Theoretical and Scientific Foundations of Professional Nursing Practice PDF

Theoretical and Scientific Foundations of Professional Nursing Practice NRS 2012 Nursing’s Theoretical and Scientific Heritage Nursing’s theoretical/scientific heritage began with Florence Nightingale (FN) when she was sent to aid British soldiers during the Crimean war (1854-...

Theoretical and Scientific Foundations of Professional Nursing Practice NRS 2012 Nursing’s Theoretical and Scientific Heritage Nursing’s theoretical/scientific heritage began with Florence Nightingale (FN) when she was sent to aid British soldiers during the Crimean war (1854- 1856). FN is credited with being the first nurse theorist/nurse scientist/nurse researcher.  What is theory and what is nursing theory? Theory helps explain events by defining concepts, explaining relationships among the concepts, and predicting outcomes. Theory = knowledge Nursing theory helps define and explain nursing phenomena, the relationships between them, and predict outcomes. Nursing theory = nursing knowledge  Nursing Theory, cont. Nurse researchers/scientists test nursing theory/ nursing knowledge to confirm or refute what is already known = nursing science. This is how scientific disciplines develop, extend, and expand their knowledge base. Nursing theory/nursing knowledge is dynamic and ever changing.  Domain The domain is the perspective of a profession or discipline, and provides the subject, concepts, values and beliefs, and phenomena of interest for the discipline. The domain of nursing is comprehensive because nursing has a large number of phenomena of interest (Think nursing diagnoses!).  Paradigm A paradigm links the beliefs, theory, and assumptions accepted by the discipline (e. g. nursing is holistic, patient-centered, outcome-focused). The nursing paradigm contains four recognized concepts: person, health, environment/situation, and nursing. These are nursing’s the meta-paradigm concepts.  The Meta-Paradigm concepts of Nursing Person – the recipient of nursing care. It can be an individual, family, group, population, etc. Health – a state of being that people define in relation to their own values, personality, and lifestyle. Environment/situation – all possible conditions affecting patients and the settings where they receive nursing care. Nursing – a verb (action/doing), a noun (person providing care), or both. How do you define nursing?  Caring Caring is not one of nursing’s meta- paradigm concepts, but caring is central to nursing. Caring means that people, events, and things matter. Caring implies connection. When a person seeks the professional guidance of a registered nurse, caring is essential to help them achieve positive outcomes.  Four levels of theory/nursing theory Grand level = most abstract; designed to provide a structural framework for the entire discipline (e.g. for nursing). Grand level theory contains all four meta-paradigm concepts (e.g. Watson, Roy, Orem, etc.). Middle-Range level = less abstract, is more relevant to clinical practice situations (e. g. pain, hope, sorrow, etc.).  Levels of theory, cont’d Practice level = less abstract; describes interventions for a specific nursing phenomenon (e.g. what to do). It is the level of theory taught to UG nursing students and is in UG nursing textbooks. Prescriptive level = very few prescriptive nursing theories. The nursing phenomenon is at the level where the intervention is prescribed – meaning it is done every time the condition warrants (e. g. turning an immobile patient Q2 hours)  Nursing Theory – Grand Level Examples Nightingale – focus is the patient’s environment; nurses manipulate the environment to restore a patient to health. Roy – focus is adaptation; nurses help the patient adapt to changes in physiological, self-concept, role function, and interdependence domains. Watson – focus is caring; caring occurs when a nurse and patient engage in a transpersonal relationship.  Watson’s Theory of Caring Watson’s Theory of Caring is a holistic model that suggests a conscious intention to care promotes wholeness (in both the nurse and the person). The focus is on the nurse-patient caring relationship. In Watson’s view, caring preserves human dignity in the technological, cure-dominated health care system, and places care before cure. Nursing Theory – Middle Range examples Benner - skill acquisition - novice to expert Kolcaba – comfort Pender – health promotion Mishel – uncertainty in illness  Nursing’s Theoretical Foundation Nursing’s theoretical foundation/knowledge base has expanded over the last 50 years due to the ever-increasing number of phenomena that nurses and/or APRNs address. Also because of nursing’s emphasis on the use of evidence to guide nursing practice. Evidence-based nursing practice de- emphasizes habits and ritual as the basis for nursing care.  Evidence-Based Nursing Practice (EBNP) EBNP is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a nurse’s expertise and patient preferences and values in making decisions about patient care.  ANA Standards of Professional Performance Besides the six Standards of Practice, the ANA (2021) also has 12 Standards of Professional Performance, e. g. professional role activities. All nurses/nursing students are expected to engage in professional role activities appropriate to their education and position.  ANA Professional Role Activities Include activities related to ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health.  Standard 14: Scholarly Inquiry The registered nurse integrates scholarship, evidence, and research findings into practice (ANA, 2021, p. 100).  Scholarly Inquiry/EBNP Competencies Based on Academic Preparation Bachelor of Science in Nursing (BSN) – read and critically appraise studies, use best research evidence in practice, and assist with problem identification in nursing practice. Master of Science in Nursing (MSN) – critically appraise and synthesize studies, implement best research evidence in practice, collaborate in research projects, and provide clinical expertise for research.  EBNP Competencies at the Doctoral Level Doctor of Nursing Practice (DNP) – develop, implement, evaluate, and revise protocols, policies, evidence-based practice guidelines, and conduct clinical studies. Doctor of Philosophy (PhD) - conducts research and contributes to the empirical knowledge generated in a select area of study. Post-doctoral – implement a funded program of research, mentor other PhD prepared researchers.  Evidence for EBNP What is evidence? For scientific disciplines, it is interpreted to mean knowledge generated by research. Who produces the evidence needed for EBNP? = REGISTERED NURSES! Nurses are the only professionals who know nursing and the needs of nursing practice. Approaches to Knowledge Development There are two scientific approaches to knowledge development, DEDUCTIVE and INDUCTIVE. Deductive reasoning = the process of developing specific predictions from general principles (top down); Quantitative. Inductive reasoning = the process of developing generalizations from specific observations (bottom up); Qualitative.  Inductive Nursing Knowledge *Often generated from nursing practice. Example: You are a pediatric nurse and you observe during your clinical experiences that the children you care for (specific) get anxious when their parents leave. You conclude that all hospitalized children (generalization) get anxious when separated from their parents.  Nursing Knowledge from Deduction *Generated from learned principles. Example – You were taught in UG nursing courses that children have separation anxiety when separated from their parents (general principle). During your pediatric clinical experiences, you look to see if the children you care for (specific) show signs and symptoms consistent with this belief.  Sources of Evidence There are many sources of evidence, but they are not all credible, valid, or reliable. Health care has, historically, had a bias toward evidence derived from deductive methods presented in academic journals as original reports of research. Inductive approaches have not always been valued as credible forms of evidence/research even when published in academic journals. Inductive approaches are primarily used when studying humans/human sciences.  Nursing Knowledge Both approaches to knowledge development (inductive/qualitative and deductive/quantitative) are necessary for understanding nursing/nursing phenomena. Neither approach to knowledge development is superior when used as the basis for nursing practice and for providing patient-centered nursing care.  Evidence for the EBP assignment & Group Presentation For the three (3) Group assignments, use original reports of research from the nursing literature. What is nursing literature – literature written by, for, and about nurses/nursing phenomena/the profession of nursing/etc., and reported in the nursing literature/nursing journals. How to know a nursing journal - with some exceptions, a nursing journal title has the word nurse, nurses, or nursing in it. Use the “airtable.”  Where to find the nursing literature Cumulative Index of Nursing and Allied Health Literature (CINAHL) database All of the nursing literature is in CINAHL, but not every article found in CINAHL is nursing literature. CINAHL also has articles/literature from other health disciplines. You have to assess the articles to see if they are published in nursing journals and are on the official INANE list of nursing journals = “airtable.”