Week 2:

Adaptation to chronic illness and disability: Theoretical Perspectives on

the health promoetion and health protection of older adults

ROYS METAPARDIGM
Person,Environment,Health,Nursing
PERSON
- humans = holistic
Environment
- all conditions, circumstances and influences surrounding and affecting the
development of the behaviours of the person
- Focal (needs) Contextual (influences of environment) , Residual ( beliefs/morals)
Health
- a state and a process of being and becoming integrated as a whole person
Nursing
- acts to enhance the interaction of the person with the environment to promote
adaptation
- science and practice > expands adaptive abilities and enhances person and
environmental transformation

Four modes of Adaptation

1. Physiologic-Physical Mode
- Behaviour pertaining to the physical aspect of the human system
- Physical and Chemial processes
- Five needs ( oxygentaiton, nutrition, elinitaion, activity and rest and protection_
2. Self concept group Identity Mode
- composite of beliefs held about oneself at a given time
- focus on the psychological and spiritual aspects of the human system
- need to know who one is, so that one can exist with a state of unity, meaning and
purposefulness
- Physical self and personal self ( 2 modes)
 3. Role function model
- set of expectations about how a person occupying one position behaves toward a
person occuypying another postion
basic need-social integrity, the need to know who one is in relation to others

4. Interdependence Mode
- behavior pertaining to interdependent relationships of individuals and groups
- focus on close relatioshonships of people and purpose
each relatiohip exists for some reason
- involves the willingness and ability to give to others and accept from others
- balance results in feelings of being valued an supported by others
- basic need of FEEELING SECURITY IN RELATIOSHIPS

Orems General theory of Nursing :

management of self care actions ( with
nursing assistance)

Consists of three related theories

- Self care theory
- Self care deficit theory
- Nursing systems theory

Orems Metaparadigm
Person
- recipient of nursing care
- functions biologically, symbolically and
socially
- potential for learning and development
- subject to forces of nature
- capacity for self-knowledge
- can engage in deliberate actions ,Interpret
experiences and perform beneficial actions
- can learn to meet self-care needs ( requisites)
Human beings are distinguished from other
living beings by their capacity to:
o Reflect upon themselves and their
environment
o Symbolize what they experience
o Use symbolic creations (ideas, words) in
thinking, communicating, and guiding
efforts to make things that are
beneficial for themselves and/or for
others
Environment
Environmental Conditions
external physical & psychosocial
surroundings
Developmental Environment
promotion of personal development
through motivation to establish
appropriate goals & to adjust
Nursing
- A service geared towards helping
the self and others
- Is required when self-care
demands exceed a clients self-
care ability (agency)
- Promotes the client as a self-care
agent
Components of nursing
- Nursing art: the theoretical
base of nursing and other
disciplines such as sciences,
art, humanities
- Nursing prudence: the
quality that enables the nurse
to seek advice in new or
difficult situations, to make
correct judgments, to decide
to act in a particular manner,
and/or to act
- Nursing service: a helping
service
- Nursing agency: the ability
 - Role theory: the role of the nurse & patient are complementary as they work
together to achieve self-care
- Special Technologies:
o Social & Interpersonal technologies - communicating, coordinating,
establishing & maintaining therapeutic relations, rendering assistance
o Regulatory technologies - maintaining and promoting life processes,
growth/development, and psycho-physiologic modes of functioning

Health
- Supports health promotion and health maintenance
- Supports the premises of holistic health in that both
- nurse and client promote the individuals responsibility for self- care
Orems Self- Care theory
Based on the concepts of:
Self-care : Self-care comprises those activities performed independently by an
individual to promote and maintain personal well-being throughout life
Self-care agency : The individuals ability to perform self-care activities
Self care agent PERSON who provides the self care
Dependent Care Agent person other than the individual who provides the
are ( parent)
Self-care requisites self care needs: actions or measures used to provde self
care
1. universal: requisites that are common to all indivudals
2. developmental: needs resulting from maturation or develop due to a
condition or event
3. health deviation: needs resulting: from illness, injury and disease or its
treatment
Self-care therapeutic demands: how people can be helped through nursing
- results when self care agent cant meet his/her self care needs or
administer self care
- nurses meet self care through five methods of help
five methods of nursing help
1. acting or doing for
2. guiding Orems system theory:
OREMS NURSING SYSTEM
Wholly
It describes:
Nursing responsibilities compensatory
Partially
Roles of the nurse and patient
compensatory
Rationales for the nurse-patient
Supportive-
relationship
educative
Types of actions needed to meet the
Roys modes of
patients demands adaptation:
Physiologic
- Refers to a series of actions a nurse
Self-concept
takes to meet a patients self-care needs
Role function
- Is determined by the patients self-care
Interdependence
needs
- Is composed of three systems:
o Wholly compensatory
o Partly compensatory
o Supportive-educative
Best Practices for Self-Management
Nurses should utilize the 5 As behavioural change that incorporates multiple self-
management strategies when supporting clients with a chronic illness to assist in
improved outcomes
assess,
advise,
agree,
assist
arrange,
(Registered Nurses Association of Ontario, 2010, p. 7)

ISSUES IN HEALTHY AGING : LIVING WITH CHRONIC DISEASE

AND DISABILITY

CHRONIC ILLNESS > may result in dissability

- min 6 months
- a year or more
- managed rather than cured
- learn to live with

Usually gradual;, slow ,progresses after an

acute episode, changes health status, lasts
for life
Or from conception-genetic variations that
are present at birth
Iinfluences health, wellness, lifeways,
prompting creativity in care to support life
and holistic adaptation
Ex. Hemophilia, huntingtons diesae,type 1
diabetes

The Intensity:
Personal, sensory ,functional,
psychological, emotional, holisstic,
existential experiences
Life threatening to inconvenience to
incapacity
Evaluated by symptoms and functional
capacity
A global health concern

ACUTE ILLNESS
- occurs with no warning
- stroke, MI,infection
VARIABILITY
- Remission : period of time when symptom
disappear/ become more manageable
- Exacerbation: period of time when