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MICHIGAN STATE UNIVERSITYCOLLEGE OF NURSING

NUR 803

Conceptual and Theoretical FrameworksFor Advanced Practice Nurses

COURSE SYLLABUSFall - 2001

Section 001 – CampusSection 701 – Gaylord

Credits: 3Thursday 1:15 PM - 4:05 PM

Faculty: Gwen Wyatt, R. N., Ph.D.(o) 517-353-6672; [email protected]: A230 Life Sciences Building

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MSU is an Affirmative Action/Equal Opportunity Institution

CONTENTS

PageCOURSE DESCRIPTION ............................................................................................................................................. . 3

COURSE OBJECTIVES.................................................................................................................................................. 3

PREREQUISITES ............................................................................................................................................................. 3

INSTRUCTIONAL METHOD ........................................................................................................................................ 3

REQUIRED AND RECOMMENDED TEXTS ........................................................................................................... 3

EVALUATION/GRADING/ASSIGNMENTS ............................................................................................................... 4

CLASS SCHEDULE .......................................................................................................................................................... 5

READINGS ......................................................................................................................................................................6-8

ADDITIONAL INFORMATION ABOUT THE COURSE ASSIGNMENTS

THE PROFESSIONAL PORTFOLIO ............................................................................................................ 9

CLASS PARTICIPATION ............................................................................................................................ 10

THE GENOGRAM ......................................................................................................................................11-14

ISSUE PAPER BASED UPON FILM ANALYSIS ...............................................................................15-22

CLASS OBJECTIVES AND ASSIGNED READINGS

CLASS 1 - COURSE OVERVIEW ................................................................................................................. 23

CLASS 2 - DEVELOPMENTAL FRAMEWORKS ...............................................................................24-25

CLASS 3 - SYSTEMS FRAMEWORKS ....................................................................................................... 26

CLASS 4 - STRESS/CRISIS/COPING FRAMEWORK........................................................................27-28

CLASS 5 AND CLASS 6 - FILM ................................................................................................................... 29

CLASS 7 - REVIEW OF NURSING DIAGNOSIS ...................................................................................... 30

CLASS 8 - REVIEW OF HEALTH PROMOTION AND DISEASE PREVENTIONAPPLICATION OF HEALTH PROMOTION ANDDISEASE PREVENTION ................................................................................................. 31

CLASS 9 - CHANGE FRAMEWORKS: individual, family, group & provider ...................................... 32

CLASS 10 - CHANGE FRAMEWORKS (cont)............................................................................................ 33



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COURSE DESCRIPTION

This course presents core conceptual and theoretical frameworks for all advanced practice nurse students. Basicphilosophical tenets are used to examine the applicability of the frameworks for advanced nursing practice. Selectedframeworks, models and theories congruent with primary care and derived from nursing and other disciplines are used asexemplars. They will enable the student to examine personal practice assumptions currently used, and identify othersconsistent with practice and research as an advanced practice nurse.

COURSE OBJECTIVES

At the conclusion of the course the student will be able to:

1) Articulate the language, use and function of conceptual and theoretical frameworks.2) Evaluate selected conceptual frameworks, models and theories using appropriate criteria.3) Compare and contrast the major concepts, assumptions, utility and relevance to primary care.4) Formulate an initial conceptual/theoretical framework for personal practice and research as an advanced practice

nurse.

PREREQUISITES

This course is open to graduate students in the nursing major.

INSTRUCTIONAL METHODS

A variety of methods will be used, e.g., lecture, seminar discussion, student presentations, films, the initiation of a personalprofessional portfolio, papers, readings, interviewing, and exam.

REQUIRED TEXTS

Friedman, M. (1998). Family nursing: Research, theory, and practice (4th ed.). Stanford, CT: Appleton & Lange.

Godwin, G. (1994). The Good Husband. New York, NY: Ballantine Books.

American Psychological Association (1994). Publication manual of the American Psychological Association (4th Ed).Washington, D.C.: American Psychological Association.

Course Required Reading Packet

RECOMMENDED TEXTS

Glanz, K., Lewis., F., & Rimer, B. (1997). Health behavior and health education - Theory, research, and practice (2nd Ed.).San Francisco: Jossey-Bass.

Harmon-Hanson, S. & Boyd, S. (1996). Family health nursing-Theory, practice, and research. Philadelphia: F. A. Davis.

Meleis, A. (1997). Theoretical Nursing: Development and progress. (1st ed.). Philadelphia: Lippincott.

Moody, H. (1998). Aging: Concepts and controversies. Thousand Oaks: Pine Forge Press.



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EVALUATION/GRADINGStudent grades for the course will be based on the following: POSSIBLE COURSE POINTS = 1000

The grading scale is: 940-1000 = 4.0875- 939 = 3.5810- 874 = 3.0750- 809 = 2.5700- 749 = 2.0650- 699 = 1.5600- 649 = 1.0

ASSIGNMENTS INCLUDE

1. PROFESSIONAL PORTFOLIO (150 points):

* Personal Practice Philosophy - Draft* Personal Practice Philosophy and History Form - Final Version (150)

2. CLASS PARTICIPATION (50 points):

* Guidelines to be discussed at first scheduled class.

3. ASSESSMENT AND ANALYSIS (200 points):

* Genogram

4. THEORY APPLICATION TO A CONTEMPORARY ISSUE / FILM (200 points):

* Paper & Class Presentation

5. MIDTERM EXAMINATION (200 points):

6. FINAL EXAMINATION (200 points):

* Final Exam will:

Be held during designated class time (day and hours) during final exam week.Be a two-hour comprehensive exam.

PLEASE NOTE:Assessments are due at the beginning of class time.Do not exceed maximum number of pages for assignments.Exam may include short essay, short answer, matching and/or multiple choice.



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NUR 803 CLASS SCHEDULE - Fall 2001

Class Date

1 8/30/01 COURSE OVERVIEWREVIEW OF BASIC THEORETICAL COMPONENTS (Nursing & Related Frameworks)

2 9/6/01 DEVELOPMENTAL FRAMEWORKSApplication of Developmental Frameworks to novel, “The Good Husband”Personal Practice Philosophy - Draft

3 9/13/01 SYSTEMS FRAMEWORKSApplication of Systems Frameworks to novel, “The Good Husband”

4 9/20/01 STRESS/CRISIS/COPING FRAMEWORKSApplication of Stress/Crisis/Coping Frameworks to novel, “The Good Husband”

5 9/27/01 IN-CLASS FILM: As context for application of developmental, systems, andstress/crisis/coping frameworks. Guest Lecture: Joan Wood R.N., Ph.D.

