schoolboy

The concept of human needs. Hierarchy of vital human needs according to A. Maslow and universal needs V. Henderson 14 fundamental needs according to Henderson

The model of W. Henderson, proposed by him in the USA in 1960, and then supplemented in 1968, focuses nursing staff more on physiological, less on psychological and social needs that can be satisfied through nursing care. One of the indispensable conditions of this model is the participation of the patient himself in the planning and implementation of care.

The main provisions of the Henderson model

Patient, according to W. Henderson, has fundamental human needs that are the same for all people: “Regardless of whether a person is sick or healthy, a sister should always keep in mind the vital needs of a person for food, shelter, clothing; in love and benevolence, in a sense of necessity and interdependence in the conditions of social relations ... "
W. Henderson cites 14 needs for everyday life. A healthy person, as a rule, does not experience difficulties in meeting these needs. At the same time, during the period of illness, pregnancy, childhood, old age, when death approaches, a person is not able to satisfy these needs on his own. It is at this time that the sister helps “a person, sick or healthy, in the performance of those functions that maintain his health or contribute to his recovery (or at the time of his death) and which this person would perform without outside help if he had strength, desire or knowledge...”. The author argues that at all times nursing care should be aimed at the speedy restoration of human independence.

The needs of everyday life according to W. Henderson

1. Breathe normally.
2. Eat enough food and fluids.
3. Allocate waste products.
4. Move and maintain the desired position.
5. Sleep and rest.
6. Independently dress and undress, choose clothes.
7. Maintain body temperature within normal limits by choosing appropriate clothing and changing the environment.
8. Observe personal hygiene, take care of appearance.
9. Ensure your own safety and not create a danger to other people.
10. Maintain communication with other people, expressing their emotions, opinions.
11. Perform religious rites in accordance with their faith.
12. Do what you love.
13. Rest, take part in entertainment and games.
14. Satisfy your curiosity, which helps to develop normally.
The source of the patient's problems. W. Henderson, developing her model, was based on the theory of the American psychologist A. Maslow about the hierarchy of basic human needs.
According to the table Below we see what the priority of the needs proposed by V. Henderson is based on. At the same time, according to V. Henderson, the needs are much less at each level than according to A. Maslow. This is explained by the fact that in the mid-1960s, when this model of nursing care was created, the real possibilities of a sister in the United States were limited by activities to meet precisely this limited list of needs. (The NANDA model, which has been used by nursing staff in North America since the late 1980s, includes needs at all levels.)
Problems requiring nursing intervention arise when a person, due to certain circumstances (illness, infancy and / or old age), is not able to take care of himself. Problems may appear during convalescence or long-term dying.

Table. The relationship of basic needs according to A. Maslow with the needs of everyday life according to V. Henderson

W. Henderson claims that a person's ability to satisfy his daily needs varies depending on his temperament and emotional state. For example, experiencing a feeling of fear and anxiety, a person may sleep and eat poorly. An elderly person who has recently experienced a bereavement may experience difficulty in communicating, moving, dressing and undressing, if he was previously assisted in this by his deceased relative. The physiological and intellectual capabilities of a person can also affect a person's ability to satisfy their fundamental needs.
Orientation of nursing intervention. Despite the fact that V. Henderson clearly does not recommend the use of the nursing process (in the 60s, such a type of nursing practice as the nursing process has not yet fully developed in today's understanding of this term), she believes that when examining a patient, the sister discusses with him nursing conditions: "Only in a state of very high dependence of the patient, such as a coma or a state of complete prostration, does the nurse have justifiable motives for deciding (without discussing this with the patient) which is good for him in this case." According to V. Henderson, the sister should try to take the place of the patient, understand his own assessment of his condition and choose the necessary intervention.
Purpose of Care. W. Henderson believes that the sister should only set long-term goals in restoring the patient's independence while meeting 14 daily needs. True, short-term and intermediate goals also have the right to exist, but only in acute conditions: shock, fever, infection or dehydration (dehydration). The author recommends drawing up a nursing care plan, changing it in writing after evaluating the result of nursing interventions.
nursing intervention. W. Henderson believes that nursing care should be associated with both drug therapy and procedures prescribed by doctors, while nursing interventions may require the participation of family members of the patient.
Assessment of the quality and results of care. According to this model, the result and quality of care can be finally assessed only when all the daily needs for which nursing intervention has been taken have been satisfied.
The role of the sister is presented by V. Henderson in two ways. On the one hand, a sister is an independent and independent specialist in the healthcare system, since she performs those functions that the patient cannot perform in order to feel independent enough, on the other hand, she is a doctor's assistant who fulfills his appointments.

Application of the W. Henderson model in the nursing process

This model is one of the most famous among practicing sisters at present. At the same time, it should be remembered that it provides for the indispensable participation of the patient in all stages of the nursing process.
During the initial assessment of the patient's condition, the nurse, together with the patient, should determine which of the 14 daily needs should be met first. Moreover, the nurse makes a decision for the patient only when he is unable to do so. For example, if the patient refuses
eating hospital food means that his need for food is not being met. Together with the patient, the sister determines the possible causes of this problem (poor appetite, squeamishness, etc.) and sets realistic goals for its solution. If the patient has a sleep disorder, the nurse should identify the causes of the problem (uncomfortable bed, stuffiness, roommate snoring, etc.) and then determine the goals of nursing care and intervention.
Care planning. W. Henderson believes that a person must fully and independently satisfy their daily needs, so the long-term goal of care is to achieve maximum independence from the patient. To solve this problem, the nurse sets several intermediate and short-term goals together with the patient. So, in the case of a patient who refuses food, it is necessary to plan a conversation with relatives, with the patient himself, possibly with employees of the catering department. In the case of a patient with sleep problems, relaxation (relaxation) exercises, ventilation of the room, or transfer to another room should be planned.
The goals set must be realistic and measurable so that the success or failure of the nursing intervention can be judged.
Nursing intervention is aimed at strengthening the health of the patient, the complete solution of the tasks assigned to him. Ultimately, intervention involves helping the patient achieve as much independence as possible.
Evaluation of care outcomes. Sisters working according to the W. Henderson model, starting the final assessment of the implementation of the care plan, begin with an assessment of each daily need, in the satisfaction of which problems were identified. The sister establishes how the goal is achieved when the need is met. If the goal is not achieved, new nursing interventions or a change in the formulation of the goal are planned.

