THEORETICAL-FOUNDATION-IN-NURSING-HANDOUTS.docx

**THEORETICAL FOUNDATION IN NURSING** NCM 100 - This Course deals with Nursing theories as applied To nursing practice on the aspect of the metaparadigm **WHAT IS NURSING?** - According to American Nursing Association (ANA), Nursing is the "Diagnosis and Treatment of Human Response t...

**THEORETICAL FOUNDATION IN NURSING** NCM 100 - This Course deals with Nursing theories as applied To nursing practice on the aspect of the metaparadigm **WHAT IS NURSING?** - According to American Nursing Association (ANA), Nursing is the "Diagnosis and Treatment of Human Response to actual or potential Health Problem. - According to Association of Deans of Philippines Colleges of Nursing (ADPCN) Nursing is "a dynamic discipline. It is an art and Science of caring for individuals, families, groups and communities gear toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. - According to INTERNATIONAL COUNCIL OF NURSES (ICN) Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. - All nursing acts are geared towards assisting the client to live a dignified and normal life. It is important that nursing is grounded on accepted scientific truths and principles in order to give safe and quality Nursing care. **What is Theory?** - Theory is an organized system of accepted knowledge that is composed of concepts, propositions, definitions and assumptions intended to explain a set of fact, event or phenomena. **What are concepts, propositions, definitions and assumptions?** - Concept is defined as an idea formulated by mind or an experience perceived and observed such justice, love, war and diseases. - Proposition explains the relationships of different concepts. - Definition is composed of various descriptions which convey general meaning and reduces the vagueness in understanding a set of concepts. - Assumptions is a statement that specifies the relationship or connection of factual concept or phenomena. **Components of a Theory by Barnum (1994)** - Context -- Resembles Environment to which nursing act takes place. - Content-Subject of the Theory - Process- Method by which nurse acts using nursing theory **WHAT IS NURSING THEORY?** - Nursing Theory is a group of interrelated concepts that are developed from various studies of discipline and related experiences. This aims to view the essence of nursing care. Specially contributed by different nursing theorists from different times and ages. Also includes how philosophy and thoughts can profoundly affect your patient care and practice. **HISTORY OF NURSING THEORY** - The history of professional nursing began with Florence Nightingale. - Nightingale envisioned nurses as a body of educated women at a time when women were neither educated nor employed in public service. - After her wartime service of organizing and caring for the wounded in Scutari during the Crimean War, Nightingale's vision and establishment of a School of Nursing at St. Thomas' Hospital in London marked the birth of modern nursing. - Nightingale's pioneering activities in nursing practice and education and her subsequent writings became a guide at the beginning of the 20th century for establishing nursing schools and hospitals in the United States - Nightingale's (1859/1969) vision of nursing has been practiced for more than a century, and theory development in nursing has evolved rapidly, leading to the recognition of nursing as an academic discipline with a specialized body of knowledge. - It was during the mid-1800s that Nightingale (1859/1969) recognized the unique focus of nursing and clarified a distinction between nursing knowledge and medical knowledge. - Despite this early edict from Nightingale in the 1850s, it was 100 years later, during the 1950s, when nursing leaders began serious discussion of the need to develop nursing knowledge apart from medical knowledge to guide nursing practice. This awareness of the need to develop nursing knowledge continues to grow. - Until the proposal of nursing as a science in the 1950s, nursing practice was based mainly on principles and traditions handed down through an apprenticeship model of education and hospital procedure manuals. - The transition from vocation to profession is described here in successive eras of history as nurses began developing a body of specialized knowledge on which to base nursing practice. Progress in each era toward the goal of specialized knowledge for nursing practice demonstrates the seriousness of this drive toward professional development (Alligood, 2014). **HISTORICAL ERAS** - The Curriculum Era - The Research Emphasis Era - The Graduate Era - The Theory Utilization Era CURRICULUM ERA - During this era questions are addressed what content nurses should study to learn how to be a nurse. - During this era, an emphasis was on what courses nursing students should take, with the goal of arriving