Evaluating Antonovsky''s Salutogenic Model for its adaptability to nursing

Despite dissatisfaction with disease-oriented models, nursing has not yet adopted a truly health-oriented paradigm. It is important that nurse theorists remain open to health-oriented conceptual models which, although developed in other disciplines, offer adaptability for nursing. In the accompanying article, Antonovsky's Salutogenic Model is analysed and evaluated for adaptability to nursing from its parent discipline, medical sociology. The central concern of this model, as its name suggests, is explaining how people manage to stay well despite omnipresent stressors. The difference between health breakdown and wellness may depend more upon one's outlook on life than upon the avoidance of stress. An orientation which views life activities as meaningful and perceives life events as comprehensible and manageable is called a sense of coherence. People who have a strong sense of coherence manage tension effectively and resist health breakdown. Nursing which strengthens the client's sense of coherence promotes wellness and fosters the client's ability to stay well or get well. Evaluation of the Salutogenic Model relative to its potential usefulness as a nursing paradigm is accomplished by applying the framework for analysis and evaluation of a model developed by Fawcett. The Salutogenic Model is determined to be explicit, comprehensible, logically congruent, and to have social significance, congruence and utility. We conclude that it is suitable for adaptation to the nursing milieu.     

The mind-body connection in elderly

In all areas of care for the older person, whether it be in the hospital, nursing home or community, person-centered care is what is aimed for. Holistic care is person centered. Therefore, what nurses do for older persons, how they do it and how they feel about what they do, all matter. This is the basis for all therapeutic encounters, acting as a creative impetus as well as a buffer from stress. This change in focus supports the patient/client and their families in ways that are empowering, uplifting, hopeful and powerful. It also protects the nurse from burnout.     

Implementation of the intersystem patient-care model in clinical practice

An intrasystem-intersystem model developed by Alfred Kuhn has been integrated into the nursing process model to serve as a model for patient-nurse interaction. In this conceptual model the patient and the nurse represent intrasystems with three components, the detector, selector and effector, which act to supply information about the environment, analyse internal values and preferences and initiate action. The intrasystems are connected through a specified set of relations as the patient and nurse interact to communicate information, transact values and organize a plan of care. An example is presented of how this model can be used to implement the nursing process in the community health setting.     

Health maintenance alteration: a nursing diagnosis of the elderly

The continually growing numbers of elderly persons in our society and the corresponding increase in health care needs for those over age 65 are providing significant challenges to the health care delivery system. Diminishing health care resources and a desire to avoid institutionalization of the elderly client are creating nursing roles for helping the elderly maintain healthful living within the community. Accurate assessment provides the nurse with access to client perceptions of health status as well as a picture of the health management practices of the older adult. A nursing diagnosis of health maintenance alteration is the basis for an individualized plan of care of nursing intervention which is directed toward reducing risk factors and assisting the elderly client to achieve optimum levels of function and independence within the limits of defined health maintenance alterations.     

Incorporation of the Tidal Model into the interdisciplinary plan of care--a program quality improvement project

The Tidal Model was utilized in the development and implementation of an Interdisciplinary Care Plan (IPC) on an inpatient psychiatric unit at St. Joseph's Healthcare Hamilton, Canada. Recovery, client-centered care and interdisciplinary team function were important concepts that were also integrated in the creation of a new care plan. The Tidal Model honors the person and the person's story. This model focuses on engaging the person rather than an illness, with the goal of understanding the person's present situation and his or her relationship with health and illness. Recovery focuses on moving beyond illness, and client centred care acknowledges clients as participants in their own care. As a program quality improvement initiative, the impact of the new IPC was evaluated. Feedback demonstrated that the IPC had a positive impact on both client and caregiver satisfaction, provided a better understanding of the client's situation, and improved the team's ability to document a care plan that reflected the client's specific goals and the goals of the interdisciplinary team. The outcomes achieved through this project have provided support for the IPC along with the need for further evaluation. Our experience with the Tidal Model and the IPC has given voice to the patient's story and helped facilitate their journey towards recovery.     

Senior students' experience in primary nursing

Unfortunately, not all students can function effectively and feel a sense of satisfaction on a primary nursing unit. Three of the 72 students found primary nursing too difficult and expressed a desire for team leading experiences. Nevertheless, in primary nursing, the majority of students begin to see nurses as colleagues, and, consequently, the hierarchy of status is lessened, and a greater openness envelopes the students. Being involved with primary nursing in the senior experience provides the student with increased awareness of the professional nurse by providing personalized patient care, and by providing opportunity to make decisions which are acted upon. Further, she realizes she can accept total responsibility for patient care, and her acceptance of responsibility and accountability affects the client, the physician and, most importantly, herself. Finally, she sees herself as a mature individual who has accomplished a goal: effective, efficient, personalized care of another human being. Consequently, her increased satisfaction with her performance deepens her sense of self-worth, and from these awarenesses she develops a strong sense of personal contribution to the total care of the client: the ultimate goal of professional nursing.     

