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• Caring sciences include humanity, role modeling, nurturing, and holistic approaches, emphasizing being human first and understanding human experience.
• Touch is vital in patient care and is influenced by context and culture.
• Touch engenders sympathy, enhances communication, and bolsters self-esteem in patients.
• It strengthens the nurse-patient relationship and helps avoid suffering through a holistic approach.
• Technology may hinder human touch in care interactions.
• Compassion fatigue and burnout can result from loss of relationship or distancing from patients.
• BSCN philosophy centers on being aware of oneself as a person/nurse.
• Nursing involves knowing, doing, and being, encompassing nursing knowledge, self-knowledge, and world knowledge.

Being

• Recognizing that everyone is unique, knowledgeable, and self-determining.
• Respecting dignity and focusing on well-being.
• Shaped by family, friends, religion, and life experiences.
• Embodiment is influenced by the world.
• Journey toward authentic connection, seeking human connections.

Knowing

• Knowledge is continually changing, pursued dynamically, and may be ambiguous with constant flux.
• It involves palliative care, ER settings, and dealing with dying persons.
• Multiple truths and perspectives should be considered, with nurses taking in various viewpoints like age, gender, and social identity.
• Nursing serves as a guide for actions and thoughts, providing a framework for decision-making and articulating relationships between concepts.
• Being, knowing, and doing are interconnected.

Propositions

• Use the 5 senses to understand different concepts
• For example: shortness of breath in relation to anxiety, sleeplessness, cancer or heart disease.
  • Determine urgency of the symptom.
• Making sense of symptoms in relation to their danger level
• Nursing theory is the language that makes nurses capable through thought and action.
• Patterns of Knowing includes objective and subjective aspects, where objective is measurable and repeatable.
• Subjective is personal and internal
• Ethical Knowing is the sense of right and wrong
• Empirical Knowing is mostly objective, borrowed from health and social sciences, and relies on measurement.
• Personal Thinking includes stories and therapeutic use of self, involves utilizing knowledge gained from patients.
• It's hard to separate personal and nursing self in professional practice.
• Aesthetic Thinking involves nursing science
• Considers how we do things, expressing all knowledge through thoughts and actions.
• These patterns must come together
• Social justice equals emancipatory knowing to free people from health barriers created by society.

Unknowing and Synoptic Knowing

• Unknowing requires an open mind and heart for sense-making
• Recognizes different truths and perspectives
• Synoptic Knowing avoids compartmentalizing knowledge, uses different knowledge in varying contexts
• Moves back and forth with knowledge.
• It addresses biases and integrates knowledge, prioritizing safety and recognizing individual uniqueness.
• Courage is needed to step out of one's comfort zone, integrating health, social sciences, and caring.

Metaparadigm

• A worldview
• A way of using knowledge, and it is divided into four concepts: nursing, person, health, and environment.
• Nursing theory definition
• Helps organize research and illuminates phenomena from a uniques perspective
• Person (1984)
  • How nurses care for one person
  • Limited to a sickness perspective, seeing patients as tasks without social identity.
  • Focused on age and ethnicity.
• Health (1984)
  • Considers physical health and WHO definition
  • Differentiates health from illness but lacks focus on nutrition and mind-spirit connection.
• Environment(1984)
  • Hospital
  • Physical, with no outside resources.
• Nursing (1984)
  • Clinicians in hospitals with skillsets at a diploma level, performing tasks robotically at a low level.
• Criticisms
  • Lack of consensus, evidence, and relationship.
  • The model is colonial/western and doesn't promote a two way patient relationship
• More Criticisms
  • Absence of outside thinking.
  • The focus should be on Nursology which is the study of nursing.

McGill Model of Nursing

• Assumes patients are capable
• Assumes that a nurse works with people
• Capacity, increased independence, empowerment, nurse puts person in a good place 
• Social awareness, person to human beings (community, organization, goals).
• Encompasses environment and planetary health
• Nursing is about studying nursing, carving pathways, and recognizing contributions.
• Focuses on capacity, capability, independence, and empowerment.
• A way of caring for everyone.

Discipline of Nursing

• A way of studying, focusing expertise in a field.
• Discipline of nursing is the focus on people.
• It expresses knowledge and integrates thoughts with actions.
• Professions must consist of 5 things
  • Four years of education
  • Code of ethics (outlines beliefs and behaviors)
  • Association (protects the public)
  • Specific service (improves health)
  • Disciplinary knowledge
• Art and science in nursing
• Nursing may be considered its own form of science
• The scientist studies topics related to nursing and human behavior
• Nursing is a combination of education and knowledge
• Continual experimentation occurs with trial and error.

