p. 191). Orem believes during a comprehensive assessment using her SCDNT, pertinent information regarding the patient allows the nurse to see if a self-care deficit exists. This examination will assist the nurse in creating a guide, determining nursing interventions, and delivering appropriate nursing care.
King’s Conceptual Framework and Theory of Goal Attainment can be applied to adult obesity. “King’s dynamic conceptual framework of interacting systems is applicable to the holistic care and the ensuing interaction that must exist between the individuals, groups, and social systems in order for the nurse to be an effective advocate” (Goodwin, Kiehl, & Peterson, 2002, p. 239). The conceptual framework includes three systems: personal, interpersonal, and social. This framework identified major concepts within each structure. The personal system concepts are perception, self, body image, growth and development, time, and space. The interpersonal system is composed of interaction, transaction, communication, role, and stress. The model is completed by the social system concepts which are organization, authority, power, status, and decision making.
King’s Theory of Goal Attainment, according to Goodwin, Kiehl, & Peterson (2002) “incorporates 10 components extracted from the personal and the interpersonal systems: perception, growth and development, self, space, time, interaction, communication, transaction, role, and coping” (p. 239). The purposes of these concepts assist common agreements between nurse and client resulting in goal achievement. Williams (2001) stated “To capture the essence of these interrelated concepts, King stated that nurse and client interactions are characterized by verbal and nonverbal communication, in which information is exchanged and interpreted; by transactions, in which values, needs, and wants of each member of the dyad are shared; by perceptions of nurse and client and the situation; by self in role of client and self in role of nurse; and by stressors influencing each person and the situation in time and space”. Applying King’s concepts to the case scenario will produce a successful weight loss plan.
Pender’s Health Promotion Model “depicts the multifaceted nature of persons interacting with the environment as they pursue health” (Tomey & Alligood, 2002,
p. 630). The health promoting lifestyle model is grouped into cognitive-perceptual factors, modifying factors, and variables affecting the likelihood of action. “Cognitive-perceptual factors are identified as “the primary motivational mechanisms for acquisition and maintenance of health promoting behaviors. These factors include importance of health, perceived control of health, perceived efficacy, definition of health, perceived health status, and perceived benefits and barriers to health promoting behavior” (Wang, 2001, p. 204). The modifying factors of the model include demographic, biological, interpersonal, situational, and behavioral factors. According to Wang (2001) Pender stated “health promotion focuses on movement toward a positively valenced state of enhanced health and well-being” (p.205). Analyzing the case study using Pender’s model will examine TW’s factors and variables that are preventing her from losing weight.
Congruent Approaches of Nursing Models
“Orem’s theory-based practice facilitates the application of nursing practice in “one voice,” guiding the nursing role within the healthcare setting” (Bernier, 2002,
p. 387). Collecting pertinent patient information and using the three major concepts to guide Orem’s theory will assist the nurse in defining the patient’s self care deficits. When a person lacks the ability to care for themselves, a self care deficit exists. The factors identified in TW’s case were universal self care requisites such as: food (weighs 240 lbs, is 5’2” tall, and eats junk food and drinks regular soft drinks), activity and rest (does not participate in sports, uses a cane for short distances, sleeps four to five hours per night, exhibits poor muscle strength), solitude and social interaction (no sexual activity since second child) normalcy (does not attend social functions due to being overweight). The determinants for health deviation self-care requisites are: obesity and difficulty ambulating.
TW is seeking knowledge from a healthcare professional about her obesity because she would like to lose weight and be more active with her family and friends. She also realizes she needs to lose weight now before her condition worsens and she develops additional physiological issues. “Requesting information, education, and care to meet the therapeutic self-care demand (action needed to overcome self-care deficits) is a deliberate action and not instinctive” (Bernier, 2002, p. 389). The nursing care plan will be directed towards an exercise program, pamphlets on healthy dietary foods, a nutritional consult, increasing her self worth and positive support from family and friends. Using Orem’s theory as a guide provided TW with increased self-esteem, a support system, increased knowledge of healthy behaviors thru education and overall improved her ambulation problem.
