NUR100 Theoretical Foundations in Nursing PDF

NUR100: Theoretical Foundations in Nursing Prepared by: KENNETH JOE R. CORALES , RN ,LPT Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories...

NUR100: Theoretical Foundations in Nursing Prepared by: KENNETH JOE R. CORALES , RN ,LPT Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory DEFINITION OF TERMS Philosophy – It specifies the definition of metaparadigm concepts in each of conceptual models of nursing. Models – Models are representations of the interaction among and between the concepts showing patterns. A model is a diagram of concepts and their relationship with each other. Concepts – Concepts are often called the building blocks of theories. The ideas and mental images that help to describe phenomena  Conceptual framework – A conceptual framework is a group of related ideas, statements, or concepts. Proposition – Propositions are statements that describe the relationship between the concepts. Theory – It is an organized system of accepted knowledge that is composed of different ideas to explain a fact. Theories are also used to describe, predict, or control phenomena.  Domain – Domain is the perspective or territory of a profession or discipline. It contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline. Process – Processes are a series of organized steps, changes or functions intended to bring about the desired result.  Paradigm – A paradigm refers to a pattern of shared understanding and assumptions about reality and the world; worldview or widely accepted value system. – A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline  Metaparadigms – These are patterns or models used to show a clear relationship among the existing theoretical works in nursing. Much of the theoretical work in nursing focused on articulating relationships among four major concepts: person, environment, health, and nursing. – They embody the knowledge base, theory, philosophy, research, practice, and educational experience and literature identified with the profession. What are 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. Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory  History of Nursing Theory 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. In 1960, Faye Abdellah published her work “Typology of 21 Nursing Problems” that shifted the focus of nursing from a disease-centered approach to a patient-centered approach.  In 1962, Ida Jean Orlando emphasized the reciprocal relationship between patient and nurse and viewed the professional function of nursing as finding out and meeting the patient’s immediate need for help. In 1968, Dorothy Johnson pioneered the Behavioral System Model and upheld the fostering of efficient and effective behavioral functioning in the patient to prevent illness. In 1970, Martha Rogers viewed nursing as both a science and an art as it provides a way to view the unitary human being, who is integral with the universe.  In 1971, Dorothea Orem states in her theory that nursing care is required if the client is unable to fulfill biological, psychological, developmental, or social needs. In 1971, Imogene King‘s Theory of Goal attainment states that the nurse is considered part of the patient’s environment and the nurse-patient relationship is for meeting goals towards good health. In 1972, Betty Neuman in her theory states that many needs exist, and each may disrupt client balance or stability. Stress reduction is the goal of the system model of nursing practice.  In 1979, Sr. Callista Roy viewed the individual as a set of interrelated systems who strives to maintain the balance between these various stimuli. In 1979, Jean Watson developed the philosophy of caring highlighted humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice. Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory CHARACTERISTICS OF THEORIES Theories: – are generalizable (simple but generally broad in nature) – should be logical in nature – are the bases for hypotheses that can be tested. – Are consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated – Increase the general body of knowledge within the discipline through the research implemented to validate them. – Are used by the practitioners to guide and improve their practice. – It should correlate concepts in such a way as to generate a different way of looking at a certain fact Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory Components of Nursing Theories Phenomenon Concepts Definitions Relational Statements Assumptions Phenomenon A term given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent. Aspect of reality that can be consciously sensed or experienced (Meleis, 1997).  Examples of phenomena of nursing include caring, self-care, and patient responses to stress. For example, in Neuman’s systems model (2011), phenomena focus on stressors perceived by the patient or caregiver. The theoretical model is an open systems model that views nursing as being primarily concerned with nursing actions in stress-related situations. These stressors may include, but are not limited to, patient responses, internal and external environmental factors, and nursing actions. Concepts Interrelated concepts define a theory. A concept is an idea or mental image that helps describe a phenomenon (Alligood and Marriner-Tomey, 2002). They are words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or concrete. – Abstract Concepts. Defined as mentally constructed independent of a specific time or place. – Examples: love, success, freedom, democracy, good and evil, feminism, morality – Concrete Concepts. Are directly experienced and related to a particular time or place. – Examples: spoon, table, velvet chair, green, hot, walking Definitions Definitions are used to convey the general meaning of the concepts of the theory. It is composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts. Definitions can be theoretical or operational. – Theoretical Definitions. Define a particular concept based on the theorist’s perspective; establish meaning – Operational Definitions. States how concepts are measured.  