Post RN BSN Advanced Concepts in Nursing I – Unit II Theoretical Frameworks and Concepts in Nursing Practice Solved Answers
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Unit II: Theoretical Frameworks and Concepts Used in Nursing Practice
Course syllabus · Model exam answers
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-I
ADVANCED CONCEPTS IN NURSING I (ACN-I) – COURSE NO. 701
UNIT II: THEORETICAL FRAMEWORKS AND CONCEPTS USED IN NURSING PRACTICE
Syllabus topics: Definitions of theory, concept, model and theoretical framework; development of nursing theories; conceptual approaches; concepts used in practice: hope, hopelessness, anxiety, aging, loss and grieving, caring; spirituality, powerlessness, loneliness and health.
Q-1. Define concept, construct, proposition, assumption, theory, model and theoretical framework. Differentiate theory from model.
| Term | Meaning | Example |
|---|---|---|
| Concept | An idea or mental image of a phenomenon; the building block of theory | Pain, anxiety, hope, caring |
| Construct | A complex or abstract concept built for a theory | Self-care agency |
| Proposition | A statement of relationship between two or more concepts | “Increased anxiety reduces learning.” |
| Assumption | A statement accepted as true without proof | “People are able to adapt.” |
| Theory | A set of related concepts, definitions and propositions that gives a systematic view of a phenomenon to describe, explain, predict or control it | Orem’s self-care deficit theory |
| Model | A simplified, often visual, representation of reality or of a theory | Roy’s adaptation model diagram |
| Conceptual framework (conceptual model) | A set of linked concepts that provides a broad structure or perspective for practice and research | Neuman’s systems model |
| Theoretical framework | A theory (or several) selected to guide a particular study or practice problem | Using Health Belief Model to study immunization uptake |
| Paradigm / metaparadigm | A world view / the most abstract concepts of a discipline | Person, environment, health, nursing |
| Theory | Model |
|---|---|
| Explains and predicts relationships | Describes structure; may not explain |
| Contains propositions that can be tested | Often a diagram or analogy |
| More specific | More abstract or general |
| Example: Peplau’s theory of interpersonal relations | Example: a concept map of the nursing process |
Q-2. Explain the metaparadigm of nursing and the levels of nursing theory.
Jacqueline Fawcett identified four concepts that every nursing theory addresses (the metaparadigm):
| Concept | Meaning |
|---|---|
| Person | The recipient of care: individual, family, group or community |
| Environment | Surroundings and conditions influencing the person (physical, social, cultural) |
| Health | The person’s level of wellness or illness, on a continuum |
| Nursing | The actions, characteristics and goals of nursing care |
| Level | Features |
|---|---|
| Grand theory | Broad in scope; abstract; covers all of nursing (Roy, Orem, Neuman, Rogers) |
| Middle-range theory | Limited scope; testable; specific phenomena (pain, uncertainty, caring, health promotion) |
| Practice (situation-specific) theory | Concrete; for particular patients or settings; guides specific interventions |
Q-3. What are the characteristics of a good nursing theory? State its importance.
Characteristics
- Logical, clear and consistent; concepts are defined.
- Simple yet general enough for a variety of settings.
- Testable: leads to hypotheses and research.
- Contributes to the body of nursing knowledge.
- Consistent with other validated theories and practice.
- Useful for practice: guides assessment, planning and evaluation.
Importance
- Gives nursing its own identity and body of knowledge.
- Guides practice, education, research and management.
- Improves communication within the profession.
- Helps nurses to explain, predict and control phenomena.
- Helps in critical thinking and decision making.
- Basis for evidence-based care and for the nursing process.
Q-4. Describe the development of nursing theories (historical overview).
| Period | Development | Examples (approximate dates) |
|---|---|---|
| Mid-1800s | Nightingale’s environmental ideas; nursing as a separate discipline | Nightingale, Notes on Nursing (1859) |
| 1900–1940s | Emphasis on procedures and curriculum; nursing became a school-based profession | Textbooks and procedure manuals |
| 1950s–1960s | Era of research and graduate education; first theories to describe nursing | Peplau (1952), Henderson (1960), Abdellah (1960), Orlando (1961), Hall |
| 1970s | Era of theory development; many conceptual models | Rogers (1970), Orem (1971), Neuman (1972), Roy (1976), Watson (1979), Leininger |
| 1980s | Theory utilization in practice; criticism and analysis | King (1981), Parse (1981), Pender (1982), Benner (1984) |
| 1990s–today | Middle-range and practice theories; evidence-based practice; theories used with research and diagnosis systems | Swanson, Mishel, Kolcaba, many middle-range theories |
Nursing theories grew from borrowed theories (psychology, sociology, systems theory, developmental theory) and now include unique nursing theories.
