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Client systems

الكلية كلية التمريض     القسم قسم التمريض العام     المرحلة 4
أستاذ المادة سلمى كاظم جهاد الابراهيمي       13/11/2016 07:44:32
Unit 3: Client systems

Client
The concept of client (or patient) is central to all nursing models because it is the client who is the
primary recipient of nursing care. Although the term client usually refers to a single individual, it
can also refer to small groups or to a large collective of individuals (e.g., for community health nurses, the community is the client).

Betty Neuman s System Model:
The Neuman Systems Model views the client as an open system that responds to stressors in the environment. The client variables are physiological, psychological, Sociocultural, developmental, and spiritual. The client system consists of a basic or core structure that is protected by lines of resistance. The usual level of health is identified as the normal line of defense that is protected by a flexible line of defense. Stressors are intra-, inter-, and Extrapersonal in nature and arise from the internal, external, and created environments. When stressors break through the flexible line of defense, the system is invaded and the lines of resistance are activated and the system is described as moving into illness on a wellness-illness continuum. If adequate energy is available, the system will be reconstituted with the normal line of defense restored at, below, or above its previous level.
Nursing interventions occur through three prevention modalities. Primary prevention occurs before the stressor invades the system; secondary prevention occurs after the system has reacted to an invading stressor; and tertiary prevention occurs after the system has reacted to an invading stressor; and tertiary prevention occurs after secondary prevention as reconstitution is being established.
Major Concepts
Human being is viewed as an open system that interacts with both internal and external environment forces or stressors. The human is in constant change, moving toward a dynamic state of system stability or toward illness of varying degrees.

The environment is a vital arena that is germane to the system and its function. The environment may be viewed as all factors that affect and are affected by the system.

The internal environment exists within the client system. All forces and interactive influences that are solely within boundaries of the client system make up this environment.

The external environment exists outside the client system.
Health is defined as the condition or degree of system stability and is viewed as a continuum from wellness to illness. When system needs are met, optimal wellness exists. When needs are not satisfied, illness exists. When the energy needed to support life is not available, death occurs.
The primary concern of nursing is to define the appropriate action in situations that are stress-related or in relation to possible reactions of the client or client system to stressors. Nursing interventions are aimed at helping the system adapt or adjust and to retain, restore, or maintain some degree of stability between and among the client system variables and environmental stressors with a focus on conserving energy.



Open System

A system in which there is a continuous flow of input and process, output and feedback. It is a system of organized complexity, where all elements are in interaction.



Basic Stricture and Energy Resources

The basic structure, or central core, is made up of those basic survival factors common to the species. These factors include the system variables, genetic features, and strengths and weaknesses of the system parts.

Client variables

Newman views the individual client holistically and considers the variables simultaneously and comprehensively.

The physiological variable refers to the structure and functions of the body.

The psychological variable refers to mental processes and relationships.

The Sociocultural variable refers to system functions that relate to social and cultural expectations and activities.

The developmental variable refers to those processes related to development over the lifespan.

The spiritual variable refers to the influence of spiritual beliefs.

Flexible line of defense

A protective accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors.

Normal line of defense

An adaptational level of health developed over time and considered normal for a particular individual client or system; it becomes a standard for wellness-deviance determination.

Lines of resistance

Protection factors activated when stressors have penetrated the normal line of defense, causing a reaction symptomatology. (Neuman, 1995) Subconcepts
Stressors

A stressor is any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either a positive or negative outcome.

Intrapersonal stressors are those that occur within the client system boundary and correlate with the internal environment.

Interpersonal stressors occur outside the client system boundary, are proximal to the system, and have an impact to the system.

Extrapersonal stressors also occur outside the client system boundaries but are at a greater distance from the system than are interpersonal stressors. An example is social policy.

Stability

A state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.

Degree of Reaction

The amount of system instability resulting from stressor invasion of the normal line of defense.

Entropy

A process of energy depletion(weakness) and disorganization moving the system toward illness or possible death.


Input/output

The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time.

Reconstitution

The return and maintenance of system stability, following treatment of stressor reaction, which may result in a higher or lower level of wellness.

Prevention as intervention

Intervention modes for nursing action and determinants for entry of both client and nurse into the health care system.

Primary prevention occurs before the system reacts to a stressor; it includes health promotion and maintenance of wellness. Primary prevention focuses on strengthening the flexible line of defense through preventing stress and reducing risk factors. This intervention occurs when the risk or hazard is identified but before a reaction occurs. Strategies that might be used include immunization, health education, exercise, and lifestyle changes.

Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing symptoms. Secondary prevention focuses on strengthening the internal lines of resistance and, thus, protects the basic structure through appropriate treatment of symptoms. The intent is to regain optimal system stability and to conserve energy in doing so. If secondary prevention is unsuccessful and reconstitution does not occur, the basic structure will be unable to support the system and its interventions, and death will occur.

Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Its purpose is to maintain wellness or protect the client system reconstitution through supporting existing strengths and continuing to preserve energy. Tertiary prevention may begin at any point after system stability has begun to be reestablished (reconstitution has begun). Tertiary prevention tend to lead back to primary prevention. (Neuman, 1995)


Family Systems Theory
The family systems theory is a theory introduced by Dr. Murray Bowen that suggests that individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system.
The family system
According to Bowen, a family is a system in which each member had a role to play and rules to respect. Members of the system are expected to respond to each other in a certain way according to their role, which is determined by relationship agreements. Within the boundaries of the system, patterns develop as certain family member s behavior is caused by and causes other family member s behaviors in predictable ways. Maintaining the same pattern of behaviors within a system may lead to balance in the family system, but also to dysfunction. For example, if a husband is depressive and cannot pull himself together, the wife may need to take up more responsibilities to pick up the slack. The change in roles may maintain the stability in the relationship, but it may also push the family towards a different equilibrium. This new equilibrium may lead to dysfunction as the wife may not be able to maintain this overachieving role over a long period of time.
Family systems therapy
One of the best ways to begin therapy and to gain understanding of how the emotional system operates in your family system is to put together your family genogram. Studying your own patterns of behavior, and how they relate to those of your multigenerational family, reveals new and more effective options for solving problems and for changing your response to the automatic role you are expected to play.
GENERAL SYSTEMS THEORY
A widely accepted method for conceptualizing and understanding the world and what is in it derives from a systems viewpoint. Generally understood as an organized unit with a set of components that interact and affect each other, a system acts as a whole because of the interdependence of its parts.
As a result, when part of the system malfunctions or fails, it interrupts the function of the whole system rather
than affecting merely one part. The terminology and principles of systems theory pervade society.
Humans, plants, cars, governments, the health-care system, the profession of nursing, and almost anything
that exists can be viewed as a system.

Very simply, a system is defined as a set of interacting parts. The parts that compose a system may
be similar or may vary a great deal from each other, but they all have the common function of making the
system work well to achieve its overall purpose.


A school is a good example of how the dynamics and connections of a system work. A school as a system consists of several units, including buildings, administrators, teachers, students, and various other individuals (e.g., counselors, financial aid personnel, bookkeepers, and maintenance persons). Each of these individuals has a unique job but also contributes to the overall goal of the school, which is to provide an education for the students and to further the development of knowledge through research.


N u r s i n g N o w !
Today’s Issues, Tomorrow’s Trends
Seventh edition Joseph T. Catalano, PhD, RN 2015


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .