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This article describes a program evaluation that examines the effect of Orem's self-care nursing model on the attitudes of nurses and on charting behavior. Implementing Orem's model increased staff nurse satisfaction with nursing and enhanced nurses' perception of the value of patient teaching.
The initial steps in theory development and testing are analysis, theoretical development, operational definition, and measurement of concepts. For nursing models to be useful in research, practice, and education, their concepts should be treated as such. This paper presents the first three of such steps using the Behavioral Systems Model for Nursing. The steps of measurement and verification will be presented in subsequent papers in Nursing Research.
The focus of this study is the development and the choice of nursing models. It doesn't intend to discuss all the aspects involved in the development of models, but to emphasize the importance of choosing one to use in nursing clinical practice.
The integration of a professional practice model of nursing and nursing informatics support for that model is congruent with the goals of a professional nursing union. Thus, the collective-bargaining unit can be a powerful ally to nursing management in achieving the integration of a professional practice model of nursing and nursing informatics. This alliance is based on a shared vision of the nature of professional nursing practice and a common concern for the quality of working life and working environment of the professional nurse. This alliance can provide the basis for decision making about the type of nursing information system to be selected or developed for installation in a particular organization. Use of a participatory decision-making process will ensure that all nursing stakeholders are committed to the decision made and prepared to assist with the resolution of implementation issues as they arise. A harmonious alliance of nursing management and the nursing union ensures a partnership that will protect the clinical nursing caregiver and provide a unified voice for nursing within the organization to resist any attempt by other stakeholders to implement an information system that will not meet the needs of nursing. If nursing management and the collective bargaining unit share the concept of a professional model of nursing practice and view nursing informatics as a tool to assist the nursing staff to operationalize the professional model of nursing, then collaboration in resolving issues related to the implementation of nursing information systems will facilitate the process of achieving the integration of a professional practice model of nursing and nursing informatics support for that model.
The adoption of nursing models has become widespread throughout the profession with little empirical evidence of their usefulness or critical evaluation. This paper gives an overview of the issues surrounding the development and use of models and presents research data which indicates that one model (Roper, Logan & Tierney's Activities of Living) is problematic in the long-term care of the elderly. The characteristics of this model which are problematic are common to other models and have relevance for other areas of nursing.
Patient satisfaction measures assist nurses in the evaluation of effectiveness of nursing practice and assist the process of improvement regarding established practice. A comparative study was carried out on 36 patients from a ward using team nursing (Model 1) and 38 patients from a ward using patient allocation (Model 2) in two orthopaedic wards of a 900 bed teaching hospital in Brisbane, Australia. The purpose of the research was to measure if differences in the levels of patient satisfaction were evident. The Patient Satisfaction Survey (Greenhill and Henderson 1997) used in this study encompassed aspects such as patients' feelings and perceptions; nurses' skills, behaviour and attitudes; nurses' communication and education skills; and continuity of care experienced. The results indicated that there were no differences between models of nursing care and levels of patient satisfaction. However, there were significant relationships between patient satisfaction and patients' characteristics such as age, education and health status.
BACKGROUND: Careful nursing, a system of nursing developed in Ireland by Catherine McAuley in the early years of the 19th century and used by Irish nurses at the Crimean war, has been described as Ireland's legacy to nursing. Although records of careful nursing have been preserved, it has received little attention in the nursing literature. AIM: The purpose of this study was to conduct a preliminary content analysis of the mainly primary source historical documentation of the careful nursing system and present it within the structure of a contemporary conceptual model of nursing. METHODS: The documents describing the careful nursing system were studied and re-studied to gain understanding of the philosophical assumptions underlying careful nursing and of the thinking, attitudes, actions and practice of the nurses. Content relating to the four central nursing concepts was identified and summarized. RESULTS: Careful nursing definitions of person, environment, health and nursing are presented. Ten key concepts of careful nursing practice are identified as disinterested love, contagious calmness, creation of a restorative environment, 'perfect' skill in fostering safety and comfort, nursing interventions, health education, participatory-authoritative management, trustworthy collaboration, power derived from service and nurses' care for themselves. The spiritual dimension of human life and the spiritual in nursing emerge as important characteristics of the model. CONCLUSIONS: The results of this preliminary analysis require further verification and critical examination. However, the careful nursing model illuminates important aspects of professional nursing and could be further developed to conceptualize and guide nursing practice.
