TFN Week 2: Concepts in Nursing History PDF

**TFN WEEK 2:** ***Concepts*** \- building blocks of theories \- pinag-ugatan ng theories ***Theory*** \- back up by research \- need evidence to validate **THE EVOLUTION OF NURSING** ***A. Intuitive Period*** \- start in primitive era to 6th century \- untaught and based from intinct \-...

**TFN WEEK 2:** ***Concepts*** \- building blocks of theories \- pinag-ugatan ng theories ***Theory*** \- back up by research \- need evidence to validate **THE EVOLUTION OF NURSING** ***A. Intuitive Period*** \- start in primitive era to 6th century \- untaught and based from intinct \- based from the compassion Intuition - based on instinct \- belonged to women \- no proper training ***\"Wet Nurse to a child\"*** - breastfeed and nurture the child. ***Shaman / Witch Doctor***- has the ability to heal using white magic. Use incantation, music, dancing, to avoid evil spirits. ***Trephining***- cutting a hole in the head, a medical technique. ***Prehistoric Medical Practice*** 1\. **use of mercury** Mercury- chemical element, a magical substance that can cure most of the serious disease. China (traditional Chinese medicine), Europe, and India uses \- use it as pain reliever, wound care, and anti-inflammatory \- highly toxic in our era 2\. **Blood Letting with Leeches** Leeches - primitive worms that feed on blood \- Medicinal leeches: ***Hirudo Medicinalis*** - each feeding it ingest 5-10ml of blood. \- use for Venus congestion 3\. **Lobotomies** \- surgical operation involving incision in the pre-frontal lobe of the brain to treat mental illness. 4\. **Heroine for headaches** \- highly addictive drug \- brown/white powder or black sticky substance 5\. **Electroconvulsive Therapy (ETC)** \- medical treatment with severe major depressionss \- use for human with bipolar disorder \- uses electricity, ***oldest most controversial treatment in psychiatry.*** 6\. **Trephining** 7\. **Cannibalistic Medical Practices** \* Sympathetic Magic - powdered blood and powdered skull to help migraine. 8\. **Radium Water** Radium- chemical element, highly radium active metal \- use for energy booster 9\. **Ecraseur** \- use for removing tumor 10\. **Plombage** \- use for treatment in tb patients \- insert fat, wax, or oil in the thoracic cavity 11\. **Peg Legs** \- made up of wood \- artificial legs or limb 12\. **Morphine for Teething** \- used as soothing syrup 13\. **Starvation for Aneurysms** 14\. **Hydroelectric Baths for Migraines** \- give low dose of electricity while bathing the patients **Rise of the Early Civilization and Ancient Cities and their Contribution to Medicine** - Civilization starts near the body of water 1\. **Mesopotamia** - modern day Iraq \- the crater of civilization \- start in *Tigris and Euphrates river* \- they believe in magic ***Diagnostic Handbook*** - it is a list of text that have symptoms, observation, along with the symptoms that patient see, diagnostic, and prognosis. ***Asipu*** - medical authority who uses magic ***Asu*** - medical doctor that treats illness and injuries, the physical symptoms. They believe that gods cause mental illness 2\. **Egypt** \- one of the oldest and greatest civilization in the history of mankind. \- start civilization near the Nile River \- Egyptian Doctors considered priest during that time. \- Egypt have advance knowledge about anatomy and surgery. ***Edwin Smith Papyrus***- buy the papyrus and named after him. \- ancient textbooks on surgery that have *62 diseases and surgery cases.* Papyrus - plant that became a brown sheet, became the writing paper for anatomical observation. The contents are Medicinal Encyclopedia and Pharmacopeia. ***The Kahun Gynecological Papyrus***- treat all about women\'s complaints Kahun- it is a place/town near Letum ***Imphotep*** - earliest known physician \- Chief of Dentists and Physicians for king Djoser in 27th Century B.C.E ***Peseshet*** (*Lady Overseer of Female Physicians*)- earliest know woman physician, guide womens physician. 