the abdomen. Does it go back very slowly? Or slowly?

CLASSIFY DIARRHEA

Assess Breastfeeding.

4 Signs of Good Positioning;
- with infant’s head and body straight
- facing her breast, with infant’s nose opposite her nipples
- with infant’s body close to her body
- supporting infant’s whole body, not just neck and shoulders

4 Sign of Good Attachment:
- Chin touching breast
- Mouth wide open
- Lower lip turned outward
- More areola visible above than below the mouth.

Suckling effectively – the infant suckles with slow, deep sucks and sometimes pauses. You may see or hear the infant swallowing.

Not suckling effectively – he is taking only rapid, shallow sucks. You may see indrawing of the cheeks. You do not see or hear swallowing.

Not suckling at all – not able to suck breastmilk into his mouth and swallow.

Look for ulcers or white patches in the mouth (thrush). Thrush looks like milk cuds on the inside of the cheek, or thick white coating of the tongue. Try to wipe it off. Milk curds will be removed but thrush will remain.

Check the Young Infant’s Immunization Status

Assess Other Problems

Breastfeeding Mnemonics:

2008-10-13T04:21:00.000-07:00

Breast feeding: benefits ABCDEFGH:
• Infant:

Allergic condition reduced

Best food for infant

Close relationship with mother

Development of IQ, jaws, mouth

• Mother:

Econmical

Fitness: quick return to pre-pregnancy body shape

Guards against cancer: breast, ovary, uterus

Hemorrhage (postpartum) reduced

A. Advantages
a. Psychologic value of closeness and satisfaction in beginning of mother-child relationship

b. Optimum nutritional value for infant

c. Economic and readily accessible

B. Prerequisites

a. Psychologic readiness of mother is a major factor in successful breastfeeding

b. Adequate diet must be available prenatally and postnatally to ensure high-quality milk

c. Suitable rest, exercise, and freedom from tension for mother will provide increased satisfaction

for both her and the infant

d. Infant’s sucking at the breast stimulates the maternal posterior pituitary to produce oxytocin,

the properties for which, in the blood system, constrict the lactiferous sinuses to move the milk

down through the nipple ducts: know as the let-down reflex; a poor sucking reflex of the child

will inhibit the let-down of milk; sucking also stimulates prolactin production

e. Family support and the absence of emotional stress in the mother, because anxiety inhibits the

let-down reflex.

C. Contraindications

a. In the mother:

1. Active tuberculosis

2. Acute contagious desease; HIV positive

3. Chronic disease such as cancer, advanced nephritis, cardiac disease

4. Extensive surgery

5. Narcotic addiction

6. Pregnancy

b. In infant: cleft lip or palate or any other condition that interfere or prevents grasp of the

nipple is the only real contraindication

c. Many drugs are excreted in the breast milk and have harmful effects on the developing infant;

these drugs must be avoided or taken with care if they must be taken by the mother; careful

monitoring of the infant is required.

Nursing Care of the Mother Who Is Breastfeeding

A. Assessment

1. Condition of nipples

2. Desire to breastfeed

3. Level of anxiety regarding breastfeeding

4. Knowledge of breastfeeding and breast care

5. Family support

B. Analysis/Nursing Diagnoses

1. Ineffective breastfeeding related to position, condition of nipples, and infant's sucking ability

2. Altered family processes related to the amount of time required for breastfeeding

3. Risk for infection related to cracked nipples secondary to improper positioning on nipples

4. Knowledge deficit related to feeding and maintenance of lactation

C. Planning/Implementation

1. Teach feeding schedule

a. Self-demand schedule (q 2 to 3 hrs) is desirable

b. Length of feeding time is usually 20 minutes, with greatest quantity of milk consumed in first

5 to 10 minutes

2. Teach feeding techniques

a. Mother and infant in comfortable position, such as semireclining or in rocking chair

b. Entire body of infant should be turned toward mother's breast; alternate starting breast and

use both breasts at each feeding

c. Initiate feeding by stimulating rooting reflex and direct nipple straight into baby's mouth

(stroking cheek toward breast, being careful not to stroke other cheek, because this will confuse

infant)

d. Burp or bubble infant during and after feeding to allow for escape of air by:

(1) Placing infant over shoulder

(2) Sitting infant on lap, flexed forward

(3) Rubbing or patting back (avoid jarring infant)

e. Breast milk intake similar to formula intake

(1) 130 to 200 ml of milk per kilogram (2 to 3 oz of milk per pound) of body weight

(2) From one sixth to one seventh of baby's weight per day

f. After lactation has been established, occasional bottlefeeding can be substituted

g. Length of time for continuing breastfeeding is variable (may be discontinued when teeth erupt,

because this can be uncomfortable for mother)

