Historical Eras of Nursing PDF

HISTORICAL ERAS OF NURSING CURRICULUM ERA Curriculum content to be studied; Courses in nursing programs 1900 – 1940s RESEARCH ERA Focus for nursing research 1950 – 1970s GRADUATE EDUCATION ERA...

HISTORICAL ERAS OF NURSING CURRICULUM ERA Curriculum content to be studied; Courses in nursing programs 1900 – 1940s RESEARCH ERA Focus for nursing research 1950 – 1970s GRADUATE EDUCATION ERA Knowledge needed to practice nursing; Carving out advanced role 1950 – 1970s and basis; Nurse important role in healthcare THEORY ERA Frameworks guiding nursing research and practice 1980 – 1990s THEORY UTILIZATION ERA New theories to produce evidence on quality care; Middle-range 21ST CENTURY theory may be quantitative/qualitative DISCIPLINE – specific academia referring to a branch of education; knowledge focus PROFESSION – specialized field of practice; knowledge and practice CRITERIA FOR THE DEVELOPMENT OF PROFESSIONAL STATUS OF NURSING 1. Utilizes in its practice a well-defined and well- 3. Entrusts the education of its practitioners to organized body of specialized knowledge. universities/ colleges. 2. Constantly enlarges the knowledge it uses and 4. Applies knowledge in practical services important to improves its techniques of education and service community welfare. thru scientific method.  5. Functions autonomously in developing professional 7. Strives to compensate nurses by providing freedom policy. of action, opportunity for continuous professional 6. Attracts individuals with intellectual and personal growth and economic security qualities of intensifying service. EPISTEMOLOGY – “episteme” (knowledge); “logos” (study of); study of knowledge and justifies beliefs; how knowledge came to be; branch of philosophy concerned with the nature and scope of knowledge RATIONALISM – (theory-then-research approach); EMPIRICISM – (research-then-theory approach); intellectual and deductive; use of rational senses to ensure knowledge comes from sensory experiences; specific to truth of phenomenon; general to specific general THEORY – “theoria” (Greek word); mere guess; generally accepted as true; intended to explain facts; idea that is possibly true but unknown/unproven; predict relationships among concepts; creative and rigorous structuring of ideas pf a systematic view CONCEPT – word/phrase representing a phenomenon; building blocks of theory  ABSTRACT – certain time and place  THEORETICAL DEFINITIONS – dictionary  CONCRETE – specific time and place meaning  DISCRETE – particular categories/classes of  OPERATIONAL DEFINITIONS – how concepts are phenomena used in the context; measure  CONTINUOUS – classifications of dimensions of a phenomena RELATIONAL STATEMENTS – THEORETICAL STATEMENTS – OPERATIONAL STATEMENTS – may state definitions/relations relate concepts to another; permit relate concept to measurements among concepts analysis SCIENTIFIC LAWS – statement of THEORY – complex and dynamic; HYPOTHESIS – educated guess facts; simple, true, universal and can be changed/improved; accepted upon observation; idea not proven absolute; based on repeated as true and proven experimental observations; causal relationship involving elements NURSING PHILOSOPHIES – sets for the meaning of nursing phenomena through analysis, reasoning, and logical argument; advances discipline and professional application FLORENCE NIGHTINGALE  Mother of Modern Nursing  Notes on Nursing (1859)  Born in Florence, Italy on May 12, 1820 o Focuses on environment manipulation for  Volunteered (w/ 38 nurses) for service to Turkey patient’s benefit during Crimean War o Advice to women who wanted to become o “The Lady with the Lamp” nurses and how to think like a nurse  Notes on Hospital (1859)  Established Nightingale School and Home for Nurses in St. Thomas Hospital  ENVIRONMENTAL THEORY o “Nursing is the art of utilizing the patient’s environment for his/her recovery.” o Environment – external conditions/influences affecting life  Proper Ventilation – keep air pure as external air without chilling pt.  Adequate Light – direct sunlight for pt.  Cleanliness – daily bath; duty uniforms clean; hands washed  Warmth – positioning pt.; opening windows; regulating room temp.  Quiet – unnecessary noise can be harmful to pt.  Diet – assess meal sched and its effect; assess pt. intake  Management – in control of environment, physically, and administratively; control environment to protect pt. o Nurse continues to control environment even if physically absent because she is still responsible for supervising other members working on her stead. JEAN WATSON  Born in Welch West Virginia  Asst. Dean at University of Colorado –  Coordinator and Director of University of Colorado Undergraduate Program – PhD Program (1978-1981)  Nursing: The Philosophy and Science of Caring  Nursing: Human Science and Human Care – A (1979) Theory of Nursing (1985) o “caritas” (connection between caring and o Conceptual and philosophical problem in love) nursing  THEORY OF TRANSPERSONAL CARING o “Caritas” (to cherish and to give special loving attention); Greek o Transpersonal – go beyond one’s own ego and the here and now o Special kind of human care relationship  Nurse’s moral commitment; protecting and enhancing human dignity  Nurse’s caring consciousness; to preserve and honor the embodied spirit  Nurse’s caring consciousness and connection; having potential to heal o Caring occasion – moment (focal point in spacetime) when the nurse and another come together in such a way that an occasion for human caring is created. 