The human needs model of nursing

A qualitative study about cancer outpatients' experiences with selective taste control of bread as a self-care intervention

Aim

Alterations in taste are distressing side effects for cancer patients receiving chemotherapy. The Center for Gastrology (Belgium) developed a self‐care intervention based on taste control. This intervention contains an assessment of the individual taste and food hedonics. It provides recipes based on the individual assessed hedonics profile, so patients can self‐prepare personalized meals. This study aims to describe the experiences of oncologic patients with the home baking of personalized bread.

Design

A qualitative, descriptive design with individual semi‐structured interviews was used.

Methods

In August 2018, eleven face‐to‐face interviews were conducted until data saturation.

Results

The analysis of the interviews revealed five major themes: “Stepping out of your role,” “Having something positive to do,” “gaining insight,” “receiving recognition” and “practical limitations.”

Spiritual coping strategies and quality of life in older adults who have sustained a hip fracture: A cross-sectional survey

AIMS

To investigate the relationship between spiritual coping strategies and quality of life in persons with a hip fracture.

DESIGN

A correlational, cross-sectional survey design.

METHODS

The total population of Maltese-speaking adults over 65 years (N = 299), with a hip fracture receiving treatment in a public hospital in Malta in 2015, were invited. The WHOQOL-BREF questionnaire and the Spiritual Coping Strategies Scale were used.

RESULTS

A response rate of 51% (n = 147) was achieved. The poorest quality of life was for the physical and psychological domains. Spiritual coping strategies were associated with better quality of life with the exception of physical quality of life. Non-religious coping strategies were the stronger predictor of quality of life compared with religious coping strategies. The former predicted physical, psychological, environmental, social and overall quality of life.

CONCLUSION

Hip fractures have serious implications on quality of life which could be improved by promoting non-religious spiritual coping strategies.

Patient value: its nature, measurement, and role in real world evidence studies and outcomes-based reimbursement

The assessment of "patient value" is fundamental to clinical trials, real world evidence studies, and outcomes-based reimbursement schemes. Measures of health-related quality-of-life (HRQoL) are widely used in health research. Such measures are effective in determining the presence or absence of symptoms and functional ability. However, HRQoL measures were not intended, nor designed, to determine the value to patients of alternative health states. Functions have no intrinsic value-they are a means to fulfil human needs. However, needs can be met in a variety of ways, for example by adopting different functions or by the provision of social services. It is possible to analyze all functions in terms of the needs they satisfy. A needs model has been applied in health research since the 1990s. It is concerned with the extent to which human needs are fulfilled in the presence of disease and its treatment. It is argued that this is the major concern of the patient. Needs-based measures are patient-centric and produce a valid unidimensional index of outcome. Consequently, they provide a direct means of measuring patient value. This approach provides the possibility of evaluating health services in terms of the value they provide to consumers and payers. It also has a role to play in real-world evidence studies and outcomes-based reimbursement. It is recommended that greater attention is given in future to the development of patient-reported outcome measures that provide direct assessments of patient value.

Integrating the perspectives of individuals with spinal cord injuries, their family caregivers and healthcare professionals from the time of rehabilitation admission to community reintegration: protocol for a scoping study on SCI needs

INTRODUCTION

There is fragmented information about the different needs following a spinal cord injury (SCI). Expressed SCI needs can be met or unmet, they change along the rehabilitation continuum (eg, acute, rehabilitation and reintegration into the community) and can be different for traumatic and non traumatic SCI. The general objective of this scoping study is to evaluate and integrate the needs of individuals with traumatic and non-traumatic SCI, their family caregivers and those reported by rehabilitation professionals from the time of rehabilitation admission to community reintegration. The specific objectives are to: (A) synthesise the needs of individuals with SCI as perceived by themselves, their family caregivers and rehabilitation professionals using two theoretical models, (B) classify needs as met and unmet, (C) explore the evolution of met/unmet needs from the time of rehabilitation admission to community reintegration and (D) provide recommendations to improve SCI care. METHODS AND ANALYSIS: (A) identifying the most frequent met and unmet needs reported by adults with traumatic and non-traumatic SCI, their family caregivers and their rehabilitation professionals from the time of rehabilitation admission to community reintegration; (B) identifying relevant studies with a search in electronic databases; (C) charting the data based on categories refined and adjusted with a stakeholder group; (D) collating, summarising and reporting the results using two analytical frameworks (Maslow's hierarchical model of human needs and the Ferrans et al's model of health-related quality of life) and (E) a stakeholder consultation phase.