6 10/4/01 SMALL AND LARGE GROUP DISCUSSION OF FILM with application to frameworks.Concept Exam (Midterm)

7 10/11/01 REVIEW OF NURSING DIAGNOSIS: Individual, family and groupApplication of Nursing Diagnosis and Frameworks to novel, “The Good Husband”Genogram Due. Guest Lecturer: Brigid Warren, R.N., MSN and Guest Lecture: LindaKeilman, R.N., MSN

8 10/18/01 REVIEW OF HEALTH PROMOTION & DISEASE PREVENTION: The EpidemiologicalModel, The Web of Causation, and Primary, Secondary and Tertiary Prevention. Applicationof Health Promotion and Disease Prevention to novel, “The Good Husband”. Guest Lecture:Joan Wood, R.N., Ph.D.

9 10/25/01 CHANGE FRAMEWORKS:Adoption of positive health behavior, and/or modifying problem health behavior.

10 11/1/01 CHANGE FRAMEWORKS (Continued)

11 11/8/01 STUDENT PRESENTATIONS Related to Films: Groups 1 and 2Issue Paper Based Upon Film Due

12 11/15/01 STUDENT PRESENTATIONS (Continued): Groups 3 and 4Issue Paper Based Upon Film Due

13 11/22/01 THANKSGIVING RECESS (No Class)

14 11/29/01 STUDENT PRESENTATIONS (Continued): Groups 5 and 6Issue Paper Based Upon Film Due

15 12/6/01 DISCUSSION OF STUDENTS’ PERSONAL PRACTICE PHILOSOPHIES (includechange models). Personal Practice Philosophy Paper - Final Due.

16 12/13/01 FINAL EXAM



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Page 1 of 3 (8-15-01)

Class Date REQUIRED READINGS

1 8/30/01 *Godwin, G. (1994). The Good Husband (1st ed., pp. 3-100). New York, NY: BallantineBooks

*Harmon-Hanson, S., Kaakinen, J., & Friedman, M. (1998). Theoretical approaches tofamily nursing. In M. Friedman (Ed.), Family Nursing - Research, Theory, and Practice(4th ed., pp. 75-96. Stanford, CT: Appleton & Lange.

Wyatt, G., Kurtz, M., & Liken, M. (1993). Breast cancer survivors: An exploration of quality oflife issues. Cancer Nursing 16(6), 440-448.

Wyatt, G., Kurtz, M., Friedman, L., & Given, B., Given, C. (1996). Preliminary Testing of theLong-Term Quality of Life Instrument for Female Cancer Survivors. Journal of NursingMeasurement, 4(2), 153-170.

Wyatt, G., & Friedman, L. (1996). Development and testing of a quality of life model for long-term female cancer survivors. Quality of Life Research, 5, 387-394.

Wyatt, G., & Friedman, L. (1996). Long-term female cancer survivors: quality of life issues andclinical implications. Cancer Nursing, 19(1), 1-7.

2 9/6/01 *Godwin, G. (1994) . The Good Husband (1st ed., pp. 101-172). New York, NY: BallantineBooks.

Harmon-Hanson, S., & Boyd, S. (1996). Family nursing practice in the twenty-first century. In S.Harmon-Hanson and S. Boyd (Eds.), Family Health Care Nursing-Theory, Practice and Research(1st ed., pp. 372-377). Philadelphia: F.A. Davis.

*Friedman, M., Conelly, C., Miller, K., & Williams, R. (1998). Family developmentaltheory. In M. Friedman, Family Nursing - Research, Theory and Practice (4th ed., pp. 111-145). Stanford, CT: Appleton & Lange.

Gedaly-Duff, V. & Heims, M. (1996). Family child health nursing. In S. Harmon-Hanson and S.Boyd (eds.), Family Health Care Nursing - Theory, Practice and Research (1st ed., pp. 245-250).Philadelphia: F.A. Davis.

Harmon-Hanson, S., & Boyd, S. (1996). Family Health Care Nursing: Theory, Practice, andResearch. Family Assessment and Intervention, 155-163. Philadelphia: F.A. Davis.

Meleis, A. (1997). Theoretical Nursing: Development and Progress (1st ed., pp 391-401).Philadelphia: Lippincott.

Puskar, K., & Nerone, M. (1996). Genogram: A useful tool for nurse practitioners. Journal ofPsychiatric and Mental Health Nursing, 3, 55-60.

Schultz, R. & Heckhausen, J. (July 1996). A life span model of successful aging. AmericanPsychologist Association, 7, 702-714.

*Readings from REQUIRED TEXT.



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Page 2 of 3 (8-15-01)


3 9/13/01 *Godwin, G. (1994). The Good Husband (1st ed., pp. 173-252). New York, NY: BallantineBooks.

*Friedman, M. (1998). Systems Theory In M. Friedman, Family Nursing 4th ed., pp. 153-165. Stanford, CT: Appleton & Lange.

Melies, A. (1997). Theoretical Nursing: Development and Progress (3rd ed., pp.318-327).Philadelphia: Lippincott.

Whitchurch, G. & Constantine, L., J., (1993). Systems Development theory. In P. Boss, W.Doherty, R. LaRossa, W. Schumm & S. Steinmetz (Eds), Source book of family theories andmethods: A contextual approach (pp. 325-352). New York: Plenum Press.

Wegner G. & Alexander R. (1993). Readings in Family Nursing, (pp. 368-380). Philadelphia:Lippincott-Raven.

Dodd, M. & Miaskowski, C. & Paul, S. Symptom Clusters and Their Effect on the FunctionalStatus of Patients with Cancer. Vol. 28 No. 3, 2001, pg. 465-470.


*Friedman, M., Svavarsadottir, E., & McCubbin, M. (1998). Family stress and copingprocesses: Family adaptation. In M. Friedman, Family Nursing (4th ed., pp. 436-446).Stanford, CT: Appleton & Lange.

Harmon-Hanson, S., & Boyd, S. (1996). Family Health Care Nursing: Theory, Practice, andResearch, (pp. 148-149). Philadelphia: F.A. Davis.Lazarus, R. (1993). Coping Theory and research: Past, present, and future. PsychosomaticMedicine, 55 234-247.Meleis, A. (1997). Theoretical nursing: Development and progress (1st ed., pp. 302-311)Philadelphia: Lippincott.Robinson, D. (1997). Family Stress theory: Implications for Family Health. Journal of theAmerican Academy of Nursing Practitioners, 9(1) 17-23.