Q-5. Describe the conceptual approaches (types) of nursing theories with examples.
| Approach | Focus | Examples |
|---|---|---|
| Needs / problem-oriented | Meeting basic needs and self-care | Henderson (14 basic needs), Abdellah (21 nursing problems), Orem (self-care) |
| Interaction / relationship | Nurse–patient relationship and communication | Peplau, Orlando, King, Travelbee |
| Systems and adaptation | Person as a system adapting to the environment | Roy, Neuman, Johnson, Rogers |
| Humanistic / caring | Caring, meaning, human experience | Watson, Leininger, Parse, Benner |
| Health promotion | Behaviour change and wellness | Pender’s health promotion model |
| Environmental | The surroundings affect health | Nightingale |
Another way of classifying theories is as descriptive, explanatory, predictive and prescriptive theories.
Q-6. Briefly describe the major nursing theories and their use in practice.
| Theorist and theory | Key ideas | Use in practice |
|---|---|---|
| Florence Nightingale – Environmental theory | Health depends on fresh air, light, warmth, cleanliness, quiet, diet; nurse manipulates the environment | Infection control, ward environment |
| Virginia Henderson – 14 basic needs | Nurse helps the person to gain independence in breathing, eating, elimination, movement, sleep, dressing, temperature, hygiene, safety, communication, worship, work, recreation and learning | Assessment of basic needs |
| Hildegard Peplau – Interpersonal relations | Phases: orientation, identification, exploitation, resolution; nurse roles: stranger, resource, teacher, leader, surrogate, counsellor | Therapeutic communication; psychiatric nursing |
| Dorothea Orem – Self-care deficit theory | Self-care, self-care deficit and nursing systems: wholly compensatory, partly compensatory and supportive-educative | Rehabilitation, chronic illness, teaching |
| Sister Callista Roy – Adaptation model | Person adapts through four modes: physiological, self-concept, role function, interdependence; stimuli: focal, contextual, residual | Assessment of adaptation to illness |
| Betty Neuman – Systems model | Person has a core, lines of resistance and defence; stressors; prevention at primary, secondary and tertiary levels | Prevention and stress-related care |
| Jean Watson – Theory of human caring | Caring is the essence of nursing; carative factors / clinical caritas processes | Humanistic, holistic care |
| Madeleine Leininger – Cultural care | Culture care diversity and universality; the Sunrise model | Transcultural nursing |
| Nola Pender – Health promotion model | Individual characteristics and beliefs affect health behaviours | Health education |
| Martha Rogers – Science of unitary human beings | Humans and environment as energy fields | Holistic, futuristic thinking |
| Patricia Benner – From novice to expert | Five levels of skill: novice, advanced beginner, competent, proficient, expert | Clinical education and development |
Q-7. How can nursing theory be applied in practice and how is a theory evaluated?
Application
- Select a theory suited to the client and setting (e.g. Orem for self-care deficits; Roy for adaptation; Peplau for psychiatric care).
- Use its concepts to organize assessment (data collection).
- Derive nursing diagnoses and outcomes in the theory’s language.
- Plan and implement interventions according to the theory.
- Evaluate the outcomes and the usefulness of the theory.
| Criterion for evaluating a theory | Question |
|---|---|
| Significance | Does it address an important nursing problem? |
| Internal consistency | Are concepts and propositions logical and consistent? |
| Clarity and simplicity | Is it understandable? |
| Testability and empirical support | Can it be tested and is there research evidence? |
| Usefulness | Does it improve practice and education? |
| Generality | Is it applicable to many settings and cultures? |
Limitations: some theories are abstract and hard to apply; may be culturally biased; not all are tested; may not fit all clinical settings.
Q-8. Define hope. Describe its attributes and the nursing measures to foster hope.
