The nursing model is being increasingly recognized as an essential element in practice, curriculum, and research. Models are merely conceptual ways of viewing some portion of reality. Practitioners in all fields use concepts to carry out their particular function with the client. An observation or diagnosis is not made on raw facts. Observations are made within a set of concepts which help the practitioner simplify and organize reality into a manageable form.' In nursing, the practitioner brings to the task some conception or mental image of the client being cared for, the goals of care, and the appropriate roles of the nurse in this case. These conceptions or mental images are what has been referred to as a nursing model. :
Models in nursing as well as other fields, are "symbolic representations of perceptual phenomena."2 Models provide a way of simplifying a complex piece of reality into something manageable so it can be analyzed, studied, and dealt with. In nursing, models are important in practice, in developing curriculum, and in carrying out research. In nursing practice, the model provides a framework for observing the client, reaching diagnoses, designing interventions to bring about change, and defining the unique role of nursing in carrying out these functions. In curriculum development, the nursing model provides a framework which organizes knowledge necessary to nursing practice. In research the nursing model provides a guide or framework for what is studied and how observations are to be interpreted.
One of the initial steps in establishing a new baccalaureate nursing program at Azusa Pacific College was to adopt a nursing model which would reflect the philosophy and purposes of the program, and could be used in curriculum development. After reviewing numerous nursing models, the faculty adopted the SystemsDevelopmental-Stress Model developed by Marilyn Chrisman at the University of California at Los Angeles.1 This model, which was found to be compatible with and representative of the faculty's philosophy, formed the foundation for development of the present Nursing Process Systems Model (NPS Model).
Every model relies on a set of concepts or theories which gives substance to the model. The NPS Model uses three basic concepts to describe the organizational structure of man: "development," "system," and "stress."
Development has been defined as a conceptualization which assumes directional change. It is assumed that there are "noticeable differences between the states of a system at different times; that the succession of these states implies the system is heading somewhere; and that there are orderly processes which explain how the system gets from its present state to wherever it is going."1 The concept of development provides a way of looking at a system in terms of change. This includes the normal growth and developmental changes as well as changes which occur as a result of an organism's response to stress.
System is a term which refers to a way of organizing reality in terms of its elements, parts, and variables. These elements are interdependent and are integrated. The system model approach is helpful in that it breaks down that portion of reality to be dealt with, into more manageable, component parts. This enables the practitioner to systematically observe and analyze the client as a whole, integrated system.1
Stress provides a way of viewing a system in terms of the system's behavior and responses. The human organism is constantly called upon to interact with others and self in a dynamic, changing environment. When a system is provoked to respond in some way to a factor occurring from within or from without this changing environment, a "stress response" is being made. Involved in this stress response is a "stressor" or the provoking agent which activates stress, and "stress" itself which is the dynamic force or tension activated within an organism in response to the Stressors.4'5
The NPS Model views man as a unified whole system made up of various subsystems which can be viewed in terms of change over time. The subsystems which make up the whole man are the biologic, psychosocial, and spiritual systems. There are eight assumptions concerning this structural way of viewing man which help illustrate the philosophy of the nursing program.
1. Man exists within a framework of development or change- life continuum of birth, growth and development, maturation, and death,
2. Change is inherent to life. The systems attempt to maintain stability or equilibrium within change.
3. At any point in time man can be viewed as a unit of interrelated biologic, psychosocial, and spiritual systems which are open to the environment and subject to change.
4. At any point in time man's present can be seen in terms of his past and potential future.
5. Man's interaction with the environment takes place ultimately on the biologic level. The five senses provide a mode for taking in from the environment and various bodily functions provide a mode for giving out into the environment.
6. Man's spirit is at the center of his being and has ultimate effects on all aspects of life. The spirit transcends time possessing an eternal quality.
7. In clinical practice the nurse focuses on aspects of the total person systematically analyzing (a) the client's biologic, psychosocial, and spiritual systems; (b) interactions of interrelations of these systems; and (c) the relationship of the systems to time and environment.
