Objectives: This learning experience will enable the student to:
1. Delineate a problem relevant to the care of a client/group/community with emphasis on the community as a client. (Careful not to focus on the individual members of the community but focus on the community as a system
2. Conduct a search of the literature pertinent to the specific problem.
3. Inter-relate findings with data gathered (from literature, interviews, and other sources) as a basis for nursing care in a scholarly manner
4. Differentiate the stressors affecting the community’s biological, interpersonal/intra-personal non-human environmental subsystems.
5. Propose relevant implications for health care delivery generally, and for professional nursing care specifically, based on community theory and research integrating community resources.
6. Synthesize information into a coherent, logical and factually accurate written presentation.
The community selected should represent one that you come in contact with either personally or professionally. Discuss your rationale for your community with your clinical instructor. (Use your windshield and formal assessments to help determine a community problem).
The emphasis of your research paper should be placed on the community considering the SDS model and the community as a client/system
The community’s biological, intrapersonal, interpersonal, and non-human environmental subsystems must be considered, and the implications for health care identified utilizing appropriate community theory.
References should be from recent professional periodicals and limit the use of text-books.
The paper must conform to college standards for acceptable written work.
1. Done on 8-1/2”x11” white paper, double space throughout with a 1-1/2” margin on the left and 1” margin on all other sides. Proper documentation, reference according to APA format, and correct punctuation must be used.
2. Cover sheet to include: topic, student’s name, course and name, and date of submission.
3. Length: No more than 10 pages between 8 – 10 pages
4. Due Dates: See course outline
5. Late papers will lose 10 points a week
Required reference format:
American Psychological Associations Guidelines.
Topics: All topics need to be approved by the third week of the semester by your clinical instructor.
Organizing Framework- Systems Developmental Stress Model (SDS)
The Organizing Framework for the RN-BSN program of the New Jersey City University, Nursing Department, is developed from the philosophy, purpose and objectives of the program. The major concepts which reflect the organizing framework of this curriculum are the person, the environment, health and nursing. The major theoretical bases from which these concepts are approached are systems, developmental and stress theories.
Because the organizing framework of this curriculum is implemented through a system-developmental-stress, model, it is first necessary to briefly examine the theoretical bases of this model before describing the majoring concepts as they are reflected by these theories.
Systems theory contributes the idea that the organism is a unified whole, which is more than the sum of the parts. Systems can be viewed dynamically synchronically, or diachronically. Systems continually shift their structures as they adapt to internal or external conditions. Organisms are in constant and significant interactions with their environments. The organism and environment are energy fields which re-pattern following mutual, simultaneous interaction; self regulation is directed toward achieving increasing complexity of organization, not towards achieving equilibrium. The system’s ability to remain itself while undergoing continuous change is a characteristic of its self-regulatory ability. Health and illness are inevitable dimensions of a person’s life. In terms of stress theory one must consider the individual systemic structure and function and place on the developmental continuum to assess the actual impact of stressors. Stress theory assumes a biological, cellular basis of life, building up to higher levels of systems. In using systems and developmental theories, the basic stress approach may be modified to allow for individual psychodynamic and systems characteristics. Because this model incorporates developmental theory it includes the elements of time. In addition, developmental theory includes the idea of what is expected at the various stages of the life process. Representative theorists include Von Bertalanffy and Rogers for systems theory, Freud, Erickson, Sullivan, and Piaget for developmental theory and Selye for stress theory.
The concept of person involves the holistic nature of people and organisms as an open system in constant mutual interaction. People are bio-psycho-social beings who evolve along developmental continua in a sequential, unidirectional manner. Although the person’s potential is a genetically determined to degree, it is not fixed at birth.
There is an inherent directness in life and a person strives to fulfill themselves as they pass through expectable stages of the life process. Attributes of person such as abstraction, language, thoughts, and emotion play an important role in the re-patterning of the human field. Persons must be viewed holistically and are more than the sum of their parts. They are capable of developing towards states of increased order, organization, differentiation, and complexity as they interact with internal and external stressors. Stress is necessary for the life and growth of person. The person as an open system uses self-regulatory mechanisms to maintain the systems in a steady state NJCU Nursing Revised July 15, 2014 Page 23
and make constant adjustments between environment demands and internal adoptive capacities. To facilitate study, the person as a system moving through space-time may be examined according to the following subsystems: biologic, intrapersonal, interpersonal, non human environmental, and socio-cultural. This interruption of the process of the person as system moving through space-time does not negate the holistic view of persons. Additional theoretical formulations which provide the means for approaching the concept of the person are group, role and family theories.