Hope is an expectation, with some confidence, that a desired good future outcome is possible; it gives energy and direction and is a coping resource, especially in serious illness. It may be hope for cure, comfort, a peaceful death, or the well-being of the family.
Attributes of hope
- Future orientation and positive expectation.
- Goal setting and a sense of options (pathways).
- Energy and motivation (agency).
- Relationships and connectedness, trust.
- Spiritual beliefs (faith and prayer).
- Meaning and purpose in life.
Factors that increase or decrease hope
| Support hope | Reduce hope |
|---|---|
| Family and friends, spiritual faith, achievable goals, humour, good symptom control, recognition of strengths, respect | Pain, isolation, loss of control, poor communication, false or hasty prognosis, financial burden, depression |
Nursing measures
- Establish a trusting relationship; listen actively; be present.
- Honest communication; give information gently, without removing all hope.
- Help the client set small realistic goals and plan to achieve them.
- Control pain and other symptoms.
- Encourage connection with family, friends, support groups and spiritual care.
- Encourage reminiscence, positive memories, prayers, music, and humour as appropriate.
- Use the Herth Hope Index or interviews to assess hope.
- Nursing diagnosis: Readiness for enhanced hope.
Q-9. Define hopelessness. State its causes, signs and nursing management. Differentiate it from powerlessness and despair.
Hopelessness is a subjective state in which a person sees limited or no alternatives or personal choices and cannot mobilize energy on his own behalf (NANDA-I).
| Causes / related factors | Signs (defining characteristics) |
|---|---|
| Prolonged stress; chronic or terminal illness; loss; failing health; abandonment; lost belief in spiritual power or transcendent values; long-term immobility; uncontrolled pain | Passivity, decreased verbalization, sleep disturbance, flat affect, decreased appetite, no response to stimuli, shrugging, lack of initiative, “nothing will help”, withdrawal |
| Term | Key difference |
|---|---|
| Hopelessness | Sees no possibilities; future seems empty |
| Powerlessness | Perceives lack of control over a situation, but alternatives may be seen |
| Despair | Intense emotional pain with loss of meaning |
Nursing management
- Assess for suicide risk: hopelessness is a strong risk factor; ask directly and report.
- Listen without judging; accept feelings; avoid saying “cheer up”.
- Help the client identify strengths, past coping and small achievable goals.
- Involve family and spiritual support; arrange counselling and psychiatric referral where needed.
- Treat pain, sleep and physical symptoms; promote activity.
- Evaluate: client expresses reasons for living, takes part in care, sets a goal.
Q-10. Define anxiety. Describe its levels, causes, signs and nursing management in general nursing practice.
Anxiety is a vague, uneasy feeling of apprehension or dread, usually from an unknown or unclear cause; fear has a known, specific source. Anxiety is a signal of threat to the self and can be a normal alert response or become harmful.
| Level (Peplau) | Perception and behaviour | Learning |
|---|---|---|
| Mild | Alert; sees more; slight restlessness | Enhanced |
| Moderate | Narrowed attention; selective inattention; voice tremors; pacing | Possible with guidance |
| Severe | Very narrowed field; headache, palpitations, sweating; cannot concentrate | Very limited |
| Panic | Loss of control; terror; disorganized; may harm self | Impossible |
| Cause (examples) | Physiological signs | Emotional / behavioural signs |
|---|---|---|
| Illness, hospitalization, surgery, pain, unknown diagnosis, loss, separation, financial problems, exams, medicines or caffeine | Tachycardia, rapid breathing, increased BP, sweating, dry mouth, tremor, nausea, frequent urination, fatigue, insomnia | Restlessness, irritability, worry, poor concentration, crying, avoidance, asking repeated questions |
Nursing management
- Assess level using observation and a scale (e.g. 0–10 or a standard anxiety scale) and physical causes.
- Stay with the client; stay calm; use simple, short sentences.
- Provide accurate information; explain procedures; reduce unknowns (e.g. before surgery).
- Reduce stimulation; quiet environment; allow expression of feelings.
- Teach deep breathing, progressive muscle relaxation, guided imagery, prayer and physical activity.
- Give prescribed anti-anxiety drugs and monitor effects; avoid caffeine.
- Involve family; refer if severe.
