THEORETICAL FRAMEWORK TOPIC: Response of Health Care Providers and Patients in the Emergency Room.

FLORENCE NIGHTINGALE ENVIRONMENTAL THEORY The focus of nursing in this model is to alter the patient's environment in order to affect change in his or her health. The environmental factors that affect health, as identified in the theory, are: fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness of the patient and environment, and light (particularly direct sunlight). If any of these areas is lacking, the patient may experience diminished health. A nurse's role in a patient's recovery is to alter the environment in order to gradually create the optimal conditions for the patient's body to heal itself. In some cases, this would mean minimal noise and in other cases could mean a specific diet. All of these areas can be manipulated to help the patient meet his or her health goals and get healthy. The Environment Theory of nursing is a patient-care theory. That is, it focuses on the care of the patient rather than the nursing process, the relationship between patient and nurse, or the individual nurse. In this way, the model must be adapted to fit the needs of individual patients. The environmental factors affect different patients unique to their situations and illnesses, and the nurse must address these factors on a case-by-case basis in order to make sure the factors are altered in a way that best cares for an individual patient and his or her needs. According to Nightingale, nursing is separate from medicine. The goal of nursing is to put the patient in the best possible condition in order for nature to act. Nursing is "the activities that promote health which occur in any caregiving situation." Health is "not only to be well, but to be able to use well every power we have." Nightingale's theory addresses disease on a literal level, explaining it as the absence of comfort. The environment paradigm in Nightingale's model is understandably the most important aspect. Her observations taught her that unsanitary environments contribute greatly to ill health, and that the environment can be altered in order to improve conditions for a patient and allow healing to occur. This theory is useful in conceptualizing the research because in the emergency room, the environment is a very important factor. Depending on the environment, both the health care provider and the patient can be affected by it. One particular factor in the environment is noise. If too loud, it can affect the work of the health care provider by adding more stress as well as affect the recovery of the patient. HILDEGARD PEPLAU THEORY OF INTERPERSONAL RELATIONS The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person, and put in the context of culture; health, which is a word symbol that implies forward movement of personality and other human processes toward creative, constructive, productive, personal, and community living. This theory is useful in conceptualizing the research because it is a way for the health care provider to learn about the behaviour of the patient and how to solve the patients problem. BETTY NEUMANS SYSTEMS MODEL

The major concepts of Neuman's theory are content, which is the variables of the person in interaction with the environment; basic structure or central core; degree to reaction; entropy, which is a process of energy depletion and disorganization moving the client toward illness; flexible line of defense; normal line of defense; line of resistance; input-output; negentropy, which is a process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness; open system; prevention as intervention; reconstitution; stability; stressors; wellness/illness; and prevention. In the Systems Model, prevention is the primary intervention. It focuses on keeping stressors and the stress response from having a detrimental effect on the body. Primary prevention occurs before the patient reacts to a stressor. It includes health promotion and maintaining wellness. Secondary prevention occurs after the patient reacts to a stressor and is provided in terms of the existing system. It focuses on preventing damage to the central core by strengthening the internal lines of resistance and removing the stressor. Tertiary prevention occurs after the patient has been treated through secondary prevention strategies. It offers support to the patient and tries to add energy to the patient or reduce energy needed to facilitate reconstitution. In the Neuman's theory, a human being is a total person as a client system and the person is a layered, multidimensional being. Each layer consists of a five-person variable or subsystem. The subsystems are physiological, which refers to the physiochemical structure and function of the body; psychological, which refers to mental processes and emotions; socio-cultural, which refers to relationships, and social/cultural expectations and activities; spiritual, which refers to the influence of spiritual beliefs; and developmental, which refers to those processes related to development over the lifespan. Neuman explains environment as the totality of the internal and external forces which surround a person, and with which they interact at any given time. These forces include the intrapersonal, interpersonal, and extra-personal stressors, which can affect the person's normal line of defense and so can affect the stability of the system. The environment has three components: the internal, which exists within the client system; the external, which exists outside the client system; and the created, which is an environment that is created and developed unconsciously by the client, and is symbolic of system wholeness. This theory helps conceptualize this research because of its emphasis regarding the environment and just how much is affects the client. In the emergency room, aside from the initial stressor (the reason as to why the client was submitted there) there are other stressors brought upon the client during their stay there, which includes waiting time, noise, etc. Since prevention is the primary intervention in this theory, the heath care provider should prevent stressors and the stress response from having a detrimental effect on the body. IDA JEAN ORLANDO NURSING PROCESS DISCIPLINE THEORY The major dimensions of the model explain that the role of the nurse is to find out and meet the patient's immediate needs for help. The patient's presenting behavior might be a cry for help. However, the help the patient needs may not be what it appears to be. Because of this, nurses have to use their own perception, thoughts about perception, or the feeling engendered from their thoughts to explore the meaning of the patient's behavior. This process helps nurses find out the nature of the patient's distress