10 ELEMENTS OF CARATIVE FACTORS Humanistic-altruistic system of value Practice of loving kindness and equanimity (self-control/composure). Faith-hope Being authentically present; enabling and sustaining deep belief system. Sensitivity to self and others Cultivation of own spiritual practices and transpersonal self. Developing and sustaining a helping-trusting, authentic caring Help-trusting, human care relationship relationship. Being present and supportive of positive and negative feelings as a Expressing positive and negative feelings connection with a deeper spirit of self. Creative problem-solving caring process Creative use of self and all ways of knowing as part of caring process. Transpersonal teaching-learning Engaging in genuine teaching-learning experience. Supportive, protective, and/or corrective Creating a healing environment at all levels (physical/nonphysical); mental, physical, societal, and spiritual wholeness, beauty, comfort, dignity, and peace are potentiated. environment Human needs assistance Assisting with basic needs; human care essentials. Existential-phenomenological-spiritual Soul care for self and the one-being -cared-of (patient). forces PATRICIA BENNER  “Nursing is a caring relationship and practice that cares for and studies the lived experiences of patients on health, illness, and disease, and the relationships among these three elements.”  "The Nurse - Patient Relationship is not a uniform, professionalized blueprint but rather a Kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life.”  Free from analytical assumptions; based on practical understanding  STAGES OF NURSING EXPERTISE (NOVICE TO EXPERT) o DREYFUS MODEL – five levels of skill acquisition and development  Movement from reliance on abstract principles and rules to use past and concrete experience.  Shifting from analytical to intuition  Change of perception from compilation of equally relevant pieces to increasingly complex whole.  Skill – nursing intervention, clinical judgement; Expertise – modifies principle-based expectations. DREYFUS MODEL Lacks background experience; difficulty differentiating relevant and irrelevant aspects of a NOVICE situation; nursing students ADVANCED BEGINNER Enough experience; guided by rules or other experienced nurses; newly registered nurses COMPETENT Exhibits sense of mastery; increased level PROFIECIENT Has holistic view of particular situation; guided by maxims; intuitive grasp of situation EXPERTISE Does not rely on analytical principles and maxims; clinical grasp; embodied know-how o COMPETENCY – interpretively defined area of skilled performance o EXPERIENCE – active process of refining and changing preconceived theories/notions/ideas  o MAXIM – mysterious description of skilled performance  Requires certain level of experience to recognize implications  Paradigm case – clinical experience that stands out  Alters nurse’s perception and understanding; opens new viewpoints HERMENEUTICS – meaningful human activities/phenomena in a careful and detailed manner MARILYN ANN RAY  BUREAUCRATIC CARING o Theoretical Sources  Dr. Leininger – transcultural nursing; ethnographic-ethnonursing research  Hegel – interrelations of thesis, antithesis, and synthesis  Chaos Theory – simultaneous order and disorder, and order within disorder o HOLOGRAPHY – everything is a whole; a part in another; part being whole; whole being a part o CARING – complex transcultural process in an ethical, spiritual context o SPIRITUALITY – creativity and choice revealed in attachment, love, and community o EDUCATIONAL – educational programs; convey and sharing of info thru teaching and AV media o PHYSICAL – state of being; biological and mental patterns (mind and body) o SOCIO-CULTURAL – ethnicity; intimacy; communication; interaction; support o LEGAL – rules and principle to guide behaviors; right to privacy o TECHNOLOGICAL – machinery to maintain patient’s physiological well-being o ECONOMIC – money, budget, insurance; human and material resources to maintain services o POLITICAL – power structure, role, and gender stratification among healthcare admin/provider KARI MARTINSEN  Caring Without Care? o Lit torch of a book o Questioned if nurses were shifting from patient care to technical roles and administration, leaving direct care to other workers.  PHILOSOPHY OF CARING o CARE – fundamental precondition for a life; trinity (relational, practical, moral); sentimentality is not care o PROFESSIONAL JUDGEMENT AND DISCERNMENT – clinical observation learned thru exercise of professional judgement; perception has an analogue character o MORAL PRACTICE – founded on care; when empathy and reflection work together where caring is expressed o PERSON-ORIENTATED PROFESSIONALISM – demands professional knowledge which views the patient as a suffering person and protect integrity o SOVEREIGN LIFE UTTERANCES – phenomena accompanying creation itself; present as potentials; beyond human control and influence; preconditions for care o UNTOUCHABLE ZONE – must not interfere within encounters with others and nature; ensures impartiality o VOCATION – ethical demand to take care of neighbor; professional refinement and knowledge o EYE OF THE HEART – parable of the good Samaritan; heart says something about the person o REGISTERING EYE – objectifying; alliance between modern natural science, technology, and industrialization  Trinity of Caring o Relational – caring requires at least two people; care-r and suffer-er o Practical – concrete and practical action; trained and learned o Moral – must not over/underestimate ability to help self KATE ERIKSSON  Pioneer of caring science in Nordic countries  CARITATIVE CARING THEORY o The Theory of Science for Caring Science o CARITAS – love and charity; fundamental motive of caring science; mediates faith, hope, and love thru tending, playing, and learning o CARING COMMUNION – form of intimate connection; source of strength and meaning in caring o THE ACT OF CARING – caring elements (faith, hope, love, tending, playing, learning); art of making smth very special about smth less special o DIGNITY – absolute (granted thru creation; right to be confirmed as unique human); relative (influenced and formed) o INVITATION – carer welcomes patient; genuine hospitality o SUFFERING – ontological concept