- Nursing diagnoses: Anxiety; Fear.
Q-11. Define aging. Describe the theories of aging and the physiological changes in old age.
Aging is the gradual, continuous, irreversible process of biological, psychological and social change over the life course. Gerontology is the study of aging; geriatrics is the medical care of older people. In many countries (and WHO usage) 60 years or more is regarded as “older age”; chronological and functional age differ.
| Theory | Main idea |
|---|---|
| Biological: genetic / programmed | Cells have a built-in limited number of divisions |
| Biological: wear and tear; free radical | Damage accumulates over time; oxidative damage |
| Psychosocial: disengagement (Cumming and Henry) | Mutual withdrawal between old person and society (criticized) |
| Psychosocial: activity (Havighurst) | Successful aging depends on staying active and keeping roles |
| Continuity (Atchley) | People maintain habits, preferences and personality |
| Erikson | Last stage: integrity versus despair |
| Maslow | Needs persist; self-actualization possible |
| System | Common changes with age |
|---|---|
| Cardiovascular | Stiffer vessels, higher systolic BP, reduced cardiac reserve, orthostatic hypotension |
| Respiratory | Reduced lung elasticity and cough reflex; more infection risk |
| Musculoskeletal | Loss of muscle mass and bone density; joint stiffness; falls and fractures |
| Nervous | Slower reaction and memory retrieval; sleep changes; reduced balance |
| Sensory | Presbyopia, cataract, hearing loss, reduced taste and smell, reduced touch and temperature sensation |
| Gastrointestinal | Reduced saliva and motility; constipation; dental problems |
| Genitourinary | Reduced kidney function; nocturia; incontinence; prostate enlargement |
| Skin | Thin, dry, wrinkled, slow healing; pressure ulcers |
| Immune and endocrine | Lower immunity; reduced glucose tolerance; thyroid and hormonal changes |
Q-12. Describe the common problems of older adults and the nursing care.
| Problem | Nursing care |
|---|---|
| Falls and injuries | Assess risk; remove hazards, good lighting, non-slip footwear, grab bars, assistive devices, exercise and balance training, review medicines |
| Urinary incontinence | Toilet schedule, pelvic floor exercises, fluids, skin care |
| Constipation | Fibre, fluids, activity, bowel routine |
| Malnutrition and dehydration | Small frequent meals, dental care, fluids, nutritional supplements |
| Polypharmacy and adverse drug effects | Medication review, simple schedule, teaching, avoid unnecessary drugs |
| Dementia and delirium | Orientation, routine, safe environment, communication; find and treat cause of delirium |
| Depression and loneliness | Screen, listen, social activities, refer |
| Pressure injury | Reposition, skin care, nutrition, pressure-relieving devices |
| Sensory loss | Hearing aids, glasses, communication aids, large print |
| Elder abuse and neglect | Observe, report, protect; respect dignity |
Principles: respect and dignity; individualized care; promote independence; address ageism (stereotyping of older people); involve family; plan for end-of-life care and community and long-term care.
Q-13. Define loss and grief. Classify types of loss and describe Kubler-Ross’s stages of grief.
Loss is a situation in which something valued is no longer available. Grief is the emotional, physical, cognitive and spiritual response to loss; mourning is the outward, culturally shaped expression; bereavement is the state of having lost a person by death.
| Type of loss | Examples |
|---|---|
| Actual | Death, amputation, loss of job |
| Perceived | Loss only the person feels (loss of self-esteem or independence) |
| Anticipatory | Grieving before an expected loss (terminal illness of a relative) |
| Maturational | Developmental events: retirement, empty nest, menopause |
| Situational | Sudden events: accident, divorce, disaster |
| Stage | Features | Nursing response |
|---|---|---|
| Denial | “This cannot be true.” Shock, disbelief | Do not argue or force acceptance; be present, give honest, gentle information |
| Anger | “Why me?”; directed at staff, family, God | Do not take it personally; listen; allow venting safely |
| Bargaining | “If I do this, I will be cured.” | Listen; do not encourage false hope; spiritual support |
| Depression | Sadness, withdrawal, crying, hopelessness | Be present; encourage expression; assess for suicide; refer if prolonged |
| Acceptance | Peace, readiness to face reality | Support planning; respect wishes; continue care |
Q-14. Describe other theories of grief and the types of grief reactions. Differentiate normal and complicated grief.
