Application of Theory to Practice

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Application of Theory to Practice

This week’s Learning Resources present information about various types of theories. For this Discussion, you will examine some of these theories and evaluate how theory is utilized in research as well as how it informs your nursing practice.

To prepare:

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  • Review the Learning Resources focusing on the different types of theories that are relevant for nursing practice.
  • Locate a scholarly article in the professional nursing literature that discusses a middle range or practice theory. Determine if the theory is descriptive, explanatory, predictive, or prescriptive in nature.
  • With this in mind, consider how nursing theory is utilized in research. For instance, how might this theory be useful for identifying a research problem?
  • Then, reflect on your nursing practice. As indicated in Chapter 2 of Theoretical Basis for Nursing, theories differ in scope—from the more abstract metatheory and grand theories to the more concrete middle range and practice theories. Brainstorm examples of how theory is applied in your nursing practice. Identify one to share in this Discussion.


By tomorrow 6/6/17, post 550 words essay in APA format with 3 references from the list below, that include the level one heading as numbered below:


post

a cohesive response that addresses the following:

1)      Summarize your selected article, identifying the middle range or practice theory utilized, and explaining whether the theory was descriptive, explanatory, predictive, or prescriptive. (Include the APA citation for the article.) (SEE ATTACHED PDF)

2)      Describe the value of theory for nursing research.

Be specific

.

3)      Share an example of how theory is applied in your nursing practice.


Required Readings


McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

Chapter 2, “Overview of Theory in Nursing”

Chapter 2 presents the evolution of nursing theory and examines the different types of theories that serve as a foundation for nursing practice.


Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

Chapter 5, “Research Problem and Purpose”

Chapter 5 explores a process for identifying, selecting, and refining research topics and articulating the purpose of the research.


Algase, D. (2009). The centrality of theoretical thinking and the value of empirical evidence. Research & Theory for Nursing Practice, 23(4), 251–252. doi:10.1891/1541-6577.23.4.251

Note: You will access this article from the Walden Library databases.

This article explores the concept that humans are natural theorists along with the importance of using empirical evidence to support theories.


Gould, D, Moralejo, D., Drey, N., & Chudleigh, J. (2010). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews, (9).

Note: You will access this article from the Walden Library databases.

This systematic review examined recent hand hygiene intervention studies seeking to improve hand hygiene compliance.


Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. Journal of Nursing Administration, 36(11), 538–544.

Note: You will access this article from the Walden Library databases.

The use of Comfort Theory by a not-for-profit New England hospital to provide a coherent and consistent pattern for enhancing care and promoting professional practice when applying for Magnet Recognition Status is described in this article.


McCurry, M. K., Revell, S. M. H., & Roy, S. C. (2010). Knowledge for the good of the   individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52. doi:10.1111/j.1466-769X.2009.00423.x

Note: You will access this article from the Walden Library databases.

This article explores many facets of the social concept nursing, and how nursing contributes to the good of society. The philosophical underpinnings, perspective, goals, and application to practice of the social mandate are examined.


O’Connell, K. (2009). Theories used in nursing research on smoking cessation. Annual Review of Nursing Research, 2733–2762. doi:10.1891/0739-6686.27.33

Note: You will access this article from the Walden Library databases.

This article identifies theories, theoretical frameworks, and conceptual models that can be applied to a specific topic. In addition, the article discusses ways nurses can devise new theories through their expert knowledge of clinical issues.


Optional Resources


Brilowski, G., & Wendler, M. (2005). An evolutionary concept analysis of caring. Journal of Advanced Nursing, 50(6), 641–650.

Note: You will access this article from the Walden Library databases.


Connor, M.J. (2004). The practical discourse in philosophy and nursing: An exploration of linkages and shifts in the evolution of praxis. Nursing Philosophy, 5(1), 54–66. doi:10.1111/j.1466-769X.2004.00152.x

Note: You will access this article from the Walden Library databases.


Falk-Rafael, A. (2005). Advancing nursing theory through theory-guided practice: The emergence of a critical caring perspective. Advances in Nursing Science, 28(1), 38–49.

Note: You will access this article from the Walden Library databases.


