Theoretical Foundations of Nursing PDF

- LEGAL PRINCIPLES IN NURSING - T H E O R E T I C A L F O U N D AT I O N S O F NURSING - NURSE THEORISTS AND MODELLERS D R S E R P İ L TO P Ç U 1 LEGAL PRINCIPLES IN NURSING 2  INTRODUCTION Laws Prescribe how a...

- LEGAL PRINCIPLES IN NURSING - T H E O R E T I C A L F O U N D AT I O N S O F NURSING - NURSE THEORISTS AND MODELLERS D R S E R P İ L TO P Ç U 1 LEGAL PRINCIPLES IN NURSING 2  INTRODUCTION Laws Prescribe how a person should act in society Liability Legal responsibility; A health care worker can be charged with civil or criminal liability depending on the particular circumstances surrounding the case. 3  INTRODUCTION Standards of Care Standards of care are the legal requirements for nursing practice that describe minimum acceptable nursing care. Standards reflect the knowledge and skill ordinarily possessed and used by nurses actively practicing in the profession Turkish Nurses Association (TNA) develops standards for nursing practice, policy statements, and similar resolutions 4  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 1- Torts A tort is a civil wrong made against a person or property. Torts are classified as intentional, quasi-intentional, or unintentional. Intentional Torts: like hitting someone (battery) or lying to hurt someone's reputation (defamation). Quasi-intentional Torts: These are acts where the harm wasn't intended, but someone still did something wrong, like accidentally invading someone's privacy. Unintentional Torts: These are usually mistakes or accidents, like a nurse giving the wrong medication by accident (negligence), which causes harm to the patient. 5  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 1- Torts- Intentional Torts Assault; If a healthcare provider threatens to physically harm a patient (even without touching them), this can be considered assault. No actual contact is necessary. It is an assault for a nurse to threaten to give a patient an injection or to threaten to restrain a patient for an x-ray procedure when the patient has refused consent. 6 CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 1- Torts- Intentional Torts Battery; Battery is any intentional touching without consent In the example of a nurse threatening to give a patient an injection without the patient’s consent, if the nurse actually gives the injection, it is battery Battery also results if the health care provider performs a procedure that goes beyond the scope of the patient’s consent For example, if the patient gives consent for an appendectomy and the surgeon performs a tonsillectomy, battery has occurred The key component is the patient’s consent 7  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 1- Torts-Quasi-Intentional Torts Invasion of Privacy. Typically invasion of privacy is the release of a patient’s medical information to an unauthorized person such as a member of the press, the patient’s employer, or the patient’s family. The information that is in a patient’s medical record is a confidential communication that may be shared with health care providers for the purpose of medical treatment only. 8  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE Invasion of Privacy For example, respect the wish not to inform the patient’s family of a terminal illness. Similarly, do not assume that a patient’s spouse or family members know all of the patient’s history, particularly with respect to private issues such as mental illness, medications, pregnancy, abortion, birth control, or sexually transmitted infections. 9 CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 1- Torts- Unintentional Torts Negligence. Negligence is conduct that falls below a standard of care - -For example, if a driver of a car acts unreasonably in failing to stop at a stop sign, it is negligence. - Hanging wrong medication 10  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 1- Torts- Unintentional Torts Malpractice Malpractice is one type of negligence and often referred to as professional negligence. Certain criteria are necessary to establish nursing malpractice: (1) the nurse had a duty to perform on the patient (2) the nurse did not carry out that duty, (3) the patient was injured, and (4) the nurse’s failure to carry out the duty caused the injury. 11 12  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 2- Consent A signed consent form is required for all routine treatment, hazardous procedures such as surgery, some treatment programs such as chemotherapy, and research involving patients A patient signs general consent forms when admitted to the hospital or other health care facility. The patient or his or her representative needs to sign separate special consent or treatment forms before the performance of a specialized procedure. Nurses need to know the law in their states and be familiar with the policies and procedures of their employing institution regarding consent 13  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 3- Informed Consent Informed consent is a person’s agreement to allow something to happen Must be taken only in case of emergency Without informed consent a patient may bring a lawsuit against the health care provider for negligence 14  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 3- Informed Consent 15 16  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 4- Nursing Students Nursing students are liable if their actions cause harm to patients. If a student harms a patient as a direct result of his or her actions or lack of action, the student, instructor, hospital, or health care facility and the university or educational institution generally share the liability for the incorrect action. They are expected to perform as professional nurses would in providing safe patient care. They should not perform tasks without staff nurse or instructor 17  CIVIL AND COMMON LAW ISSUES IN NURSING PRACTICE 5- Abandonment and Assignment Issues Health Care Providers’ Orders The health care provider (physician or advanced practice nurse) is responsible