The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.     

Incorporating holism in nursing education through the Integrative Student Growth Model (ISGM)

The concept of holism is threaded throughout nursing. Holistic nursing practice has emerged as a prevalent concept in the provision of quality nursing care, calling nurses to focus on the whole person. Holistic self-care has been said to prevent burn-out, decrease compassion fatigue, and promote workplace civility. However, strategies for teaching holism in nursing education are lacking. The Integrative Student Growth Model (ISGM) offers an innovative, systems-based model for nurse educators to teach abstract values integral to professional nursing practice such as caring, holism, inclusiveness, integrity and excellence. This article discusses one aspect of the Integrative Student Growth Model, holism, which can be integrated at three defined levels present in all nursing programs. The authors propose a conceptual definition of holistic nursing education and suggest strategies for creating a holistic academic environment at each of the three levels. Finally, recommendations for future inquiry are explored as a means to test the model and the potential impact on student learning outcomes, and subsequently, patient outcomes.     

The effects of student nurse community mental health placements on sufferers of mental health problems in the community

The effects which student nurses have on the care of clients with mental health problems in the community is an area which has seldom been studied With the closure of large psychiatric hospitals and the rise in community placements as part of Project 2000, an increasing number of students are being placed in the community The study gathers data from clients attending five self-help/support groups in the North Derbyshire area of England Analysis of the data challenges assumptions generally held by community psychiatric nurses (CPNs) that the presence of a third person, e g student/visitor, during a CPN home visit to the client is detrimental to the therapeutic interaction between the CPN and the client The findings are inconclusive but suggest that some client groups (possibly those with long-term mental health problems) may find the presence of a student during a CPN visit facilitative The study raises the issue of the student nurse/patient power relationship within a support group Findings suggest that membership of a support group is empowering to the client and illustrates that clients in the community have greater control over the involvement of student nurses in their care than patients in hospital Groups within the sample expressed a unanimous view that student nurse placements should be long enough to allow therapeutic nurse/client relationships to develop This is in direct contrast to the current Project 2000 Common Foundation Programme approach of short observational non-institutional placements     

The nurse educator as teacher: exploring the construction of the 'reluctant instructor'

This paper explores the discursive construction of the category of teacher identified as the ‘reluctant instructor’. Data are drawn from my doctoral study, an ethnography of a school of nursing located in the higher education sector in which I was employed. This study explored the question: What shapes nurse educators and what do they, in turn, shape? Participants included nurse educators who taught a pre-registration programme. Data were gathered through interview and observation of classroom teaching. Analysis focused on the discursive constitution of participants' sense of being a nurse educator and on the implications of their ways of ‘knowing and doing’ for students. The analysis suggests that the dominant subject positions adopted by participants were those of ‘academic’ and ‘victim’. They employed an ideal/real dichotomy to give a sense of coherence to the inconsistencies or contradications that they saw as structuring their daily activities. Being an academic entailed being an educator, specifically a facilitator, as being competent and having some degree of autonomy. However, participants saw the reality of their situation as markedly different from their ideal; as exhibiting traits of the ‘outmoded’, oppressive, hospital system of nurse training. Within this context most participants positioned themselves as a ‘reluctant instructor’. The implications of their practices for the creation of the ‘passive student’ are suggested in the paper. In this analysis the nurse educator is viewed as implicated in the formation and maintenance of the context in which she or he is located. Such a view challenges the neutrality that is implicated in understandings of the nurse educator that inform nursing texts and that helped constitute participants' sense of self.     

Nursing Practice Conceptualized: An Interaction Model

This paper presents a broadly based conceptualized model of nursing practice. Nursing is defined as the therapeutic use of self for the benefit of others after first having acquired the knowledge and skill necessary to identify need. Essential to nursing is the interaction of nurse with client(s). Interactions can be diagnostic, therapeutic, educative, or supportive, and can address four categories of client needs: health, developmental, emotional, and interpersonal.     

The Interaction Model of Client Health Behavior: a model for advanced practice nurses

Purpose: To present the Interaction Model of Client Health Behavior (IMCHB) as a model to guide nurse practitioners (NPs) in their practice.
Data sources: Selected research-based articles on Cox's IMCHB and selected text and writings on the NP movement and nursing practice models.
Conclusions: Many NPs practice in a medical setting where the boundaries between medicine and nursing are blurred. The IMCHB offers a nursing model to guide NPs in their practice.
Implications for practice: A nursing model that examines the elements of client uniqueness and assesses the interaction between NP and client can achieve positive health outcomes.     

