Murphy's Nursing Law

• When you need the money, your shift is cancelled; when you have a weekend planned, you have to do overtime.
• Realizing the patient you've just injected has a serious infection causes you to stab yourself with the used needle.
• A 500 pound patient needs all care, while your 80 pound patient needs a finger dressing ... and your colleague has a "bad back."
• It's you're first night shift for three years. And it's a full moon.
• You're doing the "Only 27 more minutes of the shift from hell happy-dance", only to turn around to see your supervisor standing there.
• In a critical situation, the most highly qualified clinician will offer the most advice and the least support.
• The absurdity of the suggestion is directly proportional to the distance from the bedside.
• As soon as you finish a thirty minute dressing the doctor will come in, and take a look at the wound.
• The disoriented patient always comes from a Nursing Home whose beautiful paperwork has no phone number on it.
• Your nose will itch the very moment your gloved hands get contaminated with bodily fluids.
• The patient who has been dying all night finally meets his maker 12.5 minutes before shift change.
• You walk out of a patient's room after you've asked them if they need anything: they will put the call bell on as you are about three quarters the way down the hall.
• The patient furthest away from the nurses' station rings the call bell more often than the patient nearest to the nurses' station.
• The doctor with the worst handwriting and most original use of the English Language will be responsible for your most critical patient.
• You always remember "just one more thing" you need after you've gowned, gloved, and masked and gone into that isolation room.
• The correct depth of compression in adult CPR is a bit less than the depth you just reached when you broke those ribs.
• When you cancel extra staff because it's so quiet, you are guaranteed a rash of admissions.
• If you wear a new white uniform, expect to be thrown up on.
  Corollary: Residents always poop on your brand new shoes.
• When management smiles at you, be very, very afraid ...
• Staffing will gladly send you three aides--but you have to float two of your RNs.
• As soon as you discontinue the IV line, more fluids will be ordered.
• Mandatory meetings are always scheduled after you've had the night from hell and just want to go home to bed.
• You always forget what it was you wanted after you get to the supply room. You always remember when you get back to the other end ...
• Doctors only ask your name when the patient isn't doing well.
• Success occurs when no one is looking, failure occurs when the boss is watching.
• As soon as you've ordered the pizzas, 25 patients show up at the ER registration desk along with three ambulances all with cardiac arrests!
• For every action, there is an equal and opposite criticism.
• Ten seconds after you have finished giving a complete bed bath and changing the bed, the patient has a giant code brown.
• If a patient needs four pills, the packet will contain three.
• Your buddies who were reading the paper at the nurses' desk a minute ago always disappear when you need help ...
• Expect to get your pay raise the same day the hospital raises the parking rates (and other charges)
• The better job you do, the more work you can expect to be handed ...
• The amount of clean linen available is inversely proportional to your immediate needs.
• The more confused and impulsive a patient is, the less chance there is for a family member or friend to sit with the patient.
• The perfect nurse for the job will apply the day after that post is filled by some semi qualified idiot.
• If only one solution can be found for a problem, then it is usually a stupid solution.
• When the nurse on the preceding shift has surrounded the patient with absorbent pads, the code brown will hit every sheet and miss every pad.
• Rest assured that when you are in a hurry, the nurse's notes have not been written.
• When you are starting an IV on an uncooperative patient, or dealing with a huge code brown, there is a phone call for you and it's that crabby physician that you have been paging all morning.
• Fire drills always occur on your day from hell
• The first person in line when the clinic opens will not require urgent care. The sickest person will arrive 5 minutes before closing: "I thought I'd feel better"
• The Nursing Catch-22:
  If you're running around horribly busy, you're unorganized and need to prioritize, but if you're not running around horribly busy, you're lazy and need to find more work to do.

Nursing Theories : Tidal Model

The Tidal Model is a model for the promotion of mental health developed by Professor Phil Barker, Poppy Buchanan-Barker and their colleagues. The Tidal Model focuses on the continuous process of change inherent in all people. It seeks to reveal the meaning of people's experiences, emphasising the importance of their own voice and the power of metaphor when carrying out assessment. It aims to empower people to reclaim control of their lives using the three domains of self, world and others.