of human struggle between good and evil in a state of becoming o SUFFERIN RELATED TO ILLNESS, TO CARE, AND TO LIFE – experienced thru illness and treatment o THE SUFFERING HUMAN BEING – the patient; “patiens” (Latin meaning suffering) o RECONCILIATION – drama of suffering; new wholeness o CARING CULTURE – concept for environment; total caring reality o USE OF EMPIRICAL EVIDENCE – o 2 MAJOR ASSUMPTIONS:  AXIOMS – fundamental truths in relation to the conception of the world  THESES – fundamental statements concerning the general nature of caring science MYRA E. LEVINE  CONSERVATION MODEL o “Nursing is a human interaction that promotes adaptation and maintains wholeness either by acting in the therapeutic sense or by providing supportive care in order to influence adaptation favorably, or toward renewed social well-being.” o “A holistic approach to care of all people, well or sick.” o Focused on preservation of individual’s wholeness or totality. o Nursing as conservation activities; a keeping-together function o FOUR PRINCIPLES  CONSERVATION OF ENERGY – body’s energy balance  CONSERVATION OF STRUCTURAL INTEGRITY – body system declines due to aging  CONSERVATION OF PERSONAL INTEGRITY – sense of self; recognition of person’s holiness  CONSERVATION OF SOCIAL INTEGRITY – life’s meaning in the context of social life o CONSERVATION – complex functions continuing to function; (Latin: to keep together) o WHOLENESS – oneness of persons; respond to environmental challenges in singular fashion o ADAPTATION – ability to keep integrity within situations; fit the environment  HISTORICITY – patterned responses thru genetics  SPECIFICITY – adaptive responses thru environmental changes  REDUNDANCY – availability of multiple adaptive responses o ENVIRONMENT  INTERNAL – physiologic and pathophysiologic  EXTERNAL   PERCEPTUAL – intercept and interpret with sense organs  OPERATIONAL – physically affect but not perceived  CONCEPTUAL – environment is the product of cultural patterns o ORGANISMIC REPONSE – ability to adapt to environment; four levels of integration  FIGHT OR FLIGHT – most primitive response; fights or flies away from stressor to ensure safety  INFLAMMATORY RESPONSE – body defense mechanism; protect body tissue  RESPONSE TO STRESS – wear and tear of body tissue; continued response and adaptation of body  PERCEPTUAL AWARENESS/SENSORY RESPONSE – occurs as person gains life experience o TROPHICOGNOSIS – scientific method of reaching nursing care judgement o NURSING CARE – to support adaptation and the strong drive of individual to seek wholeness. o NURSING INTERVENTIONS – both therapeutic and supportive. o THERAPEUTIC – enhancing adaptation and improving well-being. o SUPPORTIVE INTERVENTIONS – nursing care is unable to improve adaptive response. MARTHA E. ROGER  SCIENCE OF UNITARY HUMAN BEINGS NURSING CONCEPTUAL o “Nursing is an art and science that seeks to promote symphonic interaction between the environment and man, to strengthen the coherence and integrity of the human beings, and to direct and redirect patterns of interaction between man and his environment for the realization of maximum health potential.” o HUMAN FIELD – irreducible, indivisible, pan-dimensional energy field identified by pattern o ENVIRONMENTAL FIELD – integral to human field o UNIVERSE OF OPEN SYSTEM – energy fields are infinite, open, and integral with one another o BASIC ASSUMPTIONS – describing man and life process in man; building blocks  OPENNESS – individual and environment continuously exchange matter and energy  ENERGY FIELDS – fundamental unit of living and nonliving; human energy and environment energy  PATTERN – distinguishing characteristic of the energy field perceived as a single wave  PANDIMENSIONALITY – nonlinear domain without spatial or temporal attitudes; infinite domain  WHOLENESS – state which a human is a unified whole which is different from sum of parts  UNIDIRECTIONALITY – where life process exists along an irreversible space-time continuum  HOMEODYNAMICS PRINCIPLES – postulate way of perceiving unitary human being  RESONANCY – intensity of change; embrace continuous variability of evolving human energy  HELICY – unpredictable, continuous, nonlinear evolution of energy fields; postulate ordering of human evolutionary emergence  INTEGRALITY – encompass the mutual, continuous relations of human energy field and environment energy fields DOROTHEA OREM  SELF-CARE DEFICIT NURSING THEORY o “Nursing is a helping profession of assisting patients overcome or compensate for their health- associated limitations and engaging in actions to regulate their own functioning and development of their dependents.” o Collection of 3 interrelated theories  NURSING SYSTEM – relationships brought and maintained to produce nursing  SELF-CARE – practice of activities that maturing/matured individuals perform to maintain life, health, development, well-being  SELF-CARE DEFICIT – disability to meet self-care requisite o 3 systems in professional nursing practice model  WHOLLY COMPENSATORY SYSTEM – nurse accomplishes patient’s therapeutic self-care; patient’s total inability for self-care  PARTIALLY COMPENSATORY SYSTEM – performs some self-care measures; assists as required; patient’s limited ability for self-care  SUPPORTIVE-EDUCATIVE SYSTEM – assists with decision-making and skills for self-care; patient’s has ability for self-care but needs knowledge assistance o SELF-CARE REQUISITES – actions towards provision of self-care  Universal Self-care Requisites – needs common to all (water, air, food, socialization)  Developmental Self-care Requisites – needs for developmental processes  Health Deviation Self-care Requisites – needs arising from conditions/illness/injury o THERAPEUTIC SELF-CARE DEMAND – totality of nursing care measures required; manage factors o SELF-CARE AGENCY – ability of mature/maturing individuals to meet functional and developmental requirements o