3\. **India** \- Hinduism \- Vedas - sacred text ***The Atharvaveda***- asian text, collection of hymns, magic spells, incantation, dances, and mantras to cure disease, establish peace, protection, and health. \- *\"Knowledge store house\"* ***Ayurveda*** - complete knowledge for long life -science of life, each person have life force (dosha) \- treatment: internal cleansing, yoga, special diet, herbs and plants, massages. Charaka and Sushruta - 2 most famous medical Textbooks ***Charakasamhita*** - discuss diet, hygiene, and medical education ***Sushrutasamhita*** - discuss surgical procedures 4\. **China** ***Huangdi Neijing***- process of the body that follow a certain natural rule, and health and disease are influence by natural aging process and environment \- foundational text of traditional chinese medicine written by famous chinese emperor Huangdi. ***Acupuncture***- fricking a skin with a very fine needle, to arigate the pain or treat the physical and mental condition. ***Moxibustion***- form of therapy that entails the burning of your mugwort leaves. 5\. **Greece and Roman Empire** ***Hypocrotes***- Father of ancient greek medicine, and father of Modern Medicine. Wound Treatment \- use sea water and red wine \- illness was a sign of weakness \- Slaves/Greek Physician- who take care of the ill B. Apprentice Period \- 6th century to 18th century \- Period of \"OJT\" \- Start when the Religious orders is established \- Kaiserwerth Institute for training of Deaconesses \- performed without any formal education ***Religious Orders*** - military order that establish to protect and care the people who will go to holy land (Jerusalem) The beginning of Religious War \- holy war, cause by difference in religion \- christians vs muslims ***Crusades*** - holy war that attempt to get the holy city from the turks to the muslims **Military Religious Orders and their works** \- the ones who help and protects christians to go in the holy land (secretly) 1\. **Knights of St. John of Jerusalem** (Italian) \- *Knights of the Hospitalers* \- founded hospital 2\. **Teutonic Knights** (German) \- established tent hospitals 3\. **Knights of St. Lazarus** \- founder of nursing care specifically for patient who have leprosy. 4\. **The Alexian Brothers** \- established largest nursing school under religious order. \- *\"Alexian Brothers Hospital School of Nursing\"* - exclusive for American men. \- help in pandemic black plague, bubonic plague The Rise of Secular Order (women) \- group of people who established organization for the poor and sick 1\. **The order of St. Francis of Assisi** \- 2\. **The Beguines** \- ***lay nurses***, who have informal vow of chastity \- very prayerful, and active in charity 3\. **The Oblates** \- a *group of priests and brothers* who help people in need. \- ***offering*** 4\. **Benedictines** \- group of people who follow rule of St. Benedict 5\. **Ursulines** \- group of people who follow order of St. Ursula \- *education for women's* **Important Nursing Personages** 1\. **St. Claire** - founder of poor ladies \- inspired by the life of St. Francis of Assissi 2\. **St. Elizabeth of Hungary** \- *\"Patroness of Nurses\"* \- gives 200 bread to the poor 3\. **St. Catherine of Siena** \- *first lady with the lamp* \- distribute food for poor and attend hospitals to help for the sick. **The Rise of Protestantism** \- *1520-1562* \- branch of christianity \- the sin was forgiven through faith/pananampalataya \- arguments of Martin Luther with Catholic Churches \"Lutherans\" - protestants **The Start of dark period of Nursing** Industrial and Political Revolution \- the birth of steamed engine/machine \- age of mass production Reformation in the 16th Century \- reform in Santo Papa **DARK PERIOD OF NURSING** *17th to 19th century* Period of Reformation and American Civil War destroyed the unity of Christian Faith **Theodore Fliedner** \- a *german pastor and protestant* \- founded the ***Keiserwerth, Germany*** \- opening of formal training in nursing Deaconess- ministry of womens in the protestant church **1st Training School of Nursing** United States of America ***Bellevue Hospital School of Nursing*** \- *New York, 1873* \- based on principles of Florence Nightingale Philippines **Iloilo Mission Hospital School of Nursing** \- established by *baptist missionaries*, *1906* \- under