Nursing Theories Nursing Practice 3rd Edition Parker – Test Bank A+

Nursing Theories Nursing Practice 3rd Edition Parker – Test Bank A+

Nursing Theories Nursing Practice 3rd Edition Parker – Test Bank A+

Nursing Theories Nursing Practice 3rd Edition Parker – Test Bank A+

Chapter 6
On completion of this chapter, students will be able to:
1. Describe the historical, educational, and career paths of each theorist.
2. Discuss the impact Peplau, Travelbee, and Orlando had on the practice of nursing.
3. Describe the basic components of each theorist’s model.
4. Identify the commonalities and differences between the theories
5. Discuss the application of each theoretical model to clinical research

Chapter 6
Part One: Peplau’s Nurse–Patient Relationship
Introducing the Theorist
Overview of Theory: Nurse–Patient Relationship
Central to All Nursing Care
Key Components
Therapeutic Communication (Verbal and Nonverbal)
Self-awareness via Supervision
Objective and Focused on Need of Patient
Growth Promoting, Forward Movement
Time Limited
Phases of the Nurse–Patient Relationship
Orientation Phase
Working Phase
Resolutions Phase

Practice Exemplar
Part Two: Travelbee’s Human-to-Human Relationship Model
Introducing the Theorist: Travelbee
Overview of Theory: Human-to-Human Relationhsip Model
Mid-range Theory
Nursing Care: Five Stages
Action (nursing intervention)
Appraisal (evaluation)
Phases of Progression of Spiritual and Emotional Needs
Original Encounter
Emerging Identities
Practice Application
Phase Three: Orlando’s Theory of Dynamic Nurse–Patient Relationship
Introducing the Theorist: Orlando
Overview of Theory: Dynamic Nurse–Patient Relationship

Chapter 6
Questions for Classroom Discussion
1. Orlando’s theory can serve as a philosophy as well as a theory. Describe how you would use
this theory /philosophy in your nursing practice.
2. What modifications or refinement do you suggest that would make Travelbee’s theory more
applicable and useful to contemporary nursing practice?

Chapter 6
Multiple-Choice Questions
(Answers appear in bold)
1. Peplau’s publication, in 1952, Interpersonal Relations in Nursing, presented her framework
for the practice of psychiatric nursing. The publication:
A. Resulted in a paradigm shift in this field of nursing.
B. Presented revolutionary ideas.
C. Was not well received when it was first published.
D. All of the above.
2. Peplau’s goal for her input into nursing knowledge and practice was to:
A. Prepare nurse psychotherapists, referring to this training as “talking to patients.”
B. Demonstrate to the medical community that nurses could practice independently.
C. Develop a method for theory development.
D. Link psychosocial and medical nursing.
3. Peplau viewed nursing interventions as those that:
A. Supported the implementation of physician medical orders.
B. Reflected the wants and desires of the patient.
C. Are soundly based on bio-medical knowledge.
D. Assisted patients in gaining interpersonal and intellectual competencies evolved through
the nurse–patient relationship.

4. Peplau required her students to engage in unflinching self-scrutiny, examining their own
verbal and nonverbal communication and its effect on the nurse–patient relationship.
A. True
B. False
5. Forchuk’s research of Peplau’s nurse–patient relationship was focused on which phase of the
nurse–patient relationship?
A. Orientation Phase
B. Working Phase
C. Resolution Phase
6. Travelbee’s model uses the word “patient” to describe the individual in need of nursing care.
A. True
B. False
7. According to Travelbee, dehumanization occurs when:
A. The ill person is left alone to find meaning to his illness experience.
B. The term patient is used to label or categorize a person.
C. One treats the ill person with an emotional detachment.
D. All of the above
8. The nursing tasks of hope and motivation are key assumptions to which of the following

A. Peplau
B. Orlando
C. Travelbee
D. Forchuk
9. According to Orlando, professional nurses function in an independent role from physicians
and other health care providers.
A. True
B. False
10. One of the most important contributions of Orlando’s work is:
A. The values of the human transaction
B. The enormous research based on her theory
C. The phases of the nurse–patient relationship
D. The instillation of hope and motivation

