Lesson 2: Nursing Philosophies PDF

LESSON 2: NURSING PHILOSOPHIES Learning Outcomes Presentation of the Topic After working on this lesson, you should be able to: The1.Targets Discuss the different Nursing Philosophies to include: a. Nightingale’s Environmental Theory; The Contents b. Watson’s Philosophi...

LESSON 2: NURSING PHILOSOPHIES Learning Outcomes Presentation of the Topic After working on this lesson, you should be able to: The1.Targets Discuss the different Nursing Philosophies to include: a. Nightingale’s Environmental Theory; The Contents b. Watson’s Philosophies and Theory of Transpersonal Caring; Processingc.the Contents Benner’s Stages of Nursing Expertise; Applicationd.in Erikson’s Nursing Caritative Caring Theory. 2. Define the metaparadigm as described by each theorist; Recapping your 3. Utilize Learning theories to current practice; 4. Formulate a reflection paper on current nursing journals related to discussed theories. Presentation of the Topic Nursing Philosophies are theoretical works that address one or more metaparadigm concepts and are of philosophical in nature. It is broad and talk general ideas, which contribute to the nursing discipline by providing direction, clarifying values, and forming a foundation for theory development. The Contents Florence Nightingale’s Environmental Theory “Nursing ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” History and Background Born: May 12, 1820 in Florence, Italy Great compassion and concern for people of all types At age 24, she decided to help the suffering masses and desired to work in a hospital Served the wounded soldiers during the Crimean War Established a school of nursing at St. Thomas Hospital in England Wrote many manuscripts about hospital reform and nursing care Founder of Modern Nursing Advocated that nursing knowledge is different from medical knowledge Philosophy is environment-oriented Conceptual Framework Major Concepts 1. The manipulation of environment is a major component of nursing care 2. Environment includes social and psychological environment 3. When one or more aspects of environment are out of balance, the client must use increased energy to counter the environment stress 4. STRESSES drain the client of energy needed for healing Major Areas of physical, social and psychological environment 1. Health of Houses Presence of pure air, pure water, efficient drainage, cleanliness, and light 2. Ventilation and Keep the air you breathe as pure as the external air warming Not too warm or too cold 3. Light Direct sunlight Light has quite real and tangible effects upon the human body 4. Noise Patients should never be waked intentionally or accidentally Noises may irritate patients 5. Variety Need for changes in color and form Mind greatly affects the body 6. Bed and bedding Keep bed and bedding clean, neat and dry Position the patient for maximum comfort 7. Cleanliness of Use damp cloth rather than a feather duster rooms and walls Clean room is a healthy room 8. Personal Bathing and drying the skin provided great relief Cleanliness “Every nurse ought to wash her hands very frequently during the day” 9. Nutrition and Frequent small serving is more beneficial than large Taking Food breakfast/dinner 10. Chattering hopes False hope is depressing and advices Patients should hear good news that would assist them in becoming healthier 11. Observation of the Teach nurses what to observe, how to observe, what Sick symptoms indicate improvement, what is the reverse, which are of importance, which are of none, which are evidence of neglect and what kind of neglect 12. Petty Management House and hospital needed to be well-managed – organized, clean, and with appropriate supplies Metaparadigm AEnvironment Person - Surroundings - The “patient” - Anything that can be manipulated to - Passive place a patient in the best possible condition for nature to act - Nursing – to assist nature in healing the patient Health Nursing - Being well and using every - A spiritual calling power/resource to the fullest extent - Assists nature to repair the patient in living life - Uses powers of observation in - Disease and illness is a reparative caring for patients process - Must have educational background & knowledge different from physicians Processing the Contents Environmental Theory and the Nursing Process Assessment A 25-year old patient says “Nurse, I am in ✓ Ask what is needed of wanted pain.” What will you do/ask? ✓ Do not ask YES/NO questions _________________________________ ✓ Use precise and specific _________________________________ observations concerning all _________________________________ aspects of physical health and _________________________________ environment As a nurse, you have observed that a 60- Diagnosis year old male client has not eaten his ✓ Client’s response to the breakfast and lunch. What will you environment say/ask? Planning _________________________________ ✓ Identify nursing actions to keep _________________________________ client comfortable and in best state _________________________________ for nature to act upon _________________________________ Implementation A 15-year old patient in a private room is ✓ Taking actions to modify the having a chill. After assessment, you environment noticed that the air conditioning unit is set Evaluation to 160C. What will you do? ✓ Effects of the changes in the _________________________________ environment _________________________________ ✓ Use OBSERVATION _________________________________ _________________________________  Margaret Jean Watson’s Philosophy and Theory of Transpersonal Caring We are the light in institutional darkness, and in this model, we get to return to the light of out humanity.” History and Background Born in Welch, West Virginia Undergraduate and graduate degrees in nursing and psychiatric mental health nursing PhD in educational psychology and counseling The main focus in nursing is on CARATIVE FACTORS In order for nurses to develop humanistic philosophies and value system, a strong liberal arts background is necessary. Major Assumptions 1. Caring can be effectively demonstrated and practiced only interpersonally. 