ETHICS AND DISSEMINATION

The results of this scoping study will allow understanding SCI needs from the time of rehabilitation admission to community reintegration from the perspective of different stakeholders. An integrated master report combining the needs of individuals with SCI from the perspectives of different stakeholders from the time of rehabilitation admission to community reintegration will follow the consultation meetings.

Theory analysis of the Dental Hygiene Human Needs Conceptual Model

PURPOSE

Theories provide a structural knowing about concept relationships, practice intricacies, and intuitions and thus shape the distinct body of the profession. Capturing ways of knowing and being is essential to any professions' practice, education and research. This process defines the phenomenon of the profession - its existence or experience. Theory evaluation is a systematic criterion-based assessment of a specific theory. This study presents a theory analysis of the Dental Hygiene Human Needs Conceptual Model (DH HNCM).

METHODS

Using the Walker and Avant Theory Analysis, a seven-step process, the DH HNCM, was analysed and evaluated for its meaningfulness and contribution to dental hygiene. The steps include the following: (i) investigate the origins; (ii) examine relationships of the theory's concepts; (iii) assess the logic of the theory's structure; (iv) consider the usefulness to practice; (v) judge the generalizability; (vi) evaluate the parsimony; and (vii) appraise the testability of the theory.

FINDINGS

Human needs theory in nursing and Maslow's Hierarchy of Need Theory prompted this theory's development. The DH HNCM depicts four concepts based on the paradigm concepts of the profession: client, health/oral health, environment and dental hygiene actions, and includes validated eleven human needs that evolved overtime to eight. It is logical, simplistic, allows scientific predictions and testing, and provides a unique lens for the dental hygiene practitioner. With this model, dental hygienists have entered practice, knowing they enable clients to meet their human needs.

CONCLUSION

For the DH HNCM, theory analysis affirmed that the model is reasonable and insightful and adds to the dental hygiene professions' epistemology and ontology.

Meeting the needs of women in secure mental health: a conceptual framework for nurses

Within the wards of Britain’s high and medium secure mental health services, the needs of the female population differ significantly from those of their male counterparts. Although much smaller in number, the vast majority of female patients formally detained in secure services are young, Caucasian women, who are less likely to be prone to criminality and have a propensity to suffer from psychological distress. Many have experienced extensive trauma and exhibit both internally and externally driven violence. Drawn from the women’s own narratives and analysed using a descriptive phenomenological approach, the findings provide the basic structure for a new ‘humanistic conceptual framework for care’ which could be used by mental health practitioners to both inform and structure the daily provision of care and to better understand the physical and mental health needs of this unique patient group within secure mental health services.

Patient-centered Needs Assessment

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Anglo-American nursing theory, individualism and mental health care: a social conflict perspective

This paper uses social conflict theory to reconsider the relationship of American nursing theory and individualised mental health care in the UK. It is argued that nursing theory has developed within a context of 'American dream' individualism, and that this ideology may be problematic for some UK mental health nurses and service users whose values and beliefs are those of different socio-political traditions. The paper explores the historical background of Anglo-American nursing theory, and then uses conflict theory to generate challenging propositions about the culture bias and political instrumentality of individualised care in mental health settings. In so doing, it critiques the 'scientific' and 'liberal' preconceptions of individualised care which have dominated mental health care policy for over a decade.