Chapter 6: Nurse–Patient Relationship Theories: Hildegard Peplau, Joyce Travelbee, and Ida
Jean Orlando
Instructions: Read the case study and answer the questions that follow.
Ann, a community nurse, made an afternoon home visit with Susan and her father. After the
death of her mother, Susan had growing concerns about her father living alone. “I worry about
my father all the time. He is becoming more forgetful and he has trouble seeing. Mom used to
take of him. I am not sleeping and I am irritable around him. Yesterday I shouted at him because
he wouldn’t let me help him with his laundry. I felt terrible! I am at my wits’ end! My brothers
and sisters do not want to put dad in a nursing home but they are not willing to help out. As
usual, they have left me with all the responsibility. I work part time and have two small children
to care for. Susan’s father, Sam, sat quietly with tears filling his eyes. He was well nourished and
well groomed but would not make eye contact. Nurse Ann noticed that the house was clean and
orderly. A tray in front of the TV had the remains of a ham sandwich and glass of ice tea. Mail
was piled up, unopened on a small table near the front door. There was only one car in the
driveway and the yard was in need of attention.
1. What questions do the theories of Peplau, Travelbee, and Orlando guide the nurse to consider
in caring for Susan and Sam?
2. How might Peplau’s concepts of participant–observer, spectator–observer, and random
observer guide the nurse in this case study? From Travlebee’s perspective, how might Ann
prevent dehumanizing Susan and Sam? How might Orlando’s focus on alleviating helplessness
inform Ann’s approach to Susan and Sam?
3. Develop a family plan of care from the perspective of Peplau, Travelbee, and/or Orlando

Guided Response (Answer) for Instructors:
1. Peplau, Travelbee, and Orlando explicated the nature and importance of the nurse–patient
relationship. Their work moved the focus of nursing from the performance of a set of tasks to
engagement in a therapeutic nurse–patient relationship designed to facilitate patient health and
healing. Each theorist has a unique definition of nursing that informs a nursing focus.
2. Peplau’s primary focus is to assist patients in gaining interpersonal and intellectual
competencies that evolved through the nurse–patient relationship. She required her students to
engage in unflinching self-scrutiny, examining their own verbal and nonverbal communication
and its effect on the nurse–patient relationship which was an early form of reflective practice.
Ask students to reflect on the case study and identify assumptions that they immediately make
about the situations and then using the concepts of participant–observer, spectator–observer, and
random observer guide them in exploring those assumptions.
3. Travelbee asserts that through the therapeutic use of self and the integration of evidence-based
knowledge, the nurse provides quality patient care that can foster the patient’s trust and
confidence in the nurse (Travelbee, 1971). She sees the role of the nurse as assisting persons to
experience hope in order to cope with the stress of illness and suffering (Travelbee, 1971).
Orlando defines the focus of nursing as responding to individuals who suffer or anticipate a
sense of helplessness; it is focused on the process of care in an immediate experience; it is
concerned with providing direct assistance to individuals in whatever setting they are found for
the purpose of avoiding, relieving, diminishing, or curing the individual’s sense of helplessness.
(Orlando, 1972). Encourage students to identify concepts of importance in the case study from
the perspective of each theorist and explore the literature using these key concepts to develop a
sense of the variety of approaches to the nursing care of this family.

Chapter 7
Statement of Intent
The intent of this chapter is to provide an introduction to the historical, educational, and career
pathway of nursing theorist Myra Levine and an overview of her Conservation Model. The goal
of the Conservation Model is to promote adaptation and maintain wholeness using the principles
of conservation.

Chapter 7
Key Terms
Environmental Challenges
Organismic Responses
Environmental Fit
Internal and External Environment
Therapeutic Intervention

Chapter 7
On completion of this chapter, students will be able to:
1. Discuss the historical, educational, and career pathway of nursing theorist Myra Levine.
2. Identify the basic components of the Conservation Model.
3. Discuss the application of the Conservation Model to nursing practice.
4. Compare and contrast Levine’s use of the concepts: structural, social, and personal
5. Explore and discuss the impact of the Conversation Model to provide a foundation for the
future of nursing practice.

Chapter 7
Questions for Classroom Discussion
1. Levine stated that unless the “theory can be interpreted by the how nurse who reaches the
patient wherever nursing is practiced, theory will remain a questionable entity … theory should
teach nurses what they are.” Divide in to small groups and discuss how you think Levine’s
theory can be interpreted into nursing practice. Identify the barriers you perceive to utilizing the
theory in current nursing practice.
2. Levine proposes a major proposition of the conservation principles as: “The individual is
always within an environment milieu, and the consequences of his awareness of his environment
persistently influence his behavior at any given moment.” Provide a clinical example/senerio that
demonstrates this proposition.
3. Divide students into small groups. Provide groups with a clinical case study. Have groups then
address and develop strategies for applying Levine’s steps in the nursing process: Assessment,
trophicognosis, hypothesis, interventions, and evaluation.