Solari-Twadell, P., Bunkers, S., Want, C., & Snyder, D. (1995) The pinwheel model ofbereavement. IMAGE: The Journal of Nursing Scholarship, 27(4), 323-326.

Copp, Gina (1998). A review of current theories of death and dying. Journal of Advanced Nursing,28, (2), 382-390.

McClement, S.E. & Woodgate, R.L. (1998). Research with families in palliative care: Conceptualand methodological challenges. European Journal of Cancer Care, 7, 247-254.


6 10/4/01 Mid-term Exam & Concept Discussion based on film.

7 10/12/01 Ackley, B.J., & Ladwig, G.B. (1999). Nursing Diagnosis Handbook; A Guide to Planning Care(4th ed., pp. 2-6, 446-451). St. Louis: Mosby.

*Friedman, M., & Heady, S. (1998). Family role structure. In M. Friedman, FamilyNursing (4th ed., pp. 314-319 & 361-362). Stanford, CT: Appleton & Lange.

*Friedman, M., & Levac, A. (1998). The family nursing process. In N. Friedman, FamilyNursing (4th ed., pp. 53-58). Stanford, CT: Appleton & Lange.

Maas, M. (2000). Standardized Languages: NIC and NOC. Lecture Notes.



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*Readings from REQUIRED TEXT



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Page 3 of 3 (8-15-01)


8 10/18/01 Clemin-Stone, S., Eigsti, D. & McGuire, S. (1995). Comprehensive Community Health Nursing.(Pp. 286-296). St. Louis: Mosby.

Dittillo, B.A. (1998). Switching gears to primary care. American Journal of Nursing, 98(5), 16K-16L.

Glanz, K., Lewis., F., & Rimer, B. (1997). Health Behavior and Health Education - Theory,Research, and Practice (2nd ed., pp. 453-478). San Francisco, CA: Jossey-Bass Publishers

Swanson, J. & Albrecht, M. (1993). Community Health Nursing: Promoting the Health ofAggregates (1st ed., p. 8). Philadelphia: W.B. Saunders.

9 10/25/01 Baranowski, T., Perry, C., & Parcel, G. (1997). How individuals, environments, and healthbehavior interact (social cognitive theory). In Glanz K., Lewis, F., & Rimer, B. (1997). HealthBehavior and Health Education. (2nd ed., pp. 153-178). San Francisco, CA: Jossey-Bass, Inc.

*Friedman, M. & Morgan, I. (1998). The family health care function. In. M. Friedman,Family Nursing-Research, Theory, and Practice (4th ed., pp. 403-424). Stanford, CT:Appleton & Lange.

Rosenstock, I. (1998). Social learning theory and the health belief model. Health EducationQuarterly, 15(2), 175-183.

Strecher, V. & Rosenstock, I. (1997). The health belief model. In K. Glanz, F. Lewis & B. Rimer(Eds) Health behavior and health education - Theory, research, and practice (2nd ed., pp. 41-59).San Francisco, CA: Jossey-Bass Publishers.

10 11/9/01 Prochaska, J. (1994). Strong and weak principles for progressing from pre contemplation to actionon the basis of twelve problem behaviors. Health Psychology, 13(1), 47-51.

Prochaska, J., Redding, C., & Evers, K. (1997). Health behavior and health education - Theory,research, and practice, (pp. 60-84). San Francisco, CA: Jossey-Bass.

Champion, V. (1994). Beliefs about breast cancer and mammography by behavioral stage.Oncology Nursing Forum, 21(6), 1009-1014.

*Readings from REQUIRED TEXT.



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ADDITIONAL INFORMATION ABOUT COURSE ASSIGNMENTS:

THE PROFESSIONAL PORTFOLIO

The professional portfolio is introduced as part of NUR 803 and altered at intervals as the student progresses throughoutthe program and its courses. The portfolio fulfills a variety of goals:

1) It is a mechanism which will enable the student to convey personal achievements to faculty in the current andsucceeding courses.

2) It provides an opportunity for the student to demonstrate conceptual progression of APN practice.3) It can result in a product or marketing tool which the student can provide to prospective employers.

For program purposes each student is advised to purchase a standardized folder which can be used throughout theirgraduate program. An example will be available for review at the first class session. The desired portfoliocharacteristics include:

* the use of quality white paper for all items* materials are clean copies* materials are presented in an organized fashion* materials are complete.

All papers for NUR 803 are to be submitted and maintained for the semester in the Professional Portfolio. However, theprimary item contributed by NUR 803 to the Professional Portfolio is the Personal Practice Philosophy - Final Version.

THE PERSONAL PRACTICE PHILOSOPHY: (150 Possible Points)

* A Personal Practice Philosophy - Draft which describes the student’s current view of the conceptualunderpinnings of his/her practice upon entry to the graduate program (domains, concepts) (1 page).Definitions of patient/client, environment, nurse, and health care within the domains of bio-psycho-social-spiritual being. Draft a diagram of concepts and domains.

* A Personal Practice Philosophy - Final Version (150 Points) which further expands material included inDraft; it includes the student’s projected view of the conceptual underpinnings of practice reflectingpersonal selections of assumptions and concepts (from development, systems, stress, and change related to 4nursing concepts and 4 domains of being (maximum 4 pages plus diagram).Attach 820/830 History Form and add items to match your practice framework, with rationale.

(CITED REFERENCES AND BIBLIOGRAPHY REQUIRED)



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CLASS PARTICIPATION (50 Possible Points)

Participation will be assessed over the semester. The following criteria will be utilized in awarding the points at thesemester’s conclusion.

50 = Class presentations clearly reflect information/ideas from the required readings.

35 = Class presentations are pertinent to the discussion and reflect thoughtful consideration of materials.

25 = Class presentations reflect primarily own ideas rather than readings.

12 = Class presentations reflect limited knowledge of issues.

0 = Does not contribute to class.



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THE GENOGRAM (200 Possible Points)

The genogram includes the "structure" of the family from a three generational perspective. In addition, to the structureof the family, an assessment and interpretation of the data from each generation is important in order to understand thefunctioning of the unit and the generational influences.

OBJECTIVES:

* To acquire familiarity with the family assessment instrument, the Genogram, by conducting a family assessmentusing the genogram.