Theoretical Definition Operational Definition Weight The gravitational pull on an An object’s weight in pounds, to object’s mass the nearest whole pound Anxiety A feeling of unease Hamilton Anxiety Rating Scale Palmar Sweat Index Relational Statements Relational statements define the relationships between two or more concepts. They are the chains that link concepts to one another. Assumptions Assumptions are accepted as truths and are based on values and beliefs. An assumption specifies the relationship or connection of factual concepts or phenomena. Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory Classification of Nursing Theories Grand Nursing Theories Middle-Range Nursing Theories Practice-Level Nursing Theories  Grand Nursing Theories – are abstract, broad in scope, and complex, therefore requiring further research for clarification. – do not guide specific nursing interventions but rather provide a general framework and nursing ideas. – Grand nursing theorists develop their works based on their own experiences and their time, explaining why there is so much variation among theories. – Address the nursing metaparadigm components of person, nursing, health, and environment.  Examples: – Johnson’s Behavioral System’s model – Roy’s Adaptation model – Rogers’ Science of Unitary Beings – Orem’s Self-Care Deficit Nursing theory – Watson’s Theory of Human Caring  Middle-Range Nursing Theories – More limited in scope (compared to grand theories) and present concepts and propositions at a lower level of abstraction. They address a specific phenomenon in nursing. – least abstract and offer more direct application to research and practice. – Most middle-range theories are based on a grand theorist’s works, but they can be conceived from research, nursing practice, or the theories of other disciplines.  Examples: – Kolcaba’s Comfort theory – Pender’s Health Promotion model – Swanson’s Theory of Caring – Leininger’s Culture Care Theory – Peplau’s Theory of Interpersonal Relations  Practice-Level Nursing Theories – are situation-specific theories that are narrow in scope and focuses on a specific patient population at a specific time. – provide frameworks for nursing interventions and suggest outcomes or the effect of nursing practice. – Theories developed at this level have a more direct effect on nursing practice than more abstract theories.  Both grand theories and middle-range theories encompass either one or more of four types of theory: descriptive, explanatory, predictive, and prescriptive.  Nursing Theory Network defines these types as: – Descriptive theory: identifies properties and components of a discipline. Allows the nurse to know the properties of a discipline and is the primary level of theory development. – Explanatory theory: identifies how the properties and components relate to one another. Allows the nurse to present the relationship among concepts and propositions.  Predictive theory: conjectures the relationships between components of a phenomenon and predicts when the phenomena will occur. Prescriptive theory: addresses therapeutics and consequences of interventions. This kind of theory is commonly used in testing new nursing interventions. Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory  Criteria for Evaluating Theoretical Work Clarity Simplicity Generality Empirical precision Derivable Consequences  Criteria for Evaluating Theoretical Work Clarity “How clear is this theory?” In evaluating the theory, its diagram, semantics and structure should be consistent all throughout.  Criteria for Evaluating Theoretical Work Simplicity “How simple is the theory?” Theory should have as few concepts as possible with simplistic relations to aid clarity.  Criteria for Evaluating Theoretical Work Generality “How general is this theory?” In evaluating the theory, its scope of concepts and goals should be broader.  Criteria for Evaluating Theoretical Work Empirical precision “How accessible is the theory?” is linked to the testability and ultimate use of a theory and it refers to the "extent that the defined concepts are grounded in observable reality”.  Criteria for Evaluating Theoretical Work Derivable Consequences “How important is this theory?” In evaluating the theory, its concepts can be tested and result to additional knowledge to guide practice.  Criteria for Evaluating Theoretical Work Clarity - “How clear is this theory?” Simplicity - “How simple is the theory?” Generality - “How general is this theory?” Empirical precision - “How accessible is the theory?” Derivable Consequences - “How important is this theory?” Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Metaparadigms in nursing theory Purposes and significance of nursing theory The Nursing Metaparadigm Person Environment Health Nursing Person Person (also referred to as Client or Human Beings) is the recipient of nursing care and may include individuals, patients, groups, families, and communities. Environment Environment (or situation) is defined as the internal and external aspects of life that influence the core. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare. 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. Nursing The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client. There are numerous definitions of nursing, though nursing scholars may have difficulty agreeing on its exact definition, the ultimate goal of nursing theories is to improve patient care. Definition of nursing according to the American Nurses Association: – “It is the diagnosis and treatment of human responses to actual or potential health problems.” Definition of nursing according to the International Council of Nurses: – “It is an autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings.” Definition of nursing according to the Association of Deans of the Philippine Colleges of Nursing: – “It is dynamic discipline, and art and science of caring for individuals, families and groups.” Overview of the Theoretical Foundations in Nursing Definition of terms History of nursing theory Characteristics of a theory Components of a theory Classification of Nursing Theories Criteria for Evaluating Theoretical Work Metaparadigms in nursing theory Purposes and significance of nursing theory Purposes of Nursing Theories In Academic Discipline In Research In Profession  Purposes of Nursing Theories In Academic Discipline – identified the major concepts in one or two nursing models, organized the concepts and build an entire nursing curriculum around the created framework. – to explain the fundamental implications of the profession and to enhance the status of the profession – prepare students as members of the professional community  Purposes of Nursing Theories In Research – uses theory as a framework to provide perspective and guidance to the research study – used to guide the research process by creating and testing phenomena of interest – helps connect the perceived “gap” between theory and practice and promote the theory-guided practice – contribute to better understanding of technology, ideas, and emerging issues and how they can be addressed Purposes of Nursing Theories In Profession – Clinical practice generates research questions and knowledge for theory – primary contribution is the facilitation of reflecting, questioning, and thinking about what nurses do – encourages nurses to reflect on, question, and think about what they do provide an invaluable service – develop critical thinking and decision making among nurses – inculcate the value of transcultural nursing in practice Significance Of Nursing Theory Nursing theories help recognize what should set the foundation of practice by explicitly describing nursing. By providing a definition of nursing, nursing theory also helps nurses to understand their purpose and role in the healthcare setting. Theories serve as a rationale or scientific reasons for nursing interventions and give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations.  Nursing theories provide the foundations of nursing practice, helps generate further knowledge, and indicate in which direction nursing should develop in the future (Brown, 1964). By providing nurses a sense of identity, nursing theory can help patients, managers, and other healthcare professionals to acknowledge and understand the unique contribution that nurses make to the healthcare service (Draper, 1990). Nursing theories prepare the nurses to reflect on the assumptions and question the values in nursing, thus further defining nursing and increasing knowledge base.  Nursing theories aim to define, predict, and demonstrate the phenomenon of nursing (Chinn and Jacobs, 1978). It can be regarded as an attempt by the nursing profession to maintain and preserve its professional limits and boundaries. In many cases, nursing theories guide knowledge development and directs education, research, and practice although each influence the others. (Fitzpatrick and Whall, 2005). Nursing theory is important in the nursing profession as it differentiates what nursing is and what is not. Why on earth do we study nursing theory? Everyday practice enriches theory Both practice and theory are guided by values and beliefs Theory helps to reframe our thinking about nursing Theory guides use of ideas and techniques Theory can close the gap between theory and research To envision potentialities (Gordon, Parker, & Jester, 2001) So how do nurses use theory in everyday practice? Organize patient data Understand patient data Analyze patient data Make decisions about nursing interventions Plan patient care Predict outcomes of care Evaluate patient outcomes (Alligood, 2001) “ Practicing nurses who despise theory are condemned to performing a series of tasks - either at the command of a physician or in response to routines and policies.” Leah Curtin, RN, MS, FAAN (1989) Former Editor, Nursing Management References: References: Alligood, M.R. & Tomey, A.M. (2022). Nursing theory: Utilization and application. (10th ed.). Michigan: Mosby George, J. (2014) Nursing Theories: The Base for Professional Nursing Practice. (6th Ed.). Pearson Education Limited, London Kozier, B. (2016). Fundamentals in nursing. (10th ed.). Singapore: South Asian Ltd. McEwen, M & Wills, E. (2019). Theoretical Basis for Nursing. (5th Ed.) Philadelphia: Wolters Kluwer Potter, P. A. & Perry, A.G. (2023). Fundamentals in nursing. (11th ed.). Australia: Elsevier Pte. Ltd. Sitzman, K. & Eichelberger, L. (2017). Understanding the works of Nursing Theorists. A Creative Beginning. (3rd Ed.) Jones & Bartlett Learning.