Healthcare System

• Nurses are an integral part of healthcare
• Nursing science applies theory into practice, requiring critical thinking, problem-solving, and communication
• Science provides a foundation for process, actions, and thoughts
• Nursing focuses on self-knowledge for patient care and education for making good health choices.
• Centering around patient experience and human understanding shapes practice.
• Being in relationships requires connection, self-awareness, and trust.
• Healing is holistic, encompassing mind, body, and spirit, and involves peace and meaning in life.
• Curing addresses broken components, such as bones
• Is not always possible
• Nurses listen, offer pain medications, and create strategies to promote a peaceful environment for healing.
• Curing isn't always the best course of action.
• Nursing educates and guides individuals in new subjects.
• Inductive reasoning entails experimentation, forming generalizations from specifics.
• Deductive reasoning applies big ideas to small ideas.
• Grounded in relationships requires respect, honoring differences, and preventing trauma professionally.
• Listening involves critical reflexivity and needing outside perspectives.
• Curiosity entails staying informed of changing world and upcoming health implications.

Perspectives

• Possibility includes innovation and creativity, keeping mind and heart open while being aware of biases
• Sense-making entails different framing and multiple insights.
• Intuition, or "spider sense," relies on body cues to sense patterns.
• Collective thinking is informed by opinions, empirical evidence, and reliable resources
• Recognizing that we don't have all the answers fosters openness.
• ALL humans are capable of critical thinking

Levels of Critical Thinking

• Basic
  • Is concrete with prescriptive rules, distinguishing right from wrong.
• Complex
  • Creative with alternative options, recognizing grey areas and flexibility.
  • The ability to assess differences in people or situations.
• Commitment
  • Anticipates issues and uses the full scope of practice
• Nurses must consider viability in context
• The end result is growth
• Working to see the bigger picture

Nursing Process

• Is cyclic, dynamic with client centeredness, problem-solving, and universally applicable.
• The collaborative style relies on critical thinking and clinical reasoning.
• Nursing frameworks guide through assessment and evaluation, fostering consistency.
• Quality patient-centered care and accommodating change are key.

Challenges within the Nursing Process

• Individual vs systems approach
• Not focusing on problems which may perpetuate issues, or missed care due to biomedical model prioritization.
• If issues don't fit care plan, no care is given
• Assessment requires gathering and verifying various insights, including body, mind and spirit

Planning priorities

• CURE (critical, urgent, routine, extra)
• Setting collaborative goals and outcomes
• Implementation requires action and can be independent, dependent, or collaborative.
• Evaluation
  • How successful was the care plan?
  • Incorporate patient feedback
  • Improvement
• Limitations may occur as systems focus more on individuals.
• Lacks ethics and holistic considerations.
• In the nursing process people are worked on, rather than with.
• This can be rectified by considering what's going on in assessment.
• Consideration of cues through senses, environment, judgements, and information sources.
• Knowledge comes from metaparadigms, articles, theories, research, families, health, social sciences, and politics.
• Filtering requires experience and reflection.
• CURE categorizations assist in prioritizing hypothesis.

Analyzing Cues

• Start to see cues beyond the physical, sense making with:
• A patient's needs, story, and economic state.
• Co-interpretation and patient input is included.
• One must avoid becoming a technician.
• Basic needs should be met first
  • Physical safety is the bottom line
• Set priorities with patient, and generate solutions
• Brainstorm and work towards patient confidence.
• Encourage independence by understanding strength and potential limitation.
• Actions should be SMART and appropriate to the patient's individualized care.

Environmental and Individual Factors in the Delivery of Care

• Maslow Hierarchy Model
  • Base judgements on who needs the most care.
  • Promote wellbeing, stabilize health, and offer comfort.
• Evaluate outcomes include working to validate practice through constant evaluation
• Ask for feedback and consider outside factors
• Staffing, supplies, medical records, time, culture, individualities are all considerations
• Stresses are put on the nurse who must problem solve
• Case study on 3 year old with a fever
  • Find out more info from both the patient and the parent to prioritize a diagnosis
• Nurses can avoid issues by seeking input and validating the patients lived experience to assist with setting priorities.

Indigenous Knowledge

• A different relationship with the world we live in.
• It includes healing, wellbeing, relationships, community, and land
• Tribes have different views of their meta paradigm
• Tribes pass on the knowledge through oral storytelling.
• Intended to share, teach, role model and nurture others
• Nurses must see with both western and indigenous eyes (two eyed seeing)
• A blend of borrowed science with other ways of knowing to incorporate owned experiences.
• Blending indigenous and western ways enables better care
• Gather perspectives for sense-making, perceiving strengths, and establishing belonging
• Colonization
  • Includes taking rights away from people.
    • Policies and rules that dehumanize
    • Development benefits the white with little notice
• Indian Act
  • The federal government is responsible for the act itself
  • Very racist and erodes incentives to excel, resulting in cultural genocide.
  • Goal: Eradication.

UNDRIP

• Indigenous groups have the right to practice traditional medicine and the highest attainable care
• This required TRC calls to action and reconciliation for all parties.
• Government had itemized trauma and the time for a new era is now
• Loss of status contributes to health disparities through systemic discrimination and poverty, impacting society.

5 Principles

• Protocol and how we will engage
• Differ based on the source
• Personal knowledge must include work from others
• Indigenous groups must be included
• Planetary Health & Indigenous
  • Care for our land and those in it.