What is Contextual Nursing?

nurseprnRN, BSN, RN · Feb 16, 2013

First, I hate it when perfectly good words are used to confuse. There's no law against using clear English to communicate. As a matter of fact, when we don't, we confuse our patients, students, and peers unnecessarily. Ahem. Anyway. Always define your terms when you start:

CON-TEXT [kon-tekst]

noun1.the parts of a written or spoken statement that precede or follow a specific word or passage, usually influencing its meaning or effect: You have misinterpreted my remark because you took it out of context.

2.the set of circumstances or facts that surround a particular event, situation, etc.

3.Mycology . the fleshy fibrous body of the pileus in mushrooms.

Origin:

1375–1425; late Middle English con- + texere to plait, weave) + -tus suffix of v. action; cf. text

Related forms con-text-less, adjective

Synonyms

2. background, milieu, climate.

Since we can eliminate the mushroom, um, context, let's look at the rest of it.

Context means the set of circumstances or facts that surround and influence a particular event or situation. See the derivations about joining together, and joining by weaving. The synonyms are helpful, too.

So, looking at a person as a contextual being is overdone fancy-speak for "looking at a person as a part of his surroundings/milieu/or situation all put together."

"Contextual influences on his health" would be the things in his environment or situation that influence his health.

"Your perspectives on contextual nursing" seems to me to mean something like, "What do you think about working within/considering/applying knowledge of the influence of the set of circumstances or facts involved in a care situation? Where are you coming from on that? How do you think that works or would work for you?"

morte, LPN, LVN · Feb 16, 2013

I am with you on this one, Grn. I have a better than average vocab, and this word was way out there. Just to confuse, obfuscate, and a few others i will think of and come back and add. Good luck, OP

First, I hate it when perfectly good words are used to confuse. There's no law against using clear English to communicate. As a matter of fact, when we don't, we confuse our patients, students, and peers unnecessarily. Ahem. Anyway. Always define your terms when you start:
CON-TEXT [kon-tekst]
noun1.the parts of a written or spoken statement that precede or follow a specific word or passage, usually influencing its meaning or effect: You have misinterpreted my remark because you took it out of context.
2.the set of circumstances or facts that surround a particular event, situation, etc.
3.Mycology . the fleshy fibrous body of the pileus in mushrooms.
Origin:
1375–1425; late Middle English con- + texere to plait, weave) + -tus suffix of v. action; cf. text
Related forms con-text-less, adjective
Synonyms
2. background, milieu, climate.

Since we can eliminate the mushroom, um, context, let's look at the rest of it.

Context means the set of circumstances or facts that surround and influence a particular event or situation. See the derivations about joining together, and joining by weaving. The synonyms are helpful, too.

So, looking at a person as a contextual being is overdone fancy-speak for "looking at a person as a part of his surroundings/milieu/or situation all put together."

"Contextual influences on his health" would be the things in his environment or situation that influence his health.

"Your perspectives on contextual nursing" seems to me to mean something like, "What do you think about working within/considering/applying knowledge of the influence of the set of circumstances or facts involved in a care situation? Where are you coming from on that? How do you think that works or would work for you?"

illumi15 · Feb 24, 2013

Thank you so much GrnTea! :up:

(also thank you morte. After you two's comments I don't feel as stupid as I did before.)

That is a lot more helpful than my instructor's email 2 line reply of look up in a "dictionary and other resources." I am taking this course through online so I can't even meet the instructor in person to talk with her until everything is clarified.

Thank you again, I hope I get better marks on my second assignment. (I see another "contextual" word in the outline. She sure loves that word... :cry: ) I wish you have a great day!

Esme12, ASN, BSN, RN · Feb 24, 2013

I agree with GrnTea...what a bunch of manure.....look up The Roy adaptation model of nursing....Context awareness in health care: A review - IMPACT

