NCM 100: Theoretical Foundations of Nursing Chapter 1 Lesson 3 PDF

1 NCM 100: Theoretical Foundations of Nursing CHAPTER 1: EVOLUTION OF NURSING LESSON 3: STRUCTURE OF NURSING KNOWLEDGE ___________________________________________________________________________ INTRODUCTION Nursing is as varie...

1 NCM 100: Theoretical Foundations of Nursing CHAPTER 1: EVOLUTION OF NURSING LESSON 3: STRUCTURE OF NURSING KNOWLEDGE ___________________________________________________________________________ INTRODUCTION Nursing is as varied as the people who practice it, and is dynamic and diverse as a kaleidoscope of ethic, cultural and religious manifestations of the people who receive nursing care. It is important that nursing is grounded on accepted scientific truths and principles in order to give safe and quality nursing care. The systematic development of scientific nursing theories has a better chance to advancing nursing and may lead to the basis for advancing nursing science. The nurse who systematically devises a theory of nursing and presents it to the nursing community for public review is engaging in the process essential to advancing theory development. The following terminologies are very vital in understanding the different concepts. Do you want to know them? OUTCOMES At the end of the lesson, the learners must have: 1. explained the structure of nursing knowledge; and 2. discussed the metaparadigm of nursing. WARM UP ACTIVITY Read carefully the questions and encircle the letter of the correct answer. Once finished, take a photo of your output and post it to the discussion forum intended for this lesson. 1. What is the next knowledge level after metaparadigm that sets forth the meaning of phenomena through analysis, reasoning, and logical argument? A. Theory B. Concepts C. Philosophy D. Paradigm 2. One characteristic of theory must be: A. logical in nature B. paradoxical in nature C. complex in nature D. inconsistent 3. Conceptual frameworks are commonly represented through: A. diagram B. paragraph C. caricatures D. images 4. Which of the following is NOT a component of the metaparadigm in nursing? A. health B. environment C. assumption D. nursing 1 2 NCM 100: Theoretical Foundations of Nursing 5. It is defined as sets of empirical data or experiences that can be observed or touched? A. theory B. phenomenon C. metaparadigm D. assumption LEARNING INPUTS Read the following materials. Philosophy in nursing is the next knowledge level after metaparadigm; it specifies the definition of the metaparadigm concepts in each of the conceptual models of nursing; it sets forth the meaning of phenomena through analysis, reasoning, and logical argument; theory may be formed from these philosophies such as the work of Watson and Benner; contributed to the knowledge development in nursing by forming a basis for subsequent developments especially in area of human science. Example: Nightingale’s work Conceptual models or frameworks are representations of an idea or body of knowledge based on their own understanding or perception of a person or researcher on a certain topic, phenomena or theory. They can be represented thru a diagram or in narrative form which shows how concepts are interrelated. It is also a paradigm that provides a broad frame of reference for systematic approaches to the phenomena with which the discipline is concerned. Example; Dorothy Johnson focuses on behaviour; Imogene King focuses on interaction; Sister Callista Roy focuses on adaptation Physical Fitness Lowered Person Exercise Blood Pressure 2 3 NCM 100: Theoretical Foundations of Nursing Theoretical models or frameworks are highly established set of concepts that are testable. The following is a theoretical framework as proposed by Lydia Hall, a nurse theorist. The Person Social sciences Therapeutic use of self- Aspects of nursing “The Core” The Disease The Body Pathological & Natural & biological Therapeutic sciences sciences Seeing the patient & Intimate bodily care- family thru the medical aspects of nursing care-aspects of nursing “The Care” “The Cure” Middle-range theories are the least abstract level of theoretical knowledge because they include details specific to nursing practice. It includes information indicating the situation or health condition, the patient population or age group, the location or area of practice, and the action of the nurse, or the intervention. They were also developed from the themes of data in qualitative research. Example: Nola J. Pender: The health Promotion Model. Grand theories are theories because they do propose something that is true or testable such as Roy’s theory of the person as an adaptive system derived from the Roy Adaptation Model. Phenomena are the subject matter of a discipline; sets of empirical data or experiences that can be physically observed or tangible. Example: crying or grimacing when in pain. Nursing Phenomena can be: Disease process -Stomach ulcer Clinical or environmental setting of nursing- Health center Client’s behavior- Guarding behavior at the pain site Interventions-Care of the client in pain Practices- that are utilized in nursing theories and metaparadigm All natural events that the human senses can perceive can be called a phenomenon. 