Theory week 1-12 PDF

Theory week 1 1. Discuss the challenges in developing a clear and concise definition of nursing. - Nursing is a multidimensional Role: Nursing encompasses a wide range of roles and responsibilities, from direct patient care to education, research, advocacy, and administration. Defining nur...

Theory week 1 1. Discuss the challenges in developing a clear and concise definition of nursing. - Nursing is a multidimensional Role: Nursing encompasses a wide range of roles and responsibilities, from direct patient care to education, research, advocacy, and administration. Defining nursing in a way that captures all these dimensions can be difficult. - Evolving Scope of Practice: The scope of nursing practice is not static; it evolves over time as healthcare advances and societal needs change. This dynamic nature makes it challenging to create a fixed definition that remains relevant - Context-Dependent: Nursing practices can vary significantly based on the healthcare setting, patient population, and geographical location. What constitutes nursing in one context may differ from another - Interdisciplinary Collaboration: Nursing often involves collaboration with other healthcare professionals like physicians, pharmacists, and therapists. This interdependence can blur the lines of what is uniquely nursing. - Cultural and Ethical Considerations: Cultural and ethical factors play a significant role in nursing care. These considerations can make it challenging to develop a universal definition that respects diverse values and norms - Perception and Public Understanding: The perception of nursing by the public and within the healthcare system can influence how nursing is defined. Media portrayal and societal expectations may not always align with the profession's true essence - Rapid Advances in Healthcare Technology: The integration of technology into healthcare has expanded the scope of nursing practice. Nurses now work with complex medical devices and information systems, which may not be adequately reflected in traditional definitions - Educational Variability: Nursing education and training programs can vary widely, leading to differences in the competencies and skills of nurses. This variability complicates efforts to establish a consistent definition - Diverse Specializations: Nursing has numerous specialized fields, such as pediatric nursing, psychiatric nursing, and critical care nursing. Each specialization may have unique responsibilities, making it challenging to define nursing broadly - Global Variations: Nursing practice and education standards vary between countries, making it difficult to create a single, globally applicable definition - Patient-Centered Care: Modern nursing emphasizes patient-centered care, which means that nursing practice is tailored to the unique needs and preferences of individual patients. This individualized approach can be hard to capture in a one-size-fits-all definition 2. Explain why it is important for nursing to be recognized as a profession and an academic discipline and what is necessary for those distinctions. - Professions vs occupations = profss is a learned occupation that has a status of superiority and precedence within a division of work - Nursing evolves as a profession via critical reflection and evidence (science) = empirical knowledge - Professions are valued by society because the services professionals provide are beneficial for members of society. Characteristics of a profession include (1) defined and specialized knowledge base, (2) control and authority over training and education, (3) credentialing system or registration to ensure competence, (4) altruistic service to society, (5) a code of ethics, (6) formal training within institutions of higher education, (7) lengthy socialization to the profession, and (8) autonomy (control of professional activities) - Qualifications regulated by a government-regulated body (CNO) – accountability to the public 3. Nursing is a discipline with the following attributes A Philosophy Conceptual framework that defines nursing Acceptable methodology to develop knowledge 4. Differentiate the art and science of nursing and the feasibility of incorporating each, independent of the other, or integrating them in nursing. epistemology. - Nursing as art = intuitiveness, creativity, interpretive, care without judgement, communicative, critical thinking. -approach to every individual patient in a different approach, depending on their diagnosis. Using your skills to shape/alter/tailor them to each pt. - Nursing as a science = evidenced-based practice, best practices, care delivery models, applied theories 5. Philosophical school of thought that inform nursing practice Empiricism (positivism-received view) Constructivism (Naturalism-perceived view) Postmodernism (Multiple-methodologies) 6. Differentiate among the multiple “ways of knowing” in nursing and give two examples of each. - Empirics—the scientific form of knowing. Empirical knowledge comes from observation, testing, and replication. - Personal knowledge—a priori knowledge. Personal knowledge pertains to knowledge gained from thought alone. Life experiences, values, perspectives.  Intuitive knowledge—includes feelings and hunches. Intuitive knowledge is not guessing but relies on nonconscious pattern recognition and experience. Gut feeling, instinct. - Somatic knowledge—knowledge of the body in relation to physical movement. Somatic knowledge includes experiential use of muscles and balance to perform a physical task. (body remembers, riding a bike, IV skills) - Metaphysical (spiritual) knowledge—seeking the presence of a higher power. Aspects of spiritual knowing include magic, miracles, psychokinesis, extrasensory perception, and near-death experiences. - Esthetics—knowledge related to beauty, harmony, and expression. Esthetic knowledge incorporates art, creativity, and values. - Moral or ethical knowledge—knowledge of what is right and wrong. Values and social and cultural norms of behavior are components of ethical knowledge. Week 2 1. Describe inductive (qualitative) and deductive (quantitive) reasoning. - Inductive = drawing a conclusion, from data at a smaller level, to make a larger assumption/conclusion/decision. A small idea to build something larger, from specific to general. Interprets data. Can use iterative thought - reflection. Inductive reasoning in theory development = constructs ideas that create themes. - Deductive = way of thinking (positivism), deducting from something big to small, to test on a smaller group. From general to specific. Includes hypothesis, draws a conclusion. Purpose in theory development=It proposes ideas from what’s happening in the bigger world. 