Week 7 Notes PDF

Week 7: Using a Theoretical Foundation for Professional Nursing Practice **Video:** The video is about Jim Mahi, who was diagnosed with lymphoma 10 years ago. He relapsed after treatment and was given a 2-5 year prognosis. His wife was also diagnosed with Huntington\'s disease, and three of his fou...

Week 7: Using a Theoretical Foundation for Professional Nursing Practice **Video:** The video is about Jim Mahi, who was diagnosed with lymphoma 10 years ago. He relapsed after treatment and was given a 2-5 year prognosis. His wife was also diagnosed with Huntington\'s disease, and three of his four children have it as well. Jim was admitted to the hospital for treatment and found himself feeling isolated and alone. He was grateful for the care he received from the nursing staff, who treated him with compassion and respect. He believes that it is important for healthcare providers to treat patients as individuals and to show them that they care. what is most important to Jim regarding nursing care? Jim believes that it is important for healthcare providers to treat patients as individuals and to show them that they care. He also believes that it is important for nurses to have a good understanding of the patient\'s medical history and to be able to communicate effectively with the patient and their family. what types of knowledge does the nurse require to provide exemplary nursing care for Jim and his family? The following are some of the types of knowledge that the nurse requires to provide exemplary nursing care for Jim and his family: - Jim\'s medical history, including his diagnosis, treatment, and prognosis. - The symptoms of lymphoma and how to manage them. - The side effects of chemotherapy and radiation therapy. - The risks and benefits of a stem cell transplant. - The symptoms of Huntington\'s disease and how to manage them. - The emotional and psychological impact of a terminal illness on the patient and their family. - How to communicate effectively with patients and their families. - How to provide compassionate and supportive care. **Nursing Theory:**\ Nursing theory organizes knowledge to guide nursing practice in a professional and accountable way. It helps nurses understand client situations, organize data, and analyze it for informed care. It also defines nursing practice as distinct from other fields like medicine. **Why Nursing Theory Matters:**\ Nursing theory: - Provides structure for nursing care, making it distinct from biomedical or technical care. - Applies in various settings (e.g., ER, ICU) and adapts to patient-centered approaches. - Guides nurses in delivering coherent care under diverse conditions. A diagram of research Description automatically generated - *The relationship of nursing theory to practice is represented by the triad of nursing. Practice, theory, and research provide the basis for nursing knowledge and patient care. Each of these interrelated concepts influence decisions, interventions, and evaluations within the practice of nursing.* - *Relationship between theory-research-clinical practice is dynamic and reciprocal* *e.g. Clinical practice: question arises which can be tested through research* *e.g. Research-theories can emerge from research which then inform practice*  **Philosophies, models and theories (theoretical structures)** address central concepts of nursing and can be classified by level of abstraction 1. **Metaparadigm**-most abstract set of central concepts for the discipline of nursing 2. Concepts are defined within each of the conceptual models and according to the philosophy of that model 3. **Philosophies**-present the general meaning of nursing and nursing phenomena through reasoning & logical presentation of ideas (Nightingale did not present her philosophy on the relationship of patients to their environment as a theory, her philosophy contains implicit theory that guides nursing practice) 4. **Conceptual models** (also called paradigms or frameworks) are the next less abstract set of concepts in the structure a. **Grand theory** -useful in research & practice; it is more general and theories specifying the details of practice can be derived from it; called \"grand\" because they are intended to be applied to all patients in all situations (e.g. Roy Adaptation Model, the Orem Self-Care model, and the Newman Systems Model) 5. **Theory**-next less abstract level; differ from models in that they propose a direction or action that is testable 6. **Middle-range theory** -least abstract set of concepts, more precise and the most specific to nursing practice; specify such factors as age group, pt/family situation, and action of the nurse; e.g. experiencing transitions, caregiver stress, and resilience. A diagram of a nursing Description automatically generated ***Metaparadigm**- the philosophical framework of nursing; conceptualized by Jacqueline Fawcett (1978)* *Recall: nursing's metaparadigm addresses 4 major abstract concepts* *A Theorist's world view or philosophy informs the definition of concepts within a metaparadigm / theory* ***Concepts**-abstract ideas or mental images of phenomena; bring forth mental images of meaning and properties of objects/events/ things* *e.g. rash, pain, anxiety, person, health, environment*   **[Philosophy]** -**everyday meaning-** "I have my own beliefs and assumptions about the world I live in and my place in it" -**scientific discipline of its own -** own body of knowledge; asks/explores/attempts to answer questions about our experience, human affairs and the universe (Fry, as cited in McIntyre & McDonald) -philosophy is a **feature of all scientific disciplines** (e.g. OT, PT, Medicine, Astronomy, and....Nursing) -Philosophy's three main areas of scientific exploration: ontology; epistemology; ethics - **Ontology**-investigates the **nature of being human** and reality e.g. what is the purpose of our existence? - **Epistemology**-investigates the **nature of knowledge** e.g. How do we know that something is true? What is known versus unknown? - **Ethics**-nature of moral conduct and judgment **Nursing Philosophies** Sets forth the meaning of nursing phenomena through analysis, reasoning, and logical presentation Address one or more metaparadigm concepts in a broad philosophical way Broad statements of values & beliefs-propose general ideas about what nursing is, what nursing's concerns are (Alligood, 2014) A group of men with red bubbles Description automatically generated ***Discipline:*** - *A "discipline" (e.g. biology, microbiology, astronomy, nursing, medicine) refers to a branch of education, a department of learning, or a domain of knowledge* ***Profession:*** - *A "profession" -- is a specialized field of practice; **[founded on the theory]** of the science or knowledge of that discipline and accompanying practice abilities* *essential for the existence of an academic discipline* ***Theory:*** - *Essential for the existence of an academic discipline and vital to the practice of the procession* - *In 1970, Khun, a noted philosopher of science, stated that the study of theory "is what prepares the student for membership in the particular scientific community with which \[they\] will later practice" (as cited in Alligood, 2010, p.10)*  Practice-based Theories: - Florence Nightingale (1859) - The McGill Model (1987)- Dr. Moyra Allen Needs Theories: - Virginia Henderson (1955) - Dorothea Oren (1971) Interactions Theories: - Hildegard Peplau (1952) - Joyce Travelbee (1966, 1971) - Evelyn Adam (1979) Systems Theories: - Dorothy Johnson (class notes, speechless 1960's, published 1980) - The University of British Columbia Model (1976) - Betty Neuman (1972) - Sister Callista Roy (1970) **Relationship Between Theory, Practice, and Research:**\ Theories inform practice, research refines these theories, and practice tests them, creating a cycle that continually improves nursing care. **Types of Nursing Theories:** - **Grand Theories:** Broad, abstract, not easily testable (e.g., Nightingale's theory). - **Middle-Range Theories:** Narrower in scope, can be empirically tested. - **Practice-Based Theories:** Directly apply to day-to-day nursing, like the McGill Model by Dr. Moyra Allen. **Classifications:** - **By abstraction:** Conceptual models, grand theories, middle-range, and practice-level. - **By goal:** Descriptive (describes phenomena) or prescriptive (directs interventions). **Notable Models and Theories:** - Florence Nightingale\'s foundational theory of health and environment. - The McGill Model focuses on family-centered care. **Paradigm Debates:**\ Questions like \"Is nursing an art or science?\" and \"How should nursing knowledge be defined?\" are ongoing. Some frameworks include the **Totality Paradigm** (focused on health as biological balance) and the **Humanbecoming Paradigm** (focused on personal growth and human experience). **Ways of Knowing Beyond Science:** Science is one of several forms of knowledge\ Nursing integrates various knowledge forms, including: - **Empirical (science)** - **Ethical** (moral knowledge) - **Personal** (self-awareness) - **Aesthetic** (the art of nursing) - **Emancipatory** (social justice in health). **Theory-Practice Gap:**\ Challenges like abstract language, task-focused practice, and evidence-based vs. theoretical approaches lead to a gap in applying theory in clinical practice. Pressure to meet institutional outcomes can also deprioritize nursing theory. Overcoming this requires better integration of theory into practice and more focus on it in graduate programs. **Branding Nursing Theory:**\ Nurses and other healthcare professionals often undervalue or overlook nursing-specific theories. Better awareness and \"branding\" of nursing theory can help establish its significance across interdisciplinary fields. **Practice- Based Theory: Nursing Process** - Ida Orlando (1961) introduced a problem-solving approach that is still used today. - Originally had 4 steps without "diagnosing". - Useful for organizing and applying knowledge. - Later criticized for being to linear and rigid and inconsistent and potentially harmful (i.e. view that persons are problems to be solved) (Mitchell, 1991). - Still taught today when students are learning how to engage in clinical judgment. **Nursing Diagnosis** - North American Nursing Diagnoses Association (NANDA) developed in the 1970's... - List of common patient problems addressed by practising nurses - Recognized as practical versus theoretical - Advantages-categorization in electronic databases - Disadvantages-barriers to individualized care; potentially dehumanizing labels **Theory must be brought into practice to close the theory-practice gap** The gap between education and the clinical practice has always been challenge for educational experts in the field 'The gap between the theoretical knowledge and the practical application of nursing, most often expressed as a negative entity, with adverse consequences' (Greenway et al., 2018, p. 1) **The gap can have multiple interpretations:** - idealized practice and common practice - the difference between taught general principles and the difficulty in interpreting them for application to a specific situation - taught abstract nursing theory and its use in practice, - the gap between scientific knowledge and theory used as common practice, - the gap be-tween our individual mental representations of nursing and the published theories of nursing. - Attributes of the theory-practice gap: - Relational problems between university and clinical practice - Practice failing to reflect theory - Theory perceived as irrelevant to practice **Why the theory-practice gap?** - Abstract language or discomfort with alternate disciplinary values - Attitudes-theory belongs to academia and is not useful in the every-day practice - Ritualistic-task focused practice valued - Perceived incompatibility with evidence-based practice (i.e. untested philosophical ideas vs positivist research findings) - Pressure to meet competing outcomes that do not include or prioritize nursing theory (e.g. National CNO ETPs; care pathways; quality standards; score cards) - Preparation in graduate nursing programs that does not emphasize nursing science theory....depletes the theoretical leadership pool - Relational barriers between universities and clinical practice - Perceptions that theory-guided practice is more time consuming **Theorizing In the Future** - To stimulate thinking - To create a broad understanding of the science and practice of the nursing discipline - To provide a rationale for nursing actions and decisions **Key Terms** - Theory - Nursing theory - Concept - Theoretical model - Conceptual framework - Nursing process - Types of theories - Metaparadigm concepts - Ways of knowing **Major theoretical models:** - Practice-based theories - Needs theories - Interactionist theories - Systems theories - Simultaneity theories