NURS 3310 Nursing Theoretical Frameworks Fall 2024 PDF

Theoretical Frameworks for Nursing Alicia Kleinhans DNP, MSN-Ed, APRN, CPNP-AC Objectives Discuss how population shifts, cultural diversity, changes in patterns of disease, advances in technology, and economic changes over the past several decades have impacted the healthcare delivery system...

Theoretical Frameworks for Nursing Alicia Kleinhans DNP, MSN-Ed, APRN, CPNP-AC Objectives Discuss how population shifts, cultural diversity, changes in patterns of disease, advances in technology, and economic changes over the past several decades have impacted the healthcare delivery system and the practice of nursing. Discuss important leaders and significant events that significantly impacted the development of professional nursing practice. Describe the four metaparadigm concepts of nursing Examine the influence of nursing theories on nursing practice A History of Health Care and Nursing Classical Era Roman Era (Around 1000 BC) (31 BC to AD 476) Healing is result of Galen and the good and evil Romans Greek Era Middle Ages (Around 460-370 (AD 476-1453) BC) Nursing influenced Hippocrates by Christianity A History of Health Care and Nursing (cont) The Dark Period of The Renaissance Nursing (473-1500s) (1500-1860) Arts and science Worst period for nursing The Reformation The Industrial (from 1517) Revolution (mid Nursing care decline 1700s) Machinery and mass production And Then There Was Nightingale… The Crimean experience Florence Nightingale and sanitation The political reformer Military reforms Nightingale School of Nursing Taking health care to the community The legacy of Nightingale Definitions Concept Conceptual model Propositions describes a phenomenon a set of concepts and statements that describe statements relationships Assumptions Theory Metaparadigm describe concepts or connect “an organized, coherent, and global perspective of a two concepts and represent systematic articulation of a set discipline, framework values, beliefs or goals of statements…communicated in a meaningful whole” Nightingale’s Environmental Theory Metaparadigm Concepts Person: Recipient of nursing care Environment: External (temperature, bedding, ventilation) and internal (food, water, and medications) Health: Not only to be well, but to be able to use well every power we have to use Nursing: Alter or manage the environment to implement the natural laws of health Nightingale’s 13 canons Nightingale’s Theory- Environment Team Activity Basic Patient Scenario You will be developing a short act to demonstrate the nurse’s focus with your assigned nursing theory One person will be designated the patient, and one will be the nurse with other roles assigned by your team Your patient was admitted with pneumonia and has just also been diagnosed with pre-diabetes How will the nurse approach the patient using the assigned nurse theory? Virginia Henderson: Definition of Nursing and 14 Components of Care 1960’s Metaparadigm Concepts Person: Recipient of nursing care who is composed of biological, psychological, sociological, and spiritual components Environment: External environment Health: Based on the patient’s ability to function independently Nursing: Assist the person, sick or well, in performance of activities Henderson’s 14 basic needs Virginia Henderson- Nursing Need Jean Watson: Philosophy and Science of Caring (1 of 2) Metaparadigm Concepts Person (human): A unity of mind-body-spirit/nature; embodied spirit Healing space and environment: A nonphysical energetic environment; a vibrational field integral with the person where the nurse is not only in the environment but “the nurse IS the environment” Health (healing): Harmony, wholeness, and comfort Nursing: Reciprocal transpersonal relationship in caring moments guided by caritas processes Jean Watson: Philosophy and Science of Caring (2 of 2) Goal is to help persons attain a higher level of harmony within the mind-body-spirit Goal pursued through transpersonal caring guided by 10 caritas processes Jean Watson- Caring Patricia Benner’s Clinical Wisdom in Nursing Practice (1 of 2) 7 domains of nursing 5 stages of skill acquisition 6 aspects of clinical judgment and skilled comportment Reasoning-in-transition Skilled know-how Response-based practice Agency Perceptual acuity and the skill of involvement Links between clinical and ethical reasoning Patricia Benner’s Clinical Wisdom in Nursing Practice (2 of 2) Metaparadigm Concepts Person: Embodied person living in the world who is a “self-interpreting being, that is, the person does not come into the world pre-defined but gets defined in the course of living a life” Environment: A social environment with social definition and meaningfulness Health: The human experience of health or wholeness Nursing: A caring relationship that includes the care and study of the lived experience of health, illness, and disease Patricia Benner- Clinical Wisdom Martha Rogers’s Science of Unitary Human Beings (1 of 2) Metaparadigm Concepts (1 of 2) Person (human being): An irreducible, irreversible, pandimensional, negentropic energy field identified by pattern Environment: An