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an individual’s adaptation occurs in four different modes. This also holds true for families (Hanson, 1984). These include the physiologic mode, the self-concept mode, the role function mode, and the interdependence mode (Roy, 1980).
The individual’s regulator mechanism is involved primarily with the physiologic mode, whereas the cognator mechanism is involved in all four modes (Roy and Roberts, 1981). The family goals correspond to the model’s modes of adaptation: survival = physiologic mode; growth = self-concept mode; continuity = role function mode. Transactional patterns fall into the interdependence mode (Clements and Roberts, 1983).
In the physiologic mode, adaptation Involves the maintenance of physical integrity. Basic human needs such as nutrition, oxygen, fluids, and temperature regulation are identified with this mode (Fawcett, 1984). In assessing a family, the nurse would ask how the family provides for the physical and survival needs of the family members. A function of the self-concept mode is the need for maintenance of psychic integrity. Perceptions of one’s physical and personal self are included in this mode.
Families also have concepts of themselves as a family unit. Assessment of the family in this mode would include the amount of understanding provided to the family members, the solidarity of the family. the values of the family, the amount of companionship provided to the members, and the orientation (present or future) of the family (Hanson, 1984).
The need for social integrity is emphasized in the role function mode. When human beings adapt to various role changes that occur throughout a lifetime, they are adapting in this mode. According to Hanson (1984), the family’s role can be assessed by observing the communication patterns in the family.
Assessment should include how decisions are reached, the roles and communication patterns of the members, how role changes are tolerated, and the effectiveness of communication (Hanson, 1984). For example, when a couple adjusts their lifestyle appropriately following retirement from full-time employment, they are adapting in this mode.
The need for social integrity is also emphasized in the interdependence mode. Interdependence involves maintaining a balance between independence and dependence in one’s relationships with others. Dependent behaviors include affection seeking, help seeking, and attention seeking. Independent behaviors include mastery of obstacles and initiative taking.
According to Hanson (1984), when assessing this mode in families, the nurse tries to determine how successfully the family lives within a given community. The nurse would assess the interactions of the family with the neighbors and other community groups, the support systems of the family, and the significant others (Hanson, 1984).
The goal of nursing is to promote adaptation of the client during both health and illness in all four of the modes. Actions of the nurse begin with the assessment process, The family is assessed on two levels.
First, the nurse makes a judgment with regard to the presence or absence of maladaptation. Then, the nurse focuses the assessment on the stimuli influencing the family’s maladaptive behaviors. The nurse may need to manipulate the environment, an element or elements of the client system, or both in order to promote adaptation (Roy, 1980).
Many nurses, as well as schools of nursing, have adopted the Roy adaptation model as a framework for nursing practice. The model views the client in a holistic manner and contributes significantly to nursing knowledge. The model continues to undergo clarification and development by the author.

[h=3]The Nursing Process and The Roy Adaptation Model[/h]

I. Adaptation Modes
A. Physiologic Mode
1. To what extent is the family able to meet the basic survival needs of its members?
2. Are any family members having difficulty meeting basic survival needs?
[*]B. Self-Concept Mode
1. How does the family view itself in terms of its ability to meet its goals and to assist its members to achieve their goals? To what extent do they see themselves as self-directed? Other directed?
2. What are the values of the family?
3. Describe the degree of companionship and understanding given to the family members,
[*]C. Role Function Mode
1. Describe the roles assumed by the family members.
2. To what extent are the family roles supportive, in conflict, reflective of role overload?
3. How are family decisions reached?
[*]D. Interdependence Mode
1. To what extent are family members and subsystems within the family allowed to be independent in goal identification and achievement (e.g., adolescents)?
2. To what extent are the members supportive of one another?
3. What are the family’s support systems? Significant others?
4. To what extent is the family open to information and assistance from outside the family unit? Willing to assist other families outside the family unit?
5. Describe the interaction patterns of the family In the community.
[*]II. Adaptive Mechanisms
A. Regulator: Physical status of the family in terms of health? i.e., nutritional state, physical strength, availability of physical resources
B. Cognator: Educational level, knowledge base of family, source of decision making, power base, degree of openness in the system to input, ability to process
[*]III. Stimuli
A. Focal
1. What are the major concerns of the family at this time?
2. What are the major concerns of the individual members?
[*]B. Contextual
1. What elements in the family structure, dynamic, and environment are impinging on the manner and degree to which the family can cope with and adapt to their major concerns (i.e., financial and physical resources, presence or absence of support systems, clinical setting and so on)?
[*]C. Residual
1. What knowledge, skills, beliefs, and values of this family must be considered as the family attempts to adapt (i.e., stage of development, cultural background, spiritual/religious beliefs, goals, expectations)?
The nurse assesses the degree to which the family’s actions in each mode are leading to positive coping and adaptation to the focal stimuli. If coping and adaptation are not health promoting, assessment of the types of stimuli and the effectiveness of the regulators provides the basis for the design of nursing interventions to promote adaptation.

Adaptation model of nursing