for directing medical treatment Nurses follow health care providers’ orders unless they believe the orders are in error or harm patients Therefore you need to assess all orders; if you find one to be mistake or harmful, further clarification from the health care provider is necessary 18 T H E O R ET I C A L F O U N D AT I O N S O F NURSING 19 INTRODUCTION Theory-based nursing practice is important for designing and implementing nursing interventions Expertise in nursing is a result of knowledge and clinical experience You will use well-developed theories as a basis for your approach to patient care 20 NURSING THEORIES Nursing theories are organized bodies of knowledge to define what nursing is, what nurses do, and why do they do it Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines (e.g., medicine) It is a framework of concepts and purposes intended to guide the practice of nursing at a more concrete and specific level 21  What is a Nursing Theory? Purpose of Nursing Theories: Provides direction for practice, education, and research. Helps in problem-solving and guiding patient care. Offers a basis for reflection and improvement in nursing practice. 22 HISTORY OF NURSING THEORIES The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education. In 1860, Florence Nightingale defined nursing in her “Environmental Theory” as “the act of utilizing the environment of the patient to assist him in his recovery.” In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself through the production of its own scientifically tested body of knowledge. In 1952, Hildegard Peplau introduced her Theory of Interpersonal Relations that puts emphasis on the nurse-client relationship as the foundation of nursing practice. In 1955,Virginia Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs, thus her Nursing Need Theory was developed. 23  CLASSIFICATION OF NURSING THEORIES Essentially, three different categories relate to the scope of theories: - Grand theories - Middle-range theories - Practice-Level Theories: (Micro- range theories) 24  1- THE NURSING METAPARADIGM «The metaparadigm is the theory of theories» The nursing metaparadigm is a way to understand the main parts of nursing. The metaparadigm concepts provide; - the boundaries and limitations of a discipline - identify the common viewpoint that all members of a discipline share - help to focus the activities of the members of that discipline. 25  THINK ABOUT!! Consider for a moment the practice of nursing by a school nurse, an emergency room nurse, and a psychiatric nurse. What is the unifying thread among these various nurses? 26  1-THE NURSING METAPARADIGM There are four major concepts that are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. These metaparadigm elements name the overall areas of concern for the nursing discipline. Each nursing theory presents a slightly different view of the metaparadigm concepts. 27  1-THE NURSING METAPARADIGM Person The person is central to the nursing care you provide Person is the recipient of nursing care and may include individuals, patients, groups, families, and communities. 28  1- THE NURSING METAPARADIGM Environment Environment (or situation) is defined as the internal and external surrounds that affect the client It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, home, air pollution and significant others, and the setting for where they go for their healthcare 29  1-THE NURSING METAPARADIGM Health Health is defined as the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting and the health care provider. 30 1-THE NURSING METAPARADIGM Nursing The actions that nurses take to help people get better and stay healthy. The ultimate goal of nursing theories is to improve patient care. The person is the main focus but how each theorist defines the nursing metaparadigm gives a unique take specific to a particular theory 31  THE DOMAIN OF NURSING Nursing is the “… diagnosis and treatment of human responses to actual or potential health problems …” (American Nurses Association, 2010) The scope of nursing is broad For example, a nurse does not medically diagnose a patient’s health condition as heart failure. However, a nurse will assess a patient’s response to the decrease in activity tolerance as a result of the disease and develop nursing diagnoses of fatigue, activity intolerance, and ineffective coping. 32  2- GRAND THEORY Broad in scope and conceptual (Big, broad ideas about nursing) Florence Nightingale's Environmental Theory: Focuses on the environment’s role in healing (like cleanliness, fresh air, and sunlight). Dorothea Orem's Self-Care Deficit Theory: Nurses help patients who can’t take care of themselves (like brushing their teeth or taking medicine). 33  3- MIDDLE-RANGE NURSING THEORIES More limited in scope (as compared to grand theories) They address a specific phenomenon in nursing (More focused, specific ideas) Patricia Benner’s Novice to Expert Theory: Describes how nurses improve from beginners (novices) to highly skilled experts through experience. Pender’s Health Promotion Model: Focuses on encouraging patients to take steps to improve their own health, like exercising or eating healthy. 34 PRACTICE-LEVEL NURSING THEORIES Very specific, daily nursing actions Theory of Wound Healing: Focuses on specific steps and methods nurses use to help wounds heal properly. Postpartum Depression Theory: Helps nurses understand and care for new mothers who may experience depression after childbirth. 35  NURSING THEORISTS Florence Nightingale Overview: Focuses on how the environment can influence health outcomes. Emphasizes hygiene, ventilation, and cleanliness as key to patient recovery. Key Concepts: Cleanliness of the Environment: Ensures proper recovery. Fresh Air and Light: Crucial for health. Holistic Approach: Treating the patient as a whole. Application in Modern Nursing: Infection control measures, hospital design, patient safety initiatives. 