The Healing Web is a transformative nursing model, bridging gaps between nursing education and practice, baccalaureate and associate degree education, and public and private educational institutions. It is an educational prototype in which nursing students experience collaborative clinical practice in a differentiated practice model. Based on the Healing Web framework, it was hypothesized that the educational partnership model would influence specific student competencies (i.e., caring abilities, leadership skills, assertiveness, and professional nursing behaviors). Students in the Healing Web program scored higher in caring knowing, caring courage, leadership, and assertiveness than their counterparts who participated in traditional clinical experiences. Students identified collaboration, partnership with students and staff, and learning to value different nursing roles as primary benefits of the experience. Findings support the contribution of Healing Web experiences to selected student outcomes, but the research is limited by instrumentation, small numbers, and the question of adequate "dosage." Future research will emphasize qualitative methods to explicate significant concepts more completely.
At the present time nurse education is facing a number of upheavals which have major implications for curriculum development. No hard and fast rules governing the approach to educating learners about nursing theory and nursing models can be made. This paper has generated a number of suggestions which could be explored as new courses are designed and evaluated. It is the responsibility of teachers and practitioners to be aware of the changes ushered in by the implementation of Project 2000 and to seek to ensure that students are appropriately prepared for the professional demands of the years ahead.
The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.
The Army Nurse Corps plans for all contingencies in its nursing practice model. Adams-Ender, Jennings, Bartz, and Jensen tell us how they do it with a contingency model that works in war or peacetime.
Nurse education has been subject to many changes and much debate and criticism over recent years. What has become increasingly evident is that with the changing nature of nursing within society, nursing curricula have to be more flexible and dynamic if they are to meet a multiplicity of needs. There is also a need to recognize that many levels of curricula will be required to prepare the nurses of the future. At Middlesex University the development of specialist practice programmes at postgraduate diploma level, and preparation of nurses for a higher level of practice at masters level has required the development of a new curriculum model which allows both the individualization of academic programmes to meet the needs of nurses, their clients and the organization in which they work, and the integration of development and learning through practice. This model is built on the results of an evaluation of an existing postgraduate programme in interprofessional health care. Key features of the curriculum development include a structured collaboration between student, practice mentor and academic supervisor, and the use of a professional development portfolio to individualize the academic programme and facilitate autonomous learning.
This column focuses on advanced practice nursing. A definition and central competency of advanced practice are given and four roles assumed by advanced practice nurses are identified. Questions related primarily to the advanced practice role of nurse practitioner are raised. Two nurse scholars who teach and practice discuss their experiences as advanced practice nurses, with an emphasis on the importance of using a conceptual model of nursing as a guide for their practice.
The relative impact of various nursing care delivery models and management interventions on nurse satisfaction was assessed in 37 New Jersey hospitals. Nurses ranked pay as the most important factor, followed by autonomy and professional status. Changes in scores between pilot and comparison units were significantly different for satisfaction with interactions and task requirements. Change in satisfaction with interaction was significant for all initiatives in aggregate, as well as for each of the five types of initiatives separately. The change in satisfaction with task requirements was significant for all initiatives taken as a group and for those units that implemented reorganization, computer, and education initiatives. Even among nurses who eventually liked the new environment there was a period of initial dissatisfaction.
The links between anthropology and nursing are not as tenuous as they may at first appear. Social anthropology provides a relevant framework for understanding transcultural nursing and can help to explain some of the drawbacks of using transcultural ideas to care for patients from different cultures.
As nursing departments become more involved in automation, strategic planning for computer applications gains importance. Making the switch from manual to automated systems requires an understanding and analysis of the present system. This knowledge allows participants to examine the current information processing routines in relation to how well they support departmental goals. Priorities for projects can be established and alternatives for more efficient and effective information management schemes can be considered. The development of a Nursing System Model to serve this purpose is described. The model provides an overview for planning and identifies data classes created or used in nursing, organized according to the processes which act upon the data during the accomplishment of work activities.
Fiscal uncertainty, anxiety about nursing retention, and public scrutiny characterize the hospital milieu. During times such as these, introducing a conceptual model may appear inpractical and untimely. However, the conceptual model at Robert Wood Johnson University Hospital has demonstrated many practical applications. It guides nursing practice and provides a framework for quality assurance, documentation of nursing care, and education of nurses in the hospital. Future plans include using the model as a basis for developing a computerized care planning system and a method for cost accounting for nursing. The authors describe how the model serves to unify, give direction, simplify, and improve nursing practice.
Nursing has embraced philosophically the importance of liberal education to professional practice. Yet there has been little exploration of how and if liberal education influences professional action. Based on a series of studies designed to examine the role of liberal education in professional practice, this article describes six competencies related to liberal and professional education and puts forth a model of practice that appears to be influenced by liberal education.