3. Teach care of breasts

a. Cleanse with plain water once daily (soap or alcohol can cause irritation and dryness)

b. Support breasts day and night with properly fitting brassiere

c. Nursing pads should be placed inside bra cup to absorb any milk leaking between feedings;

allow nipples to air dry at intervals

d. Plastic bra liners should be avoided because they increase heat and perspiration and decrease

air circulation necessary for drying of the nipple

e. If breasts are engorged, teach mother to take warm showers and put baby to breast more

frequently

D. Evaluation/Outcomes

1. Infant receiving enough milk as evidenced by six or more wet diapers daily

2. Infant sleeping between feedings

3. Mother has no signs of nipple cracking or infection

NURSING THEORIES

2008-10-12T01:34:00.000-07:00

Introduction:

Over the years, nursing has incorporated theories from non-nursing sources, including theories of systems, human needs, change, problem solving, and decision making.

Barnum defines theory as “a construct that accounts for or organizes some phenomenon. A nursing theory, then, describes or explains nursing.”

With the formulation of different theories, concepts, and ideas in nursing it:
• It guides nurses in their practice knowing what is nursing and what is not nursing.
• It helps in the formulations of standards, policies and laws.
• It will help the people to understand the competencies and professional accountability of nurses.
• It will help define the role of the nurse in the multidisciplinary health care team.

Four Major Concepts

Nurses have developed various theories that provide different explanations of the nursing discipline. All theories, however, share four central concepts: Person, refers to all human beings. People are the recipients of nursing care; they include individuals, families, communities, and groups. Environment includes factors that affect individuals internally and externally. It means not only in the everyday surroundings but all setting where nursing care is provided. Health generally addresses the person’s state of well-being. The concept of Nursing is central to all nursing theories. Definitions of nursing describe what nursing is, what nurses do, and how nurses interact with clients. Most nursing theories address each of the four central concepts implicitly or explicitly.

Overview of Major Nursing Theorists

Theorist Focus / Development Views of Components
Florence Nightingale (1860),
Notes on Nursing: What It Is, What It Is Not Developed and described the first theory of nursing. She focused the on changing and manipulating the environment in order to put the patient in best possible conditions for nature to act.

She believed that in the nurturing environment, the body could repair itself. Client’s environment is manipulated to include appropriate noise, nutrition, hygiene, light, comfort, socialization and hope Person: An individual with vital reparative processes to deal with disease.
Environment: External conditions that affect life and individuals development.
Health: Focus is on the reparative process of getting well
Nursing: Goal is to place the individual in the best condition for good healthcare
Hildegard Peplau (1952),
Interpersonal Relations in Nursing She identifies four phases of the nurse-client relationship namely:
ORIENTATION, IDENTIFICATION, EXPLOITATION, RESOLUTION P: An organism striving to reduce tension generated by needs
E: The interpersonal process is always included, and psychodynamic milieu receives attention, with emphasis on the client’s culture and mores.
H: Ongoing human process that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.
N: Interpersonal therapeutic process that “functions cooperatively with others human processes that make health possible for individuals in communities. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality.

Virginia Henderson (1955)
The Nature of Nursing
She identified fourteen basic needs. She postulated that the unique function of the nurse is to assist the clients, sick or well, in the performance of those activities contributing to health or its recovery, that clients would perform unaided if they had the necessary strength, will or knowledge.
P: Individual requiring assistance to achieve health and independence or a peaceful death. Mind and body are inseparable.
E: All external conditions and influences that affect life and development.
H: Equated with independence, viewed in terms of the client’s ability to perform 14 components of nursing care unaided: breathing, eating, drinking, maintaining comfort, sleeping, resting clothing, maintaining body temperature, ensuring safety, communicating, worshiping, working, recreation, and continuing development.
N: Assists and supports the individual in life activities and the attainment of independence.
Faye Glenn Abdellah (1960), Patient Centered Approaches to Nursing To deliver nursing care for the whole individual P: The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert.
E: Not clearly defined. Some discussion indicates that clients interact with their environment, of which nurse is a part.
H: a state when the individual has no unmet needs and no anticipated or actual impairment.
N: Broadly grouped in “21 nursing problems,” which center around needs for hygiene, comfort, activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health promotion, interpersonal relationships, and development of self-awareness. Nursing care is doing something for an individual
Ida Jean Orlando (1961)
The Dynamic Nurse-Patient Relationship She believed that the nurse helps patients meet a perceived needs that the patient cannot meet for themselves.
To interact with clients to meet immediate needs by identifying client behaviors, nurse’s reactions, and nursing actions to take P: Unique individual behaving verbally nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times unable to do so
E: Not defined
H: Not defined. Assumption is that being without emotional or physical discomfort and having a sense of well-being contribute to a healthy state.
N: Professional nursing is conceptualized as finding out and meeting the client’s immediate need for help.
Lydia Hall (1964),
Nursing: What Is It? To provide professional nursing care to people past the acute stage of illness. She conceptualized three components of Nursing: CARE, CORE, and CURE. Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s order P: Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing.
E: Should facilitate achievement of the client’s personal goals.
H: Development of a mature self-identity that assists in the conscious selection of actions that facilitate growth.
N: Caring is the nurse’s primary function. Professional nursing is most important during the recuperative period.