2. Describe three clinical reasoning frameworks that inform the clinical judgement model (CJM). - Analytical thought: logical, weighing pros and cons, objective, rational, scientific - Intuitive thought: a gut feeling, hunch, feeling or thought or idea based on past experiences and patterns that are recognized from a previous experience, non- analytical, involves inductive reasoning - Iterative thought: reassess, repeat, revisit plans, back and forth. Editing school paper. Reflective. Broader understanding. 3. Describe the steps in the clinical judgement model (CJM).  Model = framework/guideline, directions to do something, ideally informed by evidence, may have multiple directions to follow. A way of going on about something. 4. Critically analyze a nursing practice example with the CJM. - Advocate = develop a safe environment - Communication = introducing yourself, role etc. - Professional = treat pts w respect, ethical - Clinician = nursing skills – checking pt’s POCT. - Educator = pt teaching, reinforcing healthy habits, educating the team on how to communicate with the pt. - Leader = taking initiative and leading to produce a safe environment, and develop policies and procedures. - Scholar = baseline knowledge and research, evidence-based practice. 5. Describe the interrelatedness of the College of Nurses of Ontario competency domains to the core concert: Registered Nurse. (9) - Advocate, coordinator, communicator, collaborator, professional, educator, leader, scholar, clinician. 6. Describe hierarchies of evidence and evidence-based practice. - Evidence-Based Practice = includes research, clinical expertise, and patient’s values and wishes. - Expert opinion is the lowest level of evidence  Non-experimental qualitative study Synthesis of many Quasi experiment One non-randomized trial Randomized trial Analysis of many randomized controlled trials. HIGHEST - How does theory contribute to evidence? = empirical explanations for assessment and interventions, qualitative studies that provide evidence themes/ideas to develop theories, creates testable hypothesis. Intuitive humanistic model = informs the CJM and your practice from the 5 levels of proficiency - novice, advanced beginner, competent, proficient, expert. (Patricia Benner’s understanding of nursing) Dual process reasoning theory = inform the CJM and your practice from the perspectives of intuitive thought to analytical thought based on the features of the action from complexity, ambiguity, and presentation Information processing model = inform the CJM and your practice from the cognitive building blocks of five iterative processes: recognize cues, generate hypotheses, judge hypotheses, take action, and evaluate outcomes. Week 3 1. Describe foundations of abstract thought: levels of abstraction - Concrete ideas = solid, unchanging, uses 5 senses, specific, (sky is blue, humans need oxygen, earth is round) - Attributes to abstract ideas = complex, not fixed, depth, personal opinion, subjective, different viewpoints, imagination. (love, afterlife, feelings, art, relationships) - With abstract it’s harder to use the 5 senses - Philosophy = beliefs, ideas, wisdom, study of life, overthinking, theory, a way of thinking, statements, pursuit of knowledge, phenomena of life, not necessarily proven to be true. Highest level of abstract thought to articulate, express (broadly & globally) values, beliefs perspectives. - concrete to abstract thinking moves from objective, measurable reality to subjective, cognitive representations of phenomena around us 2. Discriminate between three paradigms that influence nursing knowledge and practice positivism, naturalism, post-positivism. - Positivism = thinking about reality or truth with scientific method, evidence, verification, observable, concrete, measurable, deterministic (teaching to prevent falls) - Naturalism = not concrete, as it exists, organic, qualitative, philosophical, not influenced, real, letting things happen – it is what it is. (cultural sensitivity) - Post modernism/positivism = future, change, new norms, questioning the old, 21st century, innovative, learning from the past – understanding the old in a new way with a new lens, challenging rigid ways of thinking, liberals to conservatives, constructivism understanding, more organic approach (naturalism) m ,uy - Constructivist approaches of the perceived view focus on understanding the actions of, and meaning to, individuals. What exists depends on what individuals perceive to exist. Knowledge is subjective and created by individuals. Thus, research methodology entails the investigation of the individual’s world. There is an emphasis on subjectivity, multiple truths, trends and patterns, discovery, description, and understanding. 3. Describe the metaparadigm of nursing and the relationships among the metaparadigm concepts. 4. Describe the paradigms that influence the development of the Clinical Judgement Model. - A metaparadigm represents the worldview of a discipline—the global perspective that subsumes more specific views and approaches to the central concepts with which the discipline is concerned. The metaparadigm is the ideology within which the theories, knowledge, and processes for knowing find meaning and coherence. Nursing’s metaparadigm is generally thought to consist of the concepts of person, environment, health, and nursing. Focuses on a specific domain of practice/knowledge. - Metaparadigm has a neutral perspective, more controlled, concrete, measurable, identifies unique domains to a specific discipline, abstract, global in nature, defined - 4 criteria for metaparadigm = global, neutral, not overlapping domains, comprehensive, must be discreet for the discipline - 4 concepts of metaparadigm = nurse, person, environment, health - Environment = safety, lighting, hazardous objects, where they live, familiar vs unfamiliar, locks on units, bed rails 4. Define metatheory, grand theories, middle range theories, and practice/situation specific theories. - Metatheory (most abstract) = Metatheory refers to a theory about theory. In nursing, metatheory focuses on broad issues such as the processes of generating knowledge and theory development, and it is a forum for debate within the discipline. Metatheory discussions involved nursing as an academic discipline and the relationship of nursing to basic sciences. Later discussions addressed the predominant philosophical worldviews (received view versus perceived view) and methodologic issues related to research.  