at a standardized curriculum (Alligood, 2014). - By the mid-1930s, a standardized curriculum had been published and adopted by many diploma nursing programs where nursing was taught at the time. - The idea of moving nursing education from hospital-based diploma programs into colleges and universities began to emerge during this era (Ervin, 2015; Judd & Sitzman, 2014). - Despite this early concept of nursing education, it was the middle of the century before many states acted upon this goal, and the second half of the 20th century before diploma programs began closing and nursing education programs opened in colleges and universities (Ervin, 2015; Judd & Sitzman, 2014; Kalisch & Kalisch, 2003; Tobbell, 2018). - The curriculum era emphasized course selection and content for nursing programs. With recognition of the role research plays in scientific knowledge development and the long-range goal of acquiring substantive knowledge to guide nursing practice, the curriculum focus gave way to the research era. **The Research Emphasis Era** - Era began during the mid-20th century, more nurse leaders embraced higher education and came to an understanding of the scientific age and the research path to new nursing knowledge. - Nurses began to participate in research, and research courses were included in nursing curricula in early graduate nursing programs (Alligood, 2014; Tobbell, 2018). - In the 1970s, an evaluation of the first 25 years of the journal Nursing Research revealed that nursing studies lacked conceptual connections and theoretical frameworks, accentuating the necessity for the development of specialized nursing knowledge (Batey, 1977). - Awareness of the need for concept and theory development coincided with two other milestones in the evolution of nursing theory: the standardization of curricula for nursing master's education by the National League for Nursing accreditation criteria for baccalaureate and higher-degree programs, and the decision that doctoral education for nurses should be in nursing (Alligood, 2014; Tobbell, 2018). **The Graduate Era** - The research era and the graduate education era developed in tandem. - Master's degree programs in nursing emerged across the country to meet the need for nurses as specialists for clinical practice. - Many of these graduate programs included a course that introduced the student to the research process. Also, during this era, nursing master's programs began to include courses in concept development and nursing models, introducing students to early nursing theorists and knowledge development processes (Alligood, 2014; Tobbell, 2018). - The development of nursing knowledge was a major force at this time. The baccalaureate degree began to gain wider acceptance as the educational level for professional nursing, and nursing attained recognition as an academic discipline in higher education. **The Graduate Era** - Nurse researchers worked to develop and clarify a specialized body of nursing knowledge, with the goals of improving the quality of patient care, providing a professional style of practice, and achieving recognition as a profession. - There were debates and discussions in the 1960s regarding the proper direction and appropriate discipline for nursing knowledge development. - In the 1970s, nursing continued to make the transition from vocation to profession as nurse leaders debated whether nursing should be other-discipline based or nursing based. History records the outcome: that nursing practice is to be based on nursing science (Alligood, 2014; Fawcett, 1978; Nicoll, 1986). I - it is as Meleis (2007) noted, "theory is not a luxury in the discipline of nursing... but an integral part of the nursing lexicon in education, administration, and practice" (p. 4). An important precursor to the theory era was general acceptance of nursing as a profession and an academic discipline. **Theory Utilization Era** - The theory era was a natural outgrowth of the research and graduate education eras (Alligood, 2014; Im & Chang, 2012). - The explosive proliferation of nursing doctoral programs from the 1970s and nursing theory literature substantiated that nursing doctorates should be in nursing rather than in other disciplines. - As understanding of research and knowledge development increased, it became clear that research studies without conceptual and theoretical frameworks produced isolated information rather than a body of substantive knowledge. - The understanding that both research and theory were required to produce nursing science propelled nurses forward toward their goal (Batey, 1977; Fawcett, 1978; Hardy, 1978; Tobbell, 2018). - Doctoral education in nursing began to develop with a strong emphasis on theory development and testing. - The theory era accelerated as early works developed as frameworks for curricula and advanced practice guides began to