NURSING AGENCY – developed capabilities of nurses that empower therapeutic self-care demand of patients o DEPENDENT-CARE AGENT – adolescent know and meet functional and developmental requirements IMOGENE KING  “Nursing is an observable behavior found in the health care systems in society that aims to helps individuals maintain their health so they can function their roles.” o Importance of interaction between nurse and patients o Person is an open system in constant interaction o 3 INTERRELATED SYSTEMS REPRESENTING DOMAIN OF NURSING INTERACTING  PERSONAL SYSTEM – body image, growth, development, perception, self, space, SYSTEMS and time FRAMEWORK  INTERPERSONAL SYSTEM – 2 or more person interact; communication, interaction, role, stress, and transaction  SOCIAL SYSTEM – comprehensive interacting system composed of groups; authority, decision-making, organization, power, and status o Middle-range theory o Nurse interaction with family if patient is verbally disabled GOAL o Focused on interpersonal system and interactions between nurse-client relationship ATTAINMENT o MUTUAL GOAL-SETTING BETWEEN NURSE AND PATIENT THEORY  Nurse assessment of client’s problems  Nurse and client perception of interference  Nurse and client share of info to attain client’s goals BETTY NEUMAN  “Nursing is a unique profession that is concerned with all of the variables affecting an individual’s response to stress.”  SYSTEMS MODEL o Based in person’s relationship to stress, reaction to it, and reconstitution factors that are dynamic in nature o FIVE SYSTEM VARIABLES – interaction with environment  PHYSIOLOGIC – body structure and function  PSYCHOLOGIC – mental processes  SOCIOCULTURAL – effects and influences of sociocultural conditions  DEVELOPMENTAL – age-related processes and activities  SPIRITUAL – beliefs and influences of spirituality o LINE OF RESISTENCE  FIRST LINE OF DEFENSE – considered normal for the person  SECOND LINE OF DEFENSE – can be readily and rapidly changed o STRESSORS  INTRAPERSONAL – within the self  INTERPERSONAL – between one or more person  EXTRAPERSONAL – outside the self; environment o PREVENTIVE INTERVENTIONS  PRIMARY – stressor is known; reaction of client not visible  SECODARY – treatment of stress symptoms  TERTIARY – readjust towards stability; after active treatment; strengthen resistance to stress  o NURSING PROCESS (ADPIE)  ASSESSMENT – organizing and interpreting the collected data  Subjective (patient's feelings, perceptions, and concerns)  Objective (measurable data like vital signs, lab results)  DIAGNOSIS – identify actual or potential health problems or needs; formulate nursing diagnosis  PLANNING – developing specific, measurable, achievable, relevant, and time-bound (SMART) goals  IMPLEMENTATION – putting the planned interventions into action  EVALUATION – assessing the patient's response to the interventions; modify care plan SISTER CALLISTA ROY  “Nursing process is a problem-solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluating the outcome of care provided.”  ADAPTATION MODEL OF NURSING o NURSING PROCESS  ASSESSMENT OF BEHAVIOR – first step; data on person’s behavior  ASSESSMENT OF STIMULI – identification of internal and external stimuli  FOCAL – immediately confront  CONTEXTUAL – stimuli affecting the situation  RESIDUAL – unclear effect of stimuli in situation  NURSING DIAGNOSIS – formulation of statements of interpreted data of person  GOAL SETTING – establish statements on behavioral outcomes for nursing care   INTERVENTION – determine best assistance to attain goals  EVALUATION – judging effectiveness of nursing intervention o FOUR ADAPTIVE MODES  PHYSIOLOGICAL-PHYSICAL MODE – physical/chemical process  SELF-CONCEPT GROUP IDENTITY MODE – coping for sense of unity; identity integrity  ROLE FUNCTION MODE – primary, secondary, tertiary roles in society  INTERDEPENDENCE MODE – integrity thru giving and receiving love, respect, value DOROTHY JOHNSON  Two areas for basis of nursing care o Reduce stressful stimuli o Support natural and adaptive processes  “Nursing is an external force that acts to preserve the organization of the patient’s behavior by means of imposing regulatory mechanisms or by providing resources while the patient is under stress.”  BEHAVIORAL SYSTEMS MODEL o “All the patterned, repetitive, purposeful ways of behaving that characterize each person’s life make up an organized and integrated whole, or system.” o 7 SUBSYSTEMS OF HUMAN BEHAVIOR  ATTACHMENT most critical; provides survival and security; inclusion, intimacy, and bond  ACHIEVEMENT – mastery of an aspect of self or environment to some standard of excellence; intellectual, physical, creative, mechanical, and social skills   AGGRESSIVE – protection and preservation; not only learned but has primary intent to harm  DEPENDENCE – helping behavior that calls for nurturing response; approval, attention, recognition, and physical assistance  SEXUAL – procreation and gratification; gender role identity; sex role behaviors  INGESTIVE – conditions of eating  ELIMINATIVE – conditions of body elimination o 3 FUNCTIONAL REQUIREMENTS OF EACH SUBSYTEM  “Protected from noxious influences with which the system cannot cope”  “Nurtured through the input of appropriate supplies from the environment”  “Stimulated for use to enhance growth and prevent stagnation” HILDEGARD PEPLAU  Mother of Psychiatric Mental Health Nursing  Nurse of the Century  “Nursing is the interpersonal therapeutic process of functioning cooperatively with other human processes that make health possible for individuals in communities through education that aims to promote forward movement of personality.”  