Recent metatheoretical issues relate to the philosophy of nursing and address what level. Big theories. Clarifies grand theories. - Grand theory = suggests it’s based on respect, therapeutic relationships. Grand theories are the most complex and broadest in scope. They attempt to explain broad areas within a discipline and may incorporate numerous other theories. The term macrotheory is used by some authors to describe a theory that is broadly conceptualized and is usually applied to a general area of a specific discipline. More concrete. - Middle range theory = certain behaviours to build trust, specific concepts pulled out of the grand theory to be discussed further. It lies between the grand nursing models and more circumscribed, concrete ideas (practice or situation-specific theories). Middle range theories are substantively specific and encompass a limited number of concepts and a limited aspect of the real world. They are composed of relatively concrete concepts that can be operationally defined and relatively concrete propositions that may be empirically tested. More defined concepts. - Practice theory = least complex, situation specific, microtheories, perspective theories, test out the theory objectively, test the independent variables. Theories are related to or inform each other. Can inform from a middle range theory. *** Concrete to abstract thinking moves from objective, measurable reality to subjective, cognitive representation of phenomenon around us. Week 4 1. Define the building blocks of theory with examples of each: phenomenon, construct, concept, theorem, model, conceptual model/conceptual framework. - Phenomenon = highest level, big picture, abstract thinking, hard to measure, nature - Construct = specific, has concepts, measurable, testable when broken down, feeling of happiness, calmness, serenity - Concept = even more specific, part of a construct, measurable, can be observed - Theorem = organized framework of the building blocks, hypothesized idea, describes a relationship b/w concepts, belief related to evidence, walking in the forest reduces anxiety. - Conceptual framework = guideline, steps of action 2. Describe the influence of the paradigms: naturalism and positivism on theory development. - Naturalism = context of being situated in the forest, in the moment. - Positivism = 1h/weekly = less anxiety. Scientific, tested. 3. Describe concepts associated with theory testing: assumption, proposition, empirical indicator, hypothesis, praxis, relationship statement, taxonomy, evidence, and evidence informed practice. - Assumption = something we take for granted to be true, bias, accepted truth, educated guess, preliminary idea. - Hypothesis = predict, educated guess, testable prediction, thesis, 1h/week in forest = low anxiety. - Empirical indicator = something that’s measurable, unit, number, survery, hugging the tree, how many arms does it take to hug the tree, number of trees. More trees = dense forest. - Taxonomy = classification, naming, categorizing, labelling. Referring to chipmunks as another name - Proposition = proposed idea, deal, suggestion, sharing opinion, posit - Praxis = application of theory, putting something into practice, skills. - Relational statement = comparing 2 things, cause and effect, association, compare contrast. Evidence What constitutes evidence: What does NOT constitute evidence: - Testable outcome - Personal opinion, subjective - An outcome that supports opinion hypothesis - Assumption – we believe it’s true but no evidence. 4. Define the core constructs, concepts, empirical indicators, and directions of relationships in Meleis’ transition theory. FOR ASSIGNMENT  Nature of transitions Transition conditions Patterns of response (Mediators) Types Personal Process Indicators Developmental Meanings Feeling connected Situational Cultural beliefs and Interacting Health/Illness attitudes Located and being Organizational Socioeconomic status situated Preparation and knowledge Patterns Single Multiple Outcome Indicators:: Sequential Community Society Indicators of healthy Simultaneous Transition Related Unrelated Mastery Fluid integrated identities Properties Awareness Nursing Therapeutics Engagement Change and difference Promotive Transition time span Preventive Critical points and events Interventive Week 6 1. Explain the steps in theory development. - Concept development - Statement development = linking the concepts, critical thinking, prioritizing concepts - Theory construction = this is how it works etc - Testing theoretical relationships = research, experiments, data - Application of theory to practice - Select a concept - Identify all uses of the concept - Determine defining attributes - Identify a model case - Identify contrary causes about what it is not (opposing) - Antecedents and consequences - Empirical indicators 2. Define caring, and person and family centred care as a central construct across nursing theories. - Inclusion - Communication - Compassionate - Flexible to the patient - Shared decision making, collaborative, not authoritative - Holistic - Cultural safety - Empathy - Attentive to pt. active listening 3. Describe the dimensions in analyzing, evaluating, and comparing theories. - Comparison - Literature review - Standardized methods to analyze - Test, hypothesize - An organized systemic way 4. Apply Walker and Avant’s process for analyzing theories. a) Concept analysis = clarifies meanings of terms an defines terms/concepts, useful when needing clarification or further development. - Select a concept - Identify all uses of the concept - Determine defining attributes - Identify a model case - Identify contrary causes about what it is not (opposing) - Antecedents and consequences - Empirical indicators  b) Concept synthesis = concepts require development based on observation. Own view point. It includes qualitative, quantitative, literary synthesis and mixed methods. c) Concept derivation = comparison to another field outside nursing. - Become familiar with existing literature related to topic of interest - Search other fields for new ways of looking at the topic of interest - Select a set of concepts from another field to use in derivation process - Redefine concepts from the field. Week 7 5. Discuss the importance of grand theories and models to nursing science. - Debate on correct terminology/understanding of conceptual models and grand theories. Terms used interchangeably but differentiate according to level of abstraction. - Conceptual models = high abstract, tend to incorporate all of nursing reality in broad description of philosophy, difficult to test - Grand theories may derive from conceptual models = a little less abstract yet remain most complex and broad of all theoretical categories. Concepts are more defined but still not clearly defined that testing is feasible - 3 categories of grand = human needs (Nightingale & Orem), interactive (Watson) and human becoming (Parse) - Grand theories are analyzed by = how theorist’s background shaped their beliefs. Grand theories have assumptions, concepts and relationships. Usefulness to inform or guide nursing practice, education, research. Testability (limited), ease of understanding – parsimoniousness. Contribution or value to extend, expand and inform nursing as a practice. 