Theoretical Underpinnings F24 PGK BB Edition FNL PDF

Group Project  Structure  Deliverables  Timelines  Rubric Theoretical Underpinnings BNUR 1001 October 29, 2024 Peter Kennedy RN, BScN, MBA Learning Objectives  Describe selected theories of nursing practice and differentiate between them.  Describe challenges inherent in theorizing abo...

Group Project  Structure  Deliverables  Timelines  Rubric Theoretical Underpinnings BNUR 1001 October 29, 2024 Peter Kennedy RN, BScN, MBA Learning Objectives  Describe selected theories of nursing practice and differentiate between them.  Describe challenges inherent in theorizing about nursing practice.  Recognize selected conceptual frameworks associated with nursing practice.  Appreciate the historical development of thought related to nursing practice.  Describe relationships between theorizing and other forms of nursing knowledge. Theories  “History of nursing theory is the story of an enlightened attempt to articulate excellent clinical reasoning in nursing care.”  How does nursing organize and make sense of all available knowledge and apply it intelligently to the challenges that arise in an individual clinical case?  A purposeful set of assumptions or propositions about concepts; shows relationships between concepts and theory provides a systematic view of phenomena so that they may be explained, predicted or prescribed. Theories  Vary in their level of abstraction  The conceptualization of the client, health and illness, and nursing  The ability to describe explain or predict  Theories vary by definition of personal philosophy, scientific orientation, experience in nursing, and how that experience has affected the theorist views of nursing  How to organize and synthesize knowledge about nursing and as a result the client  Described as a conceptual framework  Theories are named for the outcome they propose or for specific characteristics of their content  Grand, middle range, descriptive, and prescriptive theories Theories “Describes what is most characteristic of and fundamental to nursing practice” Why are theories in nursing important? a) They solve specific and serious patient health problems. b) They provide a precise method of providing nursing care. c) They demonstrate how nursing is different from medicine. d) They provide a systematic view of explaining, predicting, and describing phenomena. Do We Need Them?  One of the characteristics of a profession is to have a unique, specialized body of knowledge.  Education in the 50’s and 60’s trying to distinguish and build nursing science asking three questions:  What is the focus and scope of nursing?  How is nursing unique and different from other health care professions?  What should be the appropriate disciplinary knowledge for professional nursing practice?  Goal to conceptualize nursing and nursing science as having character and nature all on their own and not simply application of knowledge from other disciplines. Early Theorists  First there was Florence Nightingale followed by early theoretical and conceptual models for nursing  The early theorists created conceptual frameworks  Theoretical structure that links concepts together for a specific purpose  Concepts and phenomena linked to nursing decisions  Wanted to organize the knowledge about nursing but constrained by concepts and issues shaping the role and context of nursing Ida Jean Orlando  Orlando developed a problem-solving approach, the nursing process: a) assessment, planning, implementation and evaluation (APIE) b) assessment, diagnosis, planning, implementation and evaluation (ADPIE) c) assessment, analyzing, planning, implementing and evaluation (AAPIE)  Clinical judgement and critical thinking:  Clinical judgement implies systematic use of the nursing process to invoke intuitive and conscious thinking strategies that are part of clinical decision making in nursing  Concept of Hope The science of hope  “Hope is a contextual term that has different connotations depending on the setting. We analyse the concept of hope with respect to its applicability for oncology. We review studies that present hope as a direct or secondary mediator of outcome. We posit that an individual's level of hope is often determined by innate personality characteristics and environmental factors, but can also be physiologically influenced by immune modulators, neurotransmitters, affective states, and even the underlying disease process of cancer. We argue that hope can be a therapeutic target and review evidence showing the effects of hope-enhancing therapies. Given the potential for hope to alter oncological outcomes in patients with cancer and the opportunity for improvement in quality of life, we suggest further research directions in this area.” DOI: 10.1016/S1470-2045(20)30210-2 Concepts  Abstract ideas or mental images of phenomena - words that bring forth mental pictures of the properties and meanings of objects events or things  Concepts can be  Readily observable or concrete – thermometer, rash  Indirectly observable or inferential – pain or temperature  Non observable or abstract – equilibrium, adaptation, stress, powerlessness  In nursing, concepts include health, helping relationships, communication Conceptual Frameworks Clinical judgement implies systematic use of the nursing process to create intuitive and conscious thinking strategies that contribute to the clinical decision making in nursing Conceptual frameworks – not linear, include those for understanding both the person as a client and the nurses' role in relation to the client Process of inquiry and a set of concepts, definitions, and model theories derived from logical thinking and inductive reasoning Major components are the metaparadigm concepts – person, environment, health, and nursing Frameworks based on ways of thinking of human behaviour, theories of human behaviour – needs interactions or systems and others from excellence in nursing practice Used to provide a way to conceptualize nursing interests and researchable nursing problems  Metaparadigm Concepts Person Nursing Health Environment Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights 13 Situation reserved.  