and provide the help he or she needs. The concepts of the theory are: function of professional nursing, presenting behavior, immediate reaction, nursing process discipline, and improvement. This theory helps conceptualize the research because another factor in the ER is the waiting time for the patient. In the ER, the patient with the most severe injury is treated first. The nurse should not ignore the other patients with less severe injuries and should also provide them with attention as well. This will alleviate the stress of the patient, which in turn helps in their recovery.

Virginia Henderson Need Theory The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible. Hendersons theory and the four major concepts 1. Individual
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Have basic needs that are component of health. Requiring assistance to achieve health and independence or a peaceful death. Mind and body are inseparable and interrelated. Considers the biological, psychological, sociological, and spiritual components. The theory presents the patient as a sum of parts with biopsychosocial needs.

2. Environment
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Settings in which an individual learns unique pattern for living. All external conditions and influences that affect life and development. Individuals in relation to families Minimally discusses the impact of the community on the individual and family. Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided

3. Health
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Definition based on individuals ability to function independently as outlined in the 14 components. Nurses need to stress promotion of health and prevention and cure of disease. Good health is a challenge -affected by age, cultural background, physical, and intellectual capacities, and emotional balance Is the individuals ability to meet these needs independently.

4. Nursing

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Temporarily assisting an individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14 basic needs. Assists and supports the individual in life activities and the attainment of independence. Nurse serves to make patient complete whole", or "independent." The nurse is expected to carry out physicians therapeutic plan Individualized care is the result of the nurses creativity in planning for care. Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver. In the Nature of Nursing Nurse role is, to get inside the patients skin and supplement his strength will or knowledge according to his needs.

Hendersons theory which is the Need Theory describes the nurse's role as substitutive (doing for the person), supplementary (helping the person), complementary (working with the person), with the goal of helping the person become as independent as possible. Thus, assisting the individuals to gain independence in relation to the performance of activities contributes to their faster recovery. In Emergency Department, Nurses best response to patient is providing efficient care to help the patient cure illness and faster recovery. Nurses should be willing to serve and that nurses will devote themselves to the patient day and night. Assist the patient to gain independence and help themselves for better recovery. And providing safe environment decreases further injury to the patient. Patients response will determine the efficiency of the care by the Nurse. Jean Watson

The ten primary carative factors 1. 2. 3. 4. 5. 6. 7. 8. The formation of a humanistic- altruistic system of values. The installation of faith-hope. The cultivation of sensitivity to ones self and to others. The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings. The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning. The provision for a supportive, protective and /or corrective mental, physical, sociocultural and spiritual environment. 9. Assistance with the gratification of human needs. 10. The allowance for existential-phenomenological forces.

Installation of faith-hope - When modern science has nothing further to offer the patient, the nurse best response is to continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual. In Emergency cases, faith-hope can help the patient and nurse attain more self esteem and be strong enough help him fight his illness.