6. Describe grand theories according to theorist background, philosophical underpinnings and key assumptions, concepts, and relationships: Human needs (Florence Nightingale & Dorothy Orem); Interactive (Jean Watson); and Unitary Process (Rosemary Parse) Human Needs - Background of Nightingale = (1800s )taking care of soldiers during war, racism involved, hygiene/sanitation emphasis to reduce infections of the wounded and death rates. - Philosophical ideas of Nightingale = foundational philosophy of nursing, healing, sanitizing, power of data and numbers, collecting stats. Positivist and descriptive. - Assumptions/concepts of Nightingale = hygiene, stats, pure air and water, efficient drainage, light, healthy environment for healing, cleanliness and social contact, critical thinking, nursing as art, medicine as science, loyal but not servile - Testability of Nightingale = very testable, measurable, visible, empirical, positivist, quantitative measurement. Concrete ideas - usefulness: broas influence over past 150 years, human dignity as central phenomenon, holistic health - Parsimony of Nightingale = yes, straightforward, easy but also may not be easy for a female back in the day to do what she did. - Value in extending nursing science: Education, public health scholarships, revolutionary, promoted/collected health statistics - Background of Orem (1930s) = self-care, self-reliance, independence of own care/autonomy - viewed person as an agent, realism - theory of self care, theory of self care deficit, theory of nursing systems, - Philosophical ideas of Orem = independence, autonomy, self directed care, notion of agency, notion of action - pts are active within their care. Positivist. Pragmatic and relativism. Everyone engages with ones self - Assumptions/concepts of Orem = self care deficit, agency, society, autonomy, humans as single or social units, environment physical, chemical, biological family culture community, health is structurally and functionally wholly, compensatory system, partial compensatory system, supportive education system, individuals and groups reflect on own self, symbolize experience, universal self care, developmental of self care, health deviation, therapeutic self care, deliberate system, product of nursing, theory of nursing systems. - Testability of Orem = more testable than nightingale, complex, assumptions, empirical approach, ableism, relationships between concepts, testable hypothesis. - usefulness: direct clinical application, newer work, specific about when nursing care is needed according to the needs of the patient. - Parsimony of Orem = more complex concepts, not as easy as Nightingale’s, have to understand all of her theories - Value in extending nursing science: education, realistic reflection of practice 4 tenets of post positivism 1. Multiple methodologies 2. macro analysis 3. reality in context to history 4. uncovering opposing views - Background of Watson = Interactive: mental health nursing, theory of human caring science, grounded in post positivism, health is a core value and understood as a continuum from a high level of wellness to illness. Human beings are understood as holistic who interact and adapt with environment. She saw human caring as deep involvement between humans and nurses, she believed humans were holistic and interactive energy fields. She values respect for the mysteries of life and that spiritual and ethical dimensions were major elements of the human care process. Humans have the responsibility to care for the planet. - 4 core post positivism = multiple methodologies, macro analysis, reality in context to history and uncovering opposing views. Everything is grounded in context of time, different eras, different ways of understanding, opposing views, not linear. - 6 working assumptions of Watson = wholeness/oneness, unity, relatedness, multiple ways of knowing, diversity of knowing all form of evidence, diverse perspective are explicit and direct, moral metaphysical integration, expanding energetic world view. Science of caring. - 10 key words for caring processes of Watson = altruism, authentically present, spiritual practices, loving trusting caring relationships, authentic listening, solution seeking, transpersonal teaching and learning, healing environment, human dignity, open to mystery - Watson theory is described as transpersonal nature of human caring science. - Background of Parse = a unitary process grand theory is an example of a simultaneity paradigm. Simultaneity refers to the notion of things event happening at the same time. Understanding human beings as energy systems. The human energy system happening at the same time as or co-occurring with the universal energy. Humans are unitary whole being who are open and free to choose their own ways of becoming. Parse’s theory is known as the “Humanbecoming” theory. Her philosophical beliefs are existential, about existence, experience and what it means to exist, the human universe is indivisible and ever changing. Humans create their reality into a continuous becoming, becoming is contextually constructed and ever changing and unique. humans continuously evolve and develop, does not look at stages, were not static, humans are always becoming. - Assumptions of Parse = structure meaning freely choosing the situation, configuring rhythmic human universe patterns, transcending illimitably with emerging possibilies, human universe cocreating a seamless symphony, parse concepts are created as paradoxes. Concept of evolution. - Existentialism: trying to understand the meaning of our life. What it means to exist/ to be a. nurse. May be understood as becoming, human being - grounded in context, unique to each person Concept Paradox - imaging – explicit/tacit, reflective/prereflectiv. - Valuing – confirming/not confirming. - Languaging – speaking/staying silent, moving/being still, revealing/concealing, disclosing/not disclosing, enabling/limiting, potentiating/restricting, connecting/separating, attending/distracting. - Powering – pushing/resisting, affirming/not affirming, being/nonbeing. - Originating – certainty/uncertainty, confronting/not confronting. Transforming – familiar/no familiar. - Usefulness of Parse = lies in its potential to deconstruct and understand practice education and research situation from a new perspective - Testability of Parse = inductive and constructivist rather than reductionist and quantitative - Parsimoniousness of Parse = unusual, less pragmatic way to view nursing practice. - Value to nursing as a science of Parse = humanbecoming theory views the values the intentionality of humans and their free choice. It guides and supports co creation of health choices. (harm reduction centres) , cocreating client choice to promote health Week 8 1) Discuss importance of middle range theories to nursing science. 2) Critically appraise middle range theories usefulness, testability, parsimoniousness, and value to nursing science. - In the middle of abstraction and concrete. More useful in practice, easier to understand - Specific concepts are more defined, amenable to quantitative measurements or operationalization. - Easier to predict relationships bw concepts referred to as variables, testing of interventions - Used to describe, explain, predict relationships bw variables. - May be used as a framework to guide the study, practice - Hypothesis, test hypothesis - Classified into high, middle and low middle range theories - Two high middle range theorists = Benner model of skill acquisition and Meleis transition theory. 3) Describe middle range theories according to theorist background, philosophical underpinnings and key assumptions, concepts and relationships in nursing middle range theories. - Skill acquisition Benner = novice, advanced beginner, competent, proficient, expert proficient. (skills of the nurse) - Based on the field and skills, it can range, from being novice in one skill and proficient in another etc. - 5 central concepts of Benner’s theory = critical thinking, experience, clinical knowledge, practical knowledge, skill acquisition - Benner’s 7 domains of practice = helping role, teaching or coaching a function, diagnostic monitoring, effective management of rapidly changing situations, administering and monitoring interventions, monitoring and ensuring quality practices, organizational and work role competencies. - Meleis transition theory = (PREVIOUS WEEKS) domains of practice/transition. The nature of transition, patterns, therapeutics. Week 9 1) Discuss importance of practice theories to nursing science. - Theory without application is intellectual exercise - To move this cognitive and intellectual understanding of our work and health care nursing particular theories need to be applied to real objective world - Theory as both a process and a product can be useful in our day to day working lives - We can determine if any theory might be usefully to practice situations. - 4 steps of theory process = analysing concepts, constructing relationships, testing relationships, validating relationships. - 2 products of theory = concept and relationships. - 4 types of relationships bw concepts = description, prediction, explanation, prescription of relationships among concepts. - We rely on theory and it helps w autonomy in the profession. - Theory are basis of practice and they inform each other. - Without theory nursing can rely on = past experience, other nurses (authority), trial and error, own values, instincts - Concerns not using theory = not evidenced based, more harm than good, ethical issues, risks of error, unreliable, unsafe. - Theory practice gap = what we learn in theory is not fully implemented in practice, disconnect bw the two. Theories are always evolving, might take time to put them into practice. It’s understood as a negative relationship. - Application of various models theories and principles from nursing biological behavioural medial and sociocultural sciences assessed as appropriate to clinical situations - To choose a theory that might be appropriate for practice, nurses need to consider the goal or context of the theory has to be consistent with your practice situation. - Other factors to consider = WHO? – identify the recipients of the theory, to whom does it apply and is that group within practice situation. WHERE? – where is the practice happening, what is the situation in practice. WHAT? – what the problem that you want the theory to address. HOW? – how are you applying the theory, how is it going to influence care. Can it describe predict, explain, clarify outcomes, specify actions, differentiate from other health professionals, promote responsibility and accountability. WHEN? – are there specific times or condition of practice stings and situations for which the theory is appropriate. 2) Describe theories specific to nursing practice, nursing administration and nursing education and nursing research. - Nursing administration = Main construct, organizational design (work specialization, chain of command, span of control, authority, responsibility, departmentalization, centralization and decentralization), shared governance model (councillor, congressional and administrative model), transformational leadership (creating a vision, building an architecture as a framework for commitment, developing sustaining organizational trust, focus on relationships), patient care delivery models (total patient care, team nursing, primary nursing, patient family centred care), case management (client being managed by a team of people, strong in mental health), disease/chronic illness mx, quality mx quality improvement, performance improvement, evidence based practice. - Theory in education = nursing curriculum related to metaparadigm of nursing. Application of 1 single theoretical model throughout the entire curriculum OR eclectic approach of various theories. - Theory in research = research is a systemic inquiry that uses disciplined methods to answer a Q or solve problems. Scientific process that validates and refines existing knowledge and generates a new knowledge that directly and indirectly influences the delivery of evidence based practice. - 7 purposes for the role of theory in practice = identifies relevant areas of study, proposes plausible approaches to examine health problems, develops middle range theories, denies concepts and purpose of relationships, interpret findings, develop clinical practice protocols and generate nursing dx. - Descriptive theory = detailed, explains - Explanatory theory = correlation bw why and what - Predictive = predicts relationships, hypothesis by experiments.  