Knight, C. M., Moule, P., & Desbottes, Z. (2000). The grid that bridges the gap. Nurse Education Today, 20(2), 116–122. doi:10.1054/nedt.1999.0374

Note: You will access this article from the Walden Library databases.Bottom of Form

Application of Theory to Practice
Costa CPV da, Luz MHBA , Bezerra AKF, Rocha SS da . Application of the nursing theo ry of Callista Roy … English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 352 ISSN: 1981 -8963 ISSN: 1981 -8963 DOI: 10.5205/reuol. 7901 -80479 -1-SP.1001sup 201622 APPLICATION OF THE NURSING THEORY OF CALLISTA ROY TO THE PATIENT WITH CEREBRAL VASCULAR ACCIDENT APLICAÇÃO DA TEORIA DE ENFERMAGEM DE CALLISTA ROY AO PACIENTE COM ACIDENTE VASCULAR CEREBRAL APLICACIÓN DE LA TEORÍA DE ENFERMERÍA DE CALLISTA ROY AL PAC IENTE CON ACCIDENTE VASCULAR CEREBRAL Cecília Passos Vaz da Costa 1, Maria Helena Barros Araújo Luz 2, Alessandra Kelly Freire Bezerra 3, Silvana Santiago da Rocha 4 ABSTRACT Objective: reporting the experience of application of the nursing process implemented in the light of the Theory of Adaptation of Callista Roy to a patient with stroke. Method: a descriptive study of type experience report, resulting from the application of the nursing process to a patient admitted in a neurological clinic of an emergency hospital in the city of Teresina, Piaui, in 2013. Results: showed itself 15 nursing diagnoses listed based on the taxonomy of the North American Nursing Diagnosis Association International and to establish interventions and nursing results there was used r espectively the Classification of Nursing Interventions and the Classification and Nursing Outcomes. Conclusion: facing the findings, Roy’s theory contributed to nursing care to patients affected by this pathology by giving importance to the stimuli that trigger responses which require the adaptation of the patient. Descriptors: Stroke; Nursing Theory; Nursing Care. RESUMO Objetivo : relatar a experiência da aplicação do processo de enfermagem implementado à luz da Teoria da Adaptação de Callista Roy a uma p aciente com acidente vascular cerebral. Método : estudo descritivo, tipo relato de experiência, resultante da aplicação do processo de enfermagem a uma paciente internada em uma clínica neurológica de um hospital de urgência do município de Teresina, Piauí no ano de 2013. Resultados : evidenciaram -se 15 diagnósticos de enfermagem elencados com base na taxonomia da North American Nursing Diagnoses Association International e para estabelecer as intervenções e resultados de enfermagem utilizou -se respectivament e a Classificação das Intervenções de Enfermagem e a Classificação dos Resultados de Enfermagem. Conclusão : diante dos achados, a teoria de Roy contribuiu com o cuidado de enfermagem a paciente acometida por tal patologia ao dar importância aos estímulos q ue desencadeiam respostas, as quais exigem a adaptação da paciente. Descritores : Acidente Vascular Cerebral; Teoria de Enfermagem; Cuidados de Enfermagem. RESUMEN Objetivo: presentar la experiencia de la aplicación del proceso de enfermería aplicado a la luz de la Teoría de Adaptación de Callista Roy a un paciente con ictus. Método: un estudio descriptivo del tipo relato de experiencia, resultante de la aplicación del proceso de enfermería a una paciente ingresada en una clínica neurológica de un hospital de emergencia en la ciudad de Teresina, Piauí, en 2013. Resultados: se presentaron 15 diagnósticos de enfermería enumerados basados en la taxonomía de la North American Nursing Diagnoses Association International y para establecer las intervenciones y resu ltados de enfermería se utilizan, respectivamente, la Clasificación de Intervenciones de Enfermería y la Clasificación de los Resultados de Enfermería. Conclusión: en los resultados, la teoría de Roy contribuyó a los cuidados de enfermería a los pacientes afectados por esta patología, dando importancia a los estímulos que desencadenan respuestas que requieran la adaptación del paciente. Descriptores: Accidente Cerebrovascular; Teoría de Enfermería; Cuidados de Enfermería. 1Nurse, Master’s Student, Nursing P ostgraduate Program, Federal University of Piaui/PPGENF/UFPI. Teresina (PI), Brazil. Email: [email protected] ; 2Nurse, Master’s Student, Nursing Postgraduate Program, Federal University of Piaui/ PPGENF/UFPI. Teresina (PI), Brazil. Email: [email protected] ; 3Nurse, Master’s Student, Nursing Postgraduate Program, Federal University of Piaui. Teresina (PI), Brazil. Email: [email protected] ; 4Nurse, Professor of Nursing, Nursing Postgraduate Program, Federal University of Piaui/PPGENF/UFPI. Teresina (PI), Brazil. Email: [email protected] CASE REPORT ARTICLE Costa CPV da, Luz MHBA , Bezerra AKF, Rocha SS da . Application of the nu rsing theory of Callista Roy … English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 353 ISSN: 1981 -8963 ISSN: 1981 -8963 DOI: 10.5205/reuol. 