Partnership in coping: an Australian system of mental health nursing

The paper identifies shortcomings of approaches used in organizing and delivering mental health nursing. It provides a rationale for the development of a new system of mental health nursing namely the Partnership in Coping system (PinC). This system has been developed by service users, clinical mental health nurses and an academic mental health nurse. Currently, it is undergoing trials in Western Australia. The PinC focuses on the strengths of clients. It uses the positive aspects of mental health nursing namely its holistic perspective, the length and nature of the informal contacts, the 'ordinariness' of relationships with clients and the nurse's knowledge of the clients' social and physical environments. It is a versatile system that can also be used across different mental health settings (community and inpatient facilities). The paper describes the philosophy behind the system, the concept of coping, the nature of the partnership between the client and nurse and their respective roles.

The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model's usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its 'fit' with the needs of the client group and the ward team philosophy.

Psychological care in nursing education and practice: a search for definition and dimensions

Despite a wealth of literature from the medical and nursing arenas pointing to the significance of psychological care in illness, there appears to be little consensus on definition, description and dimensions of the concept. A literature review and analysis of textbook content was conducted to explore the nature of the concepts of psychological need and care which might inform nurse educationalists in the preparation of appropriate teaching and learning programmes. Preliminary findings indicate that there is little consensus upon definition or description and, with the exception of information-giving, upon the dimensions or components of psychological care, despite the fact that student nurses are prepared to meet the same nationally prescribed learning outcomes by pursuing broadly the same guidelines for educational content. It is suggested that this has particular implications for nursing lecturers with a responsibility for teaching the philosophy and practice of holistic care.

The patient's perceived caring needs as a message of suffering

The aim of the study was to arrive at a deeper understanding of the patient's experience of caring needs, that is, of problems, needs and desires, by investigating and explaining how these will be expressed and shaped in the caring relation and to illuminate its implications for caring. The target population consisted of 38 patients in a medical ward and 37 patients in a surgical ward in a central hospital in Western Finland. The patients were interviewed in the wards and asked about perceived caring needs. By means of a hermeneutical process of interpretation a pattern emerged which was interpreted as pictures of themselves and of the nurses. These types of patients fell into three groups: the satisfied, the complaining and satisfied, and the complaining and dissatisfied patients. The types of nurses were divided into the competent and friendly, the competent and contact-creating and the competent and courageous. The patients' caring needs can be interpreted and understood from the standpoint of their experience of suffering, but also in relation to their experience of pleasure and comfort. The most conspicuous caring needs were experiencing confidence in the competence of the nurses, comfort, guidance, dialogue and closeness, which the patients expressed as problems, needs and desires. The patients' caring needs can contain new possibilities of growth and development. The nurse can relieve patients' suffering by promoting their experience of comfort. If the nurses' view of the limits of reality are extended to comprise the existential/ spiritual dimension of human beings as well, new possibilities will emerge of interpreting and understanding patients' caring needs as a message of suffering.

Nursing models: extant or extinct?

Although nursing models have always had their sceptics, they are now being subjected to more sustained criticism. Critiques have tended to focus mostly on the value of models for nursing practice but, increasingly, their place in nursing science is also being questioned. Reed believes that the growing disparagement of nursing models is symptomatic of the tensions between modernist and postmodernist perspectives on nursing. Drawing its title from Reed's discussion, this paper--from the opposite side of the Atlantic--reflects on the original purpose of nursing models and critically examines their relevance now, using the first and best-known British nursing model (the Roper-Logan-Tierney model for nursing) as the particular example for scrutiny. Although the popularity of this model is acknowledged, Fraser highlights the concern that it has not been tested. Can, and should, models be tested? This question is addressed in view of its apparent importance to the debate about whether or not nursing models have any continuing, legitimate role in theory or in practice.

Dependency scoring in a critical care area: a direct nursing assessment method

The evaluation of dependency in a critical care area can be a difficult process. Often, dependency scoring systems involve time-consuming data completion and collection. The innovative method of dependency scoring described here uses bedside nurses' own assessment of patient needs to provide an accurate and usable scoring system based upon nursing process documentation. It may also provide a method by which dependency may be calculated using computerized systems.