THEORY OF INTERPERSONAL RELATIONSHIP o 4 PHASES OF NURSE-PATIENT RELATIONSHIP  ORIENTATION – client seeks help; nurse assists and understand problem  IDENTIFICATION - assure client that nurse understands their interpersonal situation  EXPLOITATION – client derives full value of what nurse offers thru the relationship  RESOLUTION – old needs and goals set aside; new needs and goals adopted  o NURSING ROLES  STRANGER ROLE – accepting client in the same way one meets a stranger; provides an accepting climate that builds trust  RESOURCE ROLE – answering questions, interpret clinical treatment data, and give information  TEACHING ROLE – gives instructions and provides training  COUNSELING ROLE – help clients understand and integrate meaning of current life circumstances; provide guidance and encouragement  SURROGATE ROLE – clarify domains of dependence, interdependence, and independence; acts on client’s behalf as advocate  ACTIVE LEADERSHIP ROLE – help client assume maximum responsibility for meeting treatment goals IDA JEAN ORLANDO  “Nursing is a profession that seeks to find out and meet the patient’s immediate need for help.”  THEORY OF DELIBERATIVE NURSING PROCESS o Nursing process is an interaction of 3 basic elements  The behavior of the patient  The reaction of the nurse  The nursing actions which are designed for the patient’s benefit. JOYCE TRAVELBEE  “Human-to-human relationship is the means through which the purpose of nursing is fulfilled.”  Interpersonal Aspects of Nursing (1966; 1971)  Psychiatric Nursing: Process in the One-to-One Relationship (1969)  HUMAN-TO-HUMAN RELATIONSHIP MODEL OF NURSING o Ida Jean Orlando; her instructor; nurse and patient interrelate with e/o o Victor Frankl; Theory of Logotherapy – patient is confronted and reoriented toward meaning of class o Spiritual values determine a great extent of one’s perception of illness o RAPPORT – establishment of nurse-patient relationship; nurse and patient has progressed through the 4 phases of experience:  ORIGINAL ENCOUNTER – first impressions  EMERGING IDENTITIES – perceive e/o uniqueness  EMPATHY – gain intellectual understanding of one’s state; listens and relates  SYMPATHY – lessen patient’s cause of suffering; listens but does not relate o THERAPEUTIC USE OF SELF – ability to use personality consciously; full awareness in establishing relatedness and structure nursing intervention o COMMUNICATION – vehicle of nurse-patient relationship establishment o SUBJECTIVE HEALTH – individually defined state of well-being; physical-emotional-spiritual status. o OBJECTIVE HEALTH – absence of discernable disease/disability/defect; measured by physical examination, lab tests, and counselling. o ILLNESS – being unhealthy o SUFFERING – feeling of displeasure from spiritual discomfort to extreme anguish  o PAIN – unobservable, unique, lonely experience difficult to share with others o HOPE – desire to gain end; accomplish a goal o HOPELESSNESS – being devoid of hope ERNESTINE WIEDENBACH  “Nursing is the art of nurturing or caring for someone in a motherly fashion.”  HELPING ART OF CLINICAL NURSING THEORY o 4 ELEMENTS IN THE ART OF NURSING  PHILOSOPHY – motivates nurse to act in certain way  PURPOSE – nurse wants to accomplish through what she does; activities toward overall good of patient  PRACTICE – observable nursing actions  ART  Understanding patient’s needs and concerns  Developing goals and actions intended to enhance patient’s ability  Directing activities related to the medical plan to improve patient’s condition o WAYS TO IDENTIFY PATIENT’S NEED FOR HELP  Observing behavior consistent/inconsistent with their comfort  Exploring the meaning of their behavior  Determining the cause of their discomfort or incapacity  Determine whether they can resolve their problems or have a need-for-help o NEED-FOR-HELP – any measure desired by the patient potentially restoring/extending ability to cope o CILINICAL JUDGEMENT – nurse’s likeliness to make sound decisions o SKILLS – characterized by harmony of movement, precision, and effective use of self NANCY ROPER – WINIFRED LOGAN – ALISON TIERNEY (ROPER-LOGAN-TIERNEY)  “Nursing is the practice of assisting patients live through life.”  MODEL OF NURSING BASED ON ACTIVITIES OF LIVING o Characteristics of the person are considered w/ respect to prior development, current level of development, and future development. o DEPENDENCE-INDEPENDENCE CONTINUUM – factors and activities of a person o 12 ACTIVITIES OF LIVING: MODEL OF LIVING  Person in the complex process of living from the perspective of an amalgam of activities  Maintain safe environment  Personal cleansing/dressing  Breathing  Maintain body temperature  Communication  Working/playing  Mobilizing  Sleeping  Eating/drinking  Express sexuality  Eliminating  Dying o 5 MAIN FACTORS INFLUENCING ADL  Biological  Psychological  Sociocultural  Environmental  Politico-economic LYDIA HALL  Founder and first director of Loeb Center for Nursing and Rehabilitation at the Montefiore Medical Center  CARE, CURE, CORE THEORY OF NURSING Sole function (exclusives) of nurses; limited to helping patients and its family Motherly care provided by nurses CARE Comfort measures; patient instructions; helping patients meet needs Major purpose: achieve interpersonal relationship to develop the core Shared with members of health team; nursing activities based on physician CURE Medical interventions performed on the patient; applying of medical knowledge Shared with members of health team; social sciences (social workers, psych) CORE Recipient of care; nursing care is needed and directed o 3 INDEPENDENT BUT INTERCONNECTED CIRCLES  THE CARE CIRCLE – the body; natural/biological science; intimate bodily care  THE CURE CIRCLE – the disease; pathological/therapeutic science; medical care  THE CORE CIRCLE – the person; social science; therapeutic use of self-aspect  REFLECTIVE TECHNIQUE – used by nurse in a way that she acts as a mirror to the patient  MOTIVATIONS – make conscious decisions based on understood/accepted feelings VIRGINIA HENDERSON  “The First Lady of Nursing”  “Modern-Day Mother of Nursing”  NURSING NEED THEORY o PHYSIOLOGICAL COMPONENTS  Breathe normally.  