Theoretical Foundations of Nursing PDF

**W1: INTRODUCTION TO NURSING THEORIES** +-----------------------------------------------------------------------+ | **TOPIC OVERVIEW** | +-----------------------------------------------------------------------+ | A. **Nursing theories**...

**W1: INTRODUCTION TO NURSING THEORIES** +-----------------------------------------------------------------------+ | **TOPIC OVERVIEW** | +-----------------------------------------------------------------------+ | A. **Nursing theories** | | | | a. Historical Eras | | | | b. Nursing theory development | | | | c. Relationship of Theory, research and practice | +-----------------------------------------------------------------------+ ------- ------------------ **A** **INTRODUCTION** ------- ------------------ **FLORENCE NIGHTINGALE** - Envisioned nurses as a body of educated women at a time when women were neither educated or employed in public service - ***Matriarch** of modern nursing* - *Born in Florence, Italy on May 12, 1820* - *Also known as **Lady with the Lamp,*** +-----------------------------------------------------------------------+ | ***Nightingale's Environmental Theory*** | | | | - Persons are in connection with the | | | | | | | | - Nursing puts patients in the \"best | | | | | | | | - Health is \"the positive of which the | | | | | | | | - Nightingale\'s Environmental Theory | | | | | | | | - When aspects of the environment are | | | | | | | | - Viewed disease as a reparative | +-----------------------------------------------------------------------+ -------- ----------------------- **B.** **4 HISTORICAL ERAS** -------- -----------------------  **Curriculum Era (1900 to 1940s)** - Addressed the question of what **Major question:** - What curriculum content should student nurses study to be nurses? **Emphasis:** - Courses included in nursing programs **Outcomes:** - Standardized curricula for diploma programs **Emerging goal:** - Develop specialized knowledge and higher education **Research Era (1950 to 1970s)** - Came about as more nurses embraced higher education. - Research was perceived as the path to new knowledge **Major question:** ** Emphasis:** ** Outcomes**: ** Emerging goal:** **Graduate Education Era (1950-1970s)** - Master's degree in Nursing emerged - Include courses in concept development and nursing theory **Major question:** - What knowledge is needed for the practice of nursing? ** Emphasis:** - Carving out an advanced role and basis for nursing practice ** Outcomes:** - Nurses have an important role in health care ** Emerging goal:** **Theory Era (1980 to 1990s)** - Research without theory produced isolated information - Doctoral education (Higher education) flourished with emphasis on theory development **Major question:** - How do these frameworks guide research and practice? **Emphasis:** - There are many ways to think about nursing ** Outcomes:** - Nursing focus theoretical works shift the to the patient ** Emerging goal:** - Theories guide nursing research and practice **Utilization Era (21st Century)** - Restores the centrality of nursing practice and recognizes theory and research as tools of practice rather than ends in themselves. **Major question:** What new theories are needed to produce evidence of quality care? ** Emphasis**: - Nursing theory guides research, practice, education, and administration ** Outcomes**: - Middle-range theory may be from quantitative or qualitative approaches ** Emerging goal:** - Nursing frameworks produce. knowledge (evidence) for quality -------- ---------------------------- **A2** **ADDITIONAL INFORMATION** -------- ---------------------------- - At the beginning of the twentieth century, nursing was not recognized as an academic discipline or profession - The accomplishment of the past century led to the recognition of nursing in both areas. ------- -------------------------------- **B** **NURSING THEORY DEVELOPMENT** ------- -------------------------------- For any profession to exist and to be a service to society, it must have an extensive base of knowledge and proper means to communicate. - Provider the core structure that gives direction and purpose to those who practice it. **EDUCATION** - Primarily used to develop and guide nursing education in universities and institutions - Curriculum was built based on recognized nursing models - Prepares the students for practice as members of the professional community. **RESEARCH** - Inspired from theoretical assumptions or conceptual frameworks - Evolution of technology, ideas and emerging nursing issues provide answers to questions r/t practice **CLINICAL RESEARCH** - Guides critical thinking and decision making in clinical nursing practice - Strengthen professional independence by guiding the deepest and most important part of their practice ------- -------------------------------------------- **C** **INTERDEPENDENCE OF THEORY AND RESEARCH** ------- -------------------------------------------- +-----------------------------------+-----------------------------------+ | **THEORY AND PRACTICE** | | +-----------------------------------+-----------------------------------+ | **T** | *Guides Practice* | +-----------------------------------+-----------------------------------+ | **T** | *Give insights, provision of | | | goals,* | | | | | | *diagnosis, and intervention on* | | | | | | *Nursing practice* | +-----------------------------------+-----------------------------------+ | **T** | *Renders an efficient, effective* | | | | | | *and improved client care* | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **RESEARCH AND PRACTICE** | | +-----------------------------------+-----------------------------------+ | **R** | *key to development of a* | | | | | | *discipline* | +-----------------------------------+-----------------------------------+ | **NURSE PRACTITIONER** | *who wants to develop* | | | | | | *expertise must participates* | | | | | | *in research.* | +-----------------------------------+-----------------------------------+ | **NURSES** | *is encourage to test and* | | | | | | *redefine theories and* | | | | | | *models - to develop own* | | | | | | *personal models of practice* | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **RESEARCH AND THEORY** | | +-----------------------------------+-----------------------------------+ | **R** | *Validates and modifies theory* | +-----------------------------------+-----------------------------------+ | **NR** | *Stimulate nurses to explore* | | | | | | *significant problems in the | | | field* | | | | | | *of nursing.* | +-----------------------------------+-----------------------------------+ | **T** | *Explain the relationship | | | between* | | | | | | *phenomena.* | +-----------------------------------+-----------------------------------+ | **Results of R** | *used to verify support or* | | | | | | *disprove proposition.