Client, environment, health, nursing Activity Why and how is this conceptual body of knowledge vital to nursing?  Person Environment Individual, family, group Social environment or community, that is the (clients family, friends recipient of nursing care, and significant others) center of process and the physical Client versus patient – environment, internal or client indicates a range of external environment health states, more than interacts within complex a hospitalized patient, system interactive Metaparadigm Health Nursing Clients state of Actions taken by the wellness/illness, more nurse on behalf or in than the absence of conjunction with the disease – ideal state client subset/belief about of wellbeing, or optimal nursing practice health  Model Person Nightingale An individual with self recuperative powers Henderson A unique individual with 14 basic needs Parse An individual or family in constant interchange with the environment, having free choice within health situations Neuman Open system with 5 interacting variables: physiological, psychological, sociocultural, developmental, spiritual Campbell Individual using a range of coping behaviours to satisfy 9 basic needs Example 'Person' in Metaparadigm within Select Models Post Truth and Reconciliation Commission Considerations  Colonization and neo colonization stand in the way of intellectual development in nursing (McGibbon et al. 2014)  Arguments that the grand theories and metaparadigm are no longer relevant  Adoption of nursing, person, environment, and health puts the social mandate of nursing at risk  Why? Focus on the individual rather than the structures of oppression and inequality i.e. racism  Nursing as art and science Practical and applied Paradigm Debates Within Nursing Totality paradigm frameworks Simultaneity paradigm frameworks Major Theoretical Models Practice-based theories Needs theories Interactionist theories Systems theories Simultaneity theories Practice-Based Theories Reflect the issues that were shaping the role and context of nursing during the time in which they were created  Florence Nightingale  The McGill Model Nightingale’s Philosophy  “Notes on Nursing” originally published in 1859  Defined nursing  Importance of observing patient and accurately recording the information  Principles of cleanliness and sanitation (clean vs dirty) Florence Nightingale  Her philosophy of health, illness, and the nurse’s role in caring for patients  Focused on the relationship of patients to their surroundings  Importance of observing the patient and recording information  Importance of cleanliness  Health and recovery from illness is related to environment  Massive reform of health care delivery shifting private home nursing to hospital Notes on Nursing “No amount of medical knowledge will lessen the accountability for nurses to do what nurses do, that is, manage the environment to promote positive life processes.” Nightingale  5 components of the environment  Ventilation Fresh air, pure water, efficient  Light drainage, cleanliness, light  Warmth  Effluvia (A usually invisible emanation or exhalation, as of vapor or gas...) a) A byproduct or residue; waste. b) The odorous fumes given off by waste or decaying matter  Noise  External influences can prevent, suppress or contribute to disease or death  Person  Patient who is acted on by a nurse  Affected by the environment Nightingale  Has reparative powers Key Concepts Environment  Foundation of theory, included everything physical, psychological, and social  Health  Maintaining well being by using a person’s powers  Maintained by control of environment Nightingale Key Concepts Nursing  Provided fresh air, warmth, good diet, cleanliness, and quiet to facilitate person’s reparative process Needs Theories Conceptualized as the patient representing a collection of needs (i.e. Maslow)  Virginia Henderson  Dorothea Orem Henderson  The “Unique function of the nurse… is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.”  Nurse’s role = substitute for the patient, a helper to the patient or a partner with the patient  Head/heart/hands Henderson’s 14 Basic Needs  Breathing normally  Keeping the body clean and well groomed to promote/protect the integument  Eating and drinking adequately  Avoiding dangers in the environment and  Eliminating body waste avoiding injuring others  Communicating w/others in expressing  Moving and maintaining a desirable emotions ,needs, fears or opinions position  Worshipping according to one's faith  Sleeping and resting  Working in such a way that one feels a sense of accomplishment  Selecting suitable clothes  Playing or participating in various forms of  Maintaining normal body temperature by recreation adjusting clothing and modifying the  Learning, discovering or satisfying the environment curiosity that leads to normal development and health, and using available health facilities  Orem Theory of Self-care  Maintaining sufficient intake of air, water, and food  Maintaining a balance between activity and rest, and between solitude and interaction  Providing for elimination processes  Preventing hazards to life, functioning, and well-being  Promoting functioning and growth in social groups in accordance with human potential Orem Theory of Self-care  Focuses on patient’s self care capacities. Self care deficits and the process of designing nursing actions to meet the patient’s self care needs  Wholly compensatory nursing system – patient dependent  Partially compensatory – patient can meet some needs but needs nursing assistance  Supportive – educative – patient can meet self care requisites but needs assistance with decision making or knowledge.  