* To identify the strengths and limitations of the use of this family assessment instrument.

* To gain experience in the analysis and interpretation of family data.

* To convey the results of the analysis to the family and other health professionals through both written andverbal communication.

PROCESS:

1) Select a family (OTHER THAN YOUR OWN) composed of individuals from three generations including anindividual 65 years of age or older.

2) Conduct one or more interviews with at least two family members representing different generations to gather thedata. Consider individual vs joint interview. Refer to the “Interview Guidelines” which follow.

3) Complete the genogram assignment (MAXIMUM OF A TOTAL OF 2 PAGES) using the following criteria.

4) Submit completed assignment according to the class calendar.

5) After receiving the graded genogram assignment, conduct a final interview with the family members who wereinterviewed to discuss the genogram.

6) Do not use the family name in the text or on the genogram.

7) Keep a copy of your paper as well as a copy of the genogram.

CRITERIA FOR GENOGRAM

1. Prepare a three generational family genogram by identifying family members by first names, nicknames, andfamily labels.

a. DIAGRAM the demographic data (include legend on the genogram) Include: 1) Dates of birth/deaths;ages, 2) Education, 3) Occupation, 4) Religion, 5) Ethnicity, 6) Urban/Rural, 7) Health conditions, 8)Social Patterns

2. Select two major family themes and cite evidence from your data that supports the significance of the themesacross the three generations. Include the similarities and differences in the generations. (narrative)

Family Themes - are defined as subjects or topics of verbal or nonverbal communication that are repeated over time andinfluence the behavior of family members. The following are examples of topics which might be family themes: work;leisure; education; roles; orientation toward adults, children, or both; time (future, present, past); money;independence/dependence; culture (norm, traditions, rituals perpetuated, etc.); health issues.Required Reading:

Harmon-Hanson, S. (1996). Family assessment and intervention. In S. Harmon-Hanson and S. Boyd (Eds),Family health care nursing - Theory, practice, and research (1st ed., pp.155-162). Philadelphia: F. A. Davis.



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STUDENT NAME___________________________DATE__________________________

ASSIGNMENT: GENOGRAM

CRITERIA OF EVALUATION Possible Awarded

THREE GENERATIONAL GENOGRAMA. Diagram with legend (Dates of births/deaths, ages, education, occupation, religion,ethnicity, urban/rural, health conditions, social patterns

150

MAJOR FAMILY THEME WITH EVIDENCE (50 Points)A. Themes (Identity two themes that cross generations)B. Evidence 50

COMMENTS:

Total 200



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INTERVIEW GUIDELINES

Take time to establish a comfortable rapport with the individual(s) who agreed to be interviewed before askingthem questions for the purpose of the assignment(s).

Explain the purpose of your interview(s) as related to the assignment(s). Let the person you are interviewing knowthat they are helping you to learn more about individuals and families and that you are interested in them.

Be alert for signs of fatigue while you are conducting the interview(s). At the beginning of each interview it ishelpful to tell the person(s) that they should let you know if they are getting tired. Terminate the interview andschedule another visit if you find the person(s) is becoming tired.

Try to appear relaxed and unhurried as you conduct the interview(s). Give the person time to tell their stories andguide them toward the information you need by using cues that they give you.

Be willing to share yourself with the person you are interviewing. You are asking them for a good deal of personalinformation and you may find that they will be interested in learning about you and your background too.

Don’t make judgments about the person(s) you are interviewing. Each person has a history which is the reality oftheir life. It is important that you not give the impression that you find the information to be “inaccurate” or “thewrong way to do something”.

Enjoy the time you spend with the person(s) who agrees to be interviewed.



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THE FILM ANALYSIS PAPER

Four films depicting current issues impacting today’s families have been selected as the approach for the application ofthe various categories of frameworks included in the NUR 803. Please review each description and determine whichfilms are of special interest to you. A sign-up sheet has been developed for each film; each student will indicate apreference for one of films on a sign-up sheet. A small group of students will be matched with each film.

FILMS SELECTED FOR NUR 803

ULEE’S GOLDThis movie focuses on the efforts of a father (grandfather) to hold his family together through drug addiction, jail timeand helping raise teenage grandchildren.

MARVIN’S ROOMA story about a chronically ill father and the relationships with and between his two daughters during a time of crisis forboth.

AS GOOD AS IT GETSA diverse group of individuals who create unique family structures and learn to appreciate diversity.

GRAND CANYONA story of existential experiences for multiple characters who are on the surface living a routine American life.

FilmViolence/Crime

Cross-Cultural

Life Style

AlternativeFamily

StructureChronicIllness

SubstanceAbuse

MentalHealthIssues Aging

Spiritual/Existential Growth

Ulee’s Gold X X

Marvin’sRoom X X

As Good As ItGets X X

GrandCanyon

X X



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ISSUE PAPER FILM ANALYSIS

INDIVIDUAL STUDENT RESPONSIBILITIES (100 Possible Points)

* View each of the films prior to the film's discussion in class.

* For the film you selected, the paper will include:

- An introduction which describes the significance and current societal status of the issue and why it is significantto the APN.

- An analysis of the issue by comparing/contrasting two frameworks identified in the developmental, systems, andstress categories. Provide a systematic application of the components of each framework (i.e., assumptions,concepts, strengths/limitations when applied to the issue).

- 4 Nursing Diagnoses (2 family and 2 individual)

- Paper not to exceed 2 pages

GROUP RESPONSIBILITIES (100 Possible Points)

* Each group will have approximately 60 minutes of class time to facilitate a class discussion about the film.(50% of time for presentation and 50% of time for interactive application)

.

* As part of the discussion the group will analyze one issue utilizing the individual analysis of the groupmembers.

* Creative strategies for promoting class participation are encouraged.

* No film clips are to be used (everyone is to view all films)

* Class grades presentation 50 Points Possible

- Average Score

* Faculty grades presentation 50 Points Possible



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DATE: ______________________________ NAME: ______________________________________________

THEORY APPLICATION & A CONTEMPORARY ISSUE - INDIVIDUAL ANALYSIS PAPER


The introduction described the significance and current societal status of the issue. 25

Analysis of the issue by comparing/contrasting two of the frameworks.

the systematic application of components of each framework(e.g., two assumptions, two concepts, strengths/limitations)

50

Nursing diagnosis statements describing an individual and family diagnosis for both anactual and a potential health issue (4 diagnostic statements).