36  NURSING THEORISTS Hildegard E. Peplau Pioneered the Theory of Interpersonal Relations Peplau’s theory defined Nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” Helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting. 37 NURSING THEORISTS Virginia Henderson Developed the Nursing Need Theory Focuses on patient independence and the role of nursing in assisting with essential activities. Emphasizes the basic human needs and how nurses can assist in meeting those needs. “The nurse is expected to carry out a physician’s therapeutic plan, but individualized care is result of the nurse’s creativity in planning for care.” 38 NURSING THEORISTS Faye Glenn Abdellah Developed the 21 Nursing Problems Theory “Nursing is based on an art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs.” Changed the focus of nursing from disease-centered to patient-centered, and began to include the care of families and the elderly in nursing care. The nursing model is intended to guide care in hospital institutions, but can also be applied to community health nursing, as well. 39  NURSING THEORISTS Ida Jean Orlando She developed the Nursing Process Theory. “Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.” Allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient. According to her, persons become patients requiring nursing care when they have needs for help that cannot be met independently because of their physical limitations, negative reactions to an environment, or have an experience that prevents them from communicating their needs. The role of the nurse is to find out and meet the patient’s immediate needs for help. 40 NURSING THEORISTS Myra Estrin Levine According to the Conservation Model, “Nursing is human interaction.” Provides a framework within which to teach beginning nursing students. Logically congruent, is externally and internally consistent, has breadth as well as depth, and is understood, with few exceptions, by professionals and consumers of health care. 41 NURSING THEORISTS Joyce Travelbee States in her Human-to-Human Relationship Model that the purpose of nursing was to help and support an individual, family, or community to prevent or cope with the struggles of illness and suffering and, if necessary, to find significance in these occurrences, with the ultimate goal being the presence of hope. Nursing was accomplished through human-to-human relationships. Extended the interpersonal relationship theories of Peplau and Orlando. 42  NURSING THEORISTS Betty Neuman In Neuman’s System Model, she defined nursing as a “unique profession in that is concerned with all of the variables affecting an individual’s response to stress.” The focus is on the client as a system (which may be an individual, family, group, or community) and on the client’s responses to stressors. The client system includes five variables (physiological, psychological, sociocultural, developmental, and spiritual) 43 NURSING THEORISTS Sister Callista Roy In Adaptation Model, Roy defined nursing as a “health care profession that focuses on human life processes and patterns and emphasizes promotion of health for individuals, families, groups, and society as a whole.” Explores how individuals adapt to changes in health and the environment, focusing on holistic nursing care. Inspired the development of many middle-range nursing theories and of adaptation instruments. 44 NURSING THEORISTS Dorothea E. Orem In her Self-Care Theory, she defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness.” Focuses on each individual’s ability to perform self-care. Composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory and supportive- educative. 45 NURSING MODELS Maternal Role Attainment Theory by Ramona Mercer This mid-range theory serves as a framework for nurses in providing appropriate health care interventions to mothers, helping them develop a strong maternal identity. The basic concept of the Maternal Role Attainment Theory is the developmental and interactional process with mother and her baby 46 NURSING MODELS Self-Efficacy Theory by Alberta Bandura There are three factors that influence self-efficacy: Behavior, environment, and personal factors. These factors affect each other, but the personal or cognitive factors are the most important. According to Bandura, “motivation, performance, and feelings of frustration associated with repeated failures determine affect and behavior relations” Self-efficacy or the belief that one can manage one’s own health, is an important goal of health care providers, particularly in patients with chronic illnesses. 47  NURSING MODELS Life Perspective Rhythm Model by Joyce Fitzpatrick The Life Perspective Rhythm Model includes the concepts of nursing, person, health, and environment The model contributes to nursing knowledge by providing taxonomy for identifying and labeling nursing concepts Nursing activities basically focus on enhancing the developmental process towards health 48  NURSING MODELS Health Promotion Model by Nola Pender The Health Promotion Model was designed to be a “complementary counterpart to models of health protection.” Health promotion is directed at increasing a patient’s level of well-being. It focuses on three areas: individual characteristics and experiences, behavior- specific cognitions and affect, and behavioral outcomes The theory underscores that each person has unique characteristics that may affect their actions 49 NURSING MODELS Need Theory by Virginia Henderson 50  NURSING MODELS Activities of Living Nursing Model by Roper-Logan-Tierney 51  Many nursing education institutions use gordon's functional health patterns model to collect patient data in the clinical setting. 52 CONTINUING EVOLUTION OF NURSING THEORY Nursing practice is deeply rooted in both legal principles and theoretical foundations. Key nurse theorists have shaped modern nursing practice and continue to influence research and education. A clear understanding of these concepts enhances professional nursing practice and patient outcomes. Continued study and application of nursing theories and legal principles are essential for advancing the profession. 53