3 4 NCM 100: Theoretical Foundations of Nursing Theory is T-H-E-O-R-Y True possibly-not known or proven to be true Hypothetical sets of facts, principles or circumstances Explains facts, events or phenomena Organized set of related statements Rooted from the Greek word “theoria”- “looking at, viewing, beholding” Yes! it is followed as a basis of action Theory- is an organized set of related statements that describes or explains phenomena in a systematic way. Theory is also a group of related concepts that propose actions that guide practice. It composed of Concepts, Propositions, Assumptions, and Definitions intended to explain a set of fact, event or phenomena Concept- a mental idea of a phenomenon; the building blocks of theories; can come from an empirical phenomena or any abstraction of how a person perceived an object that is not physically present or observed.; enhances one’s capacity to understand phenomena as it helps define the meaning of a word. Two types of concepts: 1. Abstract – are indirectly observed or intangible; it is independent of time and place. Examples: love, care, freedom 2. Concrete- is directly observed or tangible. Examples: nurse, mother, pain Conceptual definitions- are the meaning of a word based on how a certain theory or relevant literature perceives it to be. Examples: roles/concepts of nurse, patient care, and environment Operational definitions- are meaning of a word based on the method of how it was measured or how the person come up with that perception. Example: significance of pain perception and practiced nursing intervention. 4 5 NCM 100: Theoretical Foundations of Nursing Types of Definition of Concepts CONCEPTUAL OPERATIONAL Comparable to definition from a Specifies exactly how the concept will be literature such as a dictionary, determined and assessed; it also encyclopaedia, and journals. identifies procedures and operations significant to determine concepts. Example 1: Hospital stay The time during which a person is a The total of days as patient, beginning registered patient in a certain hospital with admission day and finishing with discharge Example 2: Ambulation To walk from one place to another or to Taking six steps without assistance move about Proposition - a statement of relationship between concepts. Assumption-statement that specifies the relationship of factual concepts/phenomena. Definition-composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts How other authors define THEORY: Chin and Kramer (1991) – a creative and rigorous structuring of ideas that projects a tentative, purposeful and systematic view of phenomena. Parker (2001) – is an organized, coherent set of concepts and their relationship to each other that offers descriptions, explanations and predictions about phenomena. Potter (2004) – a set of concepts, definitions, relationships and assumptions that project a systematic view of phenomena. Blackwell (2005) – a reasoned proposed explanation of an occurrence, or of something that will occur or be produced, for which absolute proof is lacking. Delaune and Ladner (2006) – a set of concepts and propositions that provide an early way to view phenomena. 5 6 NCM 100: Theoretical Foundations of Nursing Mosby (2006) – an abstract statement formulated to predict, explain or describe the relationships among concepts, constructs or events. It is tested by observation and research using factual data. Kozier (2008) – is a supposition or system of ideas that is proposed to explain a given phenomenon. Characteristics of Theories 1. Can correlate concepts/generate a different way of looking at a certain fact or phenomenon. Theory must identify more than one concept and that the relationship between these concepts must be clear. 2. Logical in nature Interrelationships of concepts must be sequential and consistently used within the theory. No contradictions between the definitions of concepts, their relationships within the theory and the goals of theory. 3. Simple but generally broad in nature. Theory defined as” tight, “parsimonious”. Stated in most simple terms but at the same time describes, explains or predicts a wide range of possible experiences in nursing practice. A theory of communication that can be explained simply and generalized to all person-to-person interactions. 4. Can be the source of hypotheses that can be tested for it to be elaborated. Quantitative research tests hypotheses in clinical practice and uses statistical analyses to arrive findings. Qualitative research expands theory by using a different research methodology that focuses on the lived experiences of persons. 5. Contribute in enriching the general body of knowledge. Theories contribute to the general knowledge of the discipline of nursing. Validation of theories enhances the ability of the nurse to describe, explain, predict, or control nursing practice. 6. Can be used by practitioners to direct and enhance their practice. 6 7 NCM 100: Theoretical Foundations of Nursing Theories can be used to guide/improve nursing practitioners by describing, explaining, or predicting events in clinical practice. 7. Consistent with other validated theories, laws and principles but will open unanswered issues that need to be tested. The logic of theories and their assumptions must be based on underlying laws, previously validated knowledge and humanitarian values that are generally accepted as good and right What are the different types of Theories according to Function? 1. Descriptive Theories also known as Factor- Isolating Theories: To know the properties and workings of a discipline. The primary level of theory development. Identify and describe major concepts of phenomena. They don’t explain the relationship of the concept. Main purpose: to present a phenomenon based on the five senses together with their corresponding meaning. Example: Descriptive Researches 2. Explanatory Theories or Factor-Relating Theories: To examine how properties relate and thus affect the discipline. Present relationship among concepts and propositions. Aim to provide information on how or why concepts are related. Example : A research study on factors affecting newborns failure to thrive. 