| Theory | Main idea |
|---|---|
| Bowlby (attachment) | Phases: numbness, yearning and searching, disorganization and despair, reorganization |
| Engel | Shock and disbelief, developing awareness, restitution, resolving the loss, recovery |
| Worden’s tasks of mourning | Accept the reality of the loss; process the pain of grief; adjust to a world without the deceased; find an enduring connection while embarking on a new life |
| Rando | Six “R” processes of mourning (recognize, react, recollect, relinquish, readjust, reinvest) |
| Dual process model (Stroebe and Schut) | People oscillate between loss-orientation and restoration-orientation |
| Normal (uncomplicated) grief | Complicated (prolonged) grief |
|---|---|
| Sadness, crying, sleep and appetite change, preoccupation with the lost person, guilt; gradually eases over months | Intense yearning, inability to function, persistent for a long time (usually over 6–12 months), severe guilt, avoidance, suicidal thoughts or depression |
| Culturally expected mourning behaviours | Absent, delayed, exaggerated or prolonged reaction |
Disenfranchised grief (Doka) is grief that is not openly acknowledged or socially supported (miscarriage, death of an unmarried partner, stigmatized death such as suicide).
Q-15. Describe the nursing care of a grieving client and family. Include cultural and spiritual aspects.
Nursing diagnoses: Grieving, Risk for complicated grieving, Complicated grieving, Spiritual distress.
- Assess: type of loss, stage and behaviours, support system, culture and religion, coping, health, and risk (suicide, depression, substance use).
- Communicate: be present, listen, use simple honest language (“died”, not vague expressions), allow silence and tears; do not say “I know how you feel” or “be strong”.
- Support expression of feelings; encourage talking about the lost person; support rituals.
- Care of the dying and the body with dignity and privacy; allow family to be present and perform religious and cultural practices (e.g. prayers, recitation, washing and shrouding according to custom) as hospital policy permits.
- Provide information about practical matters (certification, funeral arrangements) and refer to social worker, counsellor or religious leader.
- Teach about normal grief and when to seek help; encourage rest, nutrition, and routines.
- Follow-up: bereavement support and community resources.
- Support the nurse: grief affects caregivers; use debriefing and peer support.
Mourning customs differ between families and communities; ask the family what is important to them.
Q-16. Define caring. Describe theories of caring and the behaviours of a caring nurse.
Caring is the central value of nursing: a way of relating to and being with another person that shows concern, respect and a commitment to the person’s well-being. Caring differs from curing: curing treats disease; caring supports the person whether or not cure is possible.
| Theorist | Key ideas |
|---|---|
| Jean Watson | Ten carative factors (later caritas processes), e.g. humanistic-altruistic values, faith-hope, sensitivity to self and others, helping-trusting relationship, expression of feelings, scientific problem-solving, teaching-learning, supportive environment, human needs assistance, existential-spiritual forces |
| Madeleine Leininger | Caring is the essence of nursing; culture care |
| Kristen Swanson | Five processes: knowing, being with, doing for, enabling, maintaining belief |
| Simone Roach | Six Cs: compassion, competence, confidence, conscience, commitment, comportment |
| Patricia Benner | Caring as the basis of expert practice |
Caring behaviours
- Presence, active listening, eye contact and touch where acceptable.
- Respect for the person’s dignity, privacy and choices.
- Competence and safety; honesty; keeping promises.
- Anticipating needs; comfort measures; teaching.
- Cultural sensitivity and empathy; involving family.
Barriers
- Workload, short staffing, stress and burnout, compassion fatigue, lack of training, rigid routines, personal bias.
Developing caring: reflection, self-care, supervision, role models.
Q-17. Define spirituality. Differentiate it from religion. Describe spiritual needs, spiritual distress and nursing care.
