Theories Based on Interactive Process

I. IMOGENE KING: THEORY OF GOAL ATTAINMENT

Major Concepts and Definitions

1. Interaction

• A process of perception and communication
• Between person and environment
• Between person and person
• Represented by verbal and  nonverbal behaviors
• Goal-directed
• Each individual brings different knowledge , needs, goals, past experiences and perceptions, which influence interaction

2. Communication

• Information from person to person
• Directly or indirectly
• Information component of interaction

3. Perception

• Each person’s representation of reality

4. Transaction

• Purposeful interaction leading to goal attainment

5. Role

• A set of behaviours expected of person’s occupying a position in a social system
• Rules that define rights and obligations in a position

6. Stress

• Dynamic state
• Human being interacts with the environment

7. Growth and development

• Continuous changes in individuals
• At cellular, molecular and behavioural levels of activities
• Helps individuals move towards maturity

8.Time

• Sequence of events
• Moving onwards to the future

9. Space

• Existing in all directions
• Same everywhere
• Immediate environment (nurse and client interaction

MAJOR ASSUMPTIONS

Nursing

• Observable behaviour
• In health care system in society
• Goal – to help individuals maintain health
• Interpersonal process of action; reaction, interaction and transaction

Person

• Social beings
• Sentient beings
• Rational beings
• Perceiving beings
• Controlling beings
• Purposeful beings
• Action – oriented beings
• Time – oriented beings

Health

• Dynamic state in the life cycle
• Continuous adaptation to stress
• To achieve maximum potential for daily living
• Function of nurse, patient, physicians, family and other interactions

Environment

• Open system
• Constantly changing
• Influences adjustment to life and health

Personal system Concepts

• Perception
• Self
• Body image
• Growth and development
• Time
• Space

Interpersonal system

Concepts

• Interaction
• Transaction
• Communication
• Role
• Stress

Social system

Concepts

• Organization
• Authority
• Power
• Status
• Decision making

ASSUMPTIONS

• Perceptions, goals, needs and values of the nurses and client influence interaction process
• Individuals have the right to knowledge about themselves and to participate in decisions that influence their life, health and community services
• Health professionals have the responsibility that helps individuals to make informed decisions about their health care
• Individuals have the right to accept or reject health care
• Goals of health professionals and recipients of health care may not be congruent

 II.  SISTER CALLISTA ROY: ADAPTATION MODEL

Introduction

• Begins with man
• Man as a biopsychosocial being
• In constant interaction with his environment

Focus of nursing

• Man’s position on the health – illness continuum
• Influenced by ability to adapt to confronted stimuli

MAJOR CONCEPTS AND DEFINITIONS

System

• a set of units so related or connected as to form a unit characterised by inputs, out puts, control and feedback process.

 Adaptational level

• a constantly changing point, made up of focal, contextual and residual stimuli
• represent the persons own standard of the range of stimuli, to which one can respond with the ordinary adaptive response

Adaptation problems:

• the occurrence of situations of  inadequate responses to need deficits or excesses

Focal stimulus:      

• stimulus most immediately confronting the person
• must make an adaptive response
• factor that precipitates behaviour

Contextual stimuli

•  all other stimuli present
• contribute to behaviour caused by the focal stimuli

Residual stimuli

• factors that may be affecting behaviour
• effect not validated

Regulator

• subsystem coping mechanism
• responds automatically  through  neural-chemical-endocrine processes

Cognator

• subsystem coping mechanism
• cognitive – emotive process
• responds through    
• perception, information
• processing, learning
• judgment and emotion

Adaptive (effector) modes

• classification of ways of coping
• manifests regulator and cognator activity
• physiologic, self concept, role function and interdependence

Adaptive responses

• Promote integrity of the person in terms of the goals of survival, growth, reproduction and mastery.

Ineffective responses:

• Does not contribute to adaptive goals

Physiological mode
-involves body’s basic needs and ways of dealing with adaptation in relation to                                    

• Fluid and electrolytes
• Exercise and rest
• Elimination
• Nutrition
• Circulation
• Oxygen

-regulation includes:

• The senses
• Temperature
• Endocrine regulation

Self – concept mode:

• composite of belief and feeling
• formed from perceptions
• directs one’s behaviour

components are :
            the physical self
            the personal self
Role performance mode:

• performance of duties
• based on given positions in society

Interdependence mode:

• one’s relation with significant others
• support system
• maintains psychic integrity
• meets needs for nurturance and affection

MAJOR ASSUMPTIONS

• from system theory
• from Helson’s theory
• from humanism

Assumptions from systems theory

• a system is a set  of units so related or connected as to form a unit or whole
• a system is  a whole that functions as a whole by virtue of the interdependence of its parts
• systems have inputs, outputs and control and feedback processes
• input, in the form of a standard or feedback (information)
• living systems are more complex than mechanical systems and have standards and feedback to direct their functioning as a whole.

Assumptions from helson’s theory

• human behaviour represents adaptation to environmental and organismic forces
• adaptive behaviour is a function of the stimulus and adaptation level, that is, the pooled effect of the focal, contextual and residual stimuli
• adaptation is a process of responding positively to environmental changes
• responses reflect the state of the organism as well as the properties of stimuli and hence are regarded as active processes.

Assumptions from humanism

• Persons have their own creative power
• A persons behaviour is purposeful and not merely a chain of cause and effect
• Person is holistic
• A person’s opinions and view points are of value
• The interpersonal relationship is significant.

Elements

Nursing

• A science and practice discipline
• A theoretical system of knowledge
• Prescribes a process of analysis and action
• Related to the care of the ill or potentially ill person

Person

• A biopsychosocial being
• A living, complex, adaptive system
• With internal processes (the cognator and regulator)
• Acting to maintain adaptation to the four modes

Health

• A state and a process of being and becoming an integrated and whole person

Environment

• All the conditions, circumstances and influences surrounding and affecting the development and behaviour of persons or groups

References

1. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby,  Philadelphia, 2002.
2. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).  Mosby,  Philadelphia, 2002.
3. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
4. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williamsand wilkins.
5. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed. Philadelphia, Lippincott.
6. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Philadelphia, Lippincott.
7. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. London Mosby Year Book.