8. Nursing process takes place in the present, taking into account the client's past and future.
The diagramed structure of the model represents an attempt to illustrate the various components and assumptions of the model (Figure 1). The developmental component is illustrated by the pastpresent-future, conception to death continuum. The systems are illustrated in terms of three superimposed circles. The biologic system is outermost to illustrate the assumption that it is through the body that man interacts with his environment. Psychosocial and spiritual aspects of man are operationalized through the body. All three systems are located in close proximity illustrating the interrelational aspect of their functions.
NURSING PROCESS SYSTEMS MODEL
The spiritual component is drawn in the center illustrating the assumption that man's spirit is at the core of his being. It is this spiritual dimension of man which has a central, ultimate effect on all other aspects of man's existence. The spirit is present in all men and has the potential of being filled by God as the central control over all aspects of man's being. In the model diagram arrows have been used to draw both the spiritual system and the time line illustrating the assumption that man's spirit transcends time and has an eternal quality.*
Each system is drawn with broken lines. This illustrates that the systems are open and in constant interaction with the changing environment. A balance has been incorporated within the broken Iinesof the systems illustrating the health-illness theory in terms of equilibrium or adaptation.
Man is described in even more specific terms by breaking down the biological and psychosocial systems into subsystems. There are two main rationales for doing this. First, the subsystems provide more thorough and specific frameworks for assessment. Second, the subsystems help define nursing function. They are stated in terms of areas with which nurses deal. The subsystems are broken down as shown in Figure 2.
The stress component of the model provides a health-illness theory and a way to identify problems and needs. Whenever an organism encounters Stressors, the purpose of the resultant stress response is to maintain or restore equilibrium. When a successful stress response occurs, the result is adaptation. Adaptation is the positive, constructive end result when the organism's equilibrium has been maintained or restored. Adaptation results in health. When the stress response is inadequate or unsuccessful, maladaptation occurs. Maladaptation involves nonconstructive or destructive end results leading to disequilibrium and illness. *
The nurse looks at the patient's systems in terms of the Stressors encountered and the degree of success of the stress response. This helps in identifying problem areas and in determining appropriate methods of intervention to assist in the attempt toward adaptation and equilibrium.
The nurse assesses clients in terms of developmental and environmental factors as well as assessment of the systems' stress response. Normal stages of growth and development are determined and related to the client's present health status. The concept of change and the effect s of change on the health of the individual are also viewed as part of a nursing assessment. The patient's environment is assessed in terms of the present situation, past experiences, and future expectations.
The nursing process is utilized within the context of this theoretical framework or model. This view of man provides a framework in which to perform the various components of the process. Nursing process is a detailed problem-solving, scientific method for use in determining the need for nursing care and for providing this care.9 The five components of the process are: assessments, diagnosis, planning, intervention, and evaluation. It is an ongoing cyclic process allowing for the testing and retesting of nursing care, with the ultimate aim of assisting the individual toward his maximum potential level of wellness. This nursing process is superimposed over the diagram of man in terms of the NFS Model. This illustrates that the process is performed in the context of viewing man as the model indicates (Figure 1). Both the nursing process diagram and the system circles are drawn so that they fall within the "present" area of the time continuum. This illustrates that nursing deals with the client in the present. It is only in the present that nursing can assess and intervene.
The NFS Model is still in a developmental stage. Each faculty member has been utilizing the model in their various clinical areas of practice. Assessment tools have been developed and tested based on the model and designed for use in the various clinical areas. The assessment tools use the structure of the model to gather information concerning the adaptive status of the client as a whole individual. Problems are identified and dealt with using the nursing process.
The model has been used in curriculum development. It has proved to be very valuable in giving direction to what is taught and in providing organizational structure to the curriculum. Courses are organized around the various concepts, basic to the model, using these concepts as curriculum strands. The model is also used as a framework for organizing specific course content.
The faculty recognizes the need for further development of the model. It was designed to be used in nursing practice, curriculum, and research. The model is presently being used in these areas, testing its value as a tool in nursing.
The following faculty members were involved in the initial NFS Model Development: Sally Jo Brown, R. N., M. N.; Terri Forshee, R. N., M. S. N.; Elaine Goehner, R.N., M.S. N.; Lois Kiehn, R. N., M. N.; Lee Laird, R. N., M.S. N.; and Rhea Williams, R.N., M.N.
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