* | +-----------------------------------+-----------------------------------+ ------- ---------------------------------------------- **C** **THE MEANING OF DISCIPLINE AND PROFESSION** ------- ---------------------------------------------- **DISCIPLINE** - Is a specific to academe and refers to a branch of education, a department of learning or a domain of knowledge. **PROFESSION** - Refers to a specialized field of practice , founded upon the theoretical structure of the science or knowledge of that discipline and accompanying practice abilities ------------------------------------------- **W2: HISTORY AND PHILOSOPHY OF SCIENCE** ------------------------------------------- +-----------------------------------------------------------------------+ | **TOPIC OVERVIEW** | +-----------------------------------------------------------------------+ | A. **Why should nurses be** | | | | a. RATIONAL | | | | b. EMPIRICAL | +-----------------------------------------------------------------------+ ------- -------------------------- **A** **Why should nurses be** ------- -------------------------- - It is important as a foundation for exploring whether scientific results are actually the **truth** - As nurses our practice should be based upon the **truth** and we need the ability to interpret the results of science... +-----------------------------------------------------------------------+ | ***RATIONALISM*** | | | | - Rationalism, in Western philosophy, the view that regards | | **REASON as the chief source and test of knowledge** | +-----------------------------------------------------------------------+ -------- -------------------------------- **A1** **Rene Descartes (1596-1650)** -------- -------------------------------- - The first of the modern rationalists - Knowledge of eternal truths could be attained by reason alone *No experience was necessary* ***COGITO ERGO SUM -*** The Latin cogito, ergo sum, usually translated into English as \"I think, therefore I am\", is the \"first principle\" of René Descartes\'s philosophy. - It emphasizes the importance of **priori reasoning** as the appropriate method for advancing knowledge - A priori reasoning utilizes deductive logic by reasoning from the **cause to an effect** or from a **generalization to a particular instance** Example: Lack of social support (cause) will result in hospital readmission (effect) +-----------------------------------------------------------------------+ | ***EMPIRICISM*** | | | | - All knowledge obtained **through SENSES** - not inherited | +-----------------------------------------------------------------------+ -------- ------------------- **A2** **Francis Bacon** -------- ------------------- - Received credit for popularizing this approach. Scientific truth was discovered through g eneralizing observed facts (Inductive Method) **Research - then - theory method** -------- ---------------------------- **A3** **John Locke (1632-1704)** -------- ---------------------------- - The most elaborate and influential presentation of empiricism was made by **John Locke** *All knowledge, he held, comes from sensation or from reflection* -- --------------------------------------------- **Why is empiricism important in Nursing?** -- --------------------------------------------- - Because the nature of the nursing practice requires predictions and explanations; empiricism has the capacity for explanation, which is necessary for clinical practice. -- ------------------ **Nice to know** -- ------------------ - Concepts are said to be **\"a posteriori\"** (Latin: \"from the latter\") if they can be applied only on the basis of experience, and they are called **\"a priori\"** (\"from the former\") if they can be applied independently of experience. - Beliefs or propositions are said to be a posteriori if they are knowable only on the basis of experience **(empiricism)** and a priori if they are knowable independently of experience **(rationalism).** -- ------------------------------ **Early 20th Century Views** -- ------------------------------ - **Positivism**, a term first used by Comte, emerged as the dominant view of modern science (Gale, 1979). - Modern logical positivists believed that **empirical research and logical analysis (deductive and inductive)** were two approaches that would produce scientific knowledge (Brown, 1977). - Propositions that affirm/deny something must be tested -- ---------------------------------------- **Deductive and Inductive Approaches** -- ---------------------------------------- ------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- **Deductive Approach** **Inductive Approach** A social phenomenon is observed. A social phenomenon is observed A theory is developed to explain why it occurred Data is collected on the possible reasons why it occurs and trends in the data are examined The theory is tested through research and the theory is either accepted, rejected, or revised. A theory is developed from this data to explain the social phenomenon. ------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- +-----------------------------------------------------------------------+ | ***Deductive Reasoning*** | | | | - Think of it like an inverted triangle. We start with generalities | | and move to specifics. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Inductive Reasoning*** | | | | - Think of it like a triangle. We start with the specifics and move | | to generalities. | +-----------------------------------------------------------------------+ -- -------------------- **Emergent Views** -- -------------------- -- ---------------------------------- **Paul MIchael Foucault (1973)** -- ---------------------------------- - Published his analysis of the epistemology (knowledge) of human sciences from the 17th to the 19th century. - Empirical knowledge was arranged in different patterns at a given time and in a given culture and that humans where emerging as objects of study. - **Foucault\'s** entire philosophy is based on the assumption that **human knowledge and existence are profoundly historical.** He argues that what is most human about man is his history. - He discusses the notions of history, change and historical method at some length at various points in his career. -- -------------------------- **Alfred Schutz (1967)** -- -------------------------- - **Alfred Schutz (1967)** main area of concern was the ways in which **people grasp the consciousness of others** while living within their own streams of consciousness. - A great deal of his work deals with the \"lifeworld,\" in which people create social reality under the constraints of preexisting social and cultural factors and structures. -- ----------------------------------- **Edmund Husseri (1859 to 1938)** -- ----------------------------------- - Principal founder of phenomenology - One of the most influential philosophers of the 20th century - He suggested that only by suspending the \"natural attitude\" could philosophy becomes its own distinctive and rigorous science, and he insisted that phenomenology is a science of consciousness rather than of empirical things +-----------------------------------------------------------------------+ | ***Phenomenology*** is a philosophical movement originating in the | | 20th century | | | | - The primary objective of which is the direct investigation and | | description of phenomena as consciously experienced, without | | theories about their causal explanation and as free as possible | | from unexamined preconceptions and presuppositions | | | | - A philosophy of experience | +-----------------------------------------------------------------------+ -- ------------------------------------------------------------------ **Emergent View of science and theory in the late 20th century** -- ------------------------------------------------------------------ New Epistemology: Science is viewed as ongoing process **Concluded that myth that science can establish final truth** ------------------------------ **W3: SOURCES OF KNOWLEDGE** ------------------------------ +-----------------------------------------------------------------------+ | **Knowledge can be defined as;** | | | | - Information, skills and expertise acquired by a person through | | [life experiences,] or through [formal/informal | | learning.] Facts and information, awareness or | | familiarity gained by experience of a fact or situation. | +-----------------------------------------------------------------------+ -- ----------------------- **COGNITIVE PROCESS** -- ----------------------- **KNOWLEDGE** - **PERCEPTION** - **ASSOCIATION** - **LEARNING** - **REASONING** - **COMMUNICATION** **TYPES OF COGNITIVE PROCESS** ------------------- ------------------------------------------------------------------------------ **PERCEPTION** Achieving understanding of sensory data **ASSOCIATION** Combining 2 or more concepts to form new concepts, or for comparison **LEARNING** Acquiring experience, skills, information and values **REASONING** Mental process of seeking conclusion through reason **COMMUNICATION** Transferring data from Sender to receiver using diff. Tools of communication ------------------- ------------------------------------------------------------------------------ -- ---------------------------------------- **What are the sources of knowledge?** -- ---------------------------------------- - **Nurses knowledge emerges from a range of sources** **3 Categories** 1. **Traditional** 2. **Authoritative** 3. **Scientific Knowledge** -------------------------- ***Traditional Source*** -------------------------- - ls a nursing practice which is passed down from generation to generation. - Example: routine changing of bed linens as an impt. component of providing quality patient care ------------------------------- ***Authoritative Knowledge*** ------------------------------- - An idea by a person of authority which is perceived as true because of his or her expertise - Example: a nurse supervisor training a nurse beginner on how to insert urinary catheter ------------------------------- ***Authoritative Knowledge*** ------------------------------- - Type of knowledge which came from a scientific method through research - Example: tepid sponge bath lowers body temperature through evaporation -- ----------------------------------------- Traditional and Authoritative knowledge -- ----------------------------------------- Advantages: - Practical o implement - Systematic and accurate theories it creates are more subjective than knowledge gained by methods Disadvantages - Based on subjective data - In nursing, scientific knowledge through EBP and research serves as the main focus - Requires time and effort to produce credible results ------------------------------------ **W4: THEORY DEVELOPMENT PROCESS** ------------------------------------ +-----------------------------------------------------------------------+ | **Importance of Nursing Theory** | +-----------------------------------------------------------------------+ | 1. Offers structure & organization to nursing knowledge & provide a | | systematic means of collecting data to describe, explain & | | predict nursing practice | | | | 2. Promote rational & systematic practice by challenging & | | validating intuition | | | | 3. Make nursing practice more purposeful by stating the focus, | | specific goals & outcomes of practice | | | | 4. Define & clarify nursing & the purpose of nursing practice to | | distinguish it from other caring professions by setting | | professional boundaries. | | | | 5. Leads to coordinated & less fragmented care | +-----------------------------------------------------------------------+ ------- ------------------------------------------------- **A** **Stages in the Development of Nursing Theory** ------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ **STAGE** **SOURCE OF KNOWLEDGE** ***IMPACT ON THEORY AND RESEARCH*** Silent knowledge Educ. & practice -- based on rules and traditions passed on as apprentice Silent knowledge Educ. & practice -- based on rules and traditions passed on as apprentice Silent knowledge Educ. & practice -- based on rules and traditions passed on as apprentice Received knowledge Learning through listening to others Theories borrowed from other discipline Nurses acquired non nursing doctoral degrees Subjective knowledge Nurses role came under scrutiny Debate from nursing Leaders- what is nursing , its purpose and function. Authority was internalized and a new sense of self emerged Negative attitude towards borrowed theories emerged Nurse scholars focused on defining nursing and on developing theories about and for nursing Research focused on the nurse rather than the client Procedural knowledge - Viewed themselves as "scientific discipline toward scientifically based practice Includes both separate and connected knowledge Proliferation of approaches to theory development Application of theory under emphasized Emphasis placed on procedures used to acquire knowledge Constructed knowledge This is the current stage Integration of different types of knowledge Nursing theory should be based on prior empirical studies, theoretical lit, client report of clinical experience and feelings and the nurse's scholar's intuition or related knowledge about the phenomenon of concern ------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ **NURSING PARADIGMS** - Are patterns of models used to show a clear relationship among the existing theoretical works in nursing **PARADIGMS** - Developed over time from the practices and beliefs of professional practitioners to give structure to the body of knowledge that is necessary to successfully meet the goals of the profession. - *Also known as **Lady with the Lamp,*** **NURSING METAPARADIGMS** - META-WITH - PARADIGM A-PATTERN +-----------------------------------------------------------------------+ | ***Metaparadigms*** | | | | - Represents worldview of discipline | | | | - Ideology within which the nursing theories, knowledge and | | processes for knowing find meaning and coherence | +-----------------------------------------------------------------------+ -- --------------------------- **NURSING METAPARADIGMS** -- --------------------------- **PERSON** - The participant or recipient of nursing care -- Individuals -- Families -- Communities - Other groups (elderly, special children, the disabled, women groups, etc.) - The "subject" of health care **MAN AS A MULTIDIMENSIONAL BEING** - Spiritual - Social - Psychological - Biological -- -- **ENVIRONMENT** - External and internal aspects of life that influence the person - includes the cultural, social, political, spiritual and economic influences on the individual, and nursing care includes monitoring and sometimes modifying the interactions of the individual with the environment. - Florence Nightingale' Environmental Theory speak of " the proper environment for the patient, uses of fresh air, light, warmth, cleanliness, quiet and proper selection and administration