“King’s dynamic conceptual framework of interacting systems is applicable to the holistic care and the ensuing interaction that must exist between the individuals, groups, socials systems in order for the nurse to be an effective advocate” (Goodwin, Kiehl, & Peterson, 2002, p. 239). These interacting systems incorporate King’s Theory of Goal Attainment 10 essential concepts. Five of the 10 components can be applied to the nurse and immobile obese patient such as: perception, time, interaction, communication, transaction. Trust needs to be established during the first interaction between the nurse and TW for a successful transaction of information about weight loss can occur. King strongly believed the nurse should perceive when nutritional education is appropriate and the client is in agreement and prepared to learn. Time is also crucial to weight loss. TW was previously not ready to make lifestyle changes and currently feels it is the right time. Her previous weight loss efforts took a long period of time resulting in her to return to her old unhealthy lifestyles. Excellent communication established trust between the nurse and TW which lead to a positive outcome. Communication is crucial so TW can be effective in her weight loss goals. Applying these concepts will direct her to lose weight and improve her ambulation.
Pender’s Health Promotion Model “provided a theoretical framework which was used to investigate life-enhancing behaviors such as exercise and weight loss” (Lannon, 1997, p. 171). This model is used to guide obese individuals to develop healthier lifestyles. Important factors from Pender’s model were identified in the case scenario of TW obesity and difficulty ambulating. These issues were: importance of health (TW is seeking medical advice about her difficulty ambulating and obesity), perceived control of health (TW is too busy and tired to focus on herself), perceived self-efficacy (TW feels she cannot lose weight), perceived barriers to health-promoting behaviors (TW fears an exercise program will be to strenuous and is hesitant to try it), and interpersonal influences (TW lacks compliance with previous diets and exercise programs).
Intervention was directed at her strength and commitment to losing weight. Discussions with TW and her husband revealed she is motivated to lose weight and he will support her in her challenge. The nurse educates TW by written nutritional, exercise material, and videos. Together the group develops a healthy foods menu and grocery list, beginner’s exercise program, and suggests removing junk food from the house. TW’s husband agrees to help watch the children and assist with chores around the house, so his wife can exercise three to four times per week. Analyzing TW’s unhealthy lifestyles allows the nurse to focus on the issues. As a result a plan is developed for TW to develop a healthier way of living for her and her family.
Implication of Nursing Models
Nursing theories provide a guideline for nurses to meet an individual’s needs and enable the nurse to implement it in the clinical setting. As a result, there are many implications. The three theories illustrated several inferences for the adult obese patient.
Orem’s SCDNT serves as a guide for application of obesity and provides consistent framework that encourages strong client responsibility for recovery and maintenance. Orem uses a systematic assessment approach to treat and evaluate obesity. Written materials about weight loss and nutrition, nutritional consult, increasing self worth and encouraging support system will aid in TW’s ability to lose weight. This will enable her to ambulate without a walker, participate in more activities with her family, and increase her confidence, and participate in the community. Resolving TW’s self-care deficit will prevent other health problems. Hahler (2002) states “Overweight individuals are at greater risk for numerous health problems, including hypertension, cardiac, and vascular disease, respiratory dysfunction, and an increased incidence in some cancers”
(p. 85). Therefore, it is important these issues are dealt with before she has additional health problems.
King’s conceptual model facilitates the interaction between the nurse and patient leading to goal attainment. Establishing a trusting, relationship will allow patients to fulfill their needs. As a result, TW and the nurse interacted by verbal and non-verbal communication in which information about healthy foods and exercise programs were taught to her. “Effective communication of health information is pivotal to the efforts of practitioners in promoting health, changing behaviors and attitudes, and preventing disease” (Wilson, Mood, Risk, & Kershaw, 2003, p. 68).TW felt it was time to make a lifestyle change; therefore, resulting in a positive outcome to lose weight. The encouraging interaction between the nurse and TW will give her the support she needs to accomplish her goals. It will also provide her comfort to call upon the nurse when difficult times arise.
Pender’s model focuses on the cognitive-perceptual factors and modifying factors for action to be assessed and a plan to be developed. Perceived self-efficacy and interpersonal influences are the two most important factors for TW to lose weight. Over-weight patients often feel they cannot do it. By providing methods for a healthier lifestyle such as including support systems and an illustrated plan, TW’s sense of worth will increase and she will overcome the weight loss battle. Lannon (1997) states “Including the patient and family in decision making values them as individuals, enhances their self-esteem and increases their chances to continue these behaviors” (p. 174). Pender’s model “facilitates identification of a patient’s strengths and weaknesses so the plan will be tailored to the individual patient’s needs and can easily be implemented by a nurse in a clinical setting” (Lannon, 1997, p. 171). Pender’s Health Promotion Model tailored to TW’s needs result in weight loss.