25

COMMENTS:

TOTAL 100



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DATE: ______________________________

FILM: __________________________________________________________________________

NAMES: __________________________________________________________________________

__________________________________________________________________________

THEORY APPLICATION TO A CONTEMPORARY ISSUE: GROUP EVALUATION


1) The Group kept within the time frame when facilitating the discussion about thefilm.

2) As part of the discussion, the group analyzed one issue drawing upon one or moreframeworks covered in class.

3) Creative strategies which promoted class participation were utilized.

4) Depth of discussion of each framework.

COMMENTS:

Total 50

Reviewer’s Name



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DATE: ______________________________ NAME: ______________________________________________

PERSONAL PRACTICE PHILOSOPHY EVALUATION FORM


Introduction 25

Definitions 25

Integration of concepts (definitions),with matching diagram

50

Summary 25

Health History Items added (3-6 questions),and rationale in relation to philosophy

25

COMMENTS:

TOTAL 150



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FRAMEWORK FORM

TITLE:

GENERAL DESCRIPTION:

ORIGIN:

KEY CONCEPTS:



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FRAMEWORK FORM

BASIC ASSUMPTIONS:

STRENTGTHS AND LIMITATIONS

ASSESSMENT QUESTIONS FOR PRIMRY CARE (i.e. variables)

USEFULNESS TO APN IN PRIMARY CARE?



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QUESTIONS TO CONSIDER WHEN EVALUATING THEORETICAL & CONCEPTUAL FRAMEWORKS:

* What values are explicit and/or implicit in the framework?

* Are the words or terms of the framework defined to promote reader understanding?

* Are the words or terms of the framework applicable to all persons or specific groups?

* Are the words or terms of the framework applicable across time and place?

* Is the internal structure of the framework logically consistent?

* Are the links between the concepts clear?

* Is there a schematic representation? Is it supported by the text?

* Does the framework reflect logical translation of diverse perspectives?

* Does the framework socially congruent, promote social change or lead to nursing activities that meetsocial expectations?

* Can testable hypotheses be derived from the framework?

* Does the framework help define nursing goals?

* Does the framework assist in identifying the appropriate recipient of nursing care?

* Does the framework reflect the four essential concepts of nursing, i.e., man, environment, health &nursing?

* Does the framework define the source of difficulty or area of need for nursing intervention?

* Does the framework direct attention to the consequences of nursing intervention?

* Does the framework provide a means of communicating about nursing practices with other nurses?



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Top 20 Primary Care Conditions(Diagnosis Clusters that Make up the Majority of Non-referred Ambulatory Visits to US Office-Based Physicians,NAMCS, 1989-1990)

Cluster Title Percent Cumulative Percent

General Medical Examination 7.2% 0.72%Acute upper respiratory tract infection 6.2% 13.4%Hypertension 4.4% 17.8%Prenatal care 4.3% 22.1%Acute otitis media 3.5% 25.6%Acute lower respiratory tract infection 2.7% 31.0%Acute sprains and strains 2.7% 31.0%Depression and anxiety 2.5% 33.5%Diabetes mellitus 2.1% 35.6%Lacerations and contusions 1.9% 37.5%Malignant neoplasms 1.7% 39.2%Degenerative joint diseases 1.7% 40.9%Acute sinusitis 1.6% 42.5%Fracture and dislocations 1.6% 44.1%Chronic rhinitis 1.5% 45.6%Ischemic heart disease 1.4% 47.0%Acne and diseases of sweat glands 1.3% 48.3%Low back pain 1.2% 49.5%Dermatitis and eczema 1.2% 50.7%Urinary tract infection 1.1% 51.8%

The estimated number of visits for 1989-1990 (the denominator) is 1,297,334 (in thousands). This is based on 74,390survey visits. All relative standard errors are less than 30%.Source: Rosenblatt et al., 1995.



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AUGUST 30, 2001

CLASS #1: COURSE OVERVIEWREVIEW OF BASIC THEORETICAL COMPONENTS (Nursing & Related Frameworks)

Objective: The student will:

1. Review the goals of conceptual and theoretical frameworks of scientific thought.2. Review the process of theory and model development and construction in nursing.3. Examine major issues related to theory development in nursing.4. Define the constructs of “assumption” and “concept”.5. Evaluate selected nursing conceptual and theoretical frameworks utilizing established criteria.6. Evaluate existing theoretical perspectives from nursing and related disciplines for APN practice and

research.

Required Readings:

Godwin, G. (1994). The good husband (1st ed., pp. 3-100). New York, NY: Ballantine Books.

Harmon-Hanson, S., Kaakinen, J. & Friedman, M. (1998). Theoretical approaches to family nursing. In M.Friedman (Ed.), Family nursing - Research, theory, and practice (4th ed., pp. 75-96). Stanford, CT: Appleton & Lange.

Wyatt, G., Kurtz, M., & Liken, M. (1993). Breast cancer survivors: An exploration of quality of life issues.Cancer Nursing, 16(6), 440-448.

Wyatt, G., Kurtz, M., Friedman, L., Given, B., & Given, C. (1996). Preliminary Testing of the Long-TermQuality of Life Instrument for Female Cancer Survivors. Journal of Nursing Measurement, 4(2), 153-170.

Wyatt, G., & Friedman, L. (1996). , Development and testing of a quality of life model for long-term femalecancer survivors. Quality of Life Research, 5, 387-394.

Wyatt, G., & Friedman, L. (1996). , Long-term female cancer survivors: quality of life issues and clinicalimplications. Cancer Nursing, 19(1), 1-7.

Supplemental References:

Anderson, K. & Tomlinson, P. (1992). The family health system as an emerging paradigmatic view of nursing.IMAGE: Journal of Nursing Scholarship, 24(1), 57-63.

Huch, M. (1996). Perspectives on health. In J. Kenney (Ed.) Philosophical and theoretical perspectives foradvanced nursing practice (pp. 199-210). Boston: Jones and Barlett.

Reed, P. (1995). A treatise in nursing knowledge development for the 21st century: Beyond post modernism.Advances in Nursing Science, 17(3), 70-83.

Schoenhofer, S. (1995). Rethinking primary care: Connections to nursing. Advances in Nursing Science, 17(4),12-21.



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FRAMEWORK ANALYSIS GUIDE

September 6, 2001 CLASS # 2: Developmental and Transition Frameworks

Objectives: The student will:

1. Evaluate selected developmental and transition frameworks (e.g., Family Development Theory, AdultTransition, The Self-Care Deficit Theory of Nursing) utilizing established criteria.