of a diet" -- -- **HEALTH** - Holistic level of wellness that the person experiences - Health -- the person's state of wellbeing at the time that nursing occurs, which can range from highlevel wellness to terminal illness A. **Physical Dimension** - Physical dimension (genetic makeup, age, developmental level, race, sex, biological condition) B. **Emotional Dimension** - feelings, affect, mood, self-worth C. **Intellectual Dimension** - Cognitive abilities - Educational background - Past experiences - Positive sense of purpose D. **Spiritual Dimension** - Recognition and ability to practice moral or religious principles or beliefs; recognition and maintenance of harmonious relationship with a Supreme Being E. **Socio Cultural Dimension** - Sense of support from family and friends; practices, values and beliefs on health F. **Economic Factors** - Production, distribution and consumption of goods and health services Example: - The nurse has to get a sufficient amount of sleep, avoid harmful substances like tobacco products, get annual physical exams. - A person who is engage in the exploration and understanding of new ideas and current events is aware of his/her \_\_\_\_\_\_\_\_\_\_\_\_\_\_ - Nurse Mary takes time for prayer or meditation each day. -- -- **NURSING** - Interventions of the nurse rendering care in support of, or in cooperation with the client - Nursing requires the development of a concerned relationship between the individual and the nurse, the use of state-of-the-art medical knowledge, and the exercise of good judgment to promote good health and healing. **Nursing metaparadigm** - Embodies the knowledge base, theory, philosophy, research, practice and educational experience and literature identified with the profession **Relationships Among the Metaparadigm Concepts (McEwen & Wills)** 1. **Person and health** -- laws and principles that govern with life processes, wellbeing and optimal functioning of human being. 2. **Person and environment** -- Nursing is concerned with patterning of human behavior in interaction with the environment in all life situation. 3. **Health and Nursing** -- Concerned with the nursing action or process by which positive changes in health status are effected. 4. **Person, environment and health** -- Nursing is concerned with the wholeness or health of human beings being aware of its continuous interactions with their environments. -- -------------------------------------------------------------- **CLASSIFICATION OF NURSING THEORIES ACCORDING TO FUNCTION** -- -------------------------------------------------------------- A. **Descriptive theories** - Also known as Factor-Isolating theories - Identify and describe major concepts of phenomena - Presents phenomena based on five senses Example : Descriptive research about Filipino Nursing Practice like use of herbal medicine and other alternative form of treatment -- -- B. **Explanatory theories** - Or Factor - Relating Theories - Present relationship among concepts and propositions - Present cause and effect relationship Example: - Factors affecting newborns in failing to thrive - A model of Chronic Dyspnea -- -- C. **Predictive theories** - Situation-Relating theories - Relationships of concepts under a certain condition are able to describe future outcomes consistently Example : Theoretical model based on the observation of the effects of unsanitary environmental condition on the recovery of post operative patients -- -- D. **Prescriptive theories** - Situation producing theory Test the validity and certainty of specific nursing interventions Example : Theory that validates and explains the different nursing management in the emergency room in relieving anxiety among clients -- ----------------------------------------------- **CLASSIFICATION OF THEORIES BASED ON SCOPE** -- ----------------------------------------------- +-----------------------------------------------------------------------+ | ***Metatheory*** | | | | - A metatheory or meta-theory is a theory whose subject matter is | | some theory , concerned with the investigation, analysis, or | | description of theory itself | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Grand Theories*** | | | | - Broad in scope and complex | | | | - Require further specification through research before they can be | | fully tested | | | | - Orem's self care theory | | | | - Neuman's system model | | | | - Roy's adaptation mode | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Middle --range theories*** | | | | - More limited scope | | | | - Address specific phenomena or concepts and reflect practice | | Reflect a wide variety of nursing care situations | | | | - Emerged when theory guides practice | | | | - Practice generates research question Research creates an | | understanding of theory and practice | | | | - Hildegard | | | | - Peplau-Psychodynamic nursing | | | | - Madeleine Leininger Transcultural Theory in Nursing | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Micro-range theories*** | | | | - More limited scope | | | | - Most concrete and narrow in scope | | | | - Situation specific and limited to a particular population | | | | - Practice Theories | | | | - Limited to specific populations or fields of practice. | | | | - Easily defined phenomena | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Practice theories*** | | | | - Limited to specific population or fields of practice. | | | | - Easily defined phenomena | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Partial theories*** | | | | - Theories that are in the developmental stage | +-----------------------------------------------------------------------+ ------- --------------------------------- **B** **CHARACTERISTICS OF A THEORY** ------- --------------------------------- **CHARACTERISTICS OF A THEORY** - Can correlate concepts in such a way to generate a different way of looking at a certain fact or phenomenon - Must be logical in nature - Simple but generally broad in nature - Contributes to enriching the general body of knowledge through the studies implemented to validate them - Can be used by practitioners to direct and enhance their practice - Must be consistent with other validated theories, laws and principles but will leave open unanswered issues that need to be tested ------- ----------------------------------------- **C** **ANALYSIS AND EVALUATION OF A THEORY** ------- ----------------------------------------- -- ------------- **CLARITY** -- ------------- - Semantics and structure are important - Identify concepts and sub concepts - Words should be defined operationally - Diagram should be clear and consistent - Assumption should be consistent with the defined goals of the theory **Clarity questions** - How clear is the theory? - Is the theory clearly stated? - Is it easily understood? -- ---------------- **SIMPLICITY** -- ---------------- - Must be adequately comprehensive - Must have as few concepts as possible - Offers greatest sense of understanding **Simplicity questions** - How simple is the theory? -- ---------------- **GENERALITY** -- ---------------- - Examine scope of concepts and goals - The more limited the concepts and the goals is, the less general the theory becomes - Situations in which theory is applicable should be boundless **Generality