Cultivation of sensitivity to ones self and to others - Development of ones own feeling is needed to interact genuinely and sensitively with others. Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and self-actualization, in both the nurse and those with whom the nurse interacts. Development of helping-trust relationship Mode of communication is the strongest tool which helps to establish rapport and care. Such as trust, Nurse should first gain the trust of a patient in order to have a systematic conversation which helps the Nurse to have information about the patient that will help in making of the Nurses Intervention. Through verbal, nonverbal and listening communication it helps the patient and nurse to have an empathetic understanding. Expression of feelings both positive and negative - Encouraging the patient to verbalized his feelings help him to feel relieve which increases the self esteem of the patient and have more strength to become independent and help himself to recover faster. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment - Nurse manipulates in order to provide support and protection for the persons mental and physical well-being. Nurse must provide comfort, privacy and safety as a part of this curative factor. Dorothy Johnson Behavioral Model System Four goals of nursing are to assist the patient: 1. Whose behavior commensurate with social demands 2. Who is able to modify his behavior in ways that it supports biological imperatives 3. Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill 4. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness Attachment or affiliative subsystem - social inclusion intimacy and the formation and attachment of a strong social bond Dependency subsystem - approval, attention or recognition and physical assistance Ingestive subsystem - the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten Eliminative subsystem - human cultures have defined different socially acceptable behaviors for excretion of waste ,but the existence of such a pattern remains different from culture to Culture Sexual subsystem - both biological and social factor affect the behavior in the sexual subsystem

Aggressive subsystem - it relates to the behaviors concerned with protection and self preservation Johnson views aggressive subsystem as one that generates defensive response from the individual when life or territory is being threatened

Achievement subsystem - provokes behavior that attempt to control the environment intellectual, physical, creative, mechanical and social skills achievement are some of the areas that Johnson recognizes

1.) Human being as having two major systems, the biological system and the

behavioral system. It is role of the medicine to focus on biological system where as Nurses focus is the behavioral system. 2.) Society relates to the environment on which the individual exists. According to Johnson an individuals behavior is influenced by the events in the environment. Such as events and environment in Emergency Department, if there are very many patients and insufficient Hospital supply, the Nurses response will be interrupted thus will lead to incompetent rendering of care. 3.) Health is a purposeful adaptive response, physically mentally, emotionally, and socially to internal and external stimuli in order to maintain stability and comfort. With proper rendering of care to patients, patients can easily recover from their illness and prevent further injury. 4.) Nursing has a primary goal that is to foster equilibrium within the individual. Nursing is concerned with the organized and integrated whole, but that the major focus is on maintaining a balance in the Behavior system when illness occurs in an individual. Behavior of both patient and nurse is very important because through behavior, it shows how a Nurse is willing to help the patient. And the patient should be willing to be assisted by the Nurse for them to have easier recovery. Ernestine Wiedenbach The patient
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"Any individual who is recieving help of some kind, be it care, instruction or advice from a member of the health profession or from a worker in the field of health." The patient is any person who has entered the healthcare system and is receiving help of some kind, such as care, teaching, or advice. The patient need not be ill since someone receiving health-related education would qualify as a patient.

A need-for-help
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A need-for-help is defined as "any measure desired by the patient that has the potential to restore or extend the ability to cope with various life situations that affect health and wellness.

Nurse
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The nurse is functioning human being. The nurse not only acts, but thinks and feels as well.

Knowledge
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Knowledge encompasses all that has been perceived and grasped by the human mind.

Judgment
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Clinical Judgment represents the nurses likeliness to make sound decisions. Sound decisions are based on differentiating fact from assumption and relating them to cause and effect. Sound Judgment is the result of disciplined functioning of mind and emotions, and improves with expanded knowledge and increased clarity of professional purpose.

Nursing Skills
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Nursing Skills are carried out to achieve a specific patient-centered purpose rather than completion of the skill itself being the end goal.

Person
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Each Person (whether nurse or patient), is endowed with a unique potential to develop self-sustaining resources. People generally tend towards independence and fulfillment of responsibilities. Self-awareness and self-acceptance are essential to personal integrity and self-worth. Whatever an individual does at any given moment represents the best available judgment for that person at the time. Nursing is the practice of identification of a patients need for help through observation of presenting behaviors and symptoms, exploration of the meaning of those symptoms with the patient, determining the cause(s) of discomfort, and determining the patients ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. Nursing primarily consists of identifying a patients need for help. With these behaviors of the Nurse towards the patient, the patient will be able to give trust. With trust, it will be easier for the Nurse to help the patient recover from its illness. Nurses skills are made up of a variety of actions, and characterized by harmony of movement, precision, and effective use of self.