2. Apply the selected developmental conceptual and theoretical frameworks to individuals andfamilies in the assigned novel, “The Good Husband”.

3. Analyze the impact of normative individual and family transitions , e.g., retirement, relocation,widowhood on the health and adaptation of aged persons within their cultural and ethnic environments.

4. Assess the impact of the stages of the family life cycle, the family developmental tasks, and familystructures on family health status.

Activities:

* Submit “Personal Practice Philosophy" Draft* Apply “Guideline for Framework Analysis”.* Examine “Personal Practice Philosophy" for possible inclusion of developmental framework.

Required Readings:


Harmon-Hanson, S., & Boyd, S. (1996). Family nursing practice in the twenty-first century. In S. Harmon-Hanson and S. Boyd (Eds.), Family health care nursing - Theory, practice and research (1st ed., pp. 372-377).Philadelphia: F. A. Davis.

Family Development TheoryFriedman, M. , Connelly, C., Miller, K., & Williams, R. (1998). Family developmental theory. In M. Friedman,

Family nursing - Research, theory and practice (4th ed., pp. 111-145). Stanford, CT: Appleton & Lange.

Individual DevelopmentGedaly-Duff, V. & Heims, M. (1996). Family child health nursing. In S. Harmon-Hanson and S. Boyd (Eds.),

Family health care nursing - Theory, practice and research (1st ed., pp. 245-250). Philadelphia: F.A. Davis.

Schulz, R. and Heckhausen, J. (1996). A lifespan model of successful aging. American Psychologist, 7, 702-714.

Genogram & EcomapHarmon-Hanson, S., & Boyd, S. Family health care nursing Theory, practice, and Research. Family Assessment

and Intervention, 155-163. Philadelphia: F.A. Davis.

Orem’s Theory of Nursing (Self-Care Deficit Theory)Meleis, A. (1997). Theoretical nursing: Development and progress (1st ed., pp. 391-401). Philadelphia:

Lippincott.

GenogramPuskar, K. & Nerone, M. (1996). Genogram: A useful tool for nurse practitioners. Journal of Psychiatric and

Mental Health Nursing, 3(1), 55-60.

**Copies available in the library

Supplemental Readings:



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Friedman, M. , Connelly, C., Miller, K., & Williams, R. (1998). Family developmental theory. In M. Friedman,Family nursing - Research, theory and practice (4th Ed., pp. 138-145). Stamford, CN: Appleton & Lange.

Hart, M. and Foster, S. (1998). Self-care agency in two groups of pregnant women. Nursing Science Quarterly,11(4), 167-171.

Kachoyeanos, M. and Selder, F. (1993). Life transitions of parents at the unexpected death of a school-ageand older child. Journal of Pediatric Nursing, 8(1), 41-49.

Schroots, J. (1996). Theoretical developments in the psychology of aging. Gerontologist, 36(6), 742-748.

Schumacher, K. and Meleis, A. (1994). Transitions: A central concept in nursing. IMAGE: Journal of NursingScholarship, 26(2), 119-127.

Shapiro, E. (1996). Family bereavement and cultural diversity: A social developmental perspective. Family Process,35(3), 313-332.

Smith,S. (1997). The retirement transition and the later life family unit. Public Health Nursing, 14(4), 207-216.

Tomlinson, P. (1996). Marital relationship change in the transition to parenthood: A reexamination as interpretedthrough transition theory. Journal of Family Nursing, 2(3), 286-304.



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September 13, 2001 CLASS # 3: Systems Frameworks

Objectives: The Student will:1. Evaluate selected systems frameworks, e.g., General Systems Theory, A Lifespan Model of Successful

Aging, The Science of Unitary Human Beings, utilizing established criteria.2. Apply the selected systems frameworks to families, groups and societal systems.3. Evaluate the selected systems frameworks for APN practice and research.

Activities:1. Apply “Guideline for Framework Analysis”.2. Examine “Personal Practice Philosophy" for possible inclusion of systems frameworks in “Final Draft”.3. Apply ecomap to “Good Husband.”

Required Readings:Godwin, G. (1994). The good husband (1st ed., pp. 173-252). New York, NY: Ballantine Books.

Roger’s Theory of NursingMeleis, A. (1997). Theoretical nursing: Development and progress (3rd ed., pp. 318-327). Philadelphia:

Lippincott.

Systems TheoryWhitchurch, G. & Constantine, L. (1993). Systems Development Theory. In P. Boss, W. Doherty, R. LaRossa, W.

Schumm & S. Steinmetz (Eds.), Source Book of Family Theories and Methods: A Contextual Approach (1st ed., pp.325-352). New York: Plenum Press.

Friedman, M. (1998). Systems Theory In M. Friedman, Family Nursing (4th ed. pp. 153-165). Stanford, CT:Appleton & Lange.

Wegner G. & Alexander R. (1992). Readings in Family Nursing, (pp. 368-380). Philadelphia: Lippincott-Raven.

Dodd, M. & Miaskowski, C. & Paul, S. Symptom Clusters and Their Effect on the Functional Status of Patientswith Cancer. Vol. 28 No. 3, 2001, pg. 465-470.

Supplemental Readings:Amato, P. (1996). Explaining the intergenerational transmission of divorce. Journal of Marriage and the Family, 8,

628-640.

Coleman, C. Piles, C., & Poggenpoel, M. (1994). Influence of caregiving on families of older adults. Journal ofGerontological Nursing, 11, 40-56.

Compton, M. (1994). A Rogerian view of drug abuse: Implications for nursing. Nursing Science Quarterly, 8, 98-105.

Knapp, E., & DelCampo, R. (1995). Developing family care plans: A systems perspective for helping hospicefamilies. American Journal of Hospice and Palliative Care, 12(6), 39-47.

Rogers, M. (1992). Nursing science and the space age. Nursing Science Quarterly, 5(1), 28-34.



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September 20, 2001 CLASS # 4: Stress/Crisis/Coping Frameworks

Objectives: The student will:1. Analyze selected stress/crisis/coping conceptual and theoretical frameworks, e.g., ABCX/Double

ABCX/Resiliency Framework, The Pinwheel Model of Bereavement, and Neuman Theory of Nursing,utilizing established criteria.

2. Examine previously reviewed developmental and systems frameworks in relation to stress/crisis/copingframeworks for the individual, family and group.