questions** - How general is the theory? - How broad is the scope of the theory? -- ------------------------- **EMPIRICAL PRECISION** -- ------------------------- - Degree in which the defined concepts are observable in actual setting - Can be measured by the evidences that support the theory **Empirical precision questions** - Is the theory testable? - How accessible is the theory? -- ---------------------------- **DERIVABLE CONSEQUENCES** -- ---------------------------- - Should give direction to research and practice, create new ideas and ought to distinguish the focus of nursing to other professions **Questions to be asked** - How important is the theory? - Does it have significant contribution to nursing knowledge --------------------------------------- **LESSON 5: EPISTEMOLOGY OF NURSING** --------------------------------------- +-----------------------------------------------------------------------+ | **TOPIC OVERVIEW** | +-----------------------------------------------------------------------+ | A. **3 Facets of Knowledge Development** | | | | a. Ontology, Epistemology and Methodology | | | | b. 4 Ways of Knowing; | | | | c. Empirics, Ethics, Personal and Aesthetic | +-----------------------------------------------------------------------+ -- ------------------ **INTRODUCTION** -- ------------------ **THREE FACETS OF KNOWLEDGE DEVELOPMENT** **Ontology -** refers to what exist. *EX.* Ontology emphasizes that patients are beings with physical, emotional, psychological, and social dimensions. **Epistemology -** ways of knowing. *EX.* Epistemology is the study of how nurses acquire knowledge and understand their practice. **Methodology -** means of acquiring knowledge. *EX.* Methodology refers to the structured approaches and processes used to acquire and apply knowledge. -------- ------------------ **A.** **EPISTEMOLOGY** -------- ------------------ - **The study of the origins of nursing knowledge, its structure, method,** - **Knowledge about knowledge** - **Science or study of knowledge** - **Branch of philosophy that defines and classify knowledge** +-----------------------------------+-----------------------------------+ | **B.** | **4 WAYS OF KNOWING** | | | | | | **NURSING EPISTEMOLOGY (CARPER)** | +-----------------------------------+-----------------------------------+ **KNOWING** - Implies the possession of knowledge which is a product of thinking. -------- ------------------------------------ **B.** **PATTERNS OF KNOWING IN NURSING** -------- ------------------------------------ **EMPIRICS** - The science of nursing. - Derived from observation and experience that is subjected to the scientific method of confirming the knowledge claim. - Knowledge obtained from books, lectures, journals, online resources. **ETHICS** - Moral knowledge in nursing. - Notions of moral right and wrong. - Addresses even the practical nature of decisions of a moral nature. ***Examples:*** - Nurse Carl defends the client's right to choose care. - Nurse Renato explains the concepts behind organ donation to terminally ill patients. **PERSONAL** - Concerns the capacity to be introspective and to be aware of one's inner being. - Encompassess knowledge of the self in relation to others and self. ***ADDITIONAL INFORMATION:*** - involves a planned interaction with another person in order to alleviate fear or anxiety, provide reassurance, obtain necessary information, provide information, give advice, and assist the other individual to gain more appreciation of, more expression of, and more functional use of his or her latent inner resources" ***Examples:*** - Involves therapeutic use of self - More effective and helpful if you are aware of who you are as a person **AESTHETIC** - Knowledge of doing or "know how". - Spontaneous expression of the art/act of doing nursing. - May be termed as artistry or mastery. - Focuses on empathy - Nurses ability in changing ways and manner or rendering nursing care based on individual client's needs. -------- ---------------------------- **A2** **ADDITIONAL INFORMATION** -------- ---------------------------- **PROFESSION** ----------------------------------------------------- **W4: ENVRIONMENTAL THEORY : FLORENCE NIGHTINGALE** ----------------------------------------------------- +-----------------------------------------------------------------------+ | **TOPIC OVERVIEW** | +-----------------------------------------------------------------------+ | A. **ENVIRONMENTAL THEORY** | | | | a. Florence Nightingale | | | | b. Theory Goal | | | | c. Environmental factors | | | | d. Majoy assumptions | | | | e. Acceptance by the nursing community | | | | f. Analaysis and Evaluation of a Theory | +-----------------------------------------------------------------------+ ------- -------------------------------------- **A** **FLORENCE NIGHTINGALE (1820-1910)** ------- --------------------------------------  **FLORENCE NIGHTINGALE** - Matriarch of modern nursing - Born in Florence, Italy on May 12, 1820 - Her father provided her with reputable education - A linguist and a statistician - Also known as Lady with the Lamp, providing care to wounded and ill soldiers during the Crimean War - Founder of Educated and Scientific Nursing +-----------------------------------------------------------------------+ | ***ENVIRONMENTAL THEORY BASIS*** | | | | - The inter-relationship of a healthful environment with nursing. | | | | - External influences and conditions can prevent, suppress, or | | contribute to disease or death | +-----------------------------------------------------------------------+ ------- ----------------- **B** **Theory Goal** ------- ----------------- - Nurses help patients retain their own vitality by meeting their basic needs through control of the environment. +-----------------------------------------------------------------------+ | ***Nursing's Focus :*** | | | | - Control of the environment for individuals, families & the | | community | +-----------------------------------------------------------------------+ -------- ---------------------------------------- **B2** **Nightingale's Environmental Theory** -------- ---------------------------------------- - Persons are in connection with the environment - Gives emphasis on the healing properties of the physical environment (fresh air, light, warmth and cleanliness) - Nursing puts patients in the "best conditions" for nature to act upon them - Health is "the positive of which the pathology is the negative" - **Nightingale's Environmental Theory** - **" Nature alone cures"** When aspects of the environment are out of balance, the client must use energy to counter these environmental stresses - Viewed disease as a **reparative process** - The health of the home/community are **critical components in an individual's health** ------- -------------------------------------------- **C** **Environmental Factors Affecting Health** ------- -------------------------------------------- -- ------------------------------- **1. Ventilation and warmth** -- ------------------------------- - Check the patient's body temperature, room temperature, - Ventilation and free from foul odor - check room for adequate light (sunlight is beneficial to the patient) -- -------------- **2. Light** -- -------------- - check room for adequate light (sunlight is