Benefits of Nursing Models
Nursing models help in formulating questions, clarifying boundaries, and reveal thoughts and assumptions of fellow nursing theorists. There are many advantages in using a nursing model to examine adult obesity. These benefits are: providing a guideline for the patient to return to best possible health, aiding in the patients personal growth, and promoting healthy lifestyles.
The first benefit of examining adult obesity using nursing models is the framework that is developed to assist the patient back to optimal health. For example, Orem’s model required a detail history assessment to reveal TW self-care deficits. Applying Orem’s theory to TW’s scenario will assist her in returning to an optimal lifestyle. Orem’s guide serves as a pragmatic nursing application of theory to practice to assist individuals with returning to their optimal health (Bernier, 2002, p. 390).
The second benefit of studying adult obesity using models is nurses’ abilities to aide in the patients’ personal growth by establishing mutual goals. Developing a trusting relationship will open the lines for communication between the nurse and the patient. For example, TW will return if she needs additional assistance in losing weight or with other medical issues because of her comfort level with the nurse. This will allow continuous goals to be formed. King firmly believed interactions between the nurse and patient result in goals (Wilson, 2001).
The last benefit of a nursing model related to adult obesity is promoting healthy behaviors. TW lacks knowledge in healthy lifestyles. Applying Pender’s Health Promotion Model will allow TW to increase her self confidence and implement healthier behaviors into her life. Lannon (1997) stated “Pender described health-promoting behaviors as continuing activities that must become an integral part of an individual’s life style” (p. 172).
Conclusion
Obesity is a global problem and the numbers of obese patients are on the rise. As this problem continues, there is an ever-increasing need for nurses to take direct involvement. Obesity remains a primary medical concern. Through the use of the nursing process and in combination with nursing theories; nurses will continue to be major factor in patient care.
Reference
Adult Obesity Association (n. d.). Obesity in the U.S. Retrieved August 6, 2005 from
http://www.obesity.org/
Bernier, F. (2002) Applying Orem’s self-care deficit theory of nursing to continence care:
Part 2. Urologic Nursing, 22(6) 384-390. Retrieved July 30, 2005 from EBSCOhost
database.
Bond, D.S., Evans, R.K., DeMaria, E.J., Meador, J.G., Warren, B.J., Shannon, K.A., &
Shannon, R.M. (2004). A conceptual application of health behavior theory in the
Design and implementation of a successful surgical weight loss program. Obesity
Surgery, 14 849-856. Retrieved July 30, 2005 from EBSCOhost database.
Cox, K.R. & Taylor, S.G. (2005). Orem’s self-care deficit nursing theory: Pediatric
asthma as exemplar. Nursing Science Quarterly, 18(3) 249-257. Retrieved August 1,
2005 from EBSCOhost database.
Goodwin, Z.J., Kiehl, E.M., Peterson, J.Z. (2002). King’s theory as foundation for an
advance directive decision-making model. Nursing Science Quarterly, 15 (3)
237-241. Retrieved August 1, 2005 from EBSCOhost database.
Hahler, B. (2002). Morbid obesity: A nursing care challenge. MedSurg Nursing, 11(2)
85-90. Retrieved August 1, 2005 from EBSCOhost database.
Lannon, S.L. (1997). Using a health promotion model to enhance medication compliance.
Journal of Neuroscience Nursing, 29 (3) 170-179. Retrieved August 7, 2005 from
Infotrac.
Tomey, A.M. & Alligood, M.R. (2002). Nursing theorists and their work, (5th ed.).
Missouri: Mosby.
Wang, H.H. (2001). A comparison of two models of health-promoting lifestyle in rural
elderly Taiwanese women. Public Health Nursing, 18 (3) 204-211. Retrieved
August 1, 2005 from PROQUEST database.
Williams, L. A. (2001). Imogene King's interacting systems theory - application in
emergency and rural nursing. Online Journal of Rural Nursing and Health Care, 2(1).
Retrieved Jul 19, 2005, from http://www.rno.org/journal/issues/Vol-2/issue-
1/Williams.htm
Wilson, F.L., Mood, D. W., Risk, J., & Kershaw, T. (2003). Evaluation of education
materials using Orem’s self-care deficit theory. Nursing Science Quarterly, 16 (1)
68-76. Retrieved August 1, 2005 from PROQUEST database.
