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The theory and model of nursing for occupational health nursing developed by Shirley L. Baughn. The theory is based on the concept of man's adaptation to stress and the unique function of nursing to assist individuals in performing activities contributing to health or its recovery. The document also introduces the nursing process as a systematic approach to implementing the theory.
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Shirley L. Baughn, R.N., M.S., C.O.H.N.
Mrs. Baughn is a staff nurse at Whirlpool Corporation, Evansville, Indiana.
uring recent years nursing has been struggling to establish itself as a scientific discipline, with its own scientific body of knowledge. An important, essential factor in the growth of any discipline is the development of theory. A theory is a scientifically acceptable general principle which governs practice. A theory may also be proposed to explain observed facts. In the interval of the past few years, much has been written in the nursing literature pertaining to nursing theory, and, more basic, about nursing concepts. Concepts are necessary both to serve as a broad foundation for nursing practice and to provide a theoretical basis for research into nursing practice. All theories of nursing have underlying basic assumptions which are arrived at after considering different aspects of a specific concept The theory of nursing pursued in this study has been formu lated after seriously considering the concepts and assumptions in regard to man, stress , adaptation, nursing, and healttVweliness. Man is a biopsychosocial cuitural being who can be located at any given time somewhere along the continuum of health-illness-wellness. High-level weIIness involves a direction in progress toward a higher potential of functioning. Any concept of nursing must begin with the recipient of nursing ca re, which is man. The basic needs of man are the ingredients of high-level wellness for the individual. Man cannot live without experiencing some degree of stress all the time. Stress plays a major role in intensifying patients' actions and reactions to
Occupational Health Nursing, January 1977
environmental stimuli. Stress can be a beneficial experience whereby a patient learns ways of coping with future stressful situations. Some individuals are better equipped to cope with stress than others. According to adaptation theory, man is an organism in constant interaction with his changing environment To respond positively to environmental changes, man must adapt Man's adaptation may either decrease or increase his successful functioning as an individual. Nursing is an open system reacting with the patient and his environment The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery. The practice of clinical nursing is goa~directed, deliberatively carried out. and pat ient- centered. One of the functions of nursing is to support and promote patient adaptation. This will involve the two factors of assessment and intervention. In her assessment of the patient. the nurse will recognize his position on the health-i IIness-wellness continuum and will determine the effectiveness of the coping mechanisms which he is using to adapt to his situation. Next. the nurse will intervene appropriately to promote the patient's adaptation. Exploration of the foregoing concepts and assumptions led to the formulation of the following theory of nursing which, although developed within the framework of an industrial setting with the primary goal being to retain a healthy worker at the optimum level of health, is both general and specific enough to apply to all areas of nursing practice. Nursing is an
7
A NURSING THEORY AND MODEL FOR OCCUPATIONAL HEALTH NURSING (continued)
open system whose purpose is to assist man in adapting to stress so that he can attain, maintain, and retain a high level of weIIness. With this theory as a basis. the next step was to deve lop a mode I of nursi ng which would facilitate implementing the theory into nursing practice by means of the nursing process. The model is demonstrated in Figure 1. Basically the model is an open system of stress and reaction. Some form of stress bri ngs the worker (patient) into the health care delivery system and into contact with the nurse. The nurse then initiates nursing action of assessment and appropriate intervention to support and promote the patient's adaptive mechanisms. Hopefully, by the nurse's intervention the patient will be able to successfully adapt to his stress and return to a pre-stress state of hig~level weIIness. In the event that the nursing action is not successfu I, the patient wou Id leave the health care delivery system and return to his previous stress state. The nursing model was implemented by means of the nursing process. The nursing process is a rational, ongoing, systematic manner of assessing, planning, implementing. and evaluating nursing care. These four steps are accomplished by and through communication and interaction. It is based on relevant theories and concepts from the physical and social