irreducible, pandimensional, negentropic energy field, identified by pattern and manifesting characteristics different from those of the parts and encompassing all that is other than any given human field Health: Health and illness are a part of a continuum Nursing: Seeks to promote symphonic interaction between fields, to strengthen the integrity of the human field, and to direct patterning of the human and environmental fields for realization of maximum health potential Martha Rogers’s Science of Unitary Human Beings (2 of 2) Principle of Homeodynamics Helicy Resonancy Integrality Martha Rogers- Unitary Human Beings Martha Rogers Interview Videos Part 1: https://youtu.be/V1XN3rPKndE Part 2: https://youtu.be/f6qWm8sGut0 Dorothea Orem’s Self-Care Deficit Theory of Nursing (1 of 3) Theory of Self-Care Universal self-care requisites Developmental self-care requisites Health-deviation self-care requisites Theory of Self-Care Deficit Diagnostic operations Prescriptive operations Regulatory operations Control operations Dorothea Orem’s Self-Care Deficit Theory of Nursing (2 of 3) Theory of Nursing Systems Wholly compensatory system Partially compensatory system Supportive-educative system Dorothea Orem’s Self-Care Deficit Theory of Nursing (3 of 3) Metaparadigm Concepts Person (patient): A person under the care of a nurse; a total being with universal, developmental needs and capable of self-care Environment: Physical, chemical, biologic, and social contexts within which human beings exist; components include environmental factors, elements, and conditions, as well as the developmental environment Health: A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning Nursing: Therapeutic self-care designed to supplement self-care requisites. Nursing actions fall into one of three categories: wholly compensatory, partly compensatory, or supportive educative system Dorothea Orem- Self Care Callista Roy’s Adaptation Model (1 of 2) Metaparadigm Concepts Person (human system): A whole with parts that function as a unity Environment: Internal and external stimuli; the world within and around humans as adaptive systems Health: A state and process of being and becoming an integrated and whole human being Nursing: Manipulation of stimuli to foster successful adaptation Callista Roy’s Adaptation Model (2 of 2) Roy’s Six-Step Nursing Process Assessing behaviors manifested from the 4 adaptive modes Assessing and categorizing stimuli Making a nursing diagnosis Setting goals to promote adaptation Implementing interventions aimed at managing stimuli to promote adaptation Evaluating achievement of adaptive goals Roy’s Adaptation Model Betty Neuman’s Systems Model (1 of 2) Client system is protected by a circular series of buffers known as lines of defense: Flexible line of defense Normal line of defense Lines of resistance Betty Neuman’s Systems Model (2 of 2) Metaparadigm Concepts Person (client system): A composite of physiological, psychological, sociocultural, developmental, and spiritual variables in interaction with the internal and external environment Environment: All internal and external factors of influences surrounding the client system Health: A continuum of wellness to illness; equated with optimal system stability Nursing: Prevention as intervention; concerned with all potential stressors Betty Neuman- Lines of Defense Imogen King’s Interacting Systems Framework Personal systems: Body image, growth and development, perception, self, space, and time Interpersonal systems: Communication, interaction, role, stress, and transaction Social systems: Authority, decision making, organization, power, and status Imogen King’s Theory of Goal Attainment Goal Attainment Assessment focuses on perceptions, communication, and interaction of nurse and client Planning involves deciding on goals Implementation focuses on transactions made Evaluation focuses on goals attained Imogen King’s Metaparadigm Concepts Person (human being): A personal system that interacts with interpersonal and social systems Environment: Can be both external and internal; the external environment is the context within which human beings grow, develop, and perform daily activities. The internal environment of human beings transforms energy to enable them to adjust to continuous external environmental changes Health: Dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living Nursing: A process of human interaction; the goal of nursing is to help patients achieve their goals Imogen King- Goal Attainment Johnson’s Behavioral System Model (1 of 2) Metaparadigm Concepts (1 of 2) Person (human being): A biopsychosocial being who is a behavioral system with 7 subsystems of behavior Environment: Includes internal and external environment Health: Efficient and effective functioning of system; behavioral system balance and stability Nursing: An external regulatory force that acts to preserve the organization and integrity of the patient’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found Johnson’s Behavioral System Model (2 of 2) Seven subsystems of behavior Johnson’s nursing diagnostic and treatment process Johnson- Behavioral System Rosemarie