Eat and drink adequately.  Eliminate body wastes.  Move and maintain desirable postures.  Sleep and rest.  Maintain body temperature within normal range by adjusting clothing and modifying environment.  Keep the body clean and well-groomed and protect the integument. o PSYCHOLOGICAL ASPECTS OF COMMUNICATING AND LEARNING  Communicate with others in expressing emotions, needs, fears, or opinions.  Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. o SPIRITUAL AND MORAL  Worship according to one’s faith. o SOCIOLOGICALLY ORIENTED TO OCCUPATION AND RECREATION  Select suitable clothes – dress and undress.  Avoid dangers in the environment and avoid injuring others.  Work in such a way that there is a sense of accomplishment.  Play or participate in various forms of recreation.  o 3 LEVELS COMPROMISING THE NURSE-PATIENT RELATIONSHIP  SUBSTITUTIVE – substitute/does actions for the patient  SUPPLEMENTARY – helping/assist the patient  COMPLEMENTARY – partner/working with the patient NOLA J. PENDER  HEALTH PROMOTION MODEL o Complementary counterpart to models of health protection o Focuses on 3 areas:  Individual characteristics and experiences  Behavior-specific cognitions and affect  Behavioral outcomes o Individuals seek to actively regulate own behavior o PERSONAL FACTORS – behavior’s nature being considered  BIOLOGICAL FACTORS – age, gender, BMI, strength, pubertal status, etc.  PSYCHOLOGICAL FACTORS – self-esteem, self-motivation, competence, definition of health  SOCIO-CULTURAL FACTORS – race, ethnicity, socioeconomic status, education o PERCEIVED BENEFITS OF ACTION – anticipated positive outcomes occurring from health behavior o PERCEIVED BARRIER TO ACTION – anticipated/imagined/real blocks; understanding given behavior o PERCEIVED SELF-EFFICACY – judgement of personal capability to promote health-promoting behavior o ACTIVITY-RELATED AFFECT – subjective feelings before/during/after behavior; influences self-efficacy o INTERPERSONAL INFLUENCES – cognition on behaviors/beliefs/attitudes of others   NORMS – expectation of significant others  SOCIAL SUPPORT – instrumental and emotional encouragement  MODELING – learns through observation o SITUATIONAL INFLUENCES – personal perceptions/cognitions facilitating behavior o COMMITMENT TO ACTION OF PLAN – intention/identification of planned strategy o COMPETING DEMANDS – alternative behavior; low control due to environmental contingencies o COMPETING PREFERENCES – alternative behavior; high control; decisions for trivial things and self o HEALTH-PROMOTING BEHAVIOR – endpoint towards positive health outcomes; optimal wellbeing MADELEINE LEININGER  Founder of the Theory of Transcultural Nursing  CULTURE CARE THEORY o Transcultural nursing – comparative study of cultures to understand similarities (culture universal) and differences (culture-specific) o RELIGION – set of beliefs in a divine or super human power; obeyed and worshipped as the creator o ETHNIC – group of people sharing common and distinctive culture; members of specific group o ETHNICITY – consciousness of belonging to a group o CULTURAL IDENTITY – sense of being part of an ethnic group or culture o CULTURE-UNIVERSALS – commonalities of values, norms, and life patterns among different cultures o CULTURE-SPECIFIES – values, beliefs, behavior unique to a designated culture o MATERIAL CULTURE – objects o NON-MATERIAL CULTURE – beliefs customs, languages, social institutions o SUBCULTURE – have distinct identity but related to larger cultural groups o BIOCULTURAL – crosses two culture o DIVERSITY – fact or state of being different o ACCULTURATION – assume attitudes, values, beliefs, practice of dominant society o CULTURAL SHOCK – disoriented or unable to respond to a different cultural environment o ETHNIC GROUPS – share common social and cultural heritage o ETHNIC IDENTITY – subjective perspective of heritage o RACE – classification of people according to biologic characteristics, genetic markers, or features o CULTURAL AWARENESS – recognizing biases, prejudices, assumptions about others o CULTURALLY CONGRUENT CARE – care fitting for one’s valued life patterns and set of meanings o CULTURALLY COMPOTENT CARE – ability of practitioner to bridge cultural gaps in caring o SUNRISE MODEL  CULTURAL CARE PRESERVATION OR MAINTAINANCE – retain/preserve care for well-being  CULTURAL CARE ACCOMMODATION OR NEGOTIATION – adapt/negotiate to achieve care  CULTURE CARE REPATTERNING OR RESTRUCTURING – modify lifestyle for well-being MARGARET A. NEWMAN  THEORY OF HEALTH AS EXPANDING CONCIOUSNESS o Health encompasses conditions heretofore described as illness, or, in medical terms, pathology o These pathological conditions can be considered a manifestation of the total pattern of the individual o The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes o Removal of the pathology in itself will not change the pattern of the individual o If becoming ill is the only way an individual's pattern can manifest itself, then that is health for that person o Health is an expansion of consciousness. o PATTERN – evolving through various permutations of order and disorder o PATTERN RECOGNITION – process of uncovering meaning in life o CONCIOUSNESS – informational capacity of the system; has 3 correlates:  MOVEMENT  TIME  SPACE ROSEMARIE RIZZO PARSE  THEORY OF HUMAN BECOMING o “Man-Living-Health Theory” (1981) o THREE ABIDING THEMES  MEANING – freely choosing personal meaning in situations; reality’s meaning through lived- experiences  RHYTHMICITY – co-creating rhythmic patterns in mutual process with the universe  TRANSCENDENCE – co-transcending multidimensional with emerging possibilities; beyond limits o SYMBOLS  BLACK AND WHITE – opposite paradox; green is hope  CENTER JOINED – co-created mutual universe; nurse-person process  GREEN AND BLACK SWIRLS INTERWINING – human-universe co-creation as ongoing process of becoming o RELATIONSHIPS OF THE DIFFERENT SHAPES  POWERING – way of revealing and concealing imaging  ORIGINATING – manifestation of enabling and limiting values  TRANSFORMING – results from languaging of connecting and separating o REVEALING-CONCEALING – disclose and keep hidden the persons they are becoming ROZZANO LOCSIN  TECHNOLOGICAL COMPETENCY AS CARING AND THE PRACTICE OF KNOWING PERSONS IN NURSING  “The practice of knowing person as whole, frequently with the use of varying technology.’ o DIMENSIONS OF TECHNICAL VALUE  TECHNOLOGY AS COMPLETING HUMAN BEINGS – to re-formulate the ideal human being; both mechanical (prostheses) or organic (transplantation of organs.)  TECHNOLOGY AS MACHINE TECHNOLOGIES – computers and gadgets enhancing nursing activities to provide quality patient care  TECHNOLOGIES THAT MIMIC HUMAN BEINGS AND HUMAN ACTIVITIES – to meet the demands of nursing care practices; cyborgs (cybernetic organisms) or anthropomorphic machines and robots o PROCESS OF NURSING  KNOWING – guided by technological knowing; nurse enters the world of the other; technology is used to magnify the aspect of the person that requires; person is dynamic, living, and cannot be predicted  DESIGNING – Both the nurse and the one nursed (patient) plan a mutual care  PARTICIPATION IN APPRECIATION – conjoined activities which are crucial to knowing persons alternating rhythm of implementation and evaluation  VERIFYING KNOWLEDGE – The continuous, circular process demonstrates the ever-changing, dynamic nature of knowing in nursing o REVEALING – a representation of the real person o DYNAMIC – person’s state change moment to moment; living, and cannot be predicted. o WHAT IS A PERSON? – empirical facts; persons as objects o WHO IS PERSON? – persons as unique individual SISTER CAROLINA S. AGRAVANTE  CASAGRA TRANSFORMATIVE LEADERSHIP MODEL  “Focus on the type of leadership in nursing that can challenge the values of the world.” o THREE-FOLD TRANSFORMATIVE LEADER CONCEPT  SERVANT-LEADER SPIRITUALITY – consist of spiritual exercise; spiritual retreat  SELF-MASTERY – expressed in a vibrant care complex  SPECIAL EXPERTISE – level in the nursing field one is engaged in o PRACTICE THEORY  COMPLEXITY/ABSTRACTNESS, SCOPE - Focuses on a narrow view of reality, simple and straightforward;  GENERALIZABILITY/SPECIFICITY - Linked to special populations or an identified field of practice;  CHARACTERISTIC OF SCOPE – Single, concrete concept that is operationalized;  CHARACTERISTIC OF PROPOSITION – Propositions defined;  TESTABILITY – Goals or outcomes defined and testable;  SOURCE OF DEVELOPMENT – Derived from practice or deduced from middle range theory or grand theory. CARMELITA DIVINAGRACIA  Former President of The Association of the Philippine Colleges of Nursing (ADPCN)  COMPOSURE MODEL o State of well-being, involves dimension of wellness o ACRONYM  COMpetence  Understanding  Presence and Prayer  Respect and Relaxation  Open-mindedness  Empathy  Stimulation o THREE MAIN THEMES  COORDINATION – intra-organizational; inter-organizational; reciprocal interdependence  COMMUNICATION – environmental factors; personal factors  INTERPERSONAL RELATIONSHIP – engagement; spirit (morale); concern; support SISTER LETTY KUAN  RETIREMENT AND ROLE DISCONTINUITIES MODEL o RETIREMENT – fulfillment of individual’s birthright and must be lived meaningfully o PHYSIOLOGICAL AGE – endurance of cells and tissues to withstand the wear-and-tear phenomenon of the human body. o ROLE – set of shared expectations focused upon a particular position, socialization experiences, and o CHANGE OF LIFE – period between near retirement and post retirement years; climacteric period of adjustment and readjustment to another tempo of life. o RETIREE – individual who has left the position occupied for the past years of productive life o ROLE DISCONTINUITY – interruption in the line of status enjoyed or role performed; may be brought about by an accident, emergency, and change of position or retirement. o COPING APPROACHES – interventions or measures applied to solve a problematic situation; restore or maintain equilibrium and normal functioning. o DETERMINANTS OF POSITIVE PERCEPTIONS IN RETIREMENT/ROLE DISCONTINUITY  HEALTH STATUS – dictates the capacities and the type of role one takes  FAMILY CONSTELLATION – positive index regarding retirement positively and also in reacting to role discontinuities  INCOME – high correlation with both perceptions of retirement and reactions toward role discontinuities  WORK STATUS – economic security that generates decent compensation  SELF-PREPARATION – both therapeutic and recreational in essence pays its worth in old age CARMENCITA ABAQUIN  PREPARE ME HOLISTIC NURSING INTERVENTIONS o Address the multidimensional problems of cancer patients that can be given in any setting where patients choose to be confined o PRESENCE – being with another person during the times of need; therapeutic communication, active listening, and touch. o REMINISCE THERAPY – recall of past experiences, feelings and thoughts to facilitate adaptation to present circumstances. o PRAYER o RELAXATION-BREATHING – techniques to encourage and elicit relaxation; decreasing undesirable signs and symptoms such as pain, muscle tension, and anxiety. o MEDITATION – encourages an elicit form of relaxation; altering patient's level of awareness by focusing on an image or thought. o VALUES CLARIFICATION – assisting another individual to clarify his own values about health and illness in order to facilitate effective decision-making skills. CECILIA LAURENTE  THEORY OF NURSING PRACTICE AND CAREER SYNCHRONICITY IN HUMAN-SPACE-TIME: A THEORY OF NURSING ENGAGEMENT IN GLOBAL COMMUNITY o ANXIETY – mental state of fear or nervousness about what might happen o NURSING CARING BEHAVIOR THAT AFFECTS PATIENT’S ANXIETY  PRESENCE – person to person contact between the client and the nurses.  