Ordinary people in contemporary society want to be in control of their lives  Patient’s baseline ability to provide adequate self-care is assessed Interactions Theories Focused on the relationships between nurses and their clients. Looking at human communication and behaviour patterns and the way practitioners met those needs  Hildegard Peplau  Joyce Travelbee  Evelyn Adam  Peplau  Interpersonal relationships between the nurse and the patient  Four sequential phases - orientation, identification, exploitation and resolution  Nursing an interactive and therapeutic relationship  Nurse is an investigator, prober, interpreter and reporter  Recognizing patterns and helping to change them  Roles: Stranger, resource, teaching, counseling, surrogate, active leadership, technical expert  Preventing illness and maintaining health System Theories Systems theory accounted for the whole of an entity and its component parts, as well as the complex interactions between the two Dorothy Johnson The University of British Columbia model Betty Neuman Sister Calista Roy Sister Callista Roy  Introduction of Nursing: An Adaptation Model (second edition 1984)  Individual as a biopsychosocial adaptive system  Nursing is a humanistic discipline that emphasizes the person’s adaptive and coping abilities  The environment can be manipulated by the nurse to further patient’s adaptation  Roy’s Adaptation Model:  Based on adaptation and adaptive behaviours which are produced by altering the environment  Not a behavioural system Roy’s 4 Modes of Adaptation Physiological needs Self concept Role function Interdependence Johnson’s Behavioural System Model  Focuses on human behaviour  System of nursing based on the observation of patient behaviour  Persons are a single system with seven subsystems…examples  Achievement behaviour  Aggressive/protective behaviour  Dependency behaviour  Ingestive behaviour  The Neuman System Model  Nursing interventions are activated to  Strengthen flexible lines of defense  Strengthen resistance to stressors  Maintain adaptation Neuman System Model View persons from the perspective of actual and potential stressors and associated health risk factors The client is referred to as the core and source of basic energy The person is a complete system with interrelated parts Maintain balance and harmony between internal and external environment by adjusting to stress and defending against tension producing stimuli Primarily concerned with effect of stress on health Wellness is equilibrium Simultaneity Theories Individual as an entirely irreducible whole, inherently and “holographically” connected with the universal environment. Martha Rogers Rosemarie Parse Jean Watson Jean Watson  The Philosophy and Science of Caring (1979)  Emphasized the caring aspects of nursing  10 Carative factors: these factors differentiate nursing from medicine (curative)  Illness or disease equated with lack of harmony within the mind, body, and soul  RN responsible for creating and maintaining an environment supporting human caring while recognizing and providing for patient’s primary human requirements Jean Watson’s Philosophy  Caring and carative factors  Formation of a humanistic-altruistic system of values  Development of a helping trust relationship  Assistance with the gratification of human needs  Proposed that nursing be concerned with spiritual matters and the inner knowledge of nurse and patient as they participate together in the transpersonal caring process  Nurses share their genuine self  Patient’s spiritual strength is recognized, supported, encouraged  RN encourages openness to understanding of self and others  Leads to trusting, accepting relationships where feelings are shared and confidence is inspired  Person Environment Human being to be Society- internal valued, cared for, and external, nurtured, influences health understood, and and wellness assisted Watson’s Views with the 4 Concepts Health Nursing Complete physical, Intentional mental, and social consciousness, well being and concerned with functioning promoting and restoring health, preventing illness Ways of Knowing  Carper – patterns of knowledge application in nursing practice  Empirical  Ethical  Personal  Aesthetic  Multiple lens within the profession  Critical thinking, emancipatory knowing, sociopolitical knowledge followed after Theorizing about nursing is perhaps best understood as an extended philosophical struggle to make sense of how highly skilled nurses think.  Why are there nursing theories? What is the role of theories? What have you learned What do they ‘do’ for us? about theories? Can you relate to any of the theories or frameworks? What are the ‘challenges’ to theories?  Why is it useful for nurses to question how they know what they think they know? What should be the appropriate discipline-specific knowledge for professional nursing practice? More Questions… How often do you think nurses refer to theories and frameworks to shape their practice? Which ones of the theories discussed in this class or from your readings do you think will guide you when dealing with different situations? What would be the advantages in doing so?