The concept of environment is integral in understanding all factors which influence open systems. The environment is the aggregate of biologic, interpersonal, cultural social, non-human, and universal influences upon person in their ever-changing interactions. Environment is critical in the development and evolution of open systems and the adaptations the systems make to stressors in the continuous mutual interaction between environment and systems. The human field re-patterned in interaction with the environment and environmental factors is examined if the re-patterning is to be understood and altered. .
The concept of health must be understood as a dynamic state of persons as open systems whose self-regulatory mechanism attempt to maintain the system in a steady state. Health is viewed on a continuum and is related to the developmental level of and stressors acting upon the person at any given point in space-time. There are fluctuations in levels of wellness of persons and intensification of the stress state may lead to exhaustion of the adaptive capacity of the organism, thus requiring negative feedback to return the system to a steady state. The health of persons is dependent upon environmental stressors and supports, the person’s developmental level and previous experiences with maturational and situational crises, and the person’s ability to maintain a steady state through self-regulatory activities.
The concept of nursing involves the understanding that nurse-person relationships are open systems which move through predictable phases and where the nurse assists the person in the maintenance of a steady state by manipulation of environmental factors which alter stressors affecting levels of wellness. Nursing’s activities are directed toward helping persons of all age groups maximize their potential for high level wellness and functioning. The scope of nursing extends to any area where persons are found and the focus of nursing is the health of persons as individuals, as families, as group members, and as members of society.
The nursing process is the method through which the systems-developmental-stress model is implemented. The steps of this process are assessment, nursing diagnosis, planning (outcomes), implementation, and evaluation. In implementing the nursing model through the use of the nursing process, the nurse analyzes client subsystems according to stressors affecting the client and the subsequent or potential adaptations or maladaptations.
The nurse is concerned with the promotion, maintenance, and restoration of the integrity of the person’s biological, intrapersonal, interpersonal, non-human environmental and socio-cultural dimensions and the interactions of these dimensions throughout the life cycle. The level of wellness of the individual fluctuates at any point in space-time according to internal and external demands and, depending upon the degree of threat of the integrity of the system, may necessitate nursing interventions to manipulate the factors in the person or environment which would promote or restore integrity, thereby facilitating the individual’s return to an optimum of wellness.
Using the first step of the nursing process, assessment of the structure and function of each of the person’s dimensions is done, including a nursing examination of the patterns of the client’s life NJCU Nursing Revised July 15, 2014 Page 24
process appropriate to the developmental phase of that individual, and the reaction of the person as a whole. The assessment phase of the nursing process is concluded with the nursing diagnoses.
After establishing the nursing diagnoses, the planning phase of the nursing process is begun. Client outcomes are formulated in conjunction with client
In the implementation phase, nursing interventions that have been planned according to priority and based upon theoretical rationales formulated in the assessment and planning phases are carried our in keeping with client-nurse outcomes to promote, maintain and/or restore the level of wellness that is optimum for that client at that time.
The evaluation phase of the nursing process includes the measurement of the degree to which the stated outcomes have been met, including client-nurse responses to the implemented interventions. If the outcomes have not been met or new data has altered planned interventions, a reformulation of the original plan, including additional assessment, must be done with an analysis of the reasons for success or failure. The phases of the nursing process are not viewed statically, the process is fluid, with overlapping of phases, and continual movement back and forth from one phase to another.
The assessment phase of the nursing process is outlined as follows according to the systems-developmental-stress model:
1. Age, Sex, Birthplace
The Biological Sub-system
The Intrapersonal Sub-system
1. developmental level (expected vs. observed)
2. self and body image
3. mood and affect
4. orientation and level of awareness
5. thought content and processes
6. apparent level of intelligence
7. psychodynamic issues
8. client perception of problem
9. coping patterns
NJCU Nursing Revised July 15, 2014 Page 25
The Interpersonal Sub-system
1. communication style
2. interaction style
3. family perceptions of client problem
4. recent life changes related to interpersonal subsystem
5. other relationships
The Non-Human Environmental Sub-system
2. home environment
3. Immediate environment (home, agency, etc.)
4. pets and valued objects
1. spiritual values
2. ethnic or cultural background
3. economic status
4. value system
5. occupational status and history
6. institutional relationships
7. social network (cultural)