3. Evaluate the selected stress/crisis/coping frameworks for APN practice and research.4. Apply selected stress/crisis/coping frameworks at the individual and family level apparent in the novel,

“The Good Husband”.

Activities:1. Apply “Guidelines for Framework Analysis”.2. Examine “Personal Practice Philosophy" for possible inclusion of selected stress/crisis/coping

frameworks in “Final Version".

Required Readings:

Godwin, G. (1994). The Good Husband (1st ed., pp. 253-310). New York, NY: Ballantine Books.

ABCX ModelFriedman, M., Svavarsdottir, E. & McCubbin, M. (1998). Family stress and coping processes: Family adaptation.

In M. Friedman, Family nursing (4th ed., pp. 436-446). Stanford, CT: Appleton & Lange.

CopingLazarus, R.S. (1993). Coping theory and research: Past, present and future. Psychosomatic Medicine, 55, 234-247.

Neuman’s Theory of NursingMeleis, A. (1997). Theoretical Nursing: Development and Progress (1st ed., pp. 302-311). Philadelphia:

Lippincott.

Harmon-Hanson, S., & Boyd, S. (1996). Family health care nursing: Theory, practice, and Research. FamilyNursing Assessment Models, pp. 148-149. Philadelphia: F. A. Davis.

Resiliency ModelRobinson, D. (1997). Family stress theory: Implication for family health. Journal of the American Academy of

Nurse Practitioners, 9(1), 17-23.

Bereavement ModelSolari-Twadell, P., Dunkers, S, Wang, C., & Snyder, D. (1995). The pinwheel model of bereavement. IMAGE: The

Journal of Nursing Scholarship, 27(4), 323-326.

Copp, Gina (1998). A review of current theories of death and dying. Journal of Advanced Nursing, 28, (2), 382-390.

McClement, S.E. & Woodgate, R.L. (1998). Research with families in palliative care: Conceptual andmethodological challenges. European Journal of Cancer Care, 7, 247-254.

Continued on Next PageCLASS #4



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September 20, 2001 CLASS #4: Stress/Crisis/Coping Frameworks (C o n t i n u e d)

Supplemental Readings:Blanchard, C, Albrecht, T & Ruckdeschel, J. (1997). The crisis of cancer: Psychological impact on family

caregivers. Oncology ,11(2), 189-194).

Drench, M. (1994). Changes in body image secondary to disease and injury. Rehabilitation Nursing, 19(1), 31-36.

Friedman, M., Svavarsdottir, E. & McCubbin, M. (1998). Family stress and coping processes: Family adaptation.In M. Friedman, Family nursing (4th ed., pp. 446-465). Stamford, CN: Appleton & Lange.

Reed, K. (1993). Adapting the Neuman systems model for family nursing. Nursing Science Quarterly, 6(2), 93-97.

Rozenzweig, A, Prigerson, H., Miller, M, & Reynolds, C. (1997). Bereavement and late-life depression: Grief and itscomplications in the elderly. Annual Review of Medicine, 48, 421-428.

Wang, J, & McKinney, J. (1997). Battered women’s perceptions of loss and health. Holistic Nursing Practice, 11(2),50-59.



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September 27, 2001 CLASS #5: In-Class Film & Guest Lecturer: Joan Wood, R.N., Ph.D.AND

October 4, 2001 CLASS # 6: Mid-term Exam & Concept Discussion based on film.

Objectives: The student will:1. Analyze the class film using the previously reviewed frameworks.2. Participate in presenting the analysis to other class participants.3. Compare and contrast the application of each of the frameworks used to analyze the film.

Activities:1. View the film through the lens of “one” of the frameworks.2. Take selected notes to assist in the application of the assigned framework.3. Participate in small group discussion with other class participants who viewed film using the same

framework.4. Following small group discussion, prepare with other class participants a transparency (s) which

demonstrates application of the framework to the film.5. Participate in large group discussion of all presented transparencies representing the various frameworks.

Required Readings:



Alexander, D. and Gwyther, R. (1995). Alcoholism in adolescents and their families: Family focused assessment andmanagement. Pediatric Clinics of North America, 33(3), 217-234.



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October 11, 2001CLASS 7: REVIEW OF NURSING DIAGNOSIS (Individual, Family and Group)APPLICATION OF NURSING DIAGNOSIS AND FRAMEWORKS

Guest Lecturer: Brigid Warren, R.N., MSN and Linda Keilman, R.N., MSN

Objectives: The student will:1. Review the basic components of a nursing diagnosis.2. Be familiar with the general characteristics of nursing classification systems, e.g., NANDA, OMAHA, NIC,

and NOC.3. Assess family data from “The Good Husband” to determine appropriate individual, family and

and group nursing diagnoses.4. Distinguish between “strength” based diagnoses vs “need” based diagnoses.5. Derive “need” based individual, family and group nursing diagnoses (actual and potential) reflective of the

NANDA or OMAHA classification systems which are appropriate to novel characters, families, and groups6. Develop “strength” based nursing diagnoses reflective of the NANDA or OMAHA classification systems

appropriate to novel characters.

Activities:1. Engage in small and large group discussion.2. Examine the MSU CON NUR 820/830 History Form using the frameworks proposed by Neuman, Orem, and

Rogers.3. Examine “Personal Practice Philosophy - Draft # 1" for possible inclusion of nursing classification systems

frameworks in final version.

Required Readings:Ackley, B. & Ladwig, G. (1999). Nursing diagnosis handbook (4th ed., pp. 2-6 & 446-451). St. Louis: Mosby.

Friedman, M., and Heady, S. (1998). Family role structure. In M. Friedman, Family nursing (4th ed., pp. 314-319& 361-362). Stamford, CT: Appleton & Lange

Friedman, M., & Levac, A. (1998). The family nursing process. In M. Friedman, Family nursing (4th ed., pp. 53-58). Stamford, CT: Appleton & Lange.

Maas, M. (2000). Standardized Languages: NIC and NOC. Lecture Notes.

Supplemental Readings:Johnson, M., & Maas, M. (Eds.). (1997). Nursing outcomes classification (NOC). St. Louis: Mosby.

McCloskey, J., & Bulechek, G. (1996). Nursing interventions classification (NIC). St. Louis: Mosby.

Mischke, K., & Harmon - Hanson, S. (1996). Family systems stressor - strength inventory (FS3I). In S. Harmon -Hanson and S. Boyd, Family health care nursing (1st ed., pp. 394-408). Philadelphia: F. A. Davis.