the leadership of *Ms. Rose Nicolet*, the *first superintendent*. **Florence Nightingale** \- came from wealthy respectful family \- May 12, 1820 \- Keiserwerth, Germany (1851) \- \"The mother of modern nursing\" \"The lady with the lamp\" & \"Professional Nurse Pioneer\" \- Crimean War (Turkey) - 1854 to 1856 Nightingale Era \- brought cleanliness, sanitation, nutritious food, and comfort to patients \- ***environmental theory*** \- providing the kind of personal care in mental health \- group of 38 nurses, mortality rate of patients fell in 6 months. \- ***Published Notes on Nursing (1859)*** \- implemented handwashing and other hygiene practices **C. EDUCATION PERIOD** \- period of Florence Nightingale \- established ***\"Nightingale Training School for Nurses\"*** in St. Thomas Hospital, London (1860) **D. CONTEMPORARY PERIOD** \- 21th Century \- belonging to the present \- nurse in the digital driven word \- starts after the World War I **Nursing after World War I** \- war between France, Russia, Britain VS Germany, Austria, Hungary, Italy \- with the aid of the coremen (military medical aid) \- *independent nursing practice*: no need doctors order \- women empowerment **Nursing after World War II** \- acute shortage of nurses/caregiver \- *open practical nurses* \- some nurses developed PTSD **Rise of BSN Curriculum** ***Julita V. Soteja*** \- starts nursing curriculum \- PGH School of Nursing \- Became principal in PGH SAJ (Spain, America, Japanese) **UST** - **College of Nursing (1946)** \- first nursing college school in the ph \- first university who have graduate nurse **MCU** - **College of Nursing (1947)** \- first offered BSN Degree and Doctor of Medicine Degree **UPM** - **College of Nursing (1948)** \- first dean Julita Sotejo **Week 3** ***NURSING IN TODAY\'S SOCIETY*** \- *\"Nursing is an Art\"* - Florence Nightingale **History of Nursing Science** \- Theory and Practice must be constantly interactive \- Theory without practice is empty \- Practice without theory is blind **CAUTI**- *Catheter Urinary Tract Infection* **Introduction to Nursing Science Theory: History** 1\. ***Curriculum Era (1900 to 1940\'s)*** Subjects need to be nurse Standardized curriculum Develop specialized knowledge in nursing 2\. ***Research Era (1950 to 1970)*** participate in research no clear theoretical framework include research subject planning doctoral education ***Isolated studies*** - not backup of nursing science starts of nursing theories 3\. **Graduate Education Era (1950 - 1970)** Formal introduction of nursing theories to educational curriculum advancement in nursing education offered PhD and Master\'s degree programs in nursing should be based on Nursing Science 4\. **Theory Era** **(1980 -- 1990)** formal development of theories ***Research + Theory = Nursing Science*** isolated information - without theory focus to the patient 5\. **Theory Utilization Era (21st Century)** nursing theory guides/application in practices practices are based on research **Nursing theory** \- SAHI that explains or predicts nursing reality **Nursing as a discipline and Profession** **Discipline** - big umbrella \- Branch of Education \- Department of Learning \- Domain of Knowledge \- Ex. Health Science **Profession** -- specialized knowledge \- Ex. Nursing, Pharmacist, Dentist **SIGNIFICANCE OF NURSING AS DISCIPLINE** \- has standardized baccalaureate programs and masters program \- Henderson and Nightingale : backbone of research because of their theories CRITERIA \- auto: me, nomous: governing \- RA 9173 IMPORTANCE OF NURSING THEORIES \- assists nursing discipline \- standards of clinical practices \- care distribution of nursing ANALYSIS OF THEORY \- Clarity: clear \- Simplicity: simple \- Generality: general/scope \- Accessibility: accessible \- Importance: important **NURSING THEORISTS** **1. Hildegard Peplau** \- Mother of Psychiatric Nursing \- *Interpersonal theory*: foundation of nursing practice \- nurse and patient relationship \- ability of nurse to understand herself - ***SELF AWARENESS*** **PHASES OF NURSES** 1\. Orientation Phase - acquainted phase \- early level of trust \- first meeting with the patient 