Chapter 7
Multiple-Choice Questions
(Answers appear in bold)
1. Levine identified two concepts critical to the use of her model:
A. Back and forth
B. Dynamic and static
C. Adaptation and Wholeness
D. Risk and risk management
2. As an organizing framework for nursing practice, the goal of the Conservation Model is to:
A. Guide the nurse to focus on the influences and responses at the organismic level.
B. Promote adaptation and maintain wholeness using the principles of conservation.
C. Provide a framework for nursing interventions to improve the patient’s condition (therapeutic)
or to promote comfort (supportive) when change in the patient’s condition is not possible.
D. All of the above
E. None of the above
3. Levine defines adaptation as:
A. The process whereby the patient maintains integrity within the realities of the environment
B. The process of change with conservation being the outcome of adaptation
C. The process of making the best of a bad situation
D. A and B
E. All of the above

4. Levine proposes that health and disease are patterns of:
A. Internal and external mitigating factors
B. Adaptive change
C. An individual response that may change over time in response to new situations, new life
challenges, aging; or social, political, economic, and spiritual factors
D. B and C
E. A and B
5. The interventions of the Conservation Model that are designed to return the patient to
wholeness are based on the assumption the intervention must attend to:
A. The conservation of energy
B. Structural, personal, and social integrities
C. Promote adaptation
D. All of the above
6. Levine rejected the notion that energy can be manipulated and transferred from one human to
another as in therapeutic touch.
A. True
B. False
7. According to Levine, the environment:
A. Includes both the internal and external environment of the individual.
B. Completes the wholeness of the individual.

C. Includes those factors that impinge on and challenge the individual.
D. A and B
E. All of the above
8. The conservation of personal integrity acknowledges the individual as:
A. One who strives for recognition, respect, self-awareness, humanness, self-hood, and selfdetermination
B. A social being who functions in a society that helps to establish boundaries of the self
C. Recognizing that the individual resides within a family, a community, a religious group, an
ethnic group, a political system, and a nation
D. Dependent on an intact defense system (immune system) that supports healing and repair
9. Levine viewed the person as a holistic being and proposed that the experience of wholeness is
the foundation of all human enterprises.
A. True
B. False
10. An organismic response is a change in behavior or change in the level of functioning during
an attempt to adapt to the environment. The organismic responses are intended to:
A. Sustain social interaction
B. Enhance the fight-or-flight response
C. Maintain the patient’s integrity
D. Maintain inflammation

Chapter 7: Levine Case Study
Instructions: Read the case study and answer the questions that follow.
As a nurse working in a mental health facility, you are responsible for the care of Jane, a
young woman in her mid-20s who has been admitted with a diagnosis of paranoid schizophrenia.
Jane has a health history of repeated hospitalizations. Her first admission occurred when she was
a young teenager.
Jane tells you she was always very shy growing up, and that she did not have many friends.
However, Jane did play the piano when she was an adolescent and found playing the piano
comforting. It was the only engaged activity she participated in during her teenage years.
Jane told the nurse that when her mother and father divorced, she became more withdrawn and
preferred to remain alone. Further conversation revealed that she did not feel motivated to pursue
goals or activities in school. She felt persecuted and interpreted events with no reference to
reality. She eventually lost interest in the piano as the symptoms of the disease resulted in being
unable to associate letters with the musical notes. She has recently stated she felt little purpose in
her life.
1. The core or central concept of Levine’s Theory is conservation. What might this mean for
2. How does Jane adapt to the internal and external environment?
3. What nursing interventions might ground the nurse in caring for Susan from Levine’s
Guided Response (Answer) for Instructors:
1. The nurse accomplishes the goals of the model through the conservation of energy, structure,
personal, and social integrity. Conservation of energy: Adequate rest, nutrition, and exercise.

Structural activity: A plan of care will promote specific interventions of self-care and
maintenance of personal hygiene. Conservation of personal integrity: Recognize and protect the
patient’s space needs, includes patient respect and his or her self-determination. Conservation of
social integrity: Help the individual to preserve his or her place in a family.
2. There is a continuous dynamic, open interaction between the internal and external
environment. This interaction provides the basis for holistic thought and the view of the
individual as whole. During the assessment process there may be a collection of challenging
facts or in observation and interview there may be challenges to the internal and external
environment … using the four conservation principles of energy, structure, personal, or social
integrity. The nursing diagnosis gives the challenging facts meaning. Patients with schizophrenia
have disturbed body temperature regulation; in the heat of summer, they may dress for winter. In
the heat of summer they may dress for winter. Patients with schizophrenia may also have
difficulty with personal hygiene. Weight gain may be a reason some patients do not take their

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