Spirituality is a person’s search for meaning, purpose, connection and hope, including a relationship with the sacred, others, nature and self. Religion is an organized system of beliefs, worship and practices. A person may be spiritual without being religious; many people express their spirituality through religion.
| Spiritual needs | Examples |
|---|---|
| Meaning and purpose | Why this happened; value of life |
| Hope and peace | Comfort from prayer |
| Connectedness | Family, community, God |
| Forgiveness, reconciliation | Resolving guilt |
| Religious practices | Prayer, fasting, reading holy books, dietary rules, modesty, ablution, religious visitors |
Spiritual distress
An impaired ability to experience and integrate meaning and purpose in life. Causes: serious illness, pain, loss, death, separation from rituals, conflict between beliefs and treatment. Signs: questioning meaning, anger at God, guilt, hopelessness, withdrawal, sleep problems, refusing treatment.
Assessment (FICA tool)
| Letter | Question |
|---|---|
| F – Faith | “Do you consider yourself a spiritual or religious person?” |
| I – Importance | “How important is it in your life?” |
| C – Community | “Are you part of a spiritual community?” |
| A – Address in care | “How would you like me to address this in your care?” |
Nursing care
- Respect all beliefs; do not impose your own.
- Provide time, privacy and facilities for prayer; arrange religious visitors; allow rituals and objects; plan care around prayer times where possible.
- Listen to the client’s search for meaning; offer presence; refer to chaplain or religious scholar.
- Respect diet and fasting rules when planning care; discuss medical safety honestly.
- Nursing diagnoses: Spiritual distress, Readiness for enhanced spiritual well-being.
Q-18. Define powerlessness. Describe its causes, levels, signs and nursing interventions.
Powerlessness is the perception that one’s own actions will not significantly affect an outcome; a perceived lack of control over a current situation or immediate happening (NANDA-I). It is linked to locus of control and to Seligman’s learned helplessness.
| Causes | Levels | Signs |
|---|---|---|
| Illness and its treatment; hospitalization and loss of privacy and routine; loss of role; dependence on others; lack of information; unmet decisions; poverty; abuse | Low (expressed uncertainty about control), moderate (passivity, dependence, anger), severe (apathy, resignation, depression) | Passivity, dependence, anger, nonparticipation in care, expressions of having no control, reluctance to express feelings, fear of alienation, depression |
Interventions
- Give information: explain procedures, diagnosis, options; answer questions honestly.
- Offer choices and involve the client in decisions and care planning (time of bath, meals, activity).
- Maintain privacy, personal belongings and routines where possible.
- Set small, achievable goals; recognize successes.
- Teach self-care skills and problem solving; encourage independence.
- Use active listening; accept anger without defence; avoid taking over tasks the client can do.
- Involve family and support groups; assertiveness training if needed.
- Nursing diagnoses: Powerlessness; Risk for powerlessness; Readiness for enhanced power.
Q-19. Define loneliness. Differentiate it from solitude and social isolation. Describe its causes, effects and nursing care.
Loneliness is a subjective, unpleasant feeling of lack of companionship or a gap between desired and actual social relationships; it can occur even among people. Solitude is a chosen, restful state of being alone. Social isolation is an objective lack of social contact.
| Type (Weiss) | Meaning |
|---|---|
| Emotional loneliness | Missing a close attachment (spouse, close friend) |
| Social loneliness | Lack of a network of friends or community |
| Causes / risk groups | Effects | Nursing care |
|---|---|---|
| Older adults, widowed, migrants and displaced people, long hospital stay, disability, chronic illness, mental illness, poor communication, sensory loss, loss of role, bereavement, stigma, living alone, loss of mobility | Depression, anxiety, poor sleep, substance use, poor self-care, cognitive decline, higher risk of heart disease and early death, suicidal thoughts | Assess (e.g. UCLA Loneliness Scale or direct questions); spend regular, unhurried time; encourage visits, calls, letters and video calls; group activities, day centres and religious or community gatherings; pets and hobbies; treat depression; address hearing, vision and mobility; teach social skills; volunteer and peer support; discharge planning |
Nursing diagnoses: Loneliness; Risk for loneliness; Social isolation.
Q-20. Explain the concept of health: definitions, models and dimensions.
The World Health Organization (1948) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The concept is further developed in Part 4 (Unit IV).
| Model | Meaning |
|---|---|
| Clinical model | Health is absence of disease |
| Role-performance model | Health is the ability to fulfil social roles |
| Adaptive model | Health is the ability to adapt to change and stress |
| Eudaimonistic (Smith) | Health is exuberant well-being and self-actualization |
| Health–illness continuum (Dunn’s high-level wellness) | Health and illness are positions on a continuum from peak wellness to death |
Dimensions of health
- Physical, emotional, intellectual, social, spiritual, occupational and environmental.