sciences. Nursing process is a term to describe what nurses do with emphasis on a systematic, methodical approach rather than any randomness of efforts. It accents a planned, deliberative method of nursing care. The nursing process is a set of actions leading to a result There are many advantages to using the nursing process in occupational health nursing. It can be a means of communication shared with the worker and his family. It provides needed legal records in the form of assessments and care plans. There is continuity of care of patients and education of workers to vital health problems. It faci litates verification of epidemics of occupational illness. Finally, it is a valuable evaluation technique. An assessment tool (Figure 2) was developed to gather pertinent information about the patient during the initial interview which followed some stressful event which caused him to enter the health-care area. In addition to the patient's major concern, this assessment tool enabled the nurse to gather data concerning past work-related medical history, present and past pertinent medical history, restrictions, stress factors which may have precipitated present concern, and coping or adaptive mechanisms which the patient might be using. The information gathered by way of the assessment
STRESS
ENTRANCE INTO HEALTH CARE DELIVERY SYSTEM
ADAPTIVE MECHANISMS
RETURN TO HIGH LEVEL WELLNESS
FIGURE 1
NURSING MODEL
NURSING ACTION
A NURSING THEORY AND MODEL FOR OCCUPATIONAL HEALTH NURSING (continued)
form was analyzed and interpreted and a nursing care- plan (Figure 3) was formulated for each patient The nursing care-plan was also a tool developed specifically for use in the industrial setting. The problem was simply stated. Planning included setting priorities, deciding on a plan of action, and appropriate intervention. I nterventi on inc luded actual treatment given, environmental manipulation, referral, supporting present coping mechanisms being used by the patient, or whatever nursing action was deemed necessary to help the patient adapt to his situation, and meet his specific need. In helping the worker adjust to his situation, or to arrange for implementation of the nursing care plan, the industrial nurse often found it necessary to enlist the skills and help of other members of the industrial complex. She/he frequently consu Ited with the plant physician and safety director. She/he also used the services of the union, members of management, and other outside referral agencies when she/he considered it necessary to implement appropriate intervention on behalf of a patient Nursing process intervention is demonstrated in Figure 4.
Criteria for evaluation were developed to measure success or fai lure of the nursi ng action:
FIGURE 3
NURSING CARE-PLAN
NAME:
HEALTH SUMMARY:
PROBLEM
AGE:
INTERVENTION
SEX: DATE:
EVALUATION
BAUGHN
Other
<, Specific Skills
Nurse
Nursing Skills Physician
-: Diagnostic Skills
Administrative /SkilIS
Management
HEALTHY WORKER
Communication
<. Union Monitoring Skills
Safety
FIGURE 4 MODEL OF NURSING PROCESS INTERVENTION
planned nursing action. Looking for physical signs of increased anxiety or tension, and assessing the verbal and non-verbal clues given by the patient are necessary nursing actions in dealing with the patient who is experiencing some life stress. Reducing tension and setting a reality focus become important in interacting with these patients. This nursing model was developed specifically to be used as a framework to improve nursing practice in the industrial area. Its main strength lies in the fact that it is structured to be implemented by means of the nursing process, a not-too-tarnl liar term to most industrial nurses. The nursing process, if used as a framework in the occupational setting, can assist the nurse in sharpening his/her total assessment of employee needs, and it can lead to thoughtful plan- ning and well-executed implementation of nursing action. Further, it emphasizes evaluation, which is many ti mes neg lected. The assessment of patients in industrial nursing is
Occupational Health Nursing, January 1977
quite important, for this is where present health needs can be detected as well as the presenting problem. The assessment tool used in conjunction with implementing the nursing model is short enough to be done in allotted time but also comprehensive enough to be of real value to the nurse in determining patient needs and in developing effective nursing care plans. The model discussed has not been previously used in clinical practice and so has no proven validity or reliability. Perhaps one argument against the model is that it is not complex enough. However, it was thought that it wouId be more advantageous to start with a simple nursing model that would work in the clinical industrial health area, and then adapt and modify it as expertise and need are demonstrated. There has been no attempt to present the nursing model herein discussed as a complete entity. Instead, it is hoped that the model wi II serve as a basis for further development and application of nursing models to the clinical area of industrial nursing, thereby improving the practice.