SEHH2258 Fundamental Concepts of Health and Nursing Lecture 3 PDF

SEHH2258 Fundamental Concepts of Health and Nursing Lecture 3 Nursing Theories and Models 1 Learning outcomes  Differentiate the terms theory, concept, conceptual framework, paradigm & metaparadigm for nursing  Describe the m...

SEHH2258 Fundamental Concepts of Health and Nursing Lecture 3 Nursing Theories and Models 1 Learning outcomes  Differentiate the terms theory, concept, conceptual framework, paradigm & metaparadigm for nursing  Describe the major purposes in applying nursing theories in nursing practice  Identify the roles of nursing theory in nursing education, research & clinical practice  Discuss the common nursing theories in the context of the metaparadigm for nursing 2 Common Terms  Concepts Often called the “building blocks” of theories Describe a set of thoughts/behavior  Conceptual Framework A group of related ideas, statements, or concepts Often used interchangeably with the terms “conceptual model” and “grand theories” 3 Common Terms  Theory Defined as a system of ideas that is presumed to explain a given phenomenon Build on or modify previous theories Varies with each discipline  Paradigm A pattern of shared understanding and assumptions about reality and the world Include notions of reality that are largely unconscious or taken for granted Aware of paradigms when realities or world views clash e.g. religious doctrines & practices clashed with emerging discoveries in astronomy 4 Metaparadigm for Nursing Concept that can be superimposed on almost any work of nursing Most of nursing theories built on metaparadigm, but have wide range of ideas for the metaparadigm Four major metaparadigms in nursing Person Environment Health Nursing 5  Person Environment Metaparadigm for Nursing Health Nursing Person Individuals/clients who are recipients of nursing care e.g. individuals, families, groups & communities A unique & holistic being with the potential to learn & develop through interacting with the changing environment Have intrinsic worth and have the right to participate in the decision-making Must always be treated with respect (Hong Kong Nursing Council, 2022) 6  Person Environment Metaparadigm for Nursing Health Nursing Environment Internal environment includes biological, psychological, spiritual & intellectual components External environment includes social, cultural and situational influences Continual interaction of internal & external environment affect person’s functioning & generate both positive & negative stressors Creation, preservation & conservation of a healthy environment is crucial to the maintenance & promotion of health 7 (Hong Kong Nursing Council, 2022)  Person Environment Metaparadigm for Nursing Health Nursing Health A state of well-being that the client experiences at specific points in time along the health-illness continuum Affected by biological, psychological, socio-economical, developmental, political, cultural and religious factors. Level of well-being depends on the maintenance of equilibrium within the person, & between the person’s interaction with the changing environment 8 (Hong Kong Nursing Council, 2022)  Person Environment Metaparadigm for Nursing Health Nursing Nursing Is holistic, client-focused & evidence-based care at the primary, secondary & tertiary levels of health care To promote & maintain health to the sick & the disabled as individuals, or in families, groups, institutions, home settings & in the community Functions through problem solving & collaboration with the client as well as other health care professionals Requires research-based professional knowledge & skills through the implementation of the nursing process; the adoption of a caring and responsible attitude; effective communication & interpersonal skill as well as ethical principles Quality of care is maintained through the enhancement of professional competencies via continuous nursing education 9 (Hong Kong Nursing Council, 2022) Nursing Theory  Before 1900s, limited/no theories for nursing practice  As a profession, nurses need to develop concepts & theories specific to nursing  Nursing theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing 10 Role of Nursing Theory  Education Nursing theory can:  Organized concepts into conceptual framework  Built curriculum around framework  Elucidated central meanings of the profession  Improved status of the profession  Research Nursing theory can:  Help in identifying philosophical assumptions or conceptual frameworks  Help in generating new ideas, research questions & interpretation  Direct research to improve clinical practice 11 Role of Nursing Theory  Clinical practice Nursing theory can:  Identify the goals of practice & improve quality of care  help in reflecting, questioning & thinking about what nurses do (critical thinking)  Provide knowledge base for acting & responding appropriately in nursing care situations (problem solving)  Facilitate application of evidence-based practice 12 The living tree of nursing theories 13 Nursing Theories  Florence Nightingale  Virginia Henderson  Callista Roy  Martha Rogers  Betty Neuman  Dorothea Orem  Jean Watson 14 Nursing Theories Florence Nightingale Nursing Theorist Central theme Application to clinical practice (Date of Theory) Florence Nightingale Meeting the Describe nursing as establishing an (1860) personal needs of environment that allows persons to the patient within recover from illness the environment Focus on ventilation, cleanliness (sanitation conditions), quiet (noise- free environment ), warmth & diet Major environmental factors: pure or fresh air, warmth, odors, pure water, efficient drainage, cleanliness, light especially direct sunlight Deficiency in any major environmental factors implies lack of health/illness (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) 15 (Smith, M. C., 2019) Nursing Theories Florence Nightingale Views of Components (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) 16 (Smith, M. C., 2019) Nursing Theories Virginia Henderson Nursing Theorist Central theme Application to clinical practice (Date of Theory) Virginia Henderson Patient is an individual Nursing is a discipline separate (1955) who requires help to from medicine reach independence Nursing is in relation to the client & the client’s environment Emphasis on the importance of nursing independence from, & interdependence with, other health disciplines Nursing roles aim to assist patient in