categorizing health issues by way of a systems approach, which was shaped by von Bertalanffy’s (1968) general systems theory and interaction theory. King’s ( 1989 ) model reflects the metaparadigm concepts of person, environment, health, and nursing as systems. The concept of person is represented by the three systems ( personal system, interpersonal system, and social system); a set of concepts for each system provides a method for nurses to organize their knowledge, skills, and values. Client goals are met through the transaction between the nurse and client. This interaction, which occurs over time, constitutes a transaction, such that eventually the person’s goal is met conceptual model is one part of the structure, or holarchy, of nursing knowledge. This structure consists of metaparadigms (most abstract), philosophies, conceptual models, theories, and empirical indicators (most concrete; Fawcett, 2005). Traditionally, key concepts in the metaparadigm of nursing, which nursing theories are expected to address in their conceptual underpinnings, are humans, the environment, health, and nursing (Fawcett, 2005). Although some theorists have proposed additional or expanded concepts, Fawcett's ideas inform this discussion. At this stage of the evolution, conceptual models of advanced practice nursing remain an appropriate focus. Conceptual model as “a set of relatively abstract and general concepts that address the phenomena of central interest to a discipline, the propositions that broadly describe these concepts, and the propositions that state relatively abstract and general relations between two or more of the concepts” 40
clinical practice, APNs use conceptual models in the delivery of their holistic, comprehensive, and collaborative care • _ Grand theories Newman’s theory of health Neuman’s philosophy is based on wholism, reality, and wellness, along with her assumptions about interactions of four metaparadigm concepts—person, environment, health, and nursing. She derived the term wholism from the holistic systems concept introduced by de Chardin (1955), a Catholic priest, scientist, and philosopher who believed in the wholeness of life as being the interconnectedness of the human spirit and mind. Neuman (1996) recognized her systems model as a wholistic conceptual framework for guiding nursing interactions with clients. A focal point in the Neuman model is nurses’ insight and involvement in the response of the client system to actual or potential environmental stressors. Neuman’s notion about reality mirrors gestalt theory in three ways: Emphasis on the perceived Awareness of what is and not what should be Completely understanding the patterns and structures in unity, or the whole situation in a perceptual field Margaret Newman’s Theory of Health as Expanding Consciousness (HEC) posits that “every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of oneself, of finding greater
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