2\. Identification Phase- begin to identify problems to nurse \- help patient to recognize his/her responsibility 3\. Exploitation Phase - full level of trust \- full use of nursing service ***Therapeutic Use of Self*** - communication skills, solve problem, self-awareness 4\. Resolution Phase \- patients discharged \- terminated patient relationship \- less reliant to nurse **NURSING ROLES** 1\. Stranger Role \- accepting client \- professional smile 2\. Resource Roles \- source of information and knowledge to patient \- answer questions to patients 3\. Teaching Role \- gives instruction and practices 4\. Counseling Role \- provides emotional support, guidance and encouragement to patient 5\. Surrogate Role \- patient advocate \- represent patient needs \- stand up for patient 6\. Technical Expert \- operate equipment 7\. Active leadership \- achieve patient goal **ASSUMPTIONS** \- nurse and patient can interact 2\. **Virginia Henderson** ** ** *The Nightingale of Modern Nursing* * The 20^th^ Century Florence Nightingale* Modern Day Mother of Nursing \- **14 basic needs theory** \- 60 years of service as nurse \- nurse researcher \- Assist the individual in Activities \- ***\"The Nature of Nursing Model\"*** \- patient focused nursing Enema- excretion **3 levels of patient-nurse relationship** 1\. Substitute for the patient 2\. Helper to the patient 3\. Partner with the patient Independent Nursing Intervention - don't need doctors order **Assumptions of need theory** \- nurse care for patients \- nurses are willing to serve **METAPARADIGM** 1\. Person -- individual who needed assistants. 2\. Health- based on 14 basic needs 3\. Environment- external condition, setting 4\. Nursing -- assist and support in activities "***UHM AHH, UHM AHH AHH" - activities*** 3\. **Faye Abdellah** \- **21 nursing problems theory** Living Legend Award nurse/psychologist public health nurse/servant published 150 + researches \- needs of the patients \- Nursing service in Individual, Families, and Society \- 10 Steps to Identify client's problem + 11 nursing skills HEALTH ASSESSMENT - HAS NCP - NURSING CARE PLAN: output/assessment in the patient **TYPOLOGY OF NURSING PROBLEMS** Purpose: To guide care and promotes use of nursing judgement 1-4 Basic Needs 5-11 Sustenal Care Needs- to sustain the body 12-18 Remedial Care Needs- emotion and spiritual goals 19-21 Restorative Care Needs- restoring the patient **METAPARADIGM** P: Person People who have 21 nursing problems H: Health not specified, but based on 21 nursing problems E: Environment focused on Individual, Family, Community N: Nursing help people cope with health needs **FOCUS OF CARE PENDULUM** ** ** The nurse should be always *client-centered* 4\. **Ida Jean Orlando** \- ***The nursing process theory*** \- Yale University School of Nursing \- nurses must validate your assessment \- analyzed 2,000 patient-nurse contact \- the theory was published in *Dynamic Nurse Patient Relationship* ***NURSING PROCESS THEORY*** Interaction between nurse and patient action should be evaluated after carried out. *ADPIE* A. **Assessment** * * Subjective Data: Complaints, History, Medications \| mga sinasabi ng patient Objective Data: Vital Signs ***D- Diagnostic*** * * Clinical Judgement ***P- Planning*** *** *** set a goal or outcome ***I- Implementation*** *** *** performing nursing care plan or intervention ***E- Evaluation*** Evaluate goal/outcome of your intervention **ASSUMPTIONS** **-** unmet needs = distress patient \- patients experience distress or feeling of helplessness \- nursing offers Mothering \- patients are secretive or explicit in their needs \- dynamic nurse-patient situation **METAPARADIGM / MAJOR CONCEPTS** ***P: Person*** Humans in need ***H: Health*** *** *** replaced by helplessness ***E: Environment*** *** *** not defined, but in a patient setting ***N: Nursing*** *** *** The nursing process has proper training 5\. **Lydia Hall** \- ***Core, Care, Cure model*** rehabilitation Nurse \- nurse has independent practice ***THE CORE / THE PERSON*** ***-** Social Sciences* \- inner feelings \- emotional need of patients ***THE CARE / THE PATIENTS BODY*** ***-** Natural and Biological