2. Caring consists of carative factors that result in the satisfaction of certain human needs. 3. Effective caring promotes health and individual or family growth. 4. Caring responses accept person not what he/she is now but what he/she may become. 5. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. 6. Caring is more “healthogenic” than is curing. A science of caring is complimentary to the science of curing. 7. The practice of caring is central to nursing. Major Elements 1. The CARATIVE Factors: replaced by CLINICAL CARITAS How NURSES develop a CARING CHARACTER? CARATIVE FACTORS CLINICAL CARITAS YOUR REFLECTIONS “caring with love” included spiritual dimension What will you ask yourself to assess if you are ready to give CARE to your client? The formation of a Practice of loving kindness __________________________ humanistic-altruistic and equanimity toward self __________________________ system of values and other within context of __________________________ caritas (caring) consciousness The installation of faith- Being authentically present, __________________________ hope enabling, sustaining, and __________________________ honoring the faith, hope, and __________________________ deep belief system and the __________________________  inner-subjective world of __________________________ self/other The cultivation of sensitivity Cultivation of one’s own __________________________ to one’s self and to others spiritual practices and __________________________ transpersonal self, going __________________________ beyond ego self, opening to __________________________ others with sensitivity and __________________________ compassion The development of a Developing and sustaining a __________________________ helping-trust relationship helping-trust, authentic caring __________________________ relationship The promotion and Being present to, and __________________________ acceptance of the supportive of the expression of __________________________ expression of positive and positive and negative feelings __________________________ negative feelings as a connection with deeper __________________________ spirit of self and the one-being- __________________________ cared for The systematic use of the Creative use of self and all __________________________ scientific problem-solving ways of knowing as part of the __________________________ method for decision- caring process to engage in __________________________ making artistry of caring-healing __________________________ practices/caritas The promotion of Engaging in a genuine __________________________ interpersonal teaching- teaching-learning experience __________________________ learning that attends the unity of being __________________________ and meaning, attempting to __________________________ stay within other’s frames of __________________________ reference The provision of a Creating healing environment __________________________ supportive, protective, and at all levels, subtle __________________________ corrective mental, physical, environment of energy and __________________________ sociocultural, and spiritual consciousness, whereby __________________________ environment wholeness, beauty, comfort, __________________________ dignity and peace are __________________________ potentiated Assistance with the Assisting with basic needs, __________________________ gratification of human with an intentional caring __________________________ needs consciousness, administering __________________________ human care essentials, which __________________________ potentiate alignment of mind- __________________________ body-spirit, wholeness and __________________________ unity of being in all aspects of __________________________ care; tending to both the __________________________ embodied spirit and evolving __________________________ spiritual emergence The allowance of Opening and attending to __________________________ existential- spiritual – mysterious and __________________________ phenomenological forces - existential dimensions of one’s __________________________ allowance for existential- own life-death; soul care for __________________________ phenomenological-spiritual self and the one-being-cared __________________________ forces for The EXISTENTIAL-PHENOMENOLOGICAL-SPIRITUAL FORCES is the most difficult to understand. Hence, Watson’s words: “Our rational minds and modern science do not have all the answers to life and death and all  the human conditions we face, thus we have to open to unknowns we cannot control, even allowing for what we may consider a miracle to enter our life and work. This process also acknowledges that the subjective world of the inner-life experiences of self and other is ultimately a phenomenon, an ineffable mystery, affected by many, many factors that can never be fully explained.” 2. The Transpersonal Caring Relationship: protecting, enhancing and preserving the person’s dignity. Humanity, wholeness and inner harmony 2.1. Characterized by a special kind of human caring relationship that depends on: 2.1.1. The nurse’s moral commitment in protecting and enhancing human dignity as well as the deeper/higher self 2.1.2. The nurse’s caring consciousness communicated to preserve and honor the embodied spirit, therefore, not reducing the person to the moral status of an object 2.1.3. The nurse’s caring consciousness and connection having the potential to heal since experience, perception, and intentional connection are taking place 3. The caring occasion/caring moment 3.1. Refers to the moment when the nurse and another person come together in such a way that an occasion for human caring is created. 3.2. A human-to-human transaction 3.3. It may become transpersonal when “it allows for the presence of the spirit of both—then the event of the moment expands the limits of openness and has the ability to expand human capabilities.” Metaparadigm AHealing Space & Environment Person/Personhood/Human Being - Early definition: stress, comfort, privacy, safety - Viewed holistically and clean aesthetic