beneficial to the patient) -- -------------------- **3. Cleanliness** -- -------------------- - Remove garbage and stagnant water Check room for dust, dirt & dampness. -- ------------------------- **4. Health of Houses** -- ------------------------- - Check surrounding environment for fresh air, pure water, drainage, cleanliness and light - Remove garbage, stagnant water and ensure clean water and fresh air. -- -------------- **5. Noise** -- -------------- - Check noise level in the room and surroundings - Keep noise level in the minimum. -- ------------------------- **6. Bed and Bedding:** -- ------------------------- - Keep the bed dry, wrinkle-free and lowest height to ensure comfort -- ------------------------------ **7. Personal Cleanliness:** -- ------------------------------ - Keep the patient dry and clean at all times - Keep the patient dry and clean at all times - Frequent skin assessment to maintain good skin integrity. -- ---------------- **8. Variety** -- ---------------- - Attempts to accomplish variety in the room and with the client - Done with cards flowers and books - Encourage friends and relatives to engage in stimulating activities. -- ------------------------------------- **9. Chattering hopes and advices** -- ------------------------------------- - Avoid talking without reason or giving advice without fact. - Continue to talk to the client as a person and continue to stimulate the client's mind. - Avoid personal talk. -- ---------------------- **10. Taking Foods** -- ---------------------- - Note the amount of foods and fluids ingested by the patient every meal. - Check the diet of the client -- -------------------------- **11. Petty Management** -- -------------------------- - Document the plan of care and evaluate the outcome to ensure continuity of care. -- --------------------------------- **12. Observation of the sick** -- --------------------------------- - Continue observation of the patient's environment and make changes in the plan of care as needed. -------- ----------------------- **D.** **MAJOR ASSUMPTIONS** -------- ----------------------- -- ------------- **NURSING** -- ------------- - Every woman at one time in her life would be a nurse - Science of environmental management - Nurses should use common sense, observation and ingenuity to allow nature to effectively repair the patient -- ------------ **PERSON** -- ------------ - Patient - See each patient as an individual - Nurse was in control of environment and by default of the client's personal choices and behavior - Respect for persons of various backgrounds -- ------------ **HEALTH** -- ------------ - Being well and using every power that the person has to the fullest exte8t - Saw illness and disease as reparative process - Modern public health nursing and health promotion -- ----------------- **ENVIRONMENT** -- ----------------- - Anything that can be manipulated to place a patient in the best possible condition for nature to act - With physical and psychological components - **"Therapeutic environment"** **Environmental factors affecting health** -------- ----------------------------------------- **E.** **Acceptance By The Nursing Community** -------- ----------------------------------------- **EDUCATION** - Nightingale's principles of Nursing training provided a universal template for early nurse training school beginning with St. Thomas Hospital **RESEARCH** - Nightingale's interest in scientific inquiry and statistics continues to define the scientific inquiry used in nursing research - Concepts that Nightingale identified served as the basis of research to test modern theories **PRACTICE** - The environmental aspects of her theory (ventilation, warmth, quiet, diet and cleanliness) remain integral components of nursing care. ------- ----------------------------------------- **F** **ANALYSIS AND EVALUATION OF A THEORY** ------- ----------------------------------------- -- -------------------------- **CRITIQUE :SIMPLICITY** -- -------------------------- **A. Environment to Patient** - Environment was the main factor creating illness in a patient **B. Nurse to Environment** - Nurses need to manipulate the environment to enhance the patient's recovery **C. Nurse To Patient** - Suggests collaboration and cooperation between the nurse and the patient - The protection of the patient from emotional distress - Conservation of energy while allowing the patient to participate in self-care -- -------------------------- **CRITIQUE: GENERALITY** -- -------------------------- - Nightingale's theory has been used to provide general guidelines for all nurses - The universality and timelessness of her concepts remain pertinent - The relation concepts (nurse, patient and environment) are applicable in all nursing settings today -- ----------------------------------- **CRITIQUE: EMPIRICAL PRECISION** -- ----------------------------------- - Nightingale's theory are presented as truths rather than tentative, testable statements - She advised nurses that their practice should be based on their observation and experiences rather than systematic, empirical research -- --------------------------------------- **CRITIQUE : DERIVABLE CONSEQUENCES** -- --------------------------------------- - Deeply religious, she viewed nursing as a means of doing the will of God (Nursing is a divine calling) - Her encouragement for a measure of independence and precision guides and motivates nurses today as the profession continues to evolve ----------------------------------------------------------------------- **LESSON 7: PHILOSOPHY AND SCIENCE OF CARING (MARGARET JEAN WATSON)** ----------------------------------------------------------------------- +-----------------------------------------------------------------------+ | **TOPIC OVERVIEW** | +-----------------------------------------------------------------------+ | A. **BACKGROUND OF JEAN WATSON** | | | | a. Metaparadigm Nursing | | | | b. 7 Assumption | | | | c. Ten Carative Factors | +-----------------------------------------------------------------------+ -- ------------------ **INTRODUCTION** -- ------------------ **JEAN WATSON** **BACKGROUND** - Born in Southern West Virginia Attained BS Nursing at Boulder Campus (1964). - MS in Psychiatric-Mental Health Nursing in 1966 at the Health Sciences campus Ph.D. In educational psychology and counseling in 1973. - Distinguished Professor and Director of Center of Human Caring School of Nursing - Fellow in the American Academy of Nursing. - Had received numerous other awards and honors. -------- ----------------------------- **A.** **METAPARADIGM IN NURSING** -------- ----------------------------- **PERSON** - Human being is a valued person in and of himself to be cared for, respected, nurtured, understood and assisted. - Human as greater than and different from, the sum of his parts. **ENVIRONMENT** - Provides the values that determine how one should behave and what goals one should strive toward. - Values affected by change in the social, cultural and spiritual arenas which affect perception of the person. **HEALTH** - Refers to unity and harmony within the mind, body and soul. **3 ELEMENTS**: - High level of overall physical,mental - and social functioning. - General adaptive-maintenance level of daily functioning. - Absence of illness. **NURSING** - Having to move educationally in the two areas of stress and developmental conflicts to provide holistic health care which she believes is central to the practice of caring in nursing. -------- ------------------- **B.