7901 -80479 -1-SP.1001sup 201622 Through the view of the World Health Organization the patient affected by a chronic disease, such as stroke (CVA), needs planned care able to meet his basic needs and provide integrated care, in addition, this conditi on requires that the same reorganize his daily life, in order to find new ways of relating to life. 1 As the base of nursing process, Nursing offers theories or conceptual models consisting of an organization of central concepts of the profession in an orde rly and scientific way to direct data collection, identification of changes in the clinical condition of the patient, the nursing interventions and evaluation of the results. Among these, it emphasizes the conceptual model of the proposed adaptation by Cal lista Roy, which includes the notion of stimuli and responses. The appearance of stimuli takes the need for part of the individual responses for coping mechanisms that are triggered which are processed through two subsystems defined as regulator and knowin g. That may be chemical, neural and endocrine, already recognizing that the subsystem is related to higher brain functions of perception, emotion or judgment processing of information. 2-3 The resulting behaviors of these subsystems are observed from four a daptive modes. In physiological way the person responds like a physical environmental incentives and involves five basic needs of physiological integrity (oxygenation, nutrition, elimination, activity and rest, and protection) and four complex processes (s ensory, fluid and electrolytes, neurological function and function endocrine). The self -mode focuses on the psychological and spiritual aspects of a person and includes self -physical (includes sensation and body image) and self -personnel (includes self – con sistency, self -ideal and self -ethical -moral – spiritual). 2-4 But the function mode/ role performance focuses on the social aspects related to the roles that one occupies in society and finally the interdependence so that is related to emotional fitness as wel l as to holders of systems, receptive behavior and contribution of behavior identified the patterns of human value, affection, love and affirmation. 2-4 The nursing process should not be seized or held for a mere fulfillment of tasks, as this methodological tool scientifically underpins the profession knowledge, allows to develop effective assistance focused on patient safety and provides the identification of individual and collective needs under a holistic and critical view. 5-6 The nursing process compri ses phases which vary according to nursing theory adopted. The elements of Roy nursing process include: research behavior, research stimuli, nursing diagnosis, goal setting, intervention and evaluation. The first element consists of collecting answers or t he person’s behavior in relation to each of the adaptive modes. The second involves the identification of focal, contextual and residual stimuli that are influencing behaviors. The third element of the process is the identification of nursing diagnoses, wh ich reflects the nurse’s judgment on the level of adaptation of the person. 4, 7 The fourth element includes goal setting, time the nurse lists the resulting behaviors of nursing care. The fifth is for the planning of interventions that should be selected according to pre -established goals, aiming to promote adaptation by stimulating change. Finally, evaluation, it is believed that the effectiveness of nursing intervention is related to human behavior adaptation. 4,7 By analysis of Callista Roy adaptation nur sing theory, sees it a theoretical framework for the development of care for people with chronic diseases which need to go through a process of adaptation to the new conditions of health and disease, among these the affected by stroke, as this condition creates stimuli that the patient requires an adaptive response. Given the above, the objective of this study is to reporting the experience of the application of the nursing process implemented in the light of the Theory of Adaptation of Callista Roy to a pa tient affected by stroke. This is a descriptive study of type experience report, resulting from the application of the nursing process mediated by the Nursing Theory of Adaptation of Callista