be recognized as theory. - The 1980s was a time of major developments in nursing theory that have been characterized as a transition from a pre paradigm to the paradigm period in nursing (Fawcett, 1984; Hardy, 1978; Kuhn, 1970; Tobbell, 2018). The prevailing nursing paradigms (models) provided perspectives for education, nursing practice, research, administration, and further theory development. In the 1980s, Fawcett's seminal - proposal of a nursing metaparadigm of four global nursing concepts as an organizing structure for existing nursing frameworks introduced a way of understanding the individual theoretical works in a meaningful relationship (Fawcett, 1978, 1984, 1993). That is, classifying nursing models as paradigms bordered by the metaparadigm. **SIGNIFICANCE OF NURSING THEORY** - At the beginning of the 20th century, nursing was not recognized as an academic discipline or a profession, but the accomplishments of the past century have led to recognition of nursing in both areas. - The terms discipline and profession are interrelated, and the meaning of each is important. - An academic discipline is a branch of knowledge or field of study taught and researched as a branch of higher learning. - A profession refers to an occupation with preparation in specific knowledge in higher learning and the performance of a practice. It is important to note their differences and specific meaning. - Nursing theory is significant for both the discipline and the profession. **Significance for the Discipline** - A discipline is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge. - When nurses entered baccalaureate and higher-degree programs in universities during the last half of the 20th century, the goal of developing knowledge as a basis for nursing practice began to be realized. **Significance for the Profession** - A profession refers to a specialized field of practice, founded on the theoretical structure of the science or knowledge of that discipline and accompanying practice abilities. - Theory is essential for the existence of nursing as an academic discipline, it is also vital to the practice of professional nursing (McCrae, 2012; Pickler, 2018). - Recognition as a profession seemed to be a less urgent issue as the 20th century ended because of consistent progress in the nursing theory era to solidify professional status. - Nursing is recognized as a profession today, and its development was guided by a set of criteria for a profession. - Published a set of criteria for a profession tailored to nursing in the American Journal of Nursing. - These criteria have historical value for enhancing our understanding of the developmental path that nurse leaders followed. **HISTORY AND PHILOSOPHY OF SCIENCE** - Modern science was established over 400 years ago as an intellectual activity to formalize given phenomena of interest in an attempt to describe, explain, predict, or control states of affairs in nature. - Scientific activity has persisted because it has improved quality of life and has satisfied human needs for creative work, a sense of order, and the desire to understand the unknown (Bronowski, 1979; Gale, 1979; Piaget, 1970). - The development of nursing science has evolved since the 1960s as a pursuit to be understood as a scientific discipline. - Because it is a scientific discipline, the unique contribution of nursing to the care of patients, families, and communities is acknowledged. - To formalize the science of nursing, basic questions must be considered, such as "What is science, knowledge, and truth?" and "What methods produce scientific knowledge?" These are philosophical questions. - The term epistemology is concerned with the theory of knowledge in philosophical inquiry. The particular philosophical perspective selected to answer these questions will influence how scientists perform scientific activities, how they interpret outcomes, and even what they regard as science and knowledge (Brown, 1977). - Although philosophy has been documented as an activity for 3000 years, formal science is a relatively new human pursuit (Brown, 1977; Foucault, 1973). - Scientific activity only recently has become the object of investigation. Two competing philosophical foundations of science, rationalism and empiricism, have evolved in the era of modern science with several variations. **What is Science, Knowledge?