In order for the practitioner to begin the process of engagement using the Tidal Model, the following needs to be accepted:

• that recovery is possible
• that change is inevitable - nothing lasts
• that ultimately, people know what is best for them
• that the person possess all the resources they need to begin the recovery journey
• that the person is the teacher and the helpers are the pupils
• that the helper needs to be creatively curious, to learn what needs to be done to help the person, now!

The philosophy underpinning the model comes from research into what people need for care in mental health carried out by Prof. Barker and Dr. Chris Stevenson at the University of Newcastle, UK in 1995.

Three domains

The process of engaging with the person in distress takes place in three discrete domains. With the Tidal Model, the practitioner explores these dimensions to be aware of the situation in the present time and determine what needs to happen now.

• Self domain is where people feel their world of experience. There is an emphasis on making people feel more secure and the practitioner helps the person develop a Security Plan to reduce threats to the person or others around them.
• World domain is where people hold their story. The Tidal Model practitioner uses a specific form of inquiry to explore this story collaboratively, revealing its hidden meanings, the person's resources, and to identify what needs to be done to assist recovery.
• Others domain represents the various relationships the person has: past, present and future. This includes Tidal Model practitioners but also other members of the health and social care team, friends, family and supporters.

The power of metaphor

The Tidal Model uses the metaphor of water and describes how people in distress can become emotionally, physically and spiritually shipwrecked. It sees the experience of health and illness as a fluid, rather than a stable phenomenon, and life as journey undertaken on an ocean of experience. It proposes that in mental health, the factors associated with a psychiatric crisis, or its more enduring consequences, can be diverse as well as cumulative. It states that by appreciating this metaphor, nurses or other helpers will gain a greater understanding of the person's current situation and the inevitability of change. With this, the helper may, in time, be guided to care with the person beginning their journey from the state of being washed ashore, drowning or being otherwise marooned by their life problems. Following the rescue, exploration can then begin as to what caused the storm in the first place and what needs to be done immediately to set sail again.

The Ten Commitments

The values of the Tidal Model can be distilled into ten commitments:

1. Value the voice - the person's story is paramount
2. Respect the language - allow people to use their own language
3. Develop genuine curiosity - show interest in the person's story
4. Become the apprentice - learn from the person you are helping
5. Reveal personal wisdom - people are experts in their own story
6. Be transparent - both the person and the helper
7. Use the available toolkit - the person's story contains valuable information as to what works and what doesn't
8. Craft the step beyond - the helper and the person work together to construct an appreciation of what needs to be done 'now'
9. Give the gift of time - time is the midwife of change
10. Know that change is constant - this is a common experience for all people

Nursing Theories : Callista Roy's Model of Nursing

Roy's model of nursing sees an individual as a set of interrelated systems, biological, psychological, and social. The individual tries to maintain a balance between each of these systems and the outside world. However, there is no absolute level of balance. According to Roy we all strive to live within a band where we can cope adequately. This band will be unique to an individual. The adaptation level is the range of adaptability within which the individual can deal effectively with new experiences.

Sr. Callista Roy maintains there are four main adaptation systems which she calls modes of adaptation. She calls these the physiological system, the self concept system, the role mastery system, and the interdependency system.

The Models And Theories of Nursing

Nursing theory is the term given to the body of knowledge that is used to support nursing practice. In their professional education nurses will study a range of interconnected subjects which can be applied to the practice setting. This knowledge may be derived from experiential learning, from formal sources such as nursing research or from non-nursing sources. To speak of nursing theory is often difficult. Nursing is many things to many people. Most universally agreed upon is that Nursing is a science involving people, environment and process fueled by a vision of transcendence in the context of healthcare. It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years. Many schools encourage students to formulate theories of Nursing as part of their curriculum. Some might argue that this multiplicity of theory is detrimental to the practice and undermines common vision. Others would say that the nature of the young science is sufficiently far reaching to require such tactics in order to elicit true consensus. It cannot be denied, however, that there is much vanity involved in the formulation of nursing theory. The pages of "Nursing Science Quarterly", a major mouthpiece for Nursing Theory, are rife with examples of semantical hair-splitting.

Nursing models are conceptual models, constructed of theories and concepts. They are used to help nurses assess, plan, and implement patient care by providing a framework within which to work. They also help nurses achieve uniformity and seamless care.