Roy to a hospitalized patient in Ju ne, 2013, in a neurological clinic of an emergency hospital in the city of Teresina, Piaui. To implement the first phase of the nursing process there was drawn up an interview script with the intention of guiding the research and behavioral stimuli (Append ix A). After behavioral and stimulation research nursing diagnoses were established, using as basis the taxonomy of the North American Nursing Diagnosis Association International (NANDA -I).8 The process of preparing and inference of nursing diagnoses follo wed the steps recommended by the reasoning of METHOD INTRODUCTION Costa CPV da, Luz MHBA , Bezerra AKF, Rocha SS da . Application of the nu rsing theory of Callista Roy … English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 354 ISSN: 1981 -8963 ISSN: 1981 -8963 DOI: 10.5205/reuol. 7901 -80479 -1-SP.1001sup 201622 Risner, namely: categorization of data, identification of data gaps, clusters of relevant data, comparison between the groups with normal patterns, inferences and propositions of etiological relations. 9 Then it set up goals and interventions needed to promote better adaptive response. The nursing interventions were defined according to the Nursing Interventions Classification (NIC) 10 and are shown in Table 1 with its specific code for each intervention with four digits. For the results we used the taxonomy Nursing Outcomes Classification (NOC) 11 identifying the result with their respective specific code, and finally there was the evaluation of the implemented actions. The application of the Roy Adaptation Model allowed identify commitment in the following components of the physiological mode: oxygenation, protection, nutrition, activity and rest, senses and neurological function. In the oxygen component it showed up the following nursi ng diagnoses according to NANDA -I: ineffective breathing pattern manifested by tachypnea defining characteristics and dyspnea, ineffective airway clearance manifested by ineffective cough, tachypnea, and dyspnea and risk of ineffective cardiac tissue perfu sion. For the diagnosis of ineffective breathing pattern nursing interventions were: respiratory monitoring, monitoring of vital signs and respiratory control with the following activities: monitoring frequency, pace, depth and effort of breaths, listen br eath sounds, monitor diaphragmatic muscle fatigue, monitor and record temperature, pulse, blood pressure and breathing pattern. Interventions facing the diagnosis of ineffective airway clearance were: listen breath sounds, vacuum when necessary, place the patient in order to maximize breathing, encourage slow, deep breathing and guide and encourage the patient to cough after inhaling and exhaling deeply. For the diagnosis of cardiac tissue perfusion ineffective risk interventions were listen heart sounds an d administering antihypertensive medication, according to prescription. As adaptive problems of the protection component, there are the nursing diagnoses, namely: impaired tissue integrity, impaired skin integrity, which were listed by the patient develops pressure ulcers (UPP) Grade III sacral area and UPP grade II calcaneus region and the diagnosis of impaired oral mucosa, and infection risk. Interventions for the care of UPP were to describe the ulcer features, monitor the color, temperature, edema moist ure and appearance of the skin around, monitor wound infection signs, perform changing positions of 2 in 2 hours, advise mattress use appropriate, guide staff and conduct healing of the wound. The activities for the intervention of oral health maintenance guide were doing oral hygiene after meals and whenever necessary and guide brush of their teeth, gums and tongue. For the restoration of intervention of oral health activities consisted of guiding the use of brush with soft bristles and monitor lesions on the lips and mucous membranes. For the diagnosis of infection risk interventions were: monitor site of venipuncture, exchange peripheral access where necessary and monitor systemic signs and symptoms and infection sites. In the nutrition component there wa s detected the nursing diagnosis of impaired dentition related to ineffective oral hygiene evidenced by loss of teeth and halitosis. Interventions for these diagnoses were the same as diagnosis of impaired oral mucosa. The physical mobility nursing diagnos es related to impaired neuromuscular impairment evidenced by hemiplegia and disturbed sleep pattern related to environmental changes evidenced by reports of trouble sleeping and staying asleep were listed as