gaining independence for 14 fundamental needs (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) 17 (Smith, M. C., 2019) Nursing Theories Virginia Henderson Views of Components (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) 18 (Smith, M. C., 2019) Nursing Theories Virginia Henderson 14 Fundamental Needs 19  Nursing Theories Martha Rogers Nursing Theorist (Date of Theory) Central theme Application to clinical practice Martha Rogers Emphasis on the Views the person as an irreducible whole, (1970) science and art the whole being greater than sum of its of nursing parts Humans are dynamic energy fields in Unitary human continuous exchange with environmental being central to field the discipline of Aim to maintain patterns of living in nursing harmony with the environment Nursing interventions focus on:  Person’s wholeness  Promoting symphonic interaction between the two energy fields (human & environment)  Coordinate the human field with environmental field  Direct & redirect patterns of interaction between human & environmental energy field Example: noncontact therapeutic touch (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) 20 (Smith, M. C., 2019) Nursing Theories Martha Rogers Views of Components 21 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Dorothea Orem Nursing Theorist Central theme Application to clinical practice (Date of Theory) Dorothea Orem Self-care is a Most adults are self-care, whereas (1971) human need infants & people weakened by Self-care deficits illness/disability require assistance requiring with self-care activities nursing actions Nursing interventions aim to help the client in achieving self-care activities & meeting self-care demands Nursing interventions of wholly compensatory, partly compensatory or supportive-educative (developmental) can be implemented to help clients sustaining health or recovering from illness or injury 22 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Dorothea Orem Views of Components 23 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Callista Roy Nursing Theorist Central theme Application to clinical (Date of Theory) practice Sister Callista Roy Humans are Both individual & (1974) biopsychosocial beings environment are sources of existing within an stimuli that require environment modification to promote Enhance life processes adaptation through adaptation Adaptive responses 4 interrelated adaptive contribute to health & modes: maladaptive responses are  physiological mode harmful to health  self-concept mode Nursing interventions are  role function mode required when individuals  interdependence mode demonstrate ineffective adaptive responses 24 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Callista Roy Views of Components 25 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Callista Roy Roy’s Four Adaptive Mode  Physiological Mode  Self-concept Mode (the body’s basic physiological needs) Physical Self Oxygenation  sensation & body image Nutrition Elimination Personal Self Activity & Rest  Self-consistency Protection  Self-ideal Senses  Moral-ethical self Fluid, Electrolyte & Acid-base Balance Neurological Function Endocrine Function 26  Nursing Theories Callista Roy Roy’s Four Adaptive Mode  Role Function Mode Refer to the performance of  Interdependence Mode duties based on given positions Involve one’s relations with within society significant others & support systems Determine by the need for social integrity (one can act appropriately) 27 Nursing Theories Betty Neuman Nursing Theorist Central theme Application to clinical practice (Date of Theory) Betty Neuman Humans are in Address effects of stress & reactions (1972) constant to stress relationship with Major concern for nursing is keeping stressors in the the client system stable through environment accurately assessing the effects of Reconstitution is environmental stressors the state of  intrapersonal e.g. infection adaptation to  interpersonal e.g. unrealistic role stressors expectation  extrapersonal e.g. financial problems Nursing interventions aim to assist client in retaining or maintaining system stability 28 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Betty Neuman View client as an open system surrounded by lines of resistance & defense Lines of resistance  internal factors that help the client defend against a stressor Normal line of defense  the person’s state of equilibrium or the state of adaptation Flexible line of defense  dynamic & protective buffer that prevent stressors from penetrating the normal line of defense 29 Nursing Theories Betty Neuman Views of Components 30 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Jean Watson Nursing Theorist Central theme Application to clinical practice (Date of Theory) Jean Watson The practice of caring is Clinical nursing care is holistic to (1979) central to nursing promote humanism, health and quality of living Caring is universal and is practiced through interpersonal relationship Nursing interventions based on 10 clinical caritas processes Views of Components 31 (Taylor, C., Lynn, P., & Bartlett, J. L., 2023) (Smith, M. C., 2019) Nursing Theories Jean Watson 10 clinical caritas processes 32 Critique of Nursing Theory  No single global, commonly accepted definition of nursing  Existing theories/models too vague or complex to guide practice  Many theories untested  Interprofessional overlap suggest theory guiding nursing practice cannot be unique to nursing  Science & the world have changed that historically fundamental theories no longer fit  Work is still needed for future development References Berman, A. & Snyder, S. (2022). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice (11th ed.). Pearson. Huston, C. J. (2021). Leadership Roles and Management Functions in Nursing: Theory and Application (10th ed.). Wolters Kluwer. Masters, K. (2020). Role Development in Professional Nursing Practice (5th ed.). Jones & Bartlett Learning. Taylor, C., Lynn, P., & Bartlett, J. L. (2023). Fundamentals of Nursing: The Art and Science of Person-Centred Care. (10th ed.). Wolters Kluwer. The Nursing Council of Hong Kong. (2022). A Reference Guide to the Syllabus of Subjects and Requirements for the Preparation of Registered Nurse (General) in the Hong Kong Special Administrative Region. https://www.nchk.org.hk/en/core_competencies_and_reference_guides/registered_nurses_general /index.html Smith, M. C. (2019). Nursing Theories and Nursing Practice (5th ed.). F.A. Davis. 34