** - Science from the latin word scientia, meaning "KNOWLEDGE" refers to any systematic knowledge or practice in a discipline of study. In more casual sense, it refers to a system of acquiring knowledge based on scientific method. It is also the organized body of knowledge gained through research. Steps of scientific Method: Observation, Gathering Information Data, Forming Hypothesis, Experimental Investigation, Conclusion or Theoretical Explanation. - Knowledge can be define as information, skills and expertisebacquired by person through various life experiences or through formal/informal learning such as formal education, self study and vocational. Cognitive Processes to acquire Knowledge: Perception, Association, Learning, Reasoning, Communication. **HISTORY AND PHILOSOPHY OF SCIENCE** - **[Rationalism]** Rationalist epistemology (scope of knowledge) emphasizes the importance of a priori reasoning as the appropriate method for advancing knowledge. A priori reasoning utilizes deductive logic by reasoning from the cause of an effect or by generalizing to a particular instance. An example in nursing is to reason that appendicitis (cause) will result in pain (effect). The scientist in this tradition approaches the task of scientific inquiry by developing a systematic explanation (theory) of a given phenomenon. - **[Empiricism]** the empiricist view is based on the central idea that scientific knowledge can be derived only from sensory experience. Francis Bacon (Gale, 1979) received credit for popularizing the basis for the empiricist approach to inquiry. Bacon believed that scientific truth was discovered through generalization of observed facts in the natural world. This approach, called the inductive method, is based on the idea that the collection of facts precedes attempts to formulate generalizations, or as Reynolds (1971) called it, the research-then-theory strategy. One of the best examples that can be used to demonstrate this form of logic in nursing has to do with formulating a differential diagnosis. Formulating a differential diagnosis requires collecting facts, then devising a list of possible theories to explain the facts - **[EARLY TWENTIETH CENTURY VIEWS OF SCIENCE AND THEORY]** During the first half of this century, philosophers focused on the analysis of theory structure, whereas scientists focused on empirical research (Brown, 1977). Minimal interest was seen in the history of science, the nature of scientific discovery, or the similarities between the philosophical view of science and the scientific methods. **STRUCTURE OF NURSING KNOWLEDGE** - Nursing knowledge has been described as the knowledge that is useful to nurses, whether it is derived from the discipline of nursing or other disciplines. It consists of a metaparadigm, philosophies, conceptual models, theories, and empirical indicators in a holarchy organized by decreasing levels of abstraction. **METAPARADIGM** - ** **Are global concepts that identify the phenomenon of central interests to a discipline, the global propositions that describe the concepts, and the global propositions that state the relations between or among concepts. **4 CONCEPTS IN NURSING METAPARADIGM** - PERSON: Human-being or individual. The recipient of nursing care; including physical, spiritual, psychological and socio-cultural components: Individual, family or community. - ENVIRONMENT: A surroundings or the condition in which a person or a particular activity is carried on all internal and external conditions, circumstances & influences affecting the person. - HEALTH: State of being free from illness or injury. Degree of wellness or illnessexperienced by a person. - NURSING: attributes, characteristics and actions of the nurse providing care to the person. **PHILOSOPHY** - Greek words: Philo (love) and Sophos(wisdom). Refers to the rational investigation of questions about the existence, knowledge & ethics. Belief/systems of beliefs accepted as authoritative by some group or school and any personal belief about how to live or how to deal with a situation. It is knowledge level which specifies the definition of metaparadigm concepts in each of the conceptual models of nursing. It sets forth the meaning of phenomena through analysis , reasoning & logical argument. - PHILOSOPHY OF NURSING Is a statement, sometimes written that declares the nurse\`s beliefs, values & ethics regarding their care and treatment of patients. Philosophies have contributed to the knowledge development in nursing by forming a basis for subsequent developments specially in the area of human science. E.g. Nightingale\`s Theory (Environmental Theory/philosophy) "Nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection & administration of diet-- all at the least expense of vital power to the patient". **CONCEPTUAL MODEL** - Is a representation of a system that uses concepts and ideas to the said representation. is used as a way to describe the physical or social aspect of the world in an abstract way. Conceptual Models/ Frameworks: are representation of an idea or body of knowledge based on the understanding of a person or a researcher on a certain topic/ phenomena/ theory. Can be represented through a diagram or in narrative form which shows how concepts are interrelate - CONCEPTUAL FRAMEWORK structure of concept which exist or tested in the literature, a ready-made map for the study.