Sciences* \- intimate bodily care \- assist ADL (Activities of Daily Living) ***THE CURE / THE DISEASE*** ***-** Pathological and Therapeutic Sciences* \- medical treatment \- applies doctor's order **METAPARADIGM** ***P: Person*** \- 16y/o above \- has long term illness ***H: Health*** \- Self awareness ***E: Environment*** \- Long term facilities (Rehab Center) ***N: Nursing*** \- Caring **HISTORY OF PHILOSOPHY AND SCIENCE** **PHILOSOPHICAL PERSPECTIVE** **RATIONALISM** \- ***reason*** and logic \- Priori Reasoning = Deductive Reasoning: cause and effect \- theory then research strategy **EMPIRICISM** \- based on ***experience*** and ***experimentation*** \- Inductive Reasoning: Gathering of facts through experience and observation, then formulate theories. \- research then theory strategy **EARLY 20TH CENTURY VIEWS OF SCIENCE AND THEORY** ***Philosophers*** -- analyze theory ***Scientist*** -- empirical research (gathering of data based on experience before formulating theory) **Epistemology** - theory of knowledge, how to answer the question - Use rationalism and empiricism **Positivism** -- believed in 2 approaches (inductive and deductive reasoning) **Propositions** -- tested through observation and experimentation - corrects or modifies hypothesis **EMERGENT VIEWS** ***Foucault (1973)*** - empirical knowledge, arranged by the differences of people's experience ***The Phenomenology of the Social World, Schutz (1967)*** - lived meaning full of Experience - differences of lived experiences ***Brown (1977)*** - challenging the empicist view - the scientists observations are based on her/his interpretation 3 Different Views of the relationship between theories and observation: 1. Scientists are passively observers--- they observed what they see (objective truth) 2. Nursing theories are back up with nursing science 3. Nursing theories and data were needed for research ***Gale (1979)*** - think outside of the box - challenge mental mindset **Paradigm Shift** -- progress of sciences : Pre-science --- normal science --- crisis --- revolution --- new normal science AHA - AMERICAN HEALTH ASSOCIATION \- every five years CAB - CIRCUMSTATION AIRWAY BREATHING (Before)ABC - AIRWAY BREATHING CIRCULATION \- priority **NURSING AS SCIENCE** - About nursing theories - Specialized knowledge - Nursing science = Theories + Research **NURSING AS AN ART** - Emphaty towards the patients **STRUCTURE OF NURSING KNOWLEDGE** **METAPARADIGM** \- 1^st^ component of structural hierarchy \- PHEN (Person, Health, Environment, Nursing) \- most abstract or general \- "Meta": with, "Paradigm": patterns **PHILOSOPHY** **-** 2^nd^ component of structural hierarchy \- beliefs and values \- guiding principles in nursing **CONCEPTUAL MODELS** **-** 3^rd^ component of structural hierarchy \- concept and their relationship with each other \- simplifies reality \- other terms: Conceptual Framework, Conceptual System, Paradigm, Disciplinary Matrix Example of Conceptual Model: ***IPO- INPUT PROCESS OUTPUT*** Input - demographic profile Throughput -- process of gathering the data Output- result of the data **THEORY** **-** 4^th^ component of structural hierarchy \- answer question in mind \- describes concepts \- interpret situations, events, behaviors.  **NURSING PHILOSOPHIES** **"MaKaKaFPJ"** ***Ma***- [Ma]rilyn Anne Ray ***Ka***- [Ka]tie Erickson ***Ka***- [Ka]ri Martinsen ***F***- [F]lorence Nightingale ***P***- [P]atricia Benner ***J***- [J]ean Watson **NURSING CONCEPTUAL MODELS** **"**Si **Betty,** nag **Call** sa friend nya, **DIDMMA!"** ***Betty --*** [Betty] Neuman ***Call --*** Sis [Call]ista Roy ***D --*** [D]orothea Orem ***I --*** [I]mogene King ***D --*** [D]orothy Johnson ***M --*** [M]yra Levine ***Ma --*** [Ma]rtha Rogers **EMPIRICAL INDICATORS** **-** 5^th^ component of structural hierarchy \- form of research instrument \- help to test your middle range theory **METHOD OF THEORY DEVELOPMENT** 1\. Theory - Practice - Theory 2\. Practice - Theory 3\. Research Theory **Theory components** 1\. Concepts and Definition Concept- building block of theories Definition- general meaning Abstract Concepts -- generic/general Ex. Transportation Concrete Concepts -- specific Ex. Wheelchair 2\. Relational Statements \- relationship between the concepts 3., Linkages and Ordering \- development of theoretical linkages \- provides explanation **Purpose of Nursing Theory** 1. Education 2. Research 3. Clinical **WEEK 4** **Week 4** **Nursing Philosophies** **FLORENCE NIGHTINGALE --- "Environment"** - "The Lady with the lamp" - "The Mother of Modern Nursing" - May 12, 1820 - Died Aug 13, 1910 - Keiserwerth, Germany (1851) - Went to paris to study - Superintendent of the Hospital for Invalid Gentlewomen in London - The meaning of nursing came from Florence Nightingale **THE NIGHTINGALE ERA** **F -** Founder of Modern Nursing **L -** Lady with the Lamp **O -** nOtes on Nursing: What it is and What it is not **R -** Rich and Intellectual Family **E -** fErst scientist theory **N -** Nightingale Training School for Nurses **C -** Called by God (God spoke to me and called me to his service) **E -** Environmental Theory **USE OF EMPIRICAL EVIDENCE** ***Empirical : Experience*** - she observed environmental problems - Lacks of sanitation - Few chamber pots - Contaminated water - Contaminated bed linens - Overflowing cesspools/poops - First ever who made diagram - Polar Area Diagram - represent the deaths in British Military Hospitals **ENVIRONMENTAL THEORY** - Act of utilizing environment - Nurse's initiative to configure environmental settings - Manipulation of physical environment as a major component of nursing **Major Concepts** - Nurses are in control in environment physically and administrative - Leader and protect who could negatively affect recovery - Pet visits might comfort to the patient **MAJOR ASSUMPTIONS** **P - Person / Patient** - the one who receives the care **H - Health** - being well and using every power (resource) - Disease and Illness: reparative process of nature, because of imbalance in environment - Health Nursing: enhancing living better **E - Environment** - anything can be manipulated to place a patient in the best possible condition **N - Nursing** - responsible for someone else's health - Spiritual - Repair the patient to the doctor **12 SUB CONCEPTS OF ENVIRONMENTAL THEORY** 1. **Health of Houses - surroundings of Hospital** 2. **Check Ventilation and Warming of the Hospital** 3. **Light - natural light** 4. **Cleanliness of Rooms and Walls** - no dust, mildew, cobwebs 5. **Personal Cleanliness** - both for patient and the nurse - Take a bath and change clothes everyday 6. **Noise** - rest and relaxing environment 7. **Variety (gives cards, flowers, pictures, books)** - give them diversional activities 8. **Bed and Bedding** - cleaned and soiled 9. **Nutrition and Taking food** - preference in taking food 10. **Chattering Hopes and Advices** - listening nurse 11. **Observing the sick** - charting and observing 12. **Petty Management** - nursing administrative skills - Pet visits - Incharge in administrative decisions **3 MAJOR RELATIONSHIPS** 1. **Environment to Patient** - environment was the source of disease/illness 2. **Nurse to Environment** - manipulates environment 3. **Nurse to Patient** - observe, document, report to the doctor **THEORETICAL ASSERTIONS** - Disease was the natural way of the body to repair - Nursing Education, "Notes on Nursing" - for women caregivers, practical tips to be nurse - Health Assessment - Patient cooperate with nurse - Concept of Contagion and Contamination - Nursing is a calling (need for commitment and dedication to nursing work) - Moral Agents, principle of confidentiality and advocated for poor **Neils (2010) liason nurse:** rounding in patients, expressing caring and spiritual support while observing the patients **LOGICAL FORM** - Childhood Education - Philosophy and Mathematics - Training in Keiserwerth, Germany - Observations - contaminated, dirty, dark environment led to disease - Richness of her experience, she a theory - Environmental Theory was based on Inductive Reasoning **ACCEPTANCE BY THE NURSING COMMUNITY** **Practice** - Foundation of nursing practice - Relevant and Evident in Modern Nursing Practice in Covid-19 Pandemic - Hospital environment increasing volume of noise - Mcphaul and Lipscomb (2005), applied