Week 10 1) Discuss importance of shared theories to nursing science. - Nursing is not limited to nursing theories in its application to practice - Nursing also borrows shared theories 2) Describe shared theories from sociological sciences, behavioural sciences and biomedical sciences. - Sociology = all about society, how we engage. - Sociological sciences = Systems Theory = the grand theory of systems is general or open system theory, suggests that when people are in interaction with eachother its as a form of a system. Can be open with exchanges of energy or closed system with defined boundaries, rules, norms, values. - Has subsystems and each with own function (nested theories) - A change in 1 part of the system changes the whole system. - Open and closed systems reach stationary states – a goal or an end point, which can be reached different ways (equifinality). - Input, throughput, output phases. Contains a feedback loop. Dynamic system, not static, always changing. (Ex. organizational QI) - Sociological sciences = Complex Adaptive Systems = specific to individuals health, threats and health care organizations. Agents are units or components of the system. Patterns are simple rules of agents actions. Concept of emergence is development of new rules. Systems are dynamic and adaptive. A self organization control is decentralized and distributed rather than centralized. - Sociological sciences = Critical Social Theory = exposes societal oppression and inequalities that affect health and health care. (Ex. feminism, gender equality, colonialism). - Sociological sciences = Feminist theory = closely aligned w critical social theory, specific to oppression of women. Liberal feminism looks at social justice and sexual inequality. Socialist feminism focuses on economic values of women work and social structures regarding women’s roles and cultural values and beliefs. - Behavioural science theory = psychodynamic, cognitive behavioural, humanistic – person centred, stress theories. - Psychodynamic = stages of new behaviours based on social and motivational factors, behaviour conceptualized as multidimensional that interfaces w personality. Personality is about how a person develops and it stops at a certain age and is unchangeable. - Psychosexual = FREUD = behaviour is an interaction among 3 systems – id ego and superego. Instinct = magnitude of psychic energy and has 4 parts – source (the need), aim/purpose (removal of tension), object (what satisfies the need), impetus (the force of underlying need). The environment satisfies or threatens the development of the self. Increased tension in the ID challenges the ego and superego to relief or satisfy is understood as anxiety. Anxiety = defense mechanism = unconscious cognition that distorts reality by denying it or creating a false understanding of it. - Id = original personality, unable to tolerate tension, tension is internal or external. Release of tension is pleasure principle - Ego = differentiates bw inner world of the mind and the external world by satisfying a perceived need. Tries to prevent id’s tension, controls cognitive and intellectual function and behaviours. Mediates the id and super ego and environment. - Superego = inhibits the id’s reactions by supporting the ego to engage in moral goals (to rise above). Focus on what’s right vs wrong. It’s the moral function of personality. Ethical part. Controlling your anger, engaging in behaviour that’s morally correct. - Psychosocial = ERIKSON = builds on Freuds work. describes physical and psychological stages of life from birth to death which are socially influenced. 4 stages = infancy, childhood, adolescent, adulthood. Stages of development are individually paced and cumulative. Ego was most powerful part of personality resilient by seeking creative solutions to challenges or threats. - Interpersonal = SULLIVAN = person depend on interpersonal relationships. dynamism = patterns of transformation of energy in relationships w others. Patterns = consistent overtime, repetitive in nature, tend to characterize persons life. Anxiety = product of relationships to protect self. Personification is self-image = feeling, attitudes, values,, beliefs, from interpersonal experiences of meeting needs and experiencing anxiety. - Cognitive behavioural = personality as learned behaviour that can be changed. Cognition links thinking w behaviour. Tends to explain thought content and processes that influence behaviours. Thought content and processes anebavle to change therefore so is behaviour. Focus is not on emotion of feelings. - Operant conditioning – SKINNER = repeating a behaviour, rewarding it, motivation, reinforcer. (Ex. dogs salivating to treats experiment). Manipulates behaviours with rewards or uses unpleasant stimuli for bad behaviour. Consistency. - Cognitive theory = BECK = based on perspective that cognitions or thoughts are false or distortions of reality. Errors in interpretation of reality,, usually repeated misinterpretation in the conscious mind although their routes are often in unconscious mind. Automatic thinking. Cognitive restructuring. (abused pt thinking its their fault). - Rational emotive theory = ELLIS = thoughts feeling and behaviours have meaning and are connected. They can be rational or irrational. Repeated irrational thinking leads to irrational behaviour. (paranoia, delusions). Self-defeating and self blame. - Humanistic theories = person centered = persons capacity for self actualization, potential within self to be healthy. The person is the centre of self determination and actualization. - Hierarchy of needs = MASLOWS = incremental psychological needs, safety, love, belonging, self-esteem, self-actualizing, self-transcendental. Deficiency/basic needs need to be met to move forward. - Stress theories = normal human function, stress adaptation and coping inevitable, unique to everyone. Equilibrium vs disequilibrium. - General adaptation theory = SELYE = stress is a wear and tear theory, alarm mild moderate, anxiety reduce stressor. Resistance moderate severe, anxiety increases, coping mechanisms. Exhaustion stressor cannot be neutralized. - Stress coping adaptation = LAZARUS = psychological response to stress, process and oriented