** **7 ASSUMPTIONS** -------- ------------------- 1. Caring can be effectively demonstrated and practiced only interpersonally. 2. Effective caring promotes health and individual or family growth. 3. Caring responses accept a person not only as he or she is now but as what he or she may become. 4. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time 5. Caring is more " healthogenic" than is curing 6. Practice of caring is central to nursing ---- -------------------------- C. **Ten Carative Factors** ---- -------------------------- 1. Formation of a humanistic altruistic system of values. 2. Instillation of faith-hope. 3. Cultivation of sensitivity to one's self and to others. 4. Development of a helping-trusting, human caring relationship. 5. Promotion and acceptance of the expression of positive and negative feelings. 6. Systematic use of creative problem solving caring process. 7. Promotion of transpersonal teaching- learning. 8. Provision of a supportive, protective and corrective mental, physical, societal and spiritual environment. 9. Assistance with gratification of human needs. 10. Allowance for existential- phenomenological-spiritual forces. ----------------------------------------------------------- **W8: Patricia Benner Novice to Expert Nursing Theorist** ----------------------------------------------------------- +-----------------------------------------------------------------------+ | **Background** | +-----------------------------------------------------------------------+ | - Born in Hampton, Virginia, and spent her childhood in California. | | | | | | - Earned her Bachelor of Arts degree in nursing from Pasadena | | College in 1964. | | | | - She was given a Master of Science in MedicalSurgical Nursing from | | the University of California at San Francisco in 1970, and a | | Ph.D. from the University of California at Berkeley in 1982. | +-----------------------------------------------------------------------+ ------- --------------------------------------------------------------- **A** **Benner's Stages of Nursing Expertise Nursing Philosophies** ------- --------------------------------------------------------------- - Has a wide range of clinical experience including positions in Medical -- Surgical, Critical Care and home health care. - Became a post graduate nurse researcher in the School of Nursing at UCSF. - A professor at the Department of Physiological Nursing at UCSF and tenured professor in professor at the Department of Physiological Nursing at UCSF and tenured professor in 1989 - She was the first occupant of the Thelma Shobe Cook Endowed Chair in Ethics and Spirituality. - She is currently a Distinguished Visiting Professor at Seattle University School of Nsg. - Recipient of numerous honors and awards, the most recent being induction into the Danish Nursing Society as an Honorary Member, and the Sigma Theta Tau International Book Author award - She was honored with 1984, 1989, 1996, and 1999 American Journal of Nursing Book of the Year awards for From Novice to Expert: Excellence and Power in Clinical Nursing Practice (1984a), for Interpretive Phenomenology in Health Care Research (Chan, Brykczynski, Malone, & Benner, 2010). +-----------------------------------------------------------------------+ | ***Benner's worked in the nursing field*** | | | | - Head Nurse of the Coronary Care Unit at the Kansas City General | | Hospital | | | | - Intensive Care Staff Nurse at the Stanford University Hospital | | and Medical Center. | | | | - From 1970 until 1975, she was a Research Associate at the | | University of California at San Francisco School of Nursing | | | | - Research Assistant to Richard S. Lazarus at the University of | | California at Berkeley | | | | - From 1979 until 1981, she was the Project Director at the San | | Francisco Consortium/University of San Francisco. | +-----------------------------------------------------------------------+ -- --------------------------------------------------------------- **Benner's Stages of Nursing Expertise Nursing Philosophies** -- --------------------------------------------------------------- - In the acquisition and development of a skill, a nurse passes through five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. +-----------------------------------------------------------------------+ | ***Stage 1: Novice (Kozier 2016)*** | | | | - No experience (e.g., nursing student). Performance is limited, | | inflexible, and governed by context-free rules and regulations | | rather than experience. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Stage 2: Advanced Beginner*** | | | | - Demonstrates marginally acceptable performance. | | | | - Recognizes the meaningful "aspects" of a real situation. | | | | - Has experienced enough real situations to make judgments about | | | | - He/she is efficient and skillful in parts of the practice area, | | requiring occasional supportive cues. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Stage 3: Competent*** | | | | - Has 2 or 3 years of experience. Demonstrates organizational and | | planning abilities. | | | | - Differentiates important factors from less important aspects of | | care. | | | | - Coordinates multiple complex care demands | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Stage 4: Proficient*** | | | | - Has 3 to 5 years of experience. | | | | - Perceives situations as wholes rather than in terms of parts, as | | in Stage II. | | | | - Uses maxims as guides for,what to consider in a situation. | | | | - Has holistic understanding of the client, which improves decision | | making. | | | | - Focuses on long-term goals. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***Stage 5: The Expert*** | | | | - Performance is fluid, flexible, and highly proficient; no longer | | requires | | | | - rules, guidelines, or maxims to connect an understanding | | | | - of the situation to appropriate action. Demonstrates highly | | skilled | | | | - intuitive and analytic ability in new situations. Is inclined to | | take a | | | | - certain action because "it felt right. | +-----------------------------------------------------------------------+ ---------------------------------------------------------------- **W9: Ericksson's Caritative Caring Theory // Katie Eriksson** ---------------------------------------------------------------- -- -------------------------------------------- **Biography and Career of Katie Eriksson** -- -------------------------------------------- - Eriksson was born on November 18, 1943, in Jakobstad, Finland. - She belongs to the Finland Swedish minority in Finland, and her native language is Swedish - She is a 1965 graduate of the Helsinki Swedish School of Nursing, and in 1967, she completed her public health nursing specialty education at the same institution. - After taking nursing in 1965 to be able to practice nursing, she became a nursing instructor at Helsinki Swedish Medical Institute. She currently works as a professor of health sciences at Abo Akademi University in Vaasa, where she built a