Sphere of Nursing Advocacy Model

The Sphere of Nursing Advocacy (SNA) model explains and depicts nursing advocacy on behalf of a client. The SNA model views the client as continually protected from the external environment by a semipermeable sphere of nursing advocacy that allows clients to self advocate if the client is emotionally and physically able or to be advocated for by the nurse if the patient is unable to advocate for him- or herself. The SNA model can be used to guide research or it can provide the basis for instruction on the subject of nursing advocacy.     

Application of the Salmon Model: A Tale of Two Cities

This report demonstrates the application of a recently developed conceptual model of public health nursing practice to a specific community problem. The nurse was able to assist one community group and lead another in identifying their needs, developing a plan to meet those needs, implementing the plan, and evaluating the results. The model provided a structure for the nurse to use in determining scope of practice, the importance of values, practice priorities and interventions, and the relevant determinants of health. This project also served to demonstrate faculty practice. Graduate students in community health nursing attended the nonsmokers' group meetings and city council hearings. They participated at various levels, but primarily they observed their instructor putting into practice the role of the public health nurse specialist as described in the classroom. Discussions regarding group dynamics and community action strategies often occurred in the classroom as a direct result of faculty and student involvement. The Salmon model for public health nursing practice has significant potential for application in numerous areas. It can serve as a unifying force in considering the many variables that influence community action. Being specifically designed for public health nursing, it holds great promise for optimizing the practice of the nurse in community settings.     

Mental health community liaison in aged care: a service of value to all

Aim.  This paper describes an effective community nursing role in which mental health care is brought to long-term care in a way that restores and promotes mental health wellbeing in the older person, builds understanding between clinicians, and develops staff confidence in attending to the whole needs of residents of nursing homes.
Background.  Mental health is a significant issue in the ageing population and there is much that mental health nurses as well as staff in long-term care can do to promote early detection of problems, facilitate effective treatment and build coping in the older person and family so that they recover from grief or depression issues and go on to make this stage of life satisfying and rewarding.
Conclusions.  The mental health nurse liaison role is a useful contribution to comprehensive aged care in the community. The role provides support to clinicians enabling them to develop skills and expand their area of practice, whilst creating an environment in which the needs of the client may also be better understood and thereby met.     

A model for nursing and nursology

Wilson (1972) believes that disciplines are forms of thought that have a characteristic approach to appropriate questions related to the subject. An attempt has been made to interpret nursing accordingly. The ‘subject’ of nursing is the patient. Because there are periods in life when a person cannot yet or can no longer perform one or more of the activities of daily living, each person could be said to have a dependent/independent continuum for each activity along which he can move in either direction according to circumstance. Appropriate questions concerning each patient or client would be: Where is he on each continuum? Why is he at that point? Where could or should he be? How can he be helped to move along any continuum? How can any movement be evaluated or measured? Use of the model could help to produce research-minded nurses; could give value and prestige to helping patients with their activities of daily living; might help the profession to portray its relevant image; could reduce discrepancy between theory and practice, a common complaint made by today's vocal students; could help the profession to make overt its characteristic approach to its subject and thus help nursing to develop as a discipline.     

Nursing care of the elderly person with an acute cardiovascular problem

Cardiovascular disease is the leading cause of morbidity and mortality of the older person. It is the disease that most frequently causes hospitalization. Patients with cardiovascular dysfunction are generally admitted to an acute care setting, the cardiac care unit. These units provide excellent care to the patient. However, the unique environment poses many potential problems for the older patient. It is very important that careful nursing assessment of needs is made and that a plan of care is individualized for each patient. Throughout the period of immediate care and rehabilitation, it is essential that one nurse be responsible for assuring that all needs are met and that provision is made to assure continuity of care from the hospital to the community. This professional nursing approach will promote successful outcomes and reasonable styles of living for the older cardiovascular patient.     

Making visible the contributions of the clinical nurse specialist

This paper reviews the knowledge gap regarding the contributions of the clinical nurse specialist (CNS) in Canada. As a first step to deal with this gap, we address how the CNS role has been conceptualized and studied in Canada. Because the CNS is a clinical leader with a primary focus on improving the quality of nursing and patient care, we propose the Spheres of Influence Model for studying the contributions of the CNS. This model directs attention to various research questions, which are illustrated with sample questions for each of the spheres of influence: the patient/client sphere, the nurses/nursing sphere and the organizations/health systems sphere. Examining the role through these spheres of influence may be a better way to illuminate the contributions of the CNS to health services and to the provision of excellent nursing care.