Parse’s Humanbecoming Theory (1 of 2) Three themes: Meaning Rhythmicity Transcendence Rosemarie Parse’s Humanbecoming Theory (2 of 2) Metaparadigm Concepts Person: An open being, more than and different than the sum of parts in mutual simultaneous interchange with the environment who chooses from options and bears responsibility for choices. Environment: Coexists in mutual process with the person. Health: Continuously changing process of becoming. Nursing: A learned discipline; the nurse uses true presence to facilitate the becoming of the participant. Rosemarie Parse- Human Becoming Madeleine Leininger’s Cultural Diversity and Universality Theory (1 of 2) Three modalities Cultural care preservation and/or maintenance Cultural care accommodation and/or negotiation Cultural care repatterning or restructuring Madeleine Leininger’s Cultural Diversity and Universality Theory (2 of 2) Metaparadigm Concepts Person: Human being, family, group, community, or institution Environment: Totality of an event, situation, or experience that gives meaning to human expressions, interpretations, and social interactions in physical, ecological, sociopolitical, and/or cultural settings Health: A state of well-being that is culturally defined, valued, and practiced Nursing: Activities directed toward assisting, supporting, or enabling with needs in ways that are congruent with the cultural values, beliefs, and lifeways of the recipient of care Madeline Leininger- Transcultural Nursing Hildegard Peplau’s Theory of Interpersonal Relations (1 of 2) Four phases in nurse-patient Six nursing roles that emerge relationships: during the phases of a Orientation relationship: Identification Teacher Exploitation Resource Resolution Counselor Leader Technical expert Surrogate Hildegard Peplau’s Theory of Interpersonal Relations (2 of 2) Metaparadigm Concepts Person: Encompasses the patient (who has problems for which expert nursing services are needed or sought) and the nurse Environment: Forces outside the organism within the context of culture Health: Implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living Nursing: The therapeutic, interpersonal process between the nurse and the patient Hildegard Peplau- Interpersonal Relationships Nola Pender’s Health Promotion Model (1 of 2) Major categories Individual characteristics and experiences Behavior-specific cognitions and affect Behavioral outcome Nola Pender’s Health Promotion Model (2 of 2) Metaparadigm Concepts Person: The individual, who is the primary focus of the model Environment: The physical, interpersonal, and economic circumstances in which persons live Health: A positive high-level state Nursing: The role of the nurse includes raising consciousness related to health- promoting behaviors, promoting self-efficacy, enhancing the benefits of change, controlling the environment to support behavior change, and managing barriers to change Nola Pender- Health Promotion Afaf Ibrahim Meleis’s Transitions Theory (1 of 2) Transition process triggered by change Types of transitions: developmental, health and illness, situational, organizational Afaf Ibrahim Meleis’s Transitions Theory (2 of 2) Metaparadigm Concepts (1 of 2) Person: Persons are active beings who experience fundamental life patterns and who have perceptions of and attach meaning to transition experiences Environment: Environmental conditions expose persons to potential damage, problematic recovery, or delayed or unhealthy coping contributing to vulnerability related to transitions Health: Health consists of complex and multidimensional transitions that are characterized by flow and movement over time; healthy outcomes are defined in terms of the transition process Nursing: Nursing means being the primary caregiver for individuals and their families during the transition process and applying nursing therapeutics during transitions to promote healthy outcomes Afaf Ibrahim Meleis- Transitions Kristen Swanson’s Theory of Caring (1 of 2) Five basic processes of caring: Maintaining belief Knowing Being with Doing for Enabling Kristen Swanson’s Theory of Caring (2 of 2) Metaparadigm Concepts Person: Unique beings who are in the midst of becoming and whose wholeness is made manifest in thoughts, feelings, and behaviors Environment: Any context that influences or is influenced by the designated client Health and well-being: To live the subjective, meaning-filled experience of wholeness; wholeness involves a sense of integration and becoming wherein all facets of being are free to be expressed Nursing: Informed caring for the well-being of others Kristen Swanson- Caring Katharine Kolcaba’s Theory of Comfort (1 of 2) Three contexts of comfort Physical Psychospiritual Sociocultural Environmental Three components of comfort care An appropriate and timely intervention to meet the comfort needs of patients A mode of delivery that projects caring and empathy The intent to comfort Katharine Kolcaba’s Theory of Comfort (2 of 2) Metaparadigm Concepts Person: Recipients of care may be individuals, families, institutions, or communities in need of health care Environment: Includes any aspect of the patient, family, or