CONCERN – development in the time though mutual trust between the nurse and the patient  STIMULATION – power of words in healing o PREDISPOSING FACTORS  Age  Sex  Civil Status  Educational Status  Length of Work  Experience o ENHANCING FACTORS  One’s caring experience, beliefs and attitude  Feeling good about  Learning at school  What patients tell about the nurse coping mechanism to problems encountered  Communication ABRAHAM MASLOW  HIERARCHY OF NEEDS THEORY o Nursing guide to prioritization of patient care needs o SELF-FULFILLMENT NEEDS  SELF-ACTUALIZATION – morality, creativity, problem solving o PSYCHOLOGICAL NEEDS  ESTEEM – confidence, self-esteem, achievement, respect  BELONGINGNESS – love, friendship, intimacy, family o BASIC NEEDS  SAFETY – security, employment, resources, health, property  PHYSIOLOGICAL – air, food, water, sex, sleep, homeostasis o DEFIENCY (D-NEEDS/DEPRIVATION NEEDS) – lack of satisfaction causes deficiency that motivates to meet needs o GROWTH NEEDS (B-NEEDS/BEING NEEDS) – higher, healthier, more likely to emerge in self-actualizing HARRY STACK SULLIVAN  Father of Interpersonal Psychiatry in America  TRANSACTIONAL ANALYSIS o Understanding people's behavior by analyzing the transactions or interactions which transpire people o DEVELOPMENTAL EPOCHS  INFANCY (Birth to 18mnths) – gratification of needs  CHILDHOOD (18mnths to 6yrs) – delayed gratification  JUVENILE ERA (6 to 9yrs) – formation of peer group  PRE-ADOLESCENCE (9 to 12yrs) – developing relationship within same gender  EARLY ADOLESCENCE (12 to 14yrs) – identity  LATE ADOLESCENCE (14 to 21yrs) – forming lasting, intimate relationships o SELF-SYSTEM  The patterns of behavior that defines and protects self from anxiety  Developed from infancy  Later develops into Personification o SECURITY OPERATIONS  DISSOCIATION – distances from something connected with self  SELECTIVE INATTENTION – ignoring threatening events that may cause anxiety o PERSONIFICATION (THREE TYPES OF SELF)  GOOD ME – what they like about themselves  BAD ME – what they do not like about themselves; result of negative feedback  NOT ME – unconscious aspect of self; contains horror and dread LUDWIG VON BERTALANFFY  GENERAL SYSTEM’S THEORY o General science of wholeness o Recognition of interplay between biological and psychological factors to determine individual behavior o Provides framework n complex processes of groups of human beings o HOLISTIC – independent of specific element and variables o SYSTEMS – self-regulating; self-correcting through feedback o BOUNDARY – structural limitation that separate systems o ENTROPY – state of disorganization o OPEN SYSTEM – interacts with environment o CLOSED SYSTEM – no interaction with environment; non-living KURT LEWIN  Father of Social Psychology  CHANGE THEORY o UNFREEZE – need for change; method to let go of old pattern o CHANGING/MOVEMENT – plan the change; process of change in thoughts, feelings, behavior o REFREEZE – reinforce change; standard operating procedure; new habit o DRIVING FORCES – push in direction that causes change; shift in equilibrium o RESTRAINING FORCES – hinder change, shift in equilibrium which opposes change o EQUILIBIUM – state of being where driving and restraining forces are equal SIGMUND FREUD  PSYCHOSEXUAL THEORY IOF DEVELOPMENT o STRUCTURAL THEORY  ID – first to develop; unconscious; pleasure principle; all drives; no awareness of reality  EGO – second to develop; reality principle; autonomous functions; defense against anxiety; mediator  SUPEREGO – third to develop; moral values; self-punishment; self-praise based on ego; mostly unconscious; conflict o LIBIDO THEORY – gratification of drive (sexual or aggressive)  ORAL (0 to 1) – mouth/tongue/lips; weaning of breast feeding/formula; eating/smoking  ANAL (1 to 3) – anus; toilet training; orderliness/messiness  PHALLIC (3 to 6) – genitals; resolving Oedipus/Electra Complex; deviancy/sexual dysfunction  LATENCY (6 to 12) – developing defense mechanism  GENITAL (12 and above) – genitals; reaching full sexual maturity; sexually matured; mentally healthy ERIK ERIKSON  STAGES OF PSYCHOSOCIAL DEVELOPMENT o 8 STAGES OF THE LIFE CYCLE  INFANCY (0 to 1) – basic trust vs mistrust; appreciation of interdependence and relatedness; hope  EARLY CHILDHOOD (1 to 3) – autonomy vs shame; acceptance of the cycle of life; will  PLAY AGE (3 to 6) – initiative vs guilt; humor/empathy/resilience; purpose  SCHOOL AGE (6 to 12) – industry vs inferiority; acceptance of life’s course; competence   ADOLESCENCE (12 to 19) – identity vs confusion; complexity of life; sensory/logical/aesthetic perception; fidelity  EALRY ADULTHOOD (20 to 25) – intimacy vs isolation; complexity of relationships; value of tenderness and loving; love  ADULTHOOD (26 to 64) – generativity vs stagnation; caritas/caring for others; empathy and concern; care  OLD AGE (65 to death) – integrity vs despair; existential identity; wisdom JEAN PAIGET  COGNITIVE DEVELOPMENT o SENSORIMOTOR STAGE (0 to 2) – learning thru senses; initiative behavior; object permanence o PREOPERATIONAL STAGE (2 to 7) – symbolic thinking; one-way logic; strong imagination and intuition; egocentrism o CONCRETE OPERATIONAL STAGE (7 to 11) – hands-on thinking; concrete situation; identity o FORMAL OPERATIONAL STAGE (11 and above) – abstract thinking; scientific reasoning; adolescent egocentrism LAWRENCE KHOLBERG  THEORY OF MORAL DEVELOPMENT o THREE LEVEL OF REASONING AND SIX STAGES OF MORAL DEVELOPMENT  PRE-CONVENTIONAL MORALITY – reward/punishment for right/wrong; reason according to self- perspective  Obedience and punishment orientation  Instrumental orientation  CONVENTIONAL MORALITY – views of others matter; avoiding blame; seeks approval; reason based on social rules/norms  Good boy and nice girl  Law and order  POST-CONVENTIONAL MORALITY – abstract notions of justice; rights overriding obedience to laws/rules; use principle of social norm to direct behavior  Social-contract orientation  Universal-ethical principal orientation