adaptive problems of the physiological mode on t heir activity component and rest. Nursing interventions prescribed for the diagnosis of impaired physical mobility were neurological positioning and therapy exercises with the following activities: avoid applying pressure on the affected side of the body, supporting the affected body part, hold stimuli and passive exercises on the affected side, guide family to monitor the realization of exercise and physical therapy forward. For intervention improves sleep has prescribed the following activities: monitor sleep patterns and the amount of hours slept, discouraging daytime sleep and provide comfort measures while sleeping. As the adaptive problem senses component found that the impaired verbal communication and diagnostics risk of falls. The activities for com munication improvement intervention were listening, encouraging the patient to repeat words, offer positive reinforcement and support, when necessary, to maintain dialogue with the patient, encourage the patient to talk slowly and observe nonverbal clues. For diagnosing EXPERIENCE REPORTS Costa CPV da, Luz MHBA , Bezerra AKF, Rocha SS da . Application of the nu rsing theory of Callista Roy … English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 355 ISSN: 1981 -8963 ISSN: 1981 -8963 DOI: 10.5205/reuol. 7901 -80479 -1-SP.1001sup 201622 risk of falls, interventions were guiding on the use of assistive devices and guide the patient to call help when jogging. The last mode of the physiological adaptive problem was identified in neurological function component with the nursing diagnosis risk of inefficient brain tissue perfusion. Although the patient be affected by a condition in the neurological system, found only a nursing diagnosis in the component neurological function, this fact can be explained because the neurological fu nction is configured as a component of the hardest physiological mode analysis due to the condition of relationship between this complex process and the other components of the physiological mode. 3 Interventions for diagnosis of neurological function compo nent were: monitor the size, shape, symmetry and reactivity of pupils, monitor level of awareness and guidance, applying the Glasgow coma scale, observe headache complaints, monitor speaks characteristics and monitor the presence of signs and symptoms of i ncreased intracranial pressure. In so self -evident that the adaptive problem in self -staff component formed by anxiety as nursing diagnosis. The interventions were outlined using a calm and safe approach, explain the procedures to be performed and encourag e the patient to verbalize feelings. The last way in which it showed an adaptive problem was the role of performance mode which nursing diagnosis raised was ineffective control of the therapeutic regimen. The activities for the nutrition counseling interve ntion were to identify the behaviors to be changed, provide information to diet modification and discuss preferences and food which the patient does not like. For behavior modification intervention activities were encouraging the replacement of undesirable habits by desirable habits, discussing the process of change with the patient and caregiver and promote family involvement in the change process. The last step of the nursing process, as Callista Roy, is the evaluation in which the nurse questions and wea ves judgment about the achievement of objectives in the process of adaptation by which the individual passes. After 3 days of use of the nursing process based on Roy’s theory in patient care it will found that interventions have allowed changes in decrease d anxiety with positive patient discourse and planning for execution of daily life activities after hospital discharge configurating itself change in strategy planning indicator is inserted into the nursing outcome “self -anxiety.” To the result of level of anxiety became evident change in the indicator improved in the pattern of sleep and rest of patients with nocturnal sleep improvement report allowing adaptation of the patient to self -concept mode and activity and rest. The physiological mode results achi eved for the diagnosis of oral hygiene with an improvement in halitosis indicator and the inefficient respiratory pattern diagnosis and ineffective airway clearance with changes in respiratory rate indicators and dyspnea at rest and the result of vital sig ns there was change in respiratory rate indicator. The mode of performance was a result of knowledge and control of hypertension with changes in control benefits indicators of the disease and strategies to improve adherence to diet and result of family sup port during treatment with change in the collaboration window with family sick in determining the care and information request indicator. The other results listed in Figure 1 represent the expected results compared to the listed diagnoses and nursing inter ventions. Costa CPV da, Luz MHBA , Bezerra AKF, Rocha SS da . Application of the nu rsing theory of Callista Roy … English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 356 ISSN: 1981 -8963 ISSN: 1981 -8963 DOI: 10.5205/reuol. 