institutional setting that can be manipulated by the nurse, a loved one, or the institution to enhance comfort Health: Considered optimal functioning of the patient, the family, the healthcare provider, or the community Nursing: The intentional assessment of comfort needs, design of comfort interventions to address those needs, and reassessment of comfort levels after implementation compared with baseline Pamela Reed’s Self-Transcendence Theory (1 of 2) Three major concepts are central to the theory of self-transcendence: Self-transcendence Well-being Vulnerability Pamela Reed’s Self-Transcendence Theory (2 of 2) Metaparadigm Concepts Person: Human beings who develop over the life span through interactions with other persons and within an environment Environment: Composed of family, social networks, physical surroundings, and community resources Health (well-being): A sense of feeling whole and healthy, according to one’s own criteria for wholeness and health Nursing: The role of nursing activity is to assist persons through interpersonal processes and therapeutic management of their environment to promote health and well-being Merle Mishel’s Uncertainty in Illness Theory (1 of 3) Three major themes Antecedents of uncertainty Appraisal of uncertainty Coping with uncertainty Merle Mishel’s Uncertainty in Illness Theory (2 of 3) Metaparadigm Concepts (1 of 2) Person: The concept of the person is the central focus of the theory and may be an individual or the family of an ill individual; the individual is viewed as a biopsychosocial being who is an open system exchanging energy with the environment. Environment: Not explicitly defined, but is acknowledged to exchange energy with the person system. Merle Mishel’s Uncertainty in Illness Theory (3 of 3) Metaparadigm Concepts (2 of 2) Health: Defined in terms of uncertainty in the context of the illness experience, with the concept of health or well-being being congruent with the formulation of a new life view and probabilistic thinking. Nursing: Nurses are viewed as a part of the antecedent variable of structure providers. Cheryl Tatano Beck’s Postpartum Depression Theory (1 of 3) Two major concepts: Postpartum mood disorders and loss of control Four stages in the coping process Cheryl Tatano Beck’s Postpartum Depression Theory (2 of 3) Metaparadigm Concepts (1 of 2) Person: Described in terms of wholeness with biological, sociological, and psychological aspects, with personhood understood in the context of family and community Environment: Viewed broadly in terms of individual factors and external factors Cheryl Tatano Beck’s Postpartum Depression Theory (3 of 3) Metaparadigm Concepts (2 of 2) Health: Not defined explicitly; traditional ideas of physical and mental health are viewed as a consequence of women’s responses to the contexts of their lives and environments Nursing: A caring profession with caring obligations; the nurse accomplishes the goals of health and wholeness through interpersonal interactions The American Association of Critical-Care Nurses Synergy Model for Patient Care (1 of 3) Eight patient characteristics and eight nurse characteristics Three levels of outcomes The American Association of Critical-Care Nurses Synergy Model for Patient Care (2 of 3) Metaparadigm Concepts (1 of 2) Persons: Viewed in the context of patients who are biological, social, and spiritual entities who are present at a particular developmental stage. Environment: The concept is not explicitly defined; however, included in the assumptions is the idea that environment is created by the nurses for the care of the patient. The American Association of Critical-Care Nurses Synergy Model for Patient Care (3 of 3) Metaparadigm Concepts (2 of 2) Health: The concept of health is not explicitly defined; an optimal level of wellness as defined by the patient is mentioned as a goal of nursing care. Nursing: The purpose of nursing is to meet the needs of patients and families and to provide safe passage through the healthcare system during a time of crisis. Overview of Selected Non-Nursing Theories General system theory (Von Bertalanffy) Social cognitive theory (Bandura) Stress and coping process theory (Lazarus) General adaptation syndrome (Selye) Relationship of Theory to Professional Nursing Practice (1 of 3) Consider the values and beliefs that you truly hold in nursing Write a philosophy of nursing that clarifies your beliefs related to person, environment, health, and nursing Survey definitions of person, environment, health, and nursing in nursing models Relationship of Theory to Professional Nursing Practice (2 of 3) Select 2 or 3 frameworks that best fit with your beliefs related to the concepts of person, environment, health, and nursing Review the assumptions of the frameworks that you have selected Make applications of those frameworks in a selected area of nursing practice Relationship of Theory to Professional Nursing Practice (3 of 3) Compare the frameworks on client focus, nursing action, and client outcome Review the nursing literature written by persons who have used the frameworks Select a framework and develop its use in your nursing practice