Ernestine Wiedenbach (1964), Clinical Nursing – A Helping Art
To assist the individuals in overcoming obstacles that prevent meeting healthcare needs. She advocated that the nurse’s individual philosophy or central purpose lends credence to nursing care. She believed that nurses meet the individual’s need for help through identification of needs, administration of help, and validation that actions were helpful. Components of clinical practice: Philosophy, Purpose, Practice and an Art. P: Any individual who is receiving help from a member of the health profession or from a worker in the field of health.
E: Not specifically addressed
H: Concepts of nursing, client, and need for help and their relationships imply health-related concerns in the nurse—client relationship..
N: the nurse is a functional human being who acts, thinks, and feels. All actions, thoughts, and feelings underlie what the nurse does.
Joyce Travelbee (1966, 1971), Interpersonal Aspects of Nursing To assist individuals, families, communities, and groups to prevent or cope with illness, regain health, finding meaning in illness, or maintaining, maximal degree of health. She further viewed that interpersonal process is a human-to-human relationship formed during illness and “experience of suffering”. P: A unique, irreplaceable individual who is in a continuous process of becoming, evolving, and changing.
E: Not defined
H: Heath includes the individual’s perceptions of health and the absence of disease.
N: An interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences.
Martha Rogers (1970),
The Science of Unitary Man To assist the client in achieving a maximum level of wellness. To Rogers, unitary man is an energy field in constant interaction with the environment. She asserted that human beings are more than and different from the sum if their parts; the distinctive properties of the whole are significantly different from its parts. Furthermore, she believed that human being is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion. P: Unitary man, a four-dimensional energy field.
E: Encompasses all that is outside any given human field. Person exchanging matter and energy.
H: Not specifically addressed, but emerges out of interaction between human and environment, moves forward, and maximizes human potential.
N: A learned profession that is both science and art. The professional practice of nursing is creative and imaginative and exists to serve people.
Imogene M. King (1971, 1981),
Open Systems Model, Goal Attainment Theory To communication to help the client reestablish a positive adaptation to his or her environment. She described nursing as a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity.
In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them, transactions occur and goals are achieved P: Biopsychosocial being
E: Internal and external environment continually interacts to assist in adjustments to change.
H: A dynamic life experience with continued goal attainment and adjustment to stressors.
N: Perceiving, thinking, relating, judging, and acting with an individual who comes to a nursing situations

Betty Neuman (1972, 1982, 1989, 1992)
The Neuman System Model or Health Care System Model.
To address the effects of stress and reactions to it on the development and maintenance of health. The concern of nursing is to prevent stress invasion, to protect the client’s basic structure and to obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client stability. P: A client system that is composed of physiologic, psychological, sociocultural, and environmental variables.
E: Internal and external forces surrounding humans at any time.
H: Health or wellness exists if all parts and subparts are in harmony with the whole person.
N: Nursing is a unique profession in that it is concerned with all the variables affecting an individual’s response to stressors.
Myra Estrin Levine (1973),
Conservation Model To use conservation activities aimed at optimal use of client’s resources. She advocated that nursing is a human interaction and proposed 4 conservation principles of nursing which are concerned with the unity and integrity of the individual.
FOUR CONSERVATION PRINCIPLES:
1. Conservation of energy
2. Conservation of structural integrity
3. Conservation of personal integrity
4. Conservation of social integrity. P: a holistic being
E: Broadly, includes all the individual’s experiences
H: The maintenance of the client’s unity and integrity
N: A discipline rooted in the organic dependency of the individual human being on his or her relationship with others

Sister Callista Roy (1979)
Adaptation Model To identify the types and demands placed on a client and client’s adaptation to the demands. P: Biopsychological beign and the recipient of nursing care.
E: All conditions, circumstances, and influences surrounding and affecting the development of an organism or groups of organisms
H: The person encounters adaptation problems in changing the environment.
N: A theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill or potentially ill persons
Jean Watson (1979)
Nursing: Human Science and Human Care

Human Caring Model To focus on curative factors derived from a humanistic perspective and from scientific knowledge. P: A valued being to be cared for, respected, nurtured, understood, and assisted, a fully functional, integrated self
E: Social environment, caring and the culture of caring affect health
H: Physical, mental, and social wellness
N: A human science of people and human health; illness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions.
Dorothy E. Johnson (1980),
The Behavioral System Model for Nursing
To reduce stress so the client can recover as quickly as possible. According to Johnson, each person as a behavioral system is composed of seven subsystems namely: INGESTIVE, ELIMINATIVE, AFFILIATIVE, AGGRESSIVE, DEPENDENCE, ACHIEVEMENT, and SEXUAL AND ROLE IDENTITY.

