Table 1-1 Perspectives on Client–Environment Relationships in ✓ Solved

Table 1-1 Perspectives on Client–Environment Relationships in Selected Nursing Theories Theorist Relationship of Client and Environment Dorothy Johnson Clients attempt to adjust to environmental factors. Strong inputs from the environment might cause imbalance and require excess energy to the point of threatening the existence of the client. Stable environments help clients conserve energy and function successfully. Sister Callista Roy Clients attempt to adjust to immediate environmental excesses or absences within a background of other stimuli. Successful adaptation allows survival, growth, and improved ability to respond to the environment. Imogene King Clients interact purposefully with other people and the environment. Health is the continuous process of using resources to function in daily life and to grow and develop. Betty Neuman Clients continuously interact with people and other environmental forces and seek to defend themselves against threats. Health is balance and harmony within the whole person. Data from Alligood, M., & Marriner-Tomey, A. (2010). Nursing theorists and their work (7th ed.). St. Louis: Mosby.

Case Study: Being Present The community health nurse greeted a 30-year-old mother at the door of her apartment. They had met several times. The mother had a history of “crack” use, although she denied current use. She had had difficulty feeding her 2-year-old son because of his almost constant seizures. The relationship between the mother and the community health nurse developed slowly. The nurse was aware that the child's pediatrician would not prescribe strong antiseizure medication because he did not trust the mother to give it appropriately and feared resultant liver damage in the child. The mother had refused to return to the pediatrician.

The nurse knew that the only health service provider the mother had visited with regularity was the health department's well-child clinic where the nurse worked and which provided screening, education, and immunizations. The child's immunizations were also delayed because of the seizures. The nurse spoke the mother's name, seated herself quietly, and took in what was happening in the room. The mother was ironing and had age-appropriate toys next to her developmentally delayed son. The nurse said hello to the boy, commenting that he seemed to be interested in the toy the mother had placed next to him. She followed the mother's lead as they discussed how the mother was providing stimulation for her son's development. The nurse commented that it must be difficult to feed a child with frequent seizures; the mother replied that she could not take all day to feed him because she had two other children to care for and she was afraid he would choke. The nurse realized that she would have similar feelings if the child were hers. She acknowledged the mother's request to obtain seizure medication and indicated that she might find another pediatrician for the child.

Because of her resourcefulness and persistence, the nurse was able to find a second pediatric neurologist in another city, 40 miles away. Transportation was arranged through volunteers, and the mother and son were seen by this physician. The child was hospitalized for regulation of the seizure medication regimen, and the mother agreed to implantation of a gastrostomy tube in the child for feedings. Three months after the home visit described earlier, the mother had been taught to feed the child, and his seizures were sufficiently controlled for him to be accepted into a special education program in the public school system. The mother was beginning to talk about seeking job training.

The nurse could have judged the mother for having used cocaine, which might have caused her child's health problems. The nurse could have labeled the mother as noncompliant when she refused to return to the first pediatrician. Instead, the community health nurse was present to the mother; she was physically present in the home several times and psychologically present to acknowledge the mother's strengths and perspective of the circumstances. In addition, the community health nurse was spiritually there and could honestly say that she liked the mother, despite all of her troubles. She felt genuine positive regard for the mother as a human being while not forgetting that her primary professional goal as a “child health nurse” was to promote the well-being of the child. Her presence demonstrated her genuine caring and led to new possibilities for this family.

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The interactions between clients and their environments, particularly in nursing, are central to promoting health and well-being. Nursing theories such as those proposed by Dorothy Johnson, Sister Callista Roy, Imogene King, and Betty Neuman emphasize the dynamic relationships between clients and their environments. These theories can enhance our understanding of how nurses interact with clients, particularly in challenging circumstances such as the one presented in the case study of the community health nurse and the mother of a child with seizure disorders.

Dorothy Johnson's theory highlights the importance of adjusting to environmental factors that impact an individual's health. A stable environment allows clients to conserve energy and function optimally. In the case study, the community health nurse recognizes the unstable environment that affects the mother and her children. The home setting is chaotic, characterized by the stress of managing a child with severe health issues and the implications of the mother's past substance use. The nurse's presence is not just physical; it extends to creating a supportive atmosphere that contributes positively to the family's health and stability.

Sister Callista Roy emphasizes adaptation in her model, where clients adjust to environmental changes. The mother in the scenario is struggling to adapt to her circumstances, which include dealing with her son's constant seizures and her own past. The community health nurse provides emotional support, which helps the mother begin to accept the need for medical intervention for her child. This aligns with Roy's assertion that successful adaptation enables individuals to grow and respond effectively to their environment.

Imogene King's theory of goal attainment posits that clients interact purposefully with their environment and with health care providers. The community health nurse does not dictate care but collaboratively engages with the mother to identify needs, acknowledge her challenges, and focus on achieving health goals for her son. By fostering a working relationship built on respect and understanding, the nurse empowers the mother to seek additional assistance, demonstrating that healthcare can be a partnership.

From Betty Neuman’s perspective, the constant interaction between individuals and various environmental elements—and the need for balance—is vital. As the community health nurse works with the mother, she recognizes the multiple stressors impacting their health. By showing empathy and respect, the nurse offers a buffer against the external pressures the mother faces. The goal here is not merely to address medical needs but to restore balance within the family unit, allowing for both emotional and physical health.

Despite the mother's past, the community health nurse maintains a stance of acceptance and support, which fosters trust. A judgmental attitude could have reinforced the mother's feelings of inadequacy and guilt. Instead, the nurse’s genuine positive regard aids in dismantling barriers to treatment, enabling the mother to take necessary steps for her child's health. Research emphasizes that positive nurse-client relationships significantly impact health outcomes, particularly in underserved populations (Hughes, 2018; Watson, 2017).

Moreover, the case underlines the importance of community resources and multidisciplinary approaches in healthcare. The community health nurse's coordination with a neurologist and transportation services exemplifies the extended role of nursing beyond bedside care. This holistic care model aligns with contemporary practices in nursing, where collaboration and community engagement are critical for effective health promotion (Kozier et al., 2016; McEwen & Wills, 2019).

In summary, understanding the relationship between clients and their environments is essential for nurses to provide optimal care. The theories of Johnson, Roy, King, and Neuman illustrate different facets of this relationship and guide nursing practice in diverse situations. The case study of the community health nurse reflects how building rapport, understanding contextual factors, and fostering a supportive environment can lead to meaningful improvements in client health outcomes. As nursing continues to evolve, incorporating these theoretical frameworks will remain pivotal in addressing the complex needs of clients and their families.

References

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