1. Breathe normally.

2. Eat enough food and fluids.

3. Allocate waste products.

4. Move and maintain the desired position.

5. Sleep and rest.

6. Independently dress and undress, choose clothes.

7. Maintain body temperature within normal limits by choosing appropriate clothing and changing the environment.

8. Observe personal hygiene, take care of appearance.

9. Ensure your own safety and not create a danger to other people.

10. Maintain communication with other people, expressing their emotions, opinions.

11. Perform religious rites in accordance with their faith.

12. Do what you love.

13. Rest, take part in entertainment and games.

14. Satisfy your curiosity, which helps to develop normally.

The source of the patient's problems. W. Henderson, developing her model, was based on the theory of the American psychologist A. Maslow about the hierarchy of basic human needs.

According to the table Below we see what the priority of the needs proposed by V. Henderson is based on. At the same time, according to V. Henderson, the needs are much less at each level than according to A. Maslow. This is explained by the fact that in the mid-1960s, when this model of nursing care was created, the real possibilities of a sister in the United States were limited by activities to meet precisely this limited list of needs.

The focus of nursing intervention. Henderson believes that when examining a patient, the sister discusses with him the conditions for providing nursing care: “Only in a state of very high dependence of the patient, such as a coma or a state of complete prostration, does the sister have justifiable motives for making a decision.” According to V. Henderson, the sister should try to take the place of the patient, understand his own assessment of his condition and choose the necessary intervention.

Purpose of Care. W. Henderson believes that the sister should only set long-term goals in restoring the patient's independence while meeting 14 daily needs. True, short-term and intermediate goals also have the right to exist, but only in acute conditions: shock, fever, infection or dehydration (dehydration). The author recommends drawing up a nursing care plan, changing it in writing after evaluating the result of nursing interventions.

Nursing intervention. W. Henderson believes that nursing care should be associated with both drug therapy and procedures prescribed by doctors, while nursing interventions may require the participation of family members of the patient.

Table. The relationship of basic needs according to A. Maslow with the needs of everyday life according to V. Henderson

Evaluation of the quality and results of care. According to this model, the result and quality of care can be finally assessed only when all the daily needs for which nursing intervention has been taken have been satisfied.

The role of the sister is presented W. Henderson in two ways. On the one hand, a sister is an independent and independent specialist in the healthcare system, since she performs those functions that the patient cannot perform in order to feel independent enough, on the other hand, she is a doctor's assistant who fulfills his appointments.

Proposed by Virginia Henderson in 1960 in the United States, and later amended in 1968. This model focuses nursing staff on physiological needs and then on the psychological and social needs that can be met through nursing care. The main thing in this model is the participation of the patient himself in the planning and implementation of care.

W.Henderson offers 14 needs for everyday life. A healthy person does not experience difficulties in meeting these needs, at the same time, a sick person is not able to satisfy these needs on his own.

W. Henderson argues that nursing care should be aimed at the speedy restoration of human independence.

The needs of everyday life according to W. Henderson.

1. Breathe normally.

2. Eat enough food and fluids.

3. Isolate waste products from the body.

4. Move and maintain the desired position.

5. Sleep, rest.

6. Independently dress and undress, choose clothes.

7. Maintain body temperature within normal limits by choosing appropriate clothing and changing the environment.

8. Observe personal hygiene, take care of appearance.

9. Ensure your own safety and not endanger others.

10. Maintain communication with other people, expressing their emotions, opinions.

11. Perform religious rites in accordance with their faith.

12. Do what you love.

13. Rest, take part in entertainment and games.

14. Satisfy your curiosity, which helps to develop normally.

Table 1.

	Basic provisions of the model	A source patient
W. Henderson	The patient has fundamental human needs that are the same for all people. Regardless of whether a person is sick or healthy, a sister should always keep in mind the vital needs of a person for food, shelter, clothing, love and goodwill in a sense of necessity and interdependence in social relations.	Problems arise when a person, due to certain circumstances (illness, infancy or old age), is not able to take care of himself. Problems may appear during recovery or long-term dying.	When examining a patient, the nurse discusses with him the conditions for the provision of nursing care.
Purpose of Care	Nursing intervention		The role of the nurse
The nurse should set only long-term goals in restoring the patient's independence in meeting daily needs. Short-term and intermediate circuits, only in emergency conditions (shock, fever, coma, etc.).	Nursing interventions may require the involvement of the patient's family.	The result and quality of patient care can only be assessed when all the daily needs for which nursing intervention has been taken have been satisfied.	The role of the sister in the model is presented in two ways: This is an independent and independent specialist in the healthcare system and performs those functions that the patient cannot perform in order to feel independent; This is a doctor's assistant who performs his appointments.

We will consider the application of the W. Henderson model in the nursing process using the following example

The patient is being treated in the therapeutic department, his sleep is disturbed for three days.

During the initial assessment of the patient's condition, the nurse should find out the cause of sleep disturbance (uncomfortable bed, unventilated room, snoring of a roommate, anxiety before an examination or operation).

Patient care planning includes; training in relaxation exercises, airing the room before going to bed, walking before going to bed, transferring the patient to another room.

Nursing intervention involves helping the patient achieve as much independence as possible.

Model D. Orem

The model proposed by Dorothea Orem in 1971 considers the person as a whole. It is based on the principles of self-care. The model pays great attention to the personal responsibility of a person for the state of his own health.

Nursing intervention is given great importance in the prevention of injury diseases and education of the patient and his relatives.

Table 2.