7901 -80479 -1-SP.1001sup 201622 Component Mode of Adaptation Nursing diagnosis (NANDA -I) Nursing intervention (NIC) -Code of NIC Nursing results (NOC) Physiological Oxygenation Ineffective breathing pattern related to hyperventilation manifested b y tachypnea and dyspnea Respiratory monitoring (3350). Monitoring of vital signs (6680). Airway control (3140). Respiratory status (0415). Vital signs (0802). Oxygenation Ineffective airway clearance related to neuromuscular dysfunction and smoking shown by ineffective cough, tachypnea and dyspnea. Respiratory monitoring (3350). Airway control (3140). Stimulus to cough (3250) Respiratory status: airway permeability (0410). Respiratory status: ventilation (0403). Oxygenation Risk of cardiac tissu e perfusion related to decreased hypertension and hyperlipidemia. Monitoring of vital signs (6680). Tissue: cardiac perfusion (0405). Vital signs (0802). Protection Impaired tissue integrity related to impaired mobility, decreased dermal vascularizat ion secondary to ageing and moisture evidenced by grade III pressure ulcer on sacral region. Caring for pressure ulcers (3520). Wound healing: second intention (1103). Tissue integrity: skin and mucous membranes (1101). Physiological Protectio n Impaired skin integrity related to motor deficit, impaired mobility and decreased Vascularity secondary dermal aging evidenced by grade II pressure ulcer in calcaneal region. Caring for pressure ulcers (3520). Wound healing: second intention (1103). Tiss ue integrity: skin and mucous membranes (1101). Protection The oral mucosa impaired related to ineffective oral hygiene evidenced by tongue coated, oral lesion and halitosis. Maintenance of oral health (1710). Restoration of oral health (1730) Oral hygi ene (1100). Protection Risk of infection related to invasive procedures. Protection against infection (6550) Risk control: infectious process (1924). Nutrition Impaired dentition related to ineffective oral hygiene evidenced by loss of teeth and halito sis. Maintenance of oral health (1710). Restoration of oral health (1730). Oral hygiene (1100). Activity and rest Impaired physical mobility related to neuromuscular impairment evidenced by hemiplegia. Neurological positioning (0844). Exercise therapy: j oint mobility (0224). Body mechanics performance (1616). Mobility (0208). Physiological Activity and rest Disturbed sleep pattern related to environmental changes, evidenced by reports of difficulty to sleep and stay asleep. Sleep improvement (185 0). Sleep (0004). Senses Impaired verbal communication related to changes in the central nervous system, manifested by dysarthria. Improvement of communication: speech deficit (4976). Listen actively (4920). Communication (0902). Communication: express ion (0903). Senses Risk of falls related to impaired physical mobility. Prevention of falls (6490). Risk control (1902). Care with the affected side (0918). Neurological Function Risk of cerebral tissue perfusion ineffective related to cerebral aneurys m and hypertension. Neurological monitoring (2620). Monitoring of vital signs (6680). Tissue perfusion: cerebral (0406). Neurological State (0909). Self -concept Self -personal Disease -related anxiety manifested by crying and insomnia. Anxiety reduction (58 20). Level of anxiety (1211). Anxiety self -control (1402). Role performance Ineffective therapeutic regimen related control the complexity of the treatment regimen indicated for failure to take action to reduce risk factors. Nutritional counseling (5246) . Behavior modification (4360). Knowledge: control of hypertension (1837). Family support during treatment (2609). Figure 1. Diagnoses, interventions and outcomes of nursing for a patient with STROKE according to the Adaptive Model of Roy. Teresina -PI, 20 14. Santos FS, Arruda AJCG de, Vasconcelos JMB . Aplicab ilidade do código de ética nas ações… English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 357 ISSN: 1981 -8963 ISSN: 19 81-8963 DOI: 10.5205/reuol. 