3. Predictive Theories otherwise known as Situation-Relating Theories: To calculate relationships between properties and how they occur Describe future outcomes consistently. Generated and tested using experimental research. Example: A theoretical model based on the observation of unsanitary environmental condition on the recovery of the post-operative patients 7 8 NCM 100: Theoretical Foundations of Nursing 4. Prescriptive Theories also called Situation-Producing Theories: To identify under which conditions relationships occurs. Test the validity and certainty of specific nursing interventions. Commonly used in testing new nursing interventions. Example: Laurente’s theory validates and explains the different nursing management in the emergency room in relieving anxiety among clients. Nursing theory is a group of related concepts that are derive from the nursing models. Some nursing theories are also derive from other disciplines such as Madeleine Leininger’s work which comes from anthropology, or Hildegard Peplau’s work which draws from psychiatric sources. Meleis (1991) defined nursing theory as “an articulated and communicated conceptualization of invented or discovered reality in or pertaining to nursing for the purpose of DESCRIBING, EXPLAINING, PREDICTING, or PRESCRIBING nursing care. This definition states the importance of expressing nursing theory in providing direction to nursing care. Barnum (1994) stated that a complete nursing theory is one that has CONTEXT, CONTENT, and PROCESS. Context= resembles environment to which nursing act takes place. Content=subject of the theory. Process=method by which the nurse acts in using nursing theory. Purposes of Nursing Theory In Education Used to develop and guide nursing education in universities and institutions. Used to assist and direct entire education system to create comprehensive curriculum. To ensure adequate and quality nursing delivery. To clarify and improve the status of nursing as a profession. In Research Offer a framework of generating knowledge and new ideas. Assist in discovering knowledge gaps in the specific field study. 8 9 NCM 100: Theoretical Foundations of Nursing Offer systematic approach to identify questions for study. Guide and broaden the nurse knowledge. In Practice Assist nurses to describe, explain and predict everyday experiences. Serve as guide in the assessment, intervention and evaluation of nursing care. Provide rationale for collecting reliable and valid data about client’s health status. Help to establish criteria to measure the quality of nursing care. Interdependence of Theory and Research Nursing Practice Nursing Theory Nursing Research “Practice without theory, like map without route, is blind; theory without practice, like route without map, is empty.” What is nursing? Is the “diagnosis and treatment of human responses actual or potential problems (American Nurses Association). Encompasses “autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings (International Council of Nurses). Virginia Henderson’s definition of Nursing is “to assist clients in the performance of activities contributing to health, its recovery or peaceful death that the client will perform unaided, if they had the necessary will, strength or knowledge.”. Association of Deans of Philippine Colleges of Nursing (ADPCN) A “DYNAMIC DISCIPLINE”. It is an art and science of caring individuals, families and communities geared toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. It is focused on assisting the client as he 9 10 NCM 100: Theoretical Foundations of Nursing or she responds to health-illness situations, utilizing the nursing process and guided by ethico-legal, moral principles. What are Nursing Paradigms? Are patterns or models used to show a clear relationship among existing theoretical frameworks in nursing. (metaparadigms: Greek word ”meta”-with and “paradeigma”-pattern) Four Major Concepts in the Nursing Metaparadigm Person – the recipient of nursing care like individuals, families and communities Example: Nightingale proposed that the physical, intellectual, and spiritual being of a person is not capable of manipulating the environment to promote health. This means that a person is a passive recipient of care. Health – the holistic level of wellness that the person experiences Example: Nightingale defined nursing as a “profession for women (a calling) with the goal to discover and use the laws governing health in the service of humanity.” She believed that the goal of all nursing activity should promote client’s health. Environment- All internal and external conditions, circumstances, and influences affecting the person. Example: Physical environment is emphasized by Nightingale in her theory. She focused on ventilation, warmth, noise, light, and cleanliness Nursing – the interventions of the nurse rendering care in support of, or in cooperation with the client. Example: Nightingale emphasized that a nurse is responsible in promoting well-being of clients by manipulating the environment. NURSING HEALTH PERSON ENVIRON- MENT 10 11 NCM 100: Theoretical Foundations of Nursing What is Science? From the Latin word scientia, meaning “knowledge”. Science is performing the processes of observation, identification, description, experimental investigation, and theoretical explanation of natural phenomena. It is best thought of as an activity that combines research (the advancement of knowledge) and theory (the explanation of knowledge). Refers to any systematic knowledge or practice in a discipline of study. Refers to system of acquiring knowledge based on scientific method. An organized body of knowledge gained through research. The scientific method includes several steps: Scientific Method Observation Integration of knowledge and/or phenomenon by a rational/sentient being. Example: Cris, a nurse-researcher observes a certain nursing phenomena and makes a study about it. Gathering information/data Recognition and collecting data for a particular scientific problem or inquiry. Example: His colleague, Rae helps him to gather data thru various methods Forming Hypothesis An attempt to explain or suggest a nature of a phenomenon. Example: They both make a hypothesis, an intelligent guess on the nature of the phenomenon. Experimental investigation A set of examinations done to solve the particular query raised through the hypothesis process. Example: They conduct a survey and interview, and apply statistical treatment on the data Conclusion or theoretical explanation A statement explaining a set of natural phenomena or a scientific query derived from experimental investigation. Example: Based from the result, they draw a conclusion. As new data emerges, the study is re-examined and verified. 