Nightingale principles to Occupational Health Nursing - company nurse **"Do the sick no harm" --- Florence Nightingale** **Education** - Universal template for early nurse training school - Good practice could result only from good education **Research** - Accurately identified in the Polar Diagram **JEAN WATSON --- "Harmony"** - ***Human Caring Theory*** - ***Transpersonal Caring Theory*** : nurse to patient, 2 individual - Continuous evolving/growing theory - Graduated at University of Colorado - Nurse Educator - Established Center for Human Caring at University of Colorado - Watson Caring Science Institute : non profit org **Transpersonal Caring Relationship** - special kind of human care relationship - Union with another person **CARATIVE FACTORS & CARITAS PROCESSES** - **Spiritual + love and charity (Caritas)** **Carative Factors** - fully aware and intentional in providing care **MAJOR CONCEPTS: 10 Caritas Processes** **1. Practice of Loving Kindness and Mental Calmness toward self and other** - **Altruistic Values --** selfless **2. Instill faith and Hope. Honor others** - humanity - Being authentically present - Therapeutic Use of Self **3. Cultivation of One\'s Own Spiritual Practices going beyond ego self** - Sensitive to yourself and others - self awareness / actualization **4. Develop and Sustaining a Helping Trust caring relationship** - - **5. Being present to, supportive of** - accepting behavior **6. Creative Use of Self** - uses knowledge creatively **7. Engaged in Genuine Teaching-Learning Experience** **8. Perform teaching & Learning** - teaching and learning techniques **9. Creating a Healing Environment at All levels** - there is a god in healing and miracles - Internal environment  - Spiritual well being of the patient **10. Assist with physical, emotional, and spiritual needs** **11. Opening and Attending to Spiritual/Mysterious unknowns of Life death** - Allow room for miracle **MAJOR ASSUMPTIONS** - **extending to multi disciplinary practitioners** - **intentional** - **sustain caring in the midst of threat and despair** - ***I - hu relationship*: seeing patient as a human** - **Sustain caring in the midst of threat and despair** - **connect in genuine presence with patient** - **continuous growth within transpersonal caring model** **CARITAS NURSE - perform altruism --- being selfless** **7 ASSUMPTIONS OF CARING AS SCIENCE** 1. **Caring can be effectively demonstrated and practiced only interpersonally.** - **nurse to nurse, and nurse to patient** 2. **Caring consists of Carative Factors that result in the satisfaction of certain human need.** - **humanity** 3. **Effective caring promotes health an individual or family growth.** - **Health promotion** 4. **Caring responses accept a person not only as he/she is now but as what he/she may become.** - **Don't judge the patient as a person** 5. **A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself at a given point of time** - **offer options** 6. **A science of caring is therefore complementary to the science of curing** - **caring + curing** 7. **The practice of caring is central to nursing.** **METAPARADIGM** **P: Personhood** - **Human being, Person, Life, Self** - **Unity of mind/Spirit and harmony** **H: Health** - **Unity and harmony within the mind, body, soul** **E: Environment** - **Sustaining the planet** - **humanity** **N: Nursing** - **as a noun tao** - **As a verb --- caring factor** **LOGICAL FORM** **Caring** - **nursing knowledge** - **Compassion** - **Emphaty** **Curing** - **medical knowledge** - **treatment** - **integrate humanities** **APPLICATION BY THE NURSING COMMUNITY** **Practice** - **Validated in outpatient, inpatient, and community health clinical setting** - **Living on a ventilator** - **Mothers struggling with mental illness** - **Women with infertile** - **Attending Nursing Caring Model (ANCM)** - **Applies of Watson Caring Science to practice** - **Study of Unique pilot project in Denver Children's Hospital** - **Nurses participate in this project** - **Human caring theory adapted in many hospitals** **Administration & Leadership** - **embrace caring** - **Consciously performing caritas processes** **Education** - **incorporate