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October 18, 2001CLASS 8: REVIEW OF HEALTH PROMOTION AND DISEASE PREVENTIONAPPLICATION OF HEALTH PROMOTION AND DISEASEPREVENTION

Guest Lecturer: Joan Wood, R.N., Ph.D.

Objectives: The student will:1. Examine epidemiological frameworks, e.g., the "web of causation" and “levels of prevention” (primary,

secondary and tertiary), utilizing established criteria.

2. Explore the applicability of these frameworks to the top 20 primary care conditions.3. Discuss primary care conditions present in "The Good Husband".3. Examine the potential relationships between these frameworks and those previously analyzed, i.e.,

developmental, systems, and stress/crisis/coping.

Activities:1) Apply "Guidelines for Framework Analysis".2) Examine "Personal Practice Philosophy -" for possible inclusion of epidemiological model

including, the "web of causation" and “levels of prevention”.

Required Readings:Clemen-Stone, S., Eigsti, D., & McGuire, S. (1995). Comprehensive Community Health Nursing (5th ed., pp. 286-

296). St. Louis: Mosby.

Ditillo, B. (1998). Switching gears to primary care. American Journal of Nursing, 98(5), 16K-16L.

Glanz, K., Lewis., F., & Rimer, B. (1997). Health behavior and health education - Theory, research, and practice (2nd

ed., pp. 453-478). San Francisco, CA: Jossey-Bass Publishers.

Swanson, J. & Albrecht, M. (1993). Community health nursing: Promoting the health of aggregates (1st ed., pp. 8).Philadelphia: W. B. Saunders.

Supplemental Readings:Clark, M. J. (1999). Nursing in the community (3rd ed., 153-161). Stamford, CT.: Appleton & Lange.

Michigan Department of Community Health and the Michigan Public Health Institute (1997). Initial results from the1996 Michigan Behavioral Risk Factor Survey. Lansing, MI: Michigan Department of Community Health.



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October 25, 2001CLASS 9: CHANGE FRAMEWORKS: Individual, family, group & providerADOPTION OF POSITIVE HEALTH BEHAVIORALTERING PROBLEM HEALTH BEHAVIOR

Objective: The student will:1. Evaluate selected change frameworks, e.g., Social Learning (Cognitive) Theory, Health Belief Model and Health

Promotion Model, utilizing established criteria.2. Examine the applicability of these frameworks to selected case situations reflecting primary care conditions.3. Examine relevant research applicable to advanced nursing interventions.4. Apply the concept of mutuality to promote health behaviors in primary care situations.

Activities:

1. Small and large group discussion of:*Heath Promotion Model as applied to diabetic teaching.*Variations on the Health Belief Model as applied to breast cancer screening.

2. Examine "Personal Practice Philosophy" for possible inclusion of selected learning andcounseling frameworks.

Required Reading:

SCTBaranowski, T., Perry, C., & Parcel, G. (1997). How individuals, environments, and health behavior interact (social

cognitive theory). In Glanz, K., Lewis, F., & Rimer, B. (1997). Health behavior and health education. (2nd ed., pp. 153-178). San Francisco, CA: Jossey-Bass Inc.

HBM & TTMFriedman, M. & Morgan, I. (1998). The family health care function. In. M. Friedman, Family nursing -Research,

theory, and practice (4th ed., pp. 403-424). Stanford, CT: Appleton & Lange.

SCT & HBMRosenstock, I. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175-

183.

HBMStrecher, V. & Rosenstock, I. (1997). The health belief model. In K. Glanz, F. Lewis, & B. Rimer (Eds) Health

behavior and health education - Theory, research, and practice (2nd ed., pp. 41-59). San Francisco, CA: Jossey-BassPublishers.


Champion, V. (1995). Development of a benefits and barriers scale for mammography utilization. Cancer Nursing,18(1), 53-59.

Eisenhauer, L. (1994). A typology of nursing therapeutics. IMAGE: Journal of Nursing Scholarship, 26(4), 261-264.

Hansen, M. (1998). Patient-centered teaching from theory to practice. American Journal of Nursing, 98(1), 56-60.

Oldnall, A. (1996). A critical analysis of nursing: Meeting the spiritual needs of patients. Journal of AdvancedNursing, 23, 138-144.

Ward-Collins, D. (1998). “Noncompliant” - Isn’t there a better way to say it?. American Journal of Nursing, 98(5).27-32.



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November 1, 2001 CLASS 10: Change Frameworks (cont’d)

Objectives: The student will:

1. Examine selected learning and change conceptual and theoretical frameworks (e.g., The TranstheoreticalModel) utilizing establish criteria.

2. Examine the selected frameworks as a basis for developing educational approaches in primarycare, including client characteristics.

3. Apply the selected frameworks to characters, families, and groups in "The Good Husband".4. Develop behavioral approaches utilizing concepts incorporated by the frameworks, e.g., self-efficacy,

adaptation).

Activities:

1. Apply "Guideline for Framework Analysis".2. Examine "Personal Practice Philosophy - Draft # 2" for possible inclusion of the selected frameworks in Draft

# 3.3. Small and large group discussion of:

*Transactional model (Prochaska) applied to smoking cessation or weight reduction.*Social learning theory (Bandura) applied to teaching in cognitive reframing and self efficacy.

Required Readings:

TTMProchaska, J. (1994). Strong and weak principles for progressing from precontemplation to action on the basis of

the 12 problem behaviors. Health Psychology, 13(1), 47-51.

Prochaska, J., Redding, C., & Evers, K. (1997). The transtheoretical model and stages of change. In Glanz, K.,Lewis, F & Rimer, B. (Eds), Health behavior and health education (2nd ed., pp. 60-84). San Francisco: Jossey-Bass.

HBM & TTMChampion, V. (1994). Beliefs about breast cancer and mammography by behavioral stage. Oncology Nursing

Forum, 21(6), 1009-1014.


Burnside, I. (1994). Reminiscence and life review: Therapeutic interventions for older people. Nurse Practitioner, 4,55-61.

LeSage, J., Slimmer, L., Lopez, M., & Ellor, J. (1986). Learned helplessness. Journal of Gerontological Nursing,15(5), 8-15.

Prochaska, et al (1994). Stages of change and decisional balance for 12 problem behaviors.Health Psychology, 13(1), 39-46.

Prochaska, J.O., et al. (1994). The transtheoretical model of change and HIV prevention: A review. HealthEducation Quarterly, 21(4), 471-486.



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