8423 -73529 -1-RV1001 201 601 The grounded nursing process in Roy’s theory contributed to effective nursing care to patients affected by stroke to give importance to the stimuli that trigger responses which require the adaptation of the patient. Befor e long the patient has demonstrated adaptive behaviors with regard to diagnosis of oral hygiene, ineffective breathing pattern, and ineffective airway pattern of sleep and rest, anxiety and ineffective control of the therapeutic regimen. In view of this is salutary that care implemented resulting from the nursing process based on the theoretical model of Roy and the use of NANDA -I taxonomy, NIC and NOC allowed direct the activities to adaptive problems contributing to the adaptation of the patient, and prov ide scientific nature to care practice with consequent empowering care by nurses. Therefore, the experience raises the need to use a conceptual framework in nursing care. 1. Organização Mundial de Saúde. Cuidados inovadores para c ondições crônicas: componentes estruturais de ação. Relatório mundial. Organização Mundial da Saúde. Brasília, 2003 [Internet]. [cited 2013 July 5]. Available from: http://www. who.int/chp/knowledge/publicat ions/icccportuguese.pdf 2. Roy C, Andrews HA. The Roy adaptation model. Stamford: Appleton e Lange; 1999. 3. Lopes MVO, Araújo TL, Rodrigues DP. A relação entre os modos adaptativos de ROY e a taxonomia de diagnósticos de enfermag em da NANDA. Rev Latino -Am Enfermagem [Internet]. 1999; [cited 2013 July 12];7(4):97 – 104. Available from: http://www.scielo.br/scielo.php?script=sci_ ar ttext&pid=S0104 – 11691999000400013&lng=en&nrm=iso 4. George JB. Teorias de enfermagem: os fundamentos à prática profissional. Porto Alegre: Artes Médicas; 2000. 5. Pereira CFD, Tourinho FS V, Miranda FAN, Medeiros SM. Ensino do processo de enfermagem: análise c ontextual. J Nurs UFPE on line [Internet]. 2014 [cited 2014 Mar 15];8(3):757 -64. Available from: http://www.revista.ufpe.br/revistaenfermage m/index.php/revista/ar ticle/view/5473 6. Freitas NF, Tannure MC, Chianca TCM. Implementation of nursing process in a neonatal intensive care unit of Belo Horizonte. J Nurs UFPE on line [Internet]. 2010 [cited 2014 Jan 10];4(esp): 1287 -293 . Available from: http://www.revista.ufpe.br/revistaenfermage m/index.php/revista/article/view/1053/pdf_ 94 7. Coelho SMS, Mendes IMDM. Da pesquisa à prática de enfermagem aplicando o modelo de adaptaçã o de Roy. Esc Anna Nery [Internet]. 2011 Dec [ cited 2013 July 11 ];15(4):845 -50. Available from: http://www.scielo.br/scielo.php?script=sci_ar ttext&pi d=S1414 – 81452011000400026&lng=en&nrm=iso 8. North American Nursing Diagnosis Association International (NANDA -I). Diagnóstico de enfermagem da NANDA: definições e classificação – 2012 -2014. Porto Alegre: Artmed; 2013. 9. Risner PB. Diagnosis: analysis and synth esis of data. In: Griffith -Kenney JW, Christensen PJ. Nursing Process application of theories, frameworks, and models. 2nd ed. St. Louis Mosby; 1986 10. Buthcher H, Bulechek GM. Classificação das Intervenções de Enfermagem (NIC). 3 ed. Porto Alegre: Artmed; 20 04. 11. Moorhead S, Johnson M, Maas M. Classificação dos resultados de enfermagem (NOC). 4th ed. Rio de Janeiro: Elsevier; 2010. REFERENCE S FINAL REMARKS Santos FS, Arruda AJCG de, Vasconcelos JMB . Aplicab ilidade do código de ética nas ações… English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 358 ISSN: 1981 -8963 ISSN: 19 81-8963 DOI: 10.5205/reuol. 8423 -73529 -1-RV1001 201 601 GUIDE FOR BEHAVIORAL AND STIMULUS RESEARCH Name: ____________________________ _______________________ Birthdate: ________________ Age: _____________________ Gender: ( ) Male ( ) Female Skin color: ( ) White ( ) Black ( ) Yellow ( ) Maroon Marital status: ( ) Married ( ) Single ( ) Widower/Wi dow ( ) Separated ( ) Stable union Schooling: ( ) Illiterate ( ) Incomplete elementary school ( ) Complete elementary school ( ) Incomplete high school ( ) Complete high school ( ) Incomplete higher education ( ) Complete higher education Occupation: ______________________________________________________ Address: _______________________________________________________ City: ________________________ State: _________________________ Date of admission: ___________________ Or igin: Home Hospital Other: ________________ Nursing: ________________ Bed: _________________ 2 PHYSIOLOGICAL MODES 2.1 OXIGENATION 2.1.1 Breath Breath: ( ) Spontaneous ( ) Nasal catheter ( ) Mask Chest: ( ) Flat ( ) Cask or Barrel ( ) Funnel -shaped ( ) Carinate Other: ___________________________ Respiratory frequency: __________ respiratory