in the University of Colorado** - **PhD in nursing with a caring science focus** **Research** - **Qualitative --- lived experience** - **Better if its combination research** **Core of Nursing - caring and kind profession** **MIND - BODY - SPIRIT = Holistic Nursing Care** **Obligation to care for the patient** **REQUIRED TLC - Tender Loving Care** **MARILYN ANNE RAY** - **Bureaucratic Caring Theory** - **complex bureaucratic healthcare system** - **Graduated from St. Joseph Hospital School of Nursing, Hamilton** - **U.S Air Force: held rank of Colonel** - **Inducted as a Fellow of the American Academy of Nursing (FAAN)** **THEORY OF BUREAUCRATIC CARING** - **provides direction and guidance for nurses** - **caring is lived and expressed throughout the hospital** - **Under hospital management** **Central Concepts:** **T- truth** **C - caring (seeing the good of things)** **C -- communication** **MAJOR CONCEPTS** **Caring - grounded in ethics, it was able to know what right and wrong** - **relationship between charity and right action** **SPIRITUAL ETHICAL CARING** - **focused on the nurse---patient relationship** - **How will the nurse decide** - **Guiding principle of nurse in decision making** **Educational** - **use of audio visual to convey information** - **Educational factors related to the meaning of caring** **Physical** - **physical state: biological, cognitively and mental** **Socio-Cultural** - **ethnicity and family structures** - **Social interaction and support** **Legal** - **responsibility and accountability** - **Policies and procedures** - **Informed consent, privacy, liability issues** **Technological** - **use of machinery** - **Diagnostic test** - **Computer assisted practice and documentation** - **EMR : Electronic Medical Record** - **EHR : Electronic Health Record** **Economic** - **Money , Budget, Insurance** **Political** - **power structure within health care administration** - **Deciding person: CEO, Mayor** - **Union activities** - **Use of power, prestige, privilege** - **human and material resources** **USE OF EMPIRICAL EVIDENCE** **Theory of Bureaucratic caring - qualitative research involves health professionals and clients in hospital setting** **M.A.R studied caring in all areas of hospital: 200 respondents** 1. **Nursing Practice** 2. **Materials Management - supplies medical materials** 3. **Administration - higher ups: Medical Director, Chief Nurse, etc** - **ICU - technological monitoring caring** - **Oncology Unit - intimate, comforting, spiritual caring** - **Staff nurses - caring in relation to patients** - **Administrator - relation to the system/hospital** **METAPARADIGM** **P : Person** - **spiritual and cultural being** - **Person are created by God** **H : Health** - **in terms of biology, mental patters** **E : Environment** - **complex spiritual, ethical, ecological, and cultural phenomenon** **N : Nursing** - **holistic, relation, spiritual, ethical caring** - **Love is the foundation of spiritual caring** **THEORETICAL ASSERTIONS** - **caring in nursing is contextual** - **It depends on what department/role/position the meaning of caring is.** - **spiritual-ethical caring is both part and a whole** - **every part secures its purpose and meaning from other parts** - **spiritual ethical caring --- operate by conscious choice** - **nurse's choice making occurs with humanity at heart** **ACCEPTANCE BY THE NURSING COMMUNITY** **Practice** **Ray (2001): deep values that underlie choice to do good will be felt inside and outside organizations** **Administration** **Based on Ray: nurses, patient, and administrators value the caring intentionally** **Education** - **developed new baccalaureate nursing program** - **combined Ray's theory bureaucratic caring with theoretical ideas from Watson (1985) and Johns (2000)** **TAKE NOTE:** **FLORENCE NIGHTINGALE** - **Environmental Theory** - **Manipulate environment to treat patients** **JEAN WATSON** - **Human Caring Theory** - **10 Caritas Processes** - **Consciously be kind to yourself and others** **MARILYN ANNE RAY** - **Bureaucratic Caring** - **Caring in the Hospital** - **Based on Nurse Spiritual-Ethical Caring**