conceptual models

CONCEPTUAL MODELS


INRODUCTION
For some time nursing has based on the structure of the nursing process and nursing models. The need to for a cohesive case delivery system and assessment strategy which would meet the needs of the patient group lead to the formation of a project team to develop a model for practice. The team’s view of nursing was that it should be person-centered. The environment of the patient group had to be more than the patient'’ internal environment and the clinical area. Between 19966 and 1998, the model was piloted and evaluated. The patient-centered nature of the assessment document allows the patient to identify his or her own problems. The patient and nurse can then together negotiate a plan of care. So the patient will help to evaluate the model through ongoing evaluation of care plan goals.
NURSING MODELS
Nursing models have been used to provide systematic care delivery stemming from a desire to organize care coherently, enabling the plan of care to be used and continued by others. Prior to the introduction of nursing models, much practice was based on the mechanistic biomedical approach. It could be argued that since the introduction of nursing models, nursing practice has become more patient centered and holistic. Certainly, most nursing models allude to the concept of holism and discuss on appreciation of ‘person’ in relation to others.
Although intended as a framework for care giving, nursing models have, in practice, been used largely as an assessment on which the nursing process was founded. In particular, the assessment framework of the ‘activities of daily living’ model has been used extensively by nurses perhaps in the part due to its resemblance to the medical systems model. However, perhaps it is the case that any model becomes mechanistic if used mechanistically.
Rose (1997) describes how the nursing process is entrenched in the modernist view of the world- these be8ing an absolute truth, which can be confirmed by systematic, rationalistic observation. The wide spread uses of the nursing process has emerged from the emphasis on rationalistic research by nurses. The nursing process has provided a structure that can be used to uniformly define practice and to conduct quantitative research.
Marks-Masan (1999) describes how the nursing process was based on the assumption that nurses think in a linear and ordered manner. However, nurses obviously do not all think in the same way. Some use protocols and routine, others use a problem solving approach- both methods being evidence- based to a degree. Benner et al describes how expert nurses make decisions about care as ‘thinking-in-action’; which is said to be a process by which the nurse makes decisions based on experienced understanding of a situation, as opposed to simply following rules and protocols. Thinking-in-action is said to describe how nurses respond effectively when assumptions in practice are flavored and beliefs about care no longer felt to be true.
The Nursing Process is argued to have been a useful process by which to record rare retrospectively, but it has failed to represent the method by which nurses makes decisions about care. However, it would be impractical to detail the complex decision making process that nurse’s use in day to day practice. Care plans can only outline the main points and stages in the process. There is, there for a need for expert nurses to articulate their thinking to educate learners and novices. This can require much skill on the part of the expert, as detailing this process is difficult without making ‘leaps’.
HOLISTIC MODEL
Health care has begun to take a more holistic view of health by considering emotional and spiritual well being, as well as others dimensions of an individual, as important aspects of physical wellness. The holistic health model of nursing attempts to create conditions that promote optimal health. In this model, nurses using the nursing process consider clients the ultimate experts regarding there own health and respect client’s subjective experience as relevant in maintaining health or assisting in healing. In the holistic health model, clients are involved in their healing process, thereby assuming some responsibility for health maintenance.
Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions, such as music therapy, reminiscence, relaxation therapy, therapeutic touch and guided imagery, because thy are effective, economical, non invasive, non pharmacological complements to traditional medical care. These holistic strategies, which can be used in all stages of health and illness, are integral in the expanding role of nursing.
Most holistic therapies are easily learned and can be applied to almost any nursing setting and in all stages of health and illness. These therapies are used either alone or in conjunction with conventional medicine. For example, ‘reminiscence’ may be used in the geriatric population to help relieve anxiety for a client dealing with memory loss or for a cancer patient dealing with the difficult side effects of chemotherapy. ‘Music therapy’ may be used in the operating room to create a soothing environment. ‘Relaxation therapy’ may be useful in any setting to distract a client during a painful procedure, such as dressing change. ‘Breathing exercises’ are commonly taught to help clients deal with the pain associated with labor and delivery.
Recently there has been an increase in the number of people using alternative and complementary medical therapies. Nurses should be aware that, their clients might have previous knowledge or experience with alternative and complementary therapies and may therefor be accepting of holistic interventions. Nurses can help all clients recognize the many options available and assist them in making choices to enhance health.
MEDICAL MODEL
The medical model refers to psychiatric care that is based on the traditional physician-patient relationship. It focuses on the diagnosis of a mental illness, and subsequent treatment is based on this diagnosis. Somatic treatments including pharmacotherapy and electroconvulsive therapy, are the important parts of the treatment process.
The interpersonal aspect of the medical model varies widely, from intensive insight-oriented intervention to brief sessions involving management of medications. Many physicians like Allen Frances and Robert Spitzer.
The medical model dominates modern psychiatric care. Under this model, physicians are seen as the leaders of the team. Elements of other models of care can be used in conjunction with the medical model. For instance, a patient with schizophrenia may be treated with phenothiazine medication. This patient also may be in supportive therapy to develop adaptive social skills.
One contribution of the medical model is the continuous search for causes of mental illness using the scientific process.
HOLISTIC PSYCHIATRIC NURSING
Holistic psychiatric nursing care requires the nurse to complete an assessment of the patient’s biological, psychological and socio-cultural health status. The assessment of the patient’s psychological well0being should include a mental status examination.
The mental status examination is a corner stone in the evaluation of any patient with a medical, neurological or psychiatric disorder that affects thought, emotion or behavior. It is used to detect changes or abnormalities in a person’s intellectual functioning, thought content, judgement, mood and affect and can be used to identify possible lesions in the brain. The mental status examination is to psychiatric nursing what the physical examination to general nursing
MENTAL STATUS EXAMINATION
The mental status examination represents a cross section of the patient’s psychological life and the sum total of the nurse’s observations and impressions at the moment. It involves observing the patient’s behavior and describing it in an objective non-judgmental manner.
The examination itself is usually divided into several parts. Much of the information needed can be gathered during the course of the routine assessment. Information obtained during the mental status examination is used along with other objective and subjective data. These include findings from the physical examination, laboratory test results, patient history, description of the presenting problem, and information obtained from family, care givers and other health professionals. With these data, the nurse is able to formulate nursing diagnosis and design the plan of care with the patient

Holistic psychiatric nursing care must take into consideration, a wide range of patient characteristics in the assessment, diagnosis, treatment and recovery process. Holistic model is a mixture of everything. It includes the total care of the patient, which includes both the physical and mental aspects.
CONCLUSION
It is possible for any nursing model to be post-modern if the way care is documented reflects the way in which it was developed. If nursing documentation is to reflect more closely the way in which the decision making process occur, then the nursing process must be abandoned. Nurses should have the courage to document clearly how they came to devise a plan of care.
BIBLIOGRAPHY
1. Perry Potter; “Fundamentals of nursing”; 6th Edition; Elsevier
Publications; Page No: 93-94.
2. Stuart W Gail, Laraia T Michele; “Principles And Practice Of Psychiatric Nursing”; 8th Edition; Mosby Publications; Page No: Pp