11 12 NCM 100: Theoretical Foundations of Nursing What is Knowledge? Knowledge suggests an understanding acquired through learning or investigation of what is known about a discipline’s subject matter. Knowledge may be based on fact or it may be theoretical based knowledge that is more tentative and subject to change as theory is tested and developed. Information, skills, and expertise acquired by a person The abstract or workable understanding of subject of idea. What is known in a particular field of discipline or study. Facts and information or awareness or familiarity gained by experience of a fact or situation. There is however no single agreed classification of knowledge. Nursing knowledge is composed of both theoretical and practical knowledge (Meleis, 1997). Theoretical knowledge - stimulates thinking and broadens understanding of the science and practice of the Nursing discipline. Practical knowledge – is referred to as the art of nursing. Knowledge acquirement involves several cognitive processes Types of Cognitive Processes Perception Achieving understanding of sensory data Association Combining two or more concepts/ideas to form a new concept or for comparison Learning Acquiring experience, skills, information and values Reasoning Mental process of seeking conclusions through reason Communication Transferring data from sender to receiver using different mediums or tools of communication What are the sources of knowledge? Knowledge emerges from a range of sources which can be categorized into three namely traditional, authoritative, and scientific sources. Traditional knowledge is a nursing practice which is passed down from generation to generation. When asked about the basis of nursing practice the answer would be as simple as “It’s always been practiced this way.” 12 13 NCM 100: Theoretical Foundations of Nursing Example: The routine changing of bed linens in an ICU set up whether it is soiled or not. Even though there are no research data to support this, still the practice is adopted in the hospital as an important component of providing quality patient care. Authoritative knowledge is an idea by a person of authority which is perceived as true because of his/her expertise. Example: A nurse supervisor who is considered expert in the field is teaching a novice nurse on the proper insertion of a urinary catheter insertion. The novice nurse accept it as true because of the “authority of the expert nurse” Scientific Knowledge is a type of knowledge which came from a scientific method through research. These new ideas are tested and measured systematically using objective criteria. Example: A student nurse providing tepid sponge bath to a patient with fever should know the rationale (reason) behind this procedure, which is heat transfer through evaporation (basic physics). The three sources of knowledge are valuable in the body of knowledge that represents the nursing profession. However, each of them has its own strong and weak points. Research is the application of systematic, scientific methods to study phenomena and generate knowledge. Research may generate theory when executed with an inductive approach or it may test theory when conducted with a deductive approach. Induction is a form of reasoning that is loosely described as moving from the specific to the general. In inductive research, particular events are observed and interpreted as a basis for formulating general theoretical statements such as phenomenology or grounded theory. Deduction is a form of logical reasoning that is loosely described as progressing from the general to the specific. Two or more relational statements are used to draw a conclusion.From the theoretical relationships, specific empirical hypotheses are derived. Retroduction combines induction and deduction to originate ideas. This form of reasoning uses analogy as a method of devising theory Hypothesis is a testable relationship statement. 13 14 NCM 100: Theoretical Foundations of Nursing ACTIVITY 1 Based on the materials read, be able to answer the following questions. 1. What is a nursing theory? 2. What are the purposes of nursing theories along education, practice and research? 3. What are the four metaparadigm of nursing? Define each in your own words. One done, take a photo your answer and post it to the discussion forum created for this lesson. WRAP–UP ACTIVITY In the light of your own understanding of the different concepts discussed, define NURSING in your own words in two-three sentences. When finished, kindly take a picture of your output and post it in the discussion forum for this lesson. ASSESSMENT A summative assessment will be administered to you. Be sure to get at least 60% of the test items. REFERENCES Alligood, Martha Raile. (2018). Nursing Theorists and their Works. 9th edition. Elsevier (Singapore) Pte. Ltd. Octaviano, Eufemia F and Carl E. Balita. (2008). Theoretical Foundations of Nursing: The Philippine perspective. Philippines: Educational Publishing House. Peterson, Sandra and Bredow, Timothy S. (2017). Middle Range Theories Application to Nursing Research and Practice 4th edition: China 14