	Key points	A source patient	Focus of Nursing Intervention
	The patient is a single functional system that has a motivation for self-care.	If the patient cannot maintain a balance between his abilities and needs in self-care, and the needs self-care exceed capabilities of the patient himself - there is a need in nursing care. Help is being provided with active participation the patient and his relatives.	Aimed at the identified lack of self-care and its causes: The reasons for the deficiency can be: Lack of knowledge Inability to perform individual self-care activities; misunderstanding of the importance of self-care. To address the need for nursing intervention, the nurse should: Determine the level of the patient's requirements for self-care; Assess the patient's ability to meet these requirements; Assess the patient's ability to safely carry out self-care; Assess the possibilities of restoring self-care in the future.
Purpose of Care	Nursing intervention	Evaluation of the quality and result of care	The role of the nurse
Identification and discussion with the patient of the possibility of self-care. Goals according to Orem are divided into short-term, intermediate, long-term.	Nursing intervention is aimed at both expanding the possibilities of self-care, and at changing the level of needs for it. D.Orem identifies 6 ways of nursing interventions: Do something for the patient; Manage the patient, direct his actions; Provide physical support; Provide psychological support; Create an environment for self-care; Educate the patient and his family. The patient must strive for self-care, want and be ready to receive nursing care.	The ability of the patient and his family to carry out self-care in the future.	Medical sister helps, teaches the patient realize deal with the consequences injury or illness.

We will consider the application of the D. Orem model in the nursing process using the following example:

The patient is being treated in the traumatology department with a diagnosis of a fracture of the bones of the left leg, the patient is put in a cast.

During the initial examination of the patient, the nurse may assume that the patient is not immediately able to move on crutches without assistance.

In this case, there is an imbalance between some of the patient's universal needs and his ability to take care of himself (actively move, go to the toilet, take a shower), that is, the patient needs outside help.

Nursing care planning will be within the framework of a partially compensatory and learning system. The patient will be able to meet the universal needs of air, food, fluids on his own, but he needs assistance with movement to meet other universal needs. The nurse plans to teach the patient safe mobility skills to prevent the risk of re-injury.

Nursing intervention aims to restore the balance between opportunities and needs for self-care. The nurse partly helps to dress and undress the patient, at the same time she teaches him to safely move on crutches, as well as new skills that allow him to dress and move independently over time.

6.2.3. Breathe normally.

6.2.4. Eat enough food and fluids.

6.2.5. Separate waste products.

6.2.6. Move and maintain the correct position.

6.2.7. Sleep and rest.

6.2.8. Dress and undress independently, choose clothes.

6.2.9. Maintain body temperature within normal limits by choosing appropriate clothing and changing the environment.

6.2.10. Observe personal hygiene, take care of appearance.

6.2.11. Ensure your own safety and not endanger others.

6.2.12. Maintain communication with other people, expressing their emotions, opinions.

6.2.13. Perform religious rites in accordance with their faith.

6.2.14. Do a job you love.

6.2.15. Rest, take part in entertainment and games.

6.2.16. Satisfy your curiosity, which helps to develop normally.

The source of the patient's problems. W. Henderson, developing her model, was based on the theory of the American psychologist A. Maslow about the hierarchy of basic human needs (see Fig. 3-3).

According to the table 6-1 we see what the priority of the needs proposed by V. Henderson is based on. At the same time, according to V. Henderson, the needs are much less at each level than according to A. Maslow. This is explained by the fact that in the mid-1960s, when this model of nursing care was created, the real possibilities of a sister in the United States were limited by activities to meet precisely this limited list of needs. (The NAN DA model, which has been used by nursing staff in North America since the late 1980s, includes needs at all levels.)

Problems requiring nursing intervention arise when a person, due to certain circumstances (illness, infancy and / or old age), is not able to take care of himself. Problems may appear during convalescence or long-term dying.

Table 6-1. The relationship of basic needs according to A. Maslow with the needs

daily life by W. Henderson

Levels of basic human needs but A. Maslow	The needs of everyday life according to W. Henderson
First level (physiological needs)	breathe normally; consume enough food and fluids; excrete waste products from the body; move and maintain the desired position; sleep and rest
Second level (need for security)	Independently dress and undress, choose clothes; maintain body temperature within normal limits by choosing appropriate clothing and changing the environment; observe personal hygiene, take care of appearance; ensure your own safety and not endanger others
Third level (social needs)	Maintain communication with other people, expressing their emotions, opinions; perform religious rites in accordance with one's faith
Fourth level (need for respect and self-respect)	Do what you love; relax, take part in a variety of entertainment, games; satisfy your curiosity, which helps to develop normally

Despite the fact that V. Henderson clearly does not recommend the use of the nursing process (in the 60s, such a type of nursing practice as the nursing process has not yet fully developed in today's understanding of this term), she believes that when examining a patient, the sister discusses with him conditions for nursing care: “Only in a state of very high dependence of the patient, such as a coma or a state of complete prostration, does the sister have

there are justifiable motives for making a decision (without discussing this with the patient), which is good for him in this case. According to V. Henderson, the sister should try to take the place of the patient, understand his own assessment of his condition and choose the necessary intervention.

Purpose of care. IN. Henderson believes that the nurse should only set long-term goals in restoring the patient's independence while meeting the 14 daily needs. True, short-term and intermediate goals also have the right to exist, but only in acute conditions: shock, fever, infection or dehydration (dehydration). The author recommends drawing up a nursing care plan, changing it in writing after evaluating the result of nursing interventions.

Nursing intervention. IN. Henderson believes that nursing care should be associated with both drug therapy and physician-prescribed procedures, while nursing interventions may require the participation of family members of the patient.

According to this model, the result and quality of care can be finally assessed only when all the daily needs for which nursing intervention has been taken have been satisfied.

Role of a sister presented IN. Henderson in two ways. On the one hand, a sister is an independent and independent specialist in the healthcare system, since she performs those functions that the patient cannot perform in order to feel independent enough, on the other hand, she is a doctor's assistant who fulfills his appointments.

6.2.17. Application of the W. Henderson model in the nursing process

At the stage initial assessment of the condition of the patient, the nurse should work with the patient to determine which of the 14 daily needs should be met first. Moreover, the nurse makes a decision for the patient only when he is unable to do so. For example, if the patient refuses

eating hospital food means that his need for food is not being met. Together with the patient, the sister determines the possible causes of this problem (poor appetite, squeamishness, etc.) and sets realistic goals for its solution. If the patient has a sleep disorder, the nurse should identify the causes of the problem (uncomfortable bed, stuffiness, roommate snoring, etc.) and then determine the goals of nursing care and intervention.

