NURSING

 “nursing is a profession as well

as an academic
discipline,always practiced and
studied in concert with all of the
disciplines that together from
the health sciences”
 The human interaction relying
on communication ,rooted in
the organic dependency of the
individual human being in his
relationships with other human
beings
 Nursing involves engaging in
“human interactions”
GOAL OF NURSING
 To promote wholeness,
realizing that every individual
requires a unique and
separate cluster of activities

 The individual integrity is his

abiding concern and it is the
nurse’s responsibility to
assist him to defend and to
seek its realization
NURSING PROCESS
 Assessment

 Trophicognosis

 Hypothesis

 Interventions

 Evaluation
 NURSING PROCESS

Assessment
 Collection of provocative
facts through
observation and
interview of challenges to
the internal and external
environment using four
conservation principles
CONT.....
 Nurses observes patient
for organismic
responses to
illness,reads medical
reports,talks to patient
and family

 Assesses factors which

challenges the
individual
 NURSING PROCESS

 TROPHICOGNOSIS
 Nursing diagnosis-gives provocative facts
meaning
 A nursing care judgment arrived at through the
use of the scientific process
 Judgment is made about patient’s needs for
assistance
NURSING PROCESS

 Hypothesis
 Planning

 Nurse proposes hypothesis about the problems

and the solutions which becomes the plan of
care
 Goal is to maintain wholeness and promoting
adaptation
NURSING PROCESS

Interventions
 Testing the hypothesis

 Interventions are designed based on the

conservation principles
 Mutually acceptable

 Goal is to maintain wholeness and promoting

adaptation
NURSING PROCESS

Evaluation
 Observation of organismic response to
interventions
 It assesses whether hypothesis is supported or
not supported
 If not supported,plan is revised,new hypothesis
is proposed
APPLICATION OF
CONSERVATION PRINCIPLES
TO CLINICAL PRACTICES
 PATIENT

 Mr. Rajiv , admitted with medical diagnosis of

hypertension and peripheral vascular disease.
CONSERVATION OF ENERGY

 Mr. Rajiv reports he cannot walk more than ½

block without resting because of pain in his leg.
 He must climb three steps to enter his house
and can usually do so without difficulty.
 He lives in a two story house but has a
bedroom on the first floor.
CONT........
 VITAL SIGNS are within normal limits- Mr. Rajiv
says that as he takes his antihypertension
medicine and limits the salt in his diet, his
blood pressure is controlled.

 CHEST X-ray clear

 LAB values: only abnormal level is cholestrol at

260
CONT......

 Mr. Rajiv reports he takes care of himself and

hires someone to come in to clean his house
and do his laundry once a week. He states he
aets two meals a day and he cooks for himself.
 He has to get up at least once a night to void.

 His bowels are usually regular- sometimes he is

constipated.
CONSERVATION OF STRUCTURAL INTEGRITY

 Medical diagnosis of peripheral vascular

disease is consistent with Mr. Rajiv’s
description of difficulty walking and indicates
impairement of his vascular system.
 Mr. Rajiv reports that his left leg either hurts or
“feels strange” most of the time. Pedal pulse
on the left are dimnished.
CONT.....
 History of smoking ½ pack per day for 40
years- stopped smoking 10 years ago and
report his breathinh is better since then.
 Reports arthritis in both hands; physical
examination indicates arthritic nodules distal
joints of index finger.
 Mr. Rajiv reports pain in proximal joints of
both thumbs and that this has weakened his
grip strength. He can fully close each hand.
CONSERVATION OF PERSONAL INTEGRITY

 89 year old male

CONSERVATION OF SOCIAL INTEGRITY

 Widower , lives alone

 Believes in GOD but doesnot “get out to temple
much anymore. It’s just too much effeort.”
 Has three living children- all are in their 60s
and live out of state.
 Mr. Rajiv states they call and write regularly and
each visits once or twice a year.
CONT....

 He has neighbours on either side of him who

“keep an eye out.” one of these neighbours
likes to cook and regularly brings food over.
NURSING DIAGNOSIS

 Pain related to arthritis in hands and peripheral

vascular disease in legs.
 Limited mobility associated with pain and
peripheral vascular disease.
 DESIRED OUTCOME :

 Able to continue to care for self and live in own

home.
PLANNING

 Pain control using prescribed medication and

possible physical therapy to support continued
function.
 Support for medical workup that could result in
recommendation of vascular surgery- provide
appropriate education and opportunity for
questions and discussion.
CONT.....

 Explain all test in level of detail he desires.

 Be sensitive to how detail he really wants.
IMPLEMENTATION
Conservation of Energy:

 Increase the servings of fruits and vegetables

to at least five daily to help assure regularity of
his bowels.

 Arrange his bath and other care activities to

allow rest before and after his physical therapy.
CONT.....

Conservation of Structural Integrity

 work with physician and patient to establish an

effective plan of analgesia to decrease his
pain- help him accept that the pain will not
totally disappear.
CONT....

Conservation of Personal and Social Integrity

 Encourage him to keep up the good work.

EVALUATION

 Can he walk with more comfort?

 Can he use his hands for activities of daily

living and desired recreation?

 Is he ready to resume independence?

NURSING PROCESS ACCORDING TO
LEVINE’S MODEL
 NURSING CARE OF MRS.SITA WITH
LEVINE’S MODEL

 Mrs. Sita, a wife of an abusive husband,

underwent a radical hysterectomy.
 Post operatively has pain ,weight loss,nausea
and inability to empty bladder .
 Patient has history of smoking and stays in
house which is less than sanitary.
 ASSESSMENT

 Challenges to the internal env:-weight

loss,nausea, loss of reproductive ability

 Challenges to the external env:-abusive

husband, insanitary condition in home

 Energy conservation:-weight loss,nausea ,pain

CONT....
 Structural integrity:-threatened by surgical
procedure,inability to pass urine

 Personal integrity:-not able to give birth to more

children

 Social integrity:-Strained relationship with

husband
 TROPHICOGNOSIS
 Inadequate nutritional status
 Pain

 Potential for wound and bladder infection

 Need to learn self catheterization

 Decreased self worth

 Potential for abuse

HYPOTHESIS

 Nutritional consultation
 Teaching and return demonstration of urinary
self catheterization
 Care of surgical wound

 Exploring concern regarding hysterectomy

 INTERVENTIONS
 Energy conservation
 Provide medication for pain and nausea
 Allowing rest period
 Structural integrity
 Administrating antibiotic for wound,
 Teaching self catheterization
 Personal integrity
 Exploring her feeling about uterus removal while respecting
her privacy
 Social integrity
 Assess potential abuse form husband
 Support to the family
EVALUATION
ORGANISMIC RESPONSE

 Controlled pain
 Abdominal wound healing

 Improved appetite ,weight gain

 Clean urinary self catheterization

 Assistance from husband