Culture, needs and nursing: a critical theory approach

This paper will bring the critique of culture, notably that undertaken by the Frankfurt School of Critical Social Science, to bear on the problem of needs, and expose its significance for the practice and discipline of nursing. The paper begins by reviewing ways in which the idea of 'needs' has been depicted in nursing literature, and it is suggested that this depiction is inadequate in fundamental ways. The critique of existing culture is then outlined and the implications for nursing are suggested in terms of the dissolution of hegemonic practices and the development of a concept of need built around the notion of 'praxis'.

Components of life model in practice

This paper attempts to cover the stages recognised as being part of the research process in order to investigate the problem related to the lack of individualised patient care documentation and supporting theoretical framework, which is both understood and accepted by the staff within Accident and Emergency (A & E). With the advent of the United Kingdom Central Council's (UKCC) document Standards of Record Keeping (1993), there is now greater need for a model to be implemented and accepted by those working in the department. The Components of Life model was introduced following a literature search, as this seemed to be a potential solution to the problem, since it emphasises the individual practising self-care activities in order to maintain independence. To initiate staff to the Components of Life model, a half study day was organised on the subject of models of care within A & E. Jones was invited to discuss his approach to A & E nursing care. Subsequently, a draft document relating to nursing care was created using the Components of Life model as a framework. The initial draft was followed with a printed document which was put into use for a trial period of 4 weeks, followed by a review. The review collected both positive and negative comments from the staff, the negative proved to be the most constructive as they served to make improvements within the care plan. Perhaps the most important success as a result of completing this project is that of increased staff enthusiasm and motivation--especially in wanting to make the documentation work.

The evaluation of a nursing model for long-stay psychiatric patient care. Part 2--Presentation and discussion of findings

A nursing model selected by a population of ward managers was implemented on a long-stay psychiatric ward in Northern Ireland using an adapted action research approach within a quasi-experimental design. A range of dependent variables were appraised at one pre-test and two post-test evaluation points on an experimental (Ward X) and a control ward (Ward Y). A thorough review of the literature and methods used can be found in Part 1 (McKenna et al., 1995, Int. J. Nurs. Stud., 32, 79-94). The findings and their interpretations are presented here. Results indicate that on the experimental ward there were statistically significant improvements in "Psychiatric Monitor", patients' and staff's perception of ward atmosphere, patient satisfaction, staff's views about nursing models, and patient dependency levels. No significant changes were noted in nurse satisfaction levels nor nurses' perception of patients' behaviour. Particular emphasis is placed on the possible threats to the internal and external reliability of these findings and on the attempts made to control these threats.

The evaluation of a nursing model for long-stay psychiatric patient care. Part 1--Literature review and methodology

A modified action research approach was used to implement a selected nursing model on a long-stay psychiatric ward. Within a broader quasi-experimental design, specific quality of care indicators were appraised before and after the implementation of the model. These dependent variables were also monitored on a control ward and data were collected on both wards at one pre-test and two post-test points. This paper presents a comprehensive overview of the literature and the methodology for the study. Planned change theory was used as a guiding framework for the implementation of the model and this process is described in detail.

The selection by ward managers of an appropriate nursing model for long-stay psychiatric patient care

The Northern Ireland National Board of Nursing, Midwifery and Health Visiting has stipulated that models of nursing must be utilized on psychiatric nurse training wards. However, since there are approximately 40 such frameworks available to the practicing nurse a problem of choosing an appropriate one arises. The philosophical basis for this research centres around the assumption that all nurses regardless of specialty possess values and beliefs concerning four essential elements. These are: nursing, health, the person, and the environment. In addition the literature reveals that each of the recognized nursing models are also constructed around these four concepts, forming in many cases the very foundations of the model. Within this study it was possible to ask 95 ward managers from 49 long-stay psychiatric wards to view how different models deal with the four elements and to choose a model which best reflects not only their personal beliefs about nursing, health, person, and environment, but also the needs of their patients.