Care planning. W. Henderson believes that a person must fully and independently satisfy their daily needs, so the long-term goal of care is to achieve maximum independence from the patient. To solve this problem, the nurse sets several intermediate and short-term goals together with the patient. So, in the case of a patient who refuses food, it is necessary to plan a conversation with relatives, with the patient himself, possibly with employees of the catering department. In the case of a patient with sleep problems, relaxation (relaxation) exercises, ventilation of the room, or transfer to another room should be planned.

The goals set must be realistic and measurable so that the success or failure of the nursing intervention can be assessed.

nursing intervention aimed at strengthening the health of the patient, the complete solution of the tasks assigned to him. Ultimately, intervention involves helping the patient achieve as much independence as possible.

Evaluation of care outcomes. Sisters working according to the W. Henderson model, starting the final assessment of the implementation of the care plan, begin with an assessment of each daily need, in the satisfaction of which problems were identified. The sister establishes how the goal is achieved when the need is met. If the goal is not achieved, new nursing interventions or a change in the formulation of the goal are planned.

6.2.18. MODEL N. ROWPER, W. LOGAN AND A. THAIRNEY

Model proposed by N. Roper in 1976, supplemented in the 80s IN. Logan and A. Tierney, was built on achievements in the field of physiology, psychology of nursing. In it, as well as in the model of V. Henderson, a certain list of needs inherent in all people is used. They think that sister

should focus on the observable aspects of human behavior, and the assessment of the success of nursing activities is based on visible, measurable and measurable results.

6.2.19. Basic provisions of the model

Considering human as an object of nursing activity,

N. Roper for the first time established 16 types of daily life activity (fundamental needs), and some of them are necessary to maintain life itself, while others, being necessary for daily life activity, affect its quality (Table 6-2). Subsequently, the authors of the model reduced this list to 12 manifestations of vital activity, which are human needs. Some of them have a biological basis, others - cultural and social. The degree of satisfaction with certain manifestations of life depends on the age of the person, his social status and cultural level.

Table 6-2. Manifestations of daily life according to N. Roper

Manifestations of daily life

6.2.20. Maintaining the safety of the environment (self-preservation functions).

6.2.21. Communication.

6.2.22. Breath.

6.2.23. Food and drink.

6.2.24. Excretion of waste products.

6.2.25. Compliance with the rules of personal hygiene.

6.2.26. Body temperature regulation.

6.2.27. Physical activity.

6.2.28. Work and leisure.

6.2.29. Sex.

6.2.31. Dying.

6.3.9. disability and associated impairment of physiological functions;

6.3.10. pathological and degenerative changes in tissues;

6.3.11. accident;

6.3.12. infection;

6.3.13. a consequence of the influence of physical, psychological and social environmental factors.

These factors can make a person partially or completely dependent.

The focus of nursing intervention. According to this model, the nurse, together with the patient, consistently evaluates his ability to meet 12 needs, establishing the patient's actual and potential problems. This model provides for continuous assessment of satisfaction of needs.

Purpose of care. Nursing care planning actually begins with an initial assessment of the patient's condition, when, together with the nurse, the goals of care are determined. The sister then determines the means to implement specific interventions.

Nursing intervention. After the nurse has discussed the goal of care with the patient, she chooses interventions based on

The role of a sister The role of a sister in the healthcare system is seen by the authors as independent, dependent and interdependent. The independent role is to assess (with the patient) their condition, plan, implement nursing interventions and evaluate the results of the care provided. Dependent role - assistance to doctors in the performance of certain procedures, as well as appointments of the attending physician. Interdependent role - work as part of a team with other specialists.

6.2.32. Application of the model of N. Roper, V. Logan and A. Tierney in the nursing process

Models N. Roper, V. Logan, A. Tyerni are used in the nursing process. At initial evaluation the nurse must collect data on the vital activity (needs) of the patient. Then for each of them it sets:

6.3.14. that in a normal situation the patient performs normally, without difficulty;

6.3.15. what the patient can do now;

6.3.16. what are the real problems at the present time;

6.3.17. what potential problems may arise.

When planning care, the nurse writes down both actual and potential problems, goals of care, and nursing interventions that will be undertaken.

Nursing interventions should:

6.3.18. prevent the development of potential problems;

6.3.19. remove (reduce) the patient's anxiety;

6.3.20. provide the patient with the opportunity to seek help and accept it for daily life;

6.3.21. help solve real problems.

During the final assessment, the nurse determines how the initial goals were achieved, as well as how useful and effective this model of nursing has been.

6.2.33. MODEL D. JOHNSON

IN his model D. Johnson (1968), in contrast to IN. Henderson and

N. Roper, proposes to radically move away from medical ideas about a person and focus nursing care on people's behavior, and not on their needs.

6.3.22. Basic provisions of the model

Patient, according to D. Johnson's model, it is "an individual having a set of interconnected systems of behavior, and each of them strives for balance and balance within itself."

A person has 7 main subsystems that somehow change his behavior (Table 6-3).

Table 6-3. Subsystems of behavior, according to the model of D. Johnson

D. Johnson determines the action of each subsystem in a person's desire to achieve certain goals based on past experience. This result depends on how he perceives his behavior, how he understands his possibilities in changing behavior (what he can and cannot change). Behavior chosen

a person is determined by his predisposition to a particular type of behavior (attitude). D. Johnson distinguishes two main types: 1) installation created by actions and objects directly around a person; 2) installation created by past habits.

The source of the patient's problems. D. Johnson believes that illness, lifestyle changes can unbalance the subsystems of human behavior. Nursing care should be aimed at restoring balance.

The focus of nursing intervention. To determine the direction of the intervention, it is necessary to assess the patient's condition with respect to each subsystem. This assessment is carried out in two stages: 1) determine whether the behavior of the patient suggests an imbalance in any subsystem; 2) determine the causes of this violation (organic or functional).