movements per minute Respiratory auscultation: ( ) Adventitious noise absent ( ) Adventitious noi ses present: ( ) Snoring ( ) Ping ( ) Rattle Other: _________ Cough: ( ) No ( ) Yes: ( ) Nonproductive ( ) Productive 2.2.2 Circulation Blood pressure: ___________mmHg Heart frequency: ______bpm Pulse: ( ) Regular ( ) Irregular ( ) Thready ( ) Full ( ) Impalpable Capillary filling time: ________seconds The presence of edema: ( ) No ( ) Yes: ( ) MMSS ( ) MMII Other: ____________ 2.2 NUTRITION AND ELIMINATION Diet: ( ) Oral ( ) SNG ( ) SNE ( ) Parenteral Dentition: ( ) Absence of teeth ( ) Loss of teeth ( ) Presence of teeth Oral mucosa: ( ) Full ( ) With lesions Oral hygiene: ( ) Unsatisfactory ( ) Satisfactory Abdomen: ( ) Flat ( ) Gl obulous ( ) Distended ( ) Flaccid ( ) Painful on palpation Fluid intake per day: ( ) less than 5 glasses ( ) 5 -10 glasses ( ) more than 10 glasses Number of meals a day: ( ) less than 3 meals ( ) between 3 -5 meals ( ) mo re than 5 meals Weight: ______kg Height: _____m BMI: _________ Bowel sounds: ( ) Absent ( ) Present ( ) Increased ( ) Diminished Nausea: ( ) No ( ) Yes Vomiting: ( ) No ( ) Yes Dyspepsia: ( ) No ( ) Yes Diarrhea: ( ) No ( ) Yes Frequency of defecation: __________times per week APPENDIX Santos FS, Arruda AJCG de, Vasconcelos JMB . Aplicab ilidade do código de ética nas ações… English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 359 ISSN: 1981 -8963 ISSN: 19 81-8963 DOI: 10.5205/reuol. 8423 -73529 -1-RV1001 201 601 Date of the last defecation: _______________ Urinary elimination: ( ) Spontaneous ( ) SVD ( ) Urinary device ( ) Urinary retention ( ) Urinary incontinence ( ) Dysuria ( ) Hematuria ( ) Anuria ( ) Oliguria Urinary volume: __________ 2.3 Activity/rest and protection, and four complex processes (sensitive, liquid and electrolytes, neurological func tion and endocrine function). Sleep: ( ) Increased ( ) Diminished ( ) Without complaints Sleep on the day shift: ( ) No ( ) Yes: _________hours Mobility: ( ) Not changed ( ) Changed: __________________________ Muco us membranes: ( ) Normochromic ( ) Hypochromic _____/4+ ( ) Icteric Eyes: ( ) Jaundice ( ) Eyelid edema Other: ______________ Skin : ( ) Normal ( ) Cyanosis ( ) Jaundice ( ) Pallor Wound: ( ) No ( ) Yes Loc al: ________________________________ Dimensions: ______________________________________________________ CLASSIFICATION: The wound: ( ) Closed ( ) Open ( ) Chronic ( ) Acute The tissue: ( ) Necrosis ( ) M ortifi cation of tissues ( ) Granulation ( ) Epithelialization The exudate: ( ) Serous ( ) Sanguineous ( ) Purulent ( ) Fibrinous exudation Quantity of the exudate: ( ) Small ( ) Moderate ( ) Intense ( ) Abund ant Odor: ( ) Odorless ( ) Fetid Recommended therapy for wound treatment: _______________________________________________________________ 2.4 NEUROLOGICAL FUNCTION Glasgow Coma Scale: Eye Opening: ______ Verbal answer: __________ Mo tor answer: ________ Pupils : ( ) Equal ( ) Anisocoric ( ) Miosis on the right ( ) Miosis on the left ( ) Mydriasis on the right ( ) Mydriasis on the left Conscious: ( ) Yes ( ) No Guided: ( ) Yes ( ) No 3. What do you know about your present illness? _______________________________________________________________ 4. Important complaints: ______________________________________________________________________________________ _________________________ _____________________________________________________________ _________________ VITAL SIGNS: T: _______ P: _________ R: _________ PA: _______ IMPORTANT LABORATORY DATA: ______________________________________________________________________ ________________ ______________________________________________________________________________________ ________________ ________________________________________________ SIGNATURE Santos FS, Arruda AJCG de, Vasconcelos JMB . Aplicab ilidade do código de ética nas ações… English /Portuguese J Nurs UFPE on line., Recife, 10(Suppl. 1):352 -60, Jan., 2016 360 ISSN: 1981 -8963 ISSN: 19 81-8963 DOI: 10.5205/reuol. 8423 -73529 -1-RV1001 201 601 Submission: 04 /0 7/2015 Accepted: 25/07/2015 Published: 01 /01/ 20 16 Cor respondence Address Cecília Passos Vaz da Costa Avenida Centenário, 3052 Bairro Aeroporto CEP 64003 -700  Teresina (PI), Brazil Copyright ofJournal ofNursing UFPE/Revista deEnfermagem UFPEisthe property of Revista deEnfermagem UFPEanditscontent maynotbecopied oremailed tomultiple sites or posted toalistserv without thecopyright holder’sexpresswrittenpermission. However, users mayprint, download, oremail articles forindividual use.

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