approach, dynamics and changes of appraisal and reappraisal. Coping and successful coping = to manage and adapt to appraisal. - Biomedical science theories = germ theory and principles of infection (viruses, bacterial), epidemiological triangle (host agent and environment – prevention, strengthen the host, minimize environmental factors), web of causation (primary/health promotion, secondary/dx, tertiary/rehab prevention), homeostasis (biological equilibrium for normal functioning, allostasis – complexity of functions to achieve and maintain homeostasis), stress and adaptation (flight or fight), immunity (pathophys), genetic theories (understanding the 46 chromosomes), cancer theories (evolving, complex, risk factors, 3 stages – initiation, promotion, progression), gate control theory (relationships bw pain and emotions) Week 11 1) Describe shared learning and ethical theories and principles. - Learning = a change in knowledge attitude skills that is measurable, engages with environment and gains new info. It’s a process overtime, becomes permanent with repetition. Essential for survival. Separate and individual process from teaching. - Types of learning = psychomotor skill acquisition and performance, affective feelings, values, beliefs and cognitive info gathering. - Teaching = learning and teaching are interrelated. Included deliberate actions to stimulate or induce learning. Sharing or providing knowledge does not in itself constitute learning. - Learning theories = the process of learning to affect change in knowledge acquisition and skill or behavioural performance. Create conditions in which teaching can be more effective for learning. - Behavioural Learning Theories = Stimulus – Response Model of Learning = Skinners operant conditioning reward and punishment. Learning a desirable behaviour is reinforced or strengthened. Behaviour is controlled by and can be measured by rewarding positive behaviours and ignoring or punishing non desirable behaviours. Learning objectives – behavioural in nature, broken down into small components that can be measured (ex. exams). Limitations – without affective and cognitive components of learning, undesirable behaviour may return, once the learner is away from the learning teaching environment. - Cognitive Learning = Cognitive Field Theories = mental capacity of learning. Learners goal and motivations rather than reward for learning. internal drive, doesn’t care about reward. How thoughts and thinking affects behaviour. Persons perceptual or psychological world is in their field of cognition, its dynamic, changing as perception changes. Unique to individuals experiences. Thoughts influence actions via motivation, self-actualization is the key motivator. evolves into interaction theories. - Cognitive Learning = Interaction Theories = earning is sequential and experimental, happens over time via interaction of behaviour, mental processes and environment. Adapts to the world. Conditions for learning are unique to individual. Individuals have preferred learning styles. - Humanistic = emotions as positive influence on learning. Third force is the human potential. Improves, always becoming, human relations skills. Creating a sense of wonder self-actualization. (ex. wellness program, self help, flipped classroom). Client centered to student centered. Similar to Meleis theory. - Information Processing Model = human memory – info flows through to become memory sequentially through the stories. Sensory store = sensory memory, just long enough for cognitive processing. Short term store = working memory which info in sensory memory is attended to, lost in 20sec if no action to retain. Long term store = over time with practice, retains more permanently. - Forgetting Theories = decay, use it or lose it. Interference something gets bw what is known and what is new. Retroactive inhibition – new info interferes w old. Proactive inhibition – old interferes w new info. Loss of retrieval cues weakening of association. - Cognitive Load Theory = working memory can only handle so much at a time. Long term memo creates a schema to store large amounts of info. Also called the compartment or drawer in my head. - Adult Learning Theories = learners responsible for own learning. Teachers facilitate environment for learning. 6 assumptions = why I need to know/why do I care, self directed/self concept, personal experience as a resource for leaning. Readiness to learn real life situations, immediacy of orientation to application of learning, motivated by desire to solve immediate and practical problems. - Learning styles = visual, auditory, tactile, analytic (cognitive), global (big perspective). - Principles of learning = simple to complex, learning is personal and individualized, activated by self, relevant to learners needs, learner attentiveness, recency/quick of feedback, growth process can be painful, emotional and intellectual and individual styles. - Ethics vs morality = Philosophical Theory of ethics = ethics is careful, reflective, systematic critical study of morality. To identify justification of how we ought to treat others. To overcome biases to make decisions fairly. Objectively justifications to overcome biases. Morality = cultural beliefs and values about what is right and wrong. Reinforces societal customs shared by a cultural group. May be unsupported beliefs or biases of the dominant group and not shared by all. Personal - values character conduct of individual or group. - Virtue Ethics – Aristotle = fulfilling human potential, rational ability, control emotions via knowledge and wisdom. Everything in moderation. Knowing the right thing to do is cognitive ability action-oriented character. Good role model is essence of good teaching. Casuistry analogical reasoning. Analyzes a new case against previous well known influential cases (law). Weakness grounded in cultural norms, not objective to critique traditions. - Modern Ethical Theories = everyone has to agree bc they are rational. Single ultimate rule for ethics categorical imperative – respect others and not treat them as a means to your own needs. Ethics are universal and result in altruistic value system that does not allow oneself intrinsic. Only act accordingly to rules which you would be willing to require everyone in the world to follow. Deontology = duty based laws, nonnegotiable, absolute (KANT). Knowledge independent of experience. Moral law universal guiding principles. We don’t think of the consequences, we have the duty to act. Rawls – egalitarianism – everyone gets treated equally. Act neutrally free from biases to make decisions (veil of ignorance). Utilitarianism = knowledge dependent upon experience (social sciences). Choosing actions that maximize pleasure and happiness and minimize pain and suffering. Everyone’s pleasure counts just as much. The greatest good for the greatest amount of ppl. Fundamentally practical, ethics in realm of experience and measurement. Has public policy. Good consequences for MOST ppl. - Bioethics = respect for persons rights of individuals to make informed decisions about health care. pt is ultimate authority on what is best for self. Beneficence – doing wat is in pts best interest, balancing benefits and burdens. Mercy kindness charity risk benefit analysis. Clinician as fiduciary – pts best interest ahead of clinicians interest (altruistic).  Paternalism = risk for preventable harm, outweighs the risks no morally better alternative, least autonomy restrictive alternative. Nonmalifences = do no harm. Justice – fairness in health care resources. - Ethical decision making = recognize an ethical issue, determine as many responses as possible, analyze. Judgement of what is at stake and for whom. Conscious reasons deliberate choice from range of perspective – semantic, logical, analytics, epistemological, and normative. Conscious reasoned deliberate choice. 2) Describe role of theoretical pluralism to inform nursing practice. - The use of more than one theory at a time to understand a phenomenon. It recognizes that there may not be only one truth or theory that explains the world or even 1 phenomenon in its complexity. Each theory has its own limits, boundaries, perspectives. Analyzing a situation from more than 1 lens helps us to comes closer to the whole truth or picture of what is really happening. Choosing the best theoretically pluralistic approach still comes down to the same questions of Who, Where, What, How, When? - Week 12 1) Define evidence-based practice (EBP). - Originates in 1980s, Cochrane collaboration funded. - Lowers value placed on expert opinion and increases value placed on data based studies - Primarily quantitive data and clinical research to make clinical decisions and educate med practitioners - Defining costs and benefits of tx. was the initial cause for EBP - Tremendous potential implication for modern med. - Florence nightingale analyzed data of lack of hygiene causing infections, therefore increasing hand hygiene. Positivist. - Research = systematic way to answer Qs, contributes to the info of what is considered to be the best evidence for practice - EBP = problem solving approach that collect and integrates the best most recent research of practice. Expanded beyond the traditional positivist paradigm, to include quasi experiment, nonexperimental positivist designs knowledge learned from designed in the constructivist paradigm. Broader and more inclusive than research. - Evidence = info that comes closest to the facts of a matter. The form it takes depends on context. The findings of high quality, methodologically appropriate research provide most accurate evidence. Because research is often incomplete and sometimes contradictory or unavailable, other kinds of info are necessary supplements to or stand ins for research (Incomplete in some way as its aways evolving, new info arise). The evidence base for a decision in in multiple forms of evidence combined to balance rigour with expedience while privileging the former over the latter. - Positivist paradigm = foundation of quantitive methodology, evidence via numeric calc, stats. Empirical or positivistic truth. May be experimental, quasi experiment, non-  experimental such as descriptive or correctional. Gold standard for the quantitive experimental designs randomized control trial. - Constructivist or naturalistic design = foundation of qualitative methodology through which the truth is discovered via narrative themes in designs such as phenomenology, grounded theory, ethnography, historical research, critical social theory. - 3 core elements of nursing EBP = best scholarly evidence, clinicians’ expertise, pts wishes. - EBP identifies a problem → searches the literature for evidence → it synthesizes the evidence to determine most appropriative or best evidence to create recommendations for practice → implements evidence → evaluates effectiveness. As research evolves over time EBP must be an ongoing process of revision for “BEST” practice to reflect the new evidence that has emerged. Iterative process. - Lowest to highest levels of rigor = 6. clinical experience 5. expert opinion, consensus, reports 4. program evaluations (systems theory – feedback loop, incident reports) 3. nonexperimental, observational, constructivist 2. quasi experiment 1. experimental – nonrandomized clinical trials, metanalysis and analytic studies. - Highest to lowest = metanalysis, 1 randomized controlled trial, controlled study w/o randomization, quasi experiment, synthesis of qualitative, nonexperimental, expert opinion. - Clinical expertise requires = experience, reading literature, education (theory into practice), clinical supervision (mentor). - Despite the best evidence, the pt may want a different approach. - Theory BP vs EBP = equivalent. Theory informs the research that supports recommendations for EBP. As theory, research and practice are interrelated. 2) Critically appraise role of theoretical concepts in the recommendation of the Person and family centred care - Recommendations = engage w pt in a participatory model of decision. Making, respecting pts right to choose the preferred interventions for their health. Collab w the pt to identify their priorities and goals of health. Sharing info to promote an understanding of available options for healthcare so pt can make informed decision. Respecting the pts as an expert on themselves and their life. - Relationship centred care (RCC) is a clinical philosophy that stressed partnerships, careful attention to relational process, shared decision making, self awareness - Theory of human interaction called complex responsive process of relating offers strong theoretical conformation for principles and practices of RCC. - Implementing evidence into practice = all BPG recommendation implementation occurs w adaptation to the clinical and organizational context. BPGs are not implemented in a linear prescriptive manner. 3) Identify future issues in theory in nursing. - Development in middle range and practice specific theories - Theory analysis testing and evaluation refinement - Deliberative integration of theory, practice and research.