Purpose of care. An imbalance within behavioral subsystems is a reason for nursing care. The goal of withdrawal may be to restore (as much as possible) balance in and between each subsystem. It can be directed to change:

6.2.34. motives of behavior;

6.2.35. actions of the subsystem, limited by the past experience of a person;

6.2.36. human behavior, determined by past predisposition to a particular type of action;

6.2.37. installation created by the environment (type 1) or past experience (type 2).

If functional changes are the cause of imbalance in the behavioral subsystem, the goal of nursing care should be to change the patient's environment and provide protection, care, and stimulation of the patient to change behavior. To achieve the goal, the sister, through specific interventions, seeks to restore the balance in each subsystem by changing certain environmental factors.

Nursing intervention. D. Johnson offers 4 areas of nursing interventions:

6.2.38. control or restriction of behavior by some framework;

6.2.39. protection from threats and other factors that cause stress; inhibition (suppression) of ineffective reactions;

6.2.40. incentives for behavior change, partnerships, assistance in the form of guardianship.

Evaluation of the quality and results of care. D. Johnson believes that, firstly, it is possible to evaluate the results of care within a particular subsystem according to the patient's behavior, i.e. by changes caused by certain structural disorders in the human body. In the event that the expected results are associated with planned environmental changes, the change in behavior due to nursing intervention directed to the environment in connection with functional changes is evaluated. If the nursing intervention did not lead to the expected result (goals), new goals and new interventions are re-formulated.

The role of a sister According to the author's definition, the role of a nurse is complementary to the role of a doctor, but does not depend on it. The sister is assigned the role of a specialist who restores the balance of the patient's behavioral subsystems during a psychological or physical crisis.

6.3.23. Application of the D. Johnson model in the nursing process

At the first stage of the nursing process - initial assessment of the patient's condition: the nurse determines if there are behavioral problems. For example, a young man who is in a medical institution for a fracture of the bones of the lower leg does not want to walk with crutches, despite the doctor's prescription. At the same time, he refuses the help of his wife, considering her to blame for this injury. In this case, violations are observed in the aggressive and dependent subsystems. Another example: a 30-year-old woman suffers from constant constipation and overweight - one can assume imbalances in both the excretory and digestive subsystems.

At the second stage of the nursing process, subsystems that are out of balance should be studied in detail. D. Johnson proposes to single out structural (organic) and functional changes that cause problems separately. The sister will have to decide where the intervention should be directed. To do this, she needs to obtain additional information from various sources (relatives, attending physician, etc.).

IN in particular, in the given example, the sister must determine whether the young man has been in a similar situation before (excessive fear for his safety, distrust of his wife, etc.). If it turned out, then the patient has structural (organic) changes. IN otherwise (if the behavior is atypical for this young person), we can conclude that these changes are of a functional nature.

In the case of a woman, it is also necessary to determine the nature of the changes in the subsystems of digestion and excretory. Nursing intervention will be aimed at restoring balance in these subsystems, in order, on the one hand, to limit the amount of food, change physical activity, on the other hand, to make nutrition rational and encourage the patient to regain control over herself.

According to D. Johnson, imbalance in one subsystem affects interconnected subsystems.

Care planning. Having established an imbalance in specific subsystems, the nurse, together with the patient, determines the goal of care. If the patient's problem is related to functional disorders, the nurse determines interventions aimed at changing the environment, changing the patient's motivation (beliefs). For example, for a patient with a fracture, a nurse could schedule psychological support and counseling to reduce the unjustified fear of walking on crutches. When planning medical care for a 30-year-old woman, it is better to focus primarily on motivation (belief) in the need to control herself, over the digestive subsystem. IN a detailed plan should establish short-term and intermediate, as well as long-term goals for restoring balance in the subsystems.

6.2.41. Restriction of behavior (in the example of a 30-year-old woman, it can be recommended that she limit certain foods in her diet, reduce the mass of the diet, increase physical activity).

6.2.42. Protecting the patient from adverse environmental factors (in the example of a patient who refuses to help his wife, you can recommend to the patient's wife some time

not to actively help her husband when walking, at least you should not insist on it).

6.2.43. Suppression of ineffective (inadequate) reactions of the patient (in the example of a young man, a sister can slow down his inappropriate behavior, convincing him that his fear is exaggerated, and distrust of his wife is not confirmed by anything).

6.2.44. Partnership (cooperation with the patient). The patient must accurately represent his role, his actions in restoring (maintaining) health.

Evaluation of the quality and results of care. Assessing the effectiveness of the D. Johnson model, the nurse should describe the results of nursing interventions, indicating one of the two types of behavior, anticipate the patient's possible behavior in advance, since it is this that determines that the intervention It was successful and goal achieved. If the expected results are not before achieved, the nurse reassesses the patient's behavior within each subsystem.

6.3.24. ADAPTATION MODEL OF NURSING K. ROY

Roy's (1976) model also draws on advances in physiology and sociology.

16. Basic provisions of the model

The provisions of this model are widely used by NANDA.

Patient, according to K. Roy, it is an individual who has a set of interconnected and influencing systems: biological (anatomical and physiological), psychological and social. The author believes that both for physiological and for psychological systems, there is a state of relative equilibrium, to which a person strives, i.e. this is some range of states in which people can adequately cope with their experiences. For each person, this range is unique. According to this model, there is a certain level of adaptation and all stimuli (stressors) that fall into this range meet a more favorable reaction than those that are outside it.

Factors that affect the level of adaptation are called stimuli. They, in turn, are of three types: focal - on the-

roam surrounded by a person; situational - arise in the provision of nursing care next to focal and affect them; residual - the result of past experiences, beliefs, relationships. When combined with focal and situational, they affect the level of adaptation.

Ways of adaptation that change behavior (Table 6-4): physiological; I-concept; role-function; interdependence.