Determinants
Genetics, behaviour and lifestyle, environment, income and education, social support, culture, and health services (social determinants of health).
Q-21. How are these concepts related in nursing practice? Solve the case studies (made up).
| Concept | Related concepts | Common nursing response |
|---|---|---|
| Hope | Spirituality, caring, loss | Presence, goal setting, support |
| Hopelessness | Powerlessness, loneliness, depression | Suicide risk assessment, listening, refer |
| Powerlessness | Anxiety, hospitalization, dependence | Information, choices, participation |
| Loneliness | Aging, grief, social isolation | Contact, community, treat depression |
| Anxiety | Hope, powerlessness | Calm, information, relaxation |
Case 1. A 70-year-old widow admitted with a hip fracture refuses to eat, says “there is no point,” and has no visitors. Which nursing diagnoses apply?
Answer: Hopelessness, Loneliness or Social isolation, Risk for suicide (assess), Imbalanced nutrition, and perhaps Grieving. Assess mood and suicide risk, spend time with her, encourage visits from family and religious community, and involve the team and the dietitian.
Case 2. A man newly diagnosed with cancer says: “It cannot be true. The report is wrong.” Which stage of grief is this? What should the nurse do?
Answer: Denial. Do not argue; listen, stay present, provide honest information in small amounts, support him and his family, and assess readiness for more information.
Case 3. A patient on prolonged bed rest says: “Nobody asks me anything; I just do what I am told.” Name the problem and plan two interventions.
Answer: Powerlessness. Offer choices in daily care and explain the plan and goals; involve him in setting daily targets.
Case 4. Before surgery, a young woman is restless, asks the same questions repeatedly and has a pulse of 110. What is the nursing diagnosis and the first intervention?
Answer: Anxiety (moderate to severe). Stay with her, speak calmly, explain the procedure simply, teach slow breathing, and report to the team.
Q-22. Write the importance of this unit for a Post RN BSN nurse.
- Theory gives a framework for the nursing process, care plans and research.
- Understanding hope, anxiety, loss, caring, spirituality, powerlessness and loneliness helps nurses to give holistic, person-centred care.
- These concepts are the basis of the nursing diagnoses used in later units (Gordon’s patterns).
- Theories and concepts help nurses to communicate and defend their practice.
Conclusion: Nursing theories organize knowledge, and concepts such as hope, loss and caring turn that knowledge into compassionate, person-centred care.
Suggested references (see the syllabus page for its own reading list): Gordon, M. Manual of Nursing Diagnosis (Functional Health Patterns; latest edition). Jones & Bartlett / Elsevier.
Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification (current edition). Thieme.
Potter, P. A., & Perry, A. G. Fundamentals of Nursing (latest edition). Elsevier.
Smeltzer, S. C., & Bare, B. G. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (latest edition). Lippincott.
Kozier, B., Erb, G., et al. Fundamentals of Nursing (latest edition). Pearson.
Source syllabus: Post RN BSN Nursing ACN-I Course (course syllabus) (original post dated April 12, 2019).
Series (Advanced Concepts in Nursing I, Course No. 701): Part 1: Unit I – Nursing Process and Diagnoses. Part 2: Unit II – Theoretical Frameworks. Part 3: Unit III – Functional Health Patterns. Part 4: Unit IV – Health Perception and Health Management. Part 5: Unit V – Nutritional-Metabolic Pattern. Part 6: Unit VI – Elimination Pattern. Part 7: Units VII–VIII – Activity-Exercise and Coping-Stress. Part 8: Units IX–X – Sleep-Rest and Sexuality-Reproduction. Part 9: Units XI–XII – Role Relationships and Pain. Part 10: Units XIII–XIV – Self-Perception and Values-Beliefs. Part 11: Clinical Objectives. Part 12: Learning Advanced Nursing Concepts – facts, skills, uses, benefits and hurdles.
Independent educational resource: POST RN BSN Nursing Resources is not affiliated with, endorsed by or an official publication of LUMHS or PNMC. Model answers are study aids; verify against your course notes and textbooks.
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