master\'s degree program in health sciences, and a four-year postgraduate studies program leading to a doctoral degree in health sciences. -- ----------------------------------------------------------------------------------- **Katie Eriksson\'s Contribution to Nursing Theory: Theory of Caritative Caring** -- ----------------------------------------------------------------------------------- This model of nursing distinguishes between caring ethics, the practical relationship between the patient and the nurse, and nursing ethics. Nursing ethics are the ethical principles that guide a nurse\'s decision-making abilities. Caritative caring consists of love and charity, which is also known as caritas, and respect and reverence for human holiness and dignity. According to the theory, suffering that occurs as a result of a lack of caritative care is a violation of human dignity. ------- ----------------------------------- **A** **MAJOR CONCEPTS AND DEFINITION** ------- ----------------------------------- -- ------------- **CARITAS** -- ------------- - Caritas - means love and charity. In caritas, eros and agapé are united, and caritas is by nature unconditional love. - Caritas, which is the fundamental motive of caring science, also constitutes the motive for all caring. It means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and learning. -- ---------------------- **Caring Communion** -- ---------------------- - Caring communion constitutes the context of the m eaning of caring and is the structure that determines caring reality. It is a form of intimate connection that characterizes caring. Caring communion requires meeting in time and space, an absolute, lasting presence. -- ----------------------- **The Act of Caring** -- ----------------------- - The act of caring contains the caring elements (faith, hope, love, tending, playing, and learning), involves the categories of infinity and eternity, and invites to deep communion. The act of caring is the art of making something very special out of something less special. -- ------------------------------ **Caritative Caring Ethics** -- ------------------------------ - Caritative caring ethics comprises the ethics of caring, the core of which is determined by the caritas motive. Caring ethics deals with the basic relation between the patient and the nurse---the way in which the nurse meets the patient in an ethical sense. - It is about the approach we have toward the patient. Caring ethics deals with the basic relation between the patient and the nurse---the way in which the nurse meets the patient in an ethical sense. It is about the approach we have toward the patient. -- ------------- **Dignity** -- ------------- - Dignity constitutes one of the basic concepts of caritative caring ethics. Human dignity is partly absolute dignity, partly relative dignity. -- ---------------- **Invitation** -- ---------------- - Invitation refers to the act that occurs when the carer welcomes the patient to the caring communication. -- --------------- **Suffering** -- --------------- - Suffering is an ontological concept described as a human being's struggle between good and evil in a state of becoming. Suffering implies in some sense dying away from something but thru reconciliation. +-----------------------------------------------------------------------+ | **Suffering Related to Illness, to Care, and to Life Three different | | forms of suffering:** | | | | 1. Suffering related to illness is experienced in connection with | | illness and treatment. | | | | 2. Not to be taken seriously, not to be welcome, being blamed, | | | | 3. Being subjected to the exercise of power are various forms of | | suffering related to care. | +-----------------------------------------------------------------------+ **The Suffering Human Being** - The suffering human being is the concept that uses to describe the patient. - The patient is a suffering human being, or a human being who suffers and patiently endures. -- -------------------- **Reconciliation** -- -------------------- - Reconciliation refers to the drama of suffering. - Reconciliation implies a change through which a new wholeness is formed of the life the human being has lost in suffering. - Reconciliation is a prerequisite of caritas. -- -------------------- **Caring culture** -- -------------------- - Is the concept that Eriksson (1987a) uses in stead of environment. It characterizes the total caring reality and is based on cultural elements such as traditions, rituals, and basic values -- ------------------ **METAPARADIGM** -- ------------------ +-----------------------------------------------------------------------+ | ***Person*** | | | | - is based on the axiom that the human being is an entity of body, | | soul, and spirit. | | | | - She emphasizes that the human being is fundamentally a religious | | being. | | | | - The human being is fundamentally holy, seen as in constant | | becoming; he is constantly in change and therefore never in a | | state of full completion. | | | | - The human being is fundamentally dependent on communion; he is | | dependent on another, and it is in the relationship between a | | concrete other (human being) and an abstract other (some form of | | God) | | | | - When the human being is entering the caring context, he or she | | becomes a patient in the original sense of the concept---a | | suffering human being. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***ENVIRONMENT*** | | | | - The ethos of caring science, as well as that of caring, consists | | of the idea of love and charity and respect and honor of the | | holiness and dignity of the human being. | | | | - Ethos is the sounding board of all caring. there is an "inner | | ought to," a target of caring " | | | | - It originally refers to home, or to the place where a human being | | feels at home. | | | | - Ethos and ethics belong together, and in the caring culture, they | | become one. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***HEALTH*** | | | | - Health as soundness, freshness, and well-being. It implies being | | whole in body, soul, and spirit | | | | - Health means as a pure concept wholeness and holiness. | | | | - Different dimensions of health as "doing, being, and becoming | | with a wholeness that is unique to human beings. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | ***NURSING*** | | | | - Caritas constitutes the inner force that is connected with the | | mission to care. A career beams forth what Eriksson calls | | caritas, or the strength and light of beauty. | | | | - The fundamentals of natural caring are constituted by the idea of | | motherliness, which implies cleansing and nourishing, and | | spontaneous and unconditional love. | | | | - Emphasizes that caritative caring relates to the innermost core | | of nursing. She distinguishes between caring nursing and nursing | | care. | | | | - She means that nursing care is based on the nursing care process, | | and it represents good care only when it is based on the | | innermost core of caring. | | | | - The core of the caring relationship, between nurse and patient is | | an open invitation that contains affirmation that the other is | | always welcome. | +-----------------------------------------------------------------------+