Table 6-4. Methods of adaptation and problems encountered by the patient in the process of adaptation

Physiological way of adaptation is a human response to temperature, humidity, atmospheric pressure, food, liquid, oxygen, carbon dioxide and other sensory stimuli. Coping ability

"I". This method of adaptation should be especially effective when preparing a person for operations that significantly change the body scheme: amputation of limbs, mastectomy, stoma, etc.

role-function involves a change in the role of a person in life (in the family, at work) due to certain circumstances. For example, a person who is engaged only in physical labor finds himself in a managerial job for a long time, or an active, active person who manages a large team finds himself in a medical institution and is forced to adapt to the passive role of the patient. In both examples, the individual may go beyond his adaptability in a role-function fashion.

Interdependence- the desire of people to achieve a state of relative balance in various relationships. For example, mother-son, husband-wife, seller-buyer, teacher-student, boss-subordinate, doctor-patient, sister-patient, etc. Se Strain staff should take into account the limited possibilities of adaptation in situations where the patient, being completely dependent on the staff, experiences a feeling of pressure, contempt, loneliness, rejection, familiarity, etc.

The source of the patient's problems. The need for nursing care arises when in the human environment there is a lack or excess of funds and opportunities for using one or another method of adaptation.

The focus of nursing intervention. When examining a patient, first of all, effective ways of adapting should be established in cases where his behavior gives cause for concern. The sister examines them in turn within the 4 named methods, then determines the focal, situational and residual stimuli, as well as the need for nursing care. The nurse determines the degree of influence of this stimulus on the patient's behavior (what is an irritant for one may not have an effect on another).

Purpose of care. Having identified possible focal (situational, residual) stimuli that cause inappropriate behavior, the nurse, together with the patient, outlines goals that allow to him adapt to a changing environment (long-term goals), and specific goals to expand the level of adaptation in a specific way. Interventions are planned that can change either stimuli or the level of adaptation.

nursing intervention is directed to stimuli that are outside the patient's level of adaptation in order to change them or to bring them within the level of adaptation. Interventions are possible aimed at expanding the level of adaptation, giving the patient the opportunity to cope with the existing stimuli. In his model, K. Roy suggests using nursing interventions mainly with focal stimuli.

When evaluating the quality of care, the sister and the patient pay attention to positive changes in one or another way of adaptation.

The role of a sister K. Roy believes that, unlike doctors, who mainly focus on biological (anatomical and physiological) systems, the role of a sister is to promote human adaptation during the period of health and illness by influencing focal stimuli that fall into the zone of one or more another way to adapt.

6.2.45. Application of the K. Roy model in the nursing process

Condition assessment patient is carried out in two stages. First, the nurse must determine if the patient's behavior in any of the 4 adjustment modes is a cause for concern. In the event that there is cause for concern, the nurse should find out what causes the patient's adaptation problems: focal, situational or residual irritation with gels.

For example, a young woman who has had her breasts removed does not want to see visitors other than close relatives. Thus, already at the first stage of the nursing process, the sister must assume the problem of adaptation in the "I-concept" system. Another example: a child often and for a long time gets sick, every time a sister approaches with a syringe, she shows signs of aggression (cries, screams, etc.). In this case, a violation of adaptation is observed within the limits of the "Interdependence" method.

The sister, using this model, determines the limits of the level of adaptation for each person. What is an irritant and creates problems for one, for another, due to its level of adaptation, is not a problem. For example, a patient refuses to see visitors for a variety of reasons - the presence of postoperative drainage, the absence of a mammary gland act as focal irritants and significantly change her own self-image due to her (and in society)

beliefs and values. In this regard, a woman cannot continue to maintain relationships with others. What exactly is this stimulus in this case, the nurse can identify by comprehending the information received from various sources. In the second case, the child may respond inadequately even to such a focal irritant as a white coat, which means a painful procedure for the child.

Having identified stimuli that cause inappropriate responses in the patient, the nurse, together with the patient, determines short-term care goals that allow increasing the level of adaptation or eliminating the stimulus. At the same time, long-term goals are also needed, upon reaching which the patient will be able to adapt to a constantly changing environment. Returning to the first example, a short-term goal for a woman might be to feel able to spend some time in the company of friends. In the second case, the goal of leaving could be to exclude the influence of a white coat.

Nursing intervention. Model TO. Roy suggests that each person strives for a state of psychological and physiological balance. In this regard, nursing intervention should change the stimulus so that it operates within the level of adaptation. K. Roy suggested that nursing interventions should be mainly aimed at focal stimuli.

In the first example, the sister will not be able to eliminate the focal irritant - the absence of a mammary gland in a woman, but she can expand the level of her adaptation, for example, by introducing a patient who has already adapted to a similar situation. In the second example, the sister cannot take off the white coat (I would like the nurses' coats in children's institutions to be colored, but dim), but she can expand the child's level of adaptation, for example, by playing with him several times, dressing up in a white coat.

Evaluation of the quality and result of care. Nursing intervention is only effective if the goal is achieved in specific adaptive ways. Thus, the effectiveness of nursing intervention in the first example can be assessed positively if the young woman receives visitors. In the second - if the child becomes friendlier to people in white coats and is not afraid of his sister.

(More on stress issues and nursing care for maladaptation are discussed in Chapter 9.)

MODEL D. OREM

The model proposed by D. Orem (1971), in contrast to the models of D. Johnson and K. Roy, considers a person as a whole. It is based on the principles of self-care, which D. Orem defines it as "life, health, and well-being activities that people initiate and carry out on their own."

In this model, much attention is paid to the personal responsibility of a person for his own health. However, nursing interventions for the prevention of disease, injury, and education are also important. Adults must rely primarily on themselves and bear a certain responsibility for their dependents while maintaining (maintaining) health.

6.2.46. Basic provisions of the model

According to the model D. Orem, patient- a single functional system that has a motivation for self-care. A person carries out self-care, regardless of whether he is healthy or sick, i.e. his possibilities and needs for self-care must be in balance.

D. Orem identifies three groups of needs for self-care:

6.3.25. Universal:

17. sufficient air intake;

18. adequate fluid intake;

19. adequate food intake;

20. Sufficient allocation capacity and needs associated with this process;

21. maintaining a balance between activity and rest;

22. time of loneliness is balanced with time in the company of other people;

23. prevention of dangers to life, normal life, well-being;

24. stimulation of the desire to correspond to a certain social group, depending on individual abilities and limitations.