In addition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting and adapting to environmental forces through learned pattern of response. Furthermore, She believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in ways that support biologic imperatives; who is able to benefit to the fullest extent during illness from the health care professional’s knowledge and skills; and whose behavior does not give evidence of unnecessary trauma as a consequence of illness. P: A system of interdependent parts with patterned, repetitive, and purposeful ways of behaving.
E: All forces that affect the person and that influence the behavioral system
H: Focus on person, not ill ness. Health is a dynamic state influenced by biologic, psychological, and social factors
N: Promotion of behavioral system, balance and stability. An art and a science providing external assistance before and during balance disturbances

Rosemarie Rizzo Parse (1981),
Man-Living-Health:
Theory of Nursing

Human Becoming Theory To focus on human as living unity and human’s qualitative participation with health experience. She emphasized free choice of personal meaning in relating value priorities, co-creating of rhythmical patterns, in exchange with the environment and contranscending in many dimensions as possibilities unfold. She also believed that each choice opens certain opportunities while closing others. Thus, referred to revealing-concealing, enabling-limiting, and connecting-separating. Since each individual makes his or her own personal choices, the role of the nurse is that of guide, not decision maker. P: A major reason for nursing existence
E: Man and environment interchange energy to create what is in the world, and man chooses the meaning given to the situations he creates
H: A lived experience that is a process of being and becoming
N: Nursing Practice is directed toward illuminating and mobilizing family interrelationships in light of the meaning assigned to health and its possibilities as language in the cocreated patterns of relating.

FLUID ELECTROLYTES ACID BASE BALANCE

2008-10-11T02:45:00.000-07:00

Physiology - Fluid, Electroylyte and Acid-Base Dynamics [iBooks.tk] - Upload a Document to Scribd

2008-10-11T01:31:00.001-07:00

FOOTPRINTS IN THE SAND

2008-10-11T01:30:00.001-07:00

One night a man had a dream.

He dreamed he was walking along the beach with the Lord.

Scenes from his life flashed across the sky
and he noticed two sets of footprints in the sand,
one belonging to him and the other to the Lord.

When the last scene of his life had flashed before him,
he recalled that at the lowest and saddest times of his life
there was only one set of footprints.

Dismayed, he asked, "Lord, you said that once I decided to follow you,
you'd walk with me all the way.
I don't understand why, when I needed you most,
you would leave me."

The Lord replied, "My precious child.
I love you and I would never leave you.

During your times of trial and suffering
when you saw only one set of footprints...

That was when I carried you."

WHAT COMES OF TOMORROW

2008-10-11T01:28:00.000-07:00

I have very few friends who are true to my heart. Yet, those that are, I care for and love unconditionally. I wish for them health, happiness, prosperity, beauty, and love. I wish for them all things good.

This poem is one I wrote to one of my very closest friends when she had to go off to graduate school over two- hundred miles away from her friends and family, to a city where she knew absolutely no one. She was so excited about polishing her college education, yet at the same time she was anxious and fearful. She was scared she would loose her friends and not be able to make new ones. Though, I couldn't bare the thought of her leaving, I knew she was edifying her dreams and ambitions, and I knew that I was so proud of her and that I would always be here for her, just as I knew she would always be there for me no matter how many miles apart. The day she left, we both embraced crying as if we would never see each other again.

It has been almost a year now, and we see each other once a month and we write and e- mail each other sometimes twice a day. I am grateful to have her as a friend.

ODE TO A CHATROOM

2008-10-11T01:27:00.000-07:00

One day I decided to get on the net,
I thought a chat room would be my best bet.
I saw names and words come up from where
I knew not.
I soon took a chance and had a nice thought,
Could I do this, it looked really neat.
I saw names on the screen that started with sweet,
sweet smiles, Jo, and Smokey were there too,
And then I saw it, "Oh, yes, we're talking to you,
come on in and chat for awhile. "
And when I did I started to smile.
I saw Chuckie and Robbie and soon I was friends
with quite a few people by the days end.
And after awhile they called me their friend.
Sometimes I come in and my friends are not there,
But I'll go back again because I know that they care.
Some live in the states and some do not,

But they always know when I need to talk.
I am so glad I took the leap and went into the
chat room where friends are so neat.

by Marie Lehmkuhl

I AM NOT ALONE

2008-10-11T01:25:00.000-07:00

I am alone,
so very alone

I hurt,
so very bad

I am ignored,
just thrown aside

I am security,
for others to have

I am lonely,
there is no one close,
no one sees the pain

I cry,
hope is gone

I am alone,
and no one knows

by Stefani Baucom