The level of satisfaction of each of the 8 universal needs is individual for each person. Factors influencing these needs: age, gender, stage of development, health status, cultural level, social environment, financial opportunities. A healthy person is capable

self-care to meet these universal needs (Figure 6-2).

6.2.47. Needs related to the stage of development(from infancy to old age and during pregnancy). These needs are satisfied, as a rule, by all adults who are amenable to training and education.

6.2.48. Health related needs due to hereditary, congenital and acquired diseases and injuries. There are three types of violations in this group:

6.3.26. anatomical changes (for example, severe edema, burns);

6.3.27. functional physiological changes (eg, shortness of breath, joint stiffness);

6.3.28. change in behavior or daily living habits (eg, feelings of indifference, insomnia, sudden mood changes).

If a person copes with these problems, the overall balance is maintained, which means that he does not need care.

The source of the patient's problems. If the patient (his relatives or close ones) cannot maintain a balance between his capabilities and the needs for self-care, and the needs of self-care exceed the capabilities of the person himself, there is a need for nursing care. At the same time, D. Orem believes that assistance is provided with the active participation of the patient, his relatives and friends.

The focus of nursing intervention. Nursing intervention should address the identified deficits in self-care and its causes. The reasons for the deficit may be a lack of knowledge, inability to perform individual actions for self-care, misunderstanding of the importance of self-care.

The author of this model links the lack of understanding of the need for self-care with the level and stage of development, as well as with the past life experience of the patient. D. Orem believes that in order to resolve the issue of the need for nursing intervention, a sister should:

6.2.49. determine the level of the patient's requirements for self-care;

6.2.50. assess the person's ability to meet these requirements and safely self-care;

6.2.51. assess the possibilities of restoring self-care in the future.

Purpose of care. Short-term, intermediate and long-term goals (or combinations thereof) should be focused on the patient (his ability to self-care). At the same time, not only the goals of care, but also planned nursing interventions should be discussed with the patient.

Nursing intervention. Nursing intervention can be aimed both at expanding the possibilities of self-care, and at changing the level of needs for it. D. Orem calls these changes recovery.

D. Orem identifies 6 ways of nursing interventions:

6.2.52. do something for the patient;

6.2.53. guide the patient, direct his actions;

6.2.54. provide physical support;

6.2.55. provide psychological support;

6.2.56. create an environment for self-care;

6.2.57. educate the patient (or his relatives).

Offering these 6 ways of helping, D. Orem assumes that the patient wants and can play this or that role, seeking to provide self-care, i.e. the patient is ready and willing to receive nursing care.

In addition to methods, the author defines three systems of nursing care: fully compensatory - used in cases where the patient is either in an unconscious state, or he cannot move, or he is not capable of learning; partially compensating - applied to a patient who has temporarily or partially lost the ability to carry out self-care; advisory (training) - is used when it is necessary to teach the patient (relatives) the skills of self-care.

Evaluation of the quality and results of care. D. Orem believes that the assessment of the quality of care should be carried out primarily from the point of view of the ability of the patient and his family to subsequently carry out self-care. Even if nursing intervention has moved from a fully compensatory system to a partially compensatory system that supports the patient in self-care, nursing intervention can be considered effective.

6.2.58. Application of the D. Orem model in the nursing process

Every person, healthy or sick, must maintain a balance between the need for self-care and the ability to carry it out. Having determined the therapeutically necessary behavior for self-care during an injury or illness, the nurse, together with the patient, finds a way and type of nursing intervention.

When conducting initial evaluation needs and opportunities of the patient in self-care, the sister determines the therapeutically necessary behavior in self-care - the balance between the needs and opportunities to carry out self-care (Fig. 6-3).

Conducting an initial examination of the patient's condition in a medical institution, the nurse determines whether her help is needed. For example, if a patient is put in a cast due to a broken leg, the nurse may assume that the patient is unable to walk on crutches without assistance immediately afterwards. In this case, there is an imbalance between some of the patient's universal needs and his ability to take care of himself (actively move, use the toilet, take a shower, etc.), i.e. the patient needs help.

In another case, assessing the condition of an 8-year-old girl with a common childhood infection, the sister finds that her mother cannot meet her daughter's needs for self-care (the mother does not understand why the girl should not be warmly dressed, why she needs to stay in bed, drink more fluids etc.). In this case, there is an imbalance between the mother's ability to help her daughter with self-care and the requirements for the mother at the moment.

In this regard, the sister should collect additional information and find out why there is a lack of self-care. Inspection, observation, conversation will help her understand its cause: lack of knowledge and skills, motivation, restriction of behavior by the framework dictated by social and cultural norms, etc.

In the young man example, the self-care deficit is related to the lack of some crutch walking skills that would help him cope with his current situation in order to restore the ability to self-give. In the second example, the mother of a sick girl is either not sure that she can do everything right, or she does not have enough knowledge to help her daughter with self-care.

Nursing care planning. Nursing care is planned depending on the possibilities of self-care of both the patient and his relatives. In the first of the given examples, the planned intervention will be within the framework of a partially compensatory and educational system. The young man will be able to independently

to satisfy such universal needs as the consumption of air, food, liquid. However, he needs assistance with mobility, in particular, even in order to satisfy his other universal needs. The sister plans to teach him safe movement skills to prevent the risk of re-injury. In the second case, the sister plans a teaching, counseling intervention to teach the mother how to care for her daughter.

Nursing intervention. In each case, the goal of nursing intervention is to restore the balance between opportunities and needs for self-care. In the first case, the patient needs the nurse to help him put on or take off his trousers, using a fully compensatory intervention, as she acts for the patient. At the same time, she teaches him how to safely move on crutches, as well as new skills that allow him to dress and move independently over time. In the second case, the sister can tell the mother how the girl's illness progresses and what needs to be done to alleviate the child's condition. The psychological support of the mother, the praise of her actions can greatly help in caring for the child.

Evaluation of the quality and results of care. When evaluating the effectiveness of nursing care, the nurse first of all takes into account what the patient himself has achieved by the time appointed by them together. So, in the first example, the assessment will be positive if the young person learns to walk on crutches and manage most of the time without outside help. In the second case, nursing intervention can be considered effective if the mother of a sick girl confidently takes care of her daughter.

Thus, nursing care is considered effective if it is possible to maintain or restore a balance between the opportunities and needs for self-care.

6.2.59. MODELS OF NURSING: ONE OR MORE?

So, you got acquainted with several models from the many existing ones. Today there is no single model, although, of course, it would contribute to a better mutual understanding both in teaching sisters and in practical activities, especially in our country, where the reform of nursing is just beginning.

Nurse practitioners in many countries simultaneously use several models, and the choice depends solely on the inability of the patient to meet certain needs.

Understanding the already developed models helps to choose suitable for a particular patient. The model of nursing care is a tool that helps to imagine what the nurse should focus on when examining a patient, what should be the goals and nursing interventions. For care planning, some elements are selected from various models. Due to the changing needs of society in nursing, it is likely that new models will be created.

Need- this is a conscious psychological or physiological deficiency of something, reflected in the perception of a person, which he experiences throughout his life and must fill it in order to achieve health and well-being.

The American psychophysiologist of Russian origin Abraham Maslow in 1943 identified 14 basic human needs and arranged them according to five steps. According to his theory, which determines human behavior, some needs for a person are more significant than others. This made it possible to classify them according to a hierarchical system - from physiological to needs for self-expression. Arranging human needs in the form of a pyramid, A. Maslow showed that without satisfying the lower, physiological needs underlying the pyramid, it is impossible to satisfy the higher needs.

The first level of human needs. Physiological basic needs. Survival. These are the lower needs controlled by the organs of the body, such as breathing, food, sexual, the need for self-defense.

1. The need to breathe - provides constant gas exchange between the cells of the body and the environment. This is one of the basic physiological needs of a person. Breath and life are inseparable concepts. A person, satisfying this need, maintains the gas composition of the blood necessary for life.

2. There is a need - provides the body with the nutrients it needs to stay healthy. Rational and adequate nutrition helps eliminate risk factors for many diseases.

3. The need to drink - Satisfying the need to drink, a person delivers water to the body to maintain water-salt metabolism.

4. The need to highlight - ensures the excretion of waste products, toxins, substances harmful to the body.

5. The need to sleep, rest - satisfaction of this need ensures the restoration of the exhausted nervous system and the impaired functional state of the body, thereby normalizing the physical and mental activity of a person.

Second level. Reliability Needs - Security- striving for material security, health, provision for old age, etc. To achieve this, certain needs must be met.

6. The need to be clean. The skin and mucous membranes of a person perform a protective function, remove waste products from the body, and participate in the processes of thermoregulation. Therefore, a person needs to take care of maintaining the purity of the body.

7. The need to dress, undress. Depending on the state of the body and climatic conditions, a person needs to maintain and regulate body temperature with clothing, ensuring a comfortable state of the body, regardless of the season. To do this, it is important to choose clothes according to age, gender, season, environment.

8. The need to maintain body temperature. A constant body temperature (within physiological fluctuations) is created by the process of thermoregulation, as a result of which the body maintains a balance between heat production and heat loss. To do this, it is necessary to maintain a microclimate in the premises where a person is located and control the choice of clothing for the season.

9. The need to be healthy - It is ensured by a person’s desire for independence in meeting vital needs in the event of a change in the state of health, the occurrence of an illness, to independently solve many problems, to actively participate in the chosen course of treatment or rehabilitation.

10. The need to avoid danger, illness, stress - provides a person with the avoidance of risk factors that lead to the occurrence of diseases. It is important to avoid indifference to your state of health.

11. The need to move- provides appropriate blood circulation in the body, thereby improves tissue nutrition, increases muscle tone, and promotes the resorption of congestion.

Third level. Social needs. Affiliation- these are the needs for family, friends, their communication, approval, affection, love, etc. Satisfying the needs of this level is biased and difficult to describe. In one person, the need for communication is expressed very strongly, in another it is limited to very few contacts. Helping a person solve a social problem can significantly improve the quality of his life.

12. The need to communicate. Communication as a complex, multifaceted process of establishing contacts between people, generated by the needs of joint activities, is necessary for the patient for normal life, especially psycho-emotional balance. Violation of a person's social contacts can lead him to isolation, a desire for self-isolation, or, conversely, to irritability and increased demands on himself.

Fourth level. Consciousness of self-worth is the achievement of success.

The need for respect, awareness of one's own dignity - here we are talking about respect, prestige, social success. It is unlikely that these needs are met by an individual, this requires groups.

13. Need for success. Communicating with people, a person cannot be indifferent to the evaluation of his success by others. A person has a need for respect and self-respect. The higher the level of socio-economic development of society, the more fully the needs for self-esteem are satisfied.

Fifth level. Realization of oneself, service. The need for personal development, self-realization, self-realization, self-actualization, understanding one's purpose in the world.

The need to play, learn, work is the highest level of human need. It is necessary for self-expression, self-realization. A child realizes himself in the game, an adult - in work. To do this, he needs to learn, improve.

Needs affect experiences, the will of a person, form the orientation of the personality. The dominant need suppresses other needs, determines the main direction of human activity. Man consciously regulates the needs and this differs from animals.

In 1977, the hierarchy of human needs according to A. Maslow is undergoing changes. As a result of these changes, the number of pyramid levels increases to 7, cognitive, aesthetic needs appear, and the list of needs also changes.

Virginia Henderson, developing her model of nursing in the mid-60s of the last century, was based on A. Maslow's theory of the hierarchy of basic human needs. According to V. Henderson, the needs are much less at each level than according to A. Maslow.

W. Henderson offers 14 necessities for daily life:

1. Breathe normally

2. Eat enough food and fluids

3. Remove waste products from the body

4. Move and maintain proper position

5. Sleep, relax

6. Independently dress and undress, choose clothes

7. Maintain body temperature within normal limits by choosing appropriate clothing and changing the environment

8. Observe personal hygiene, take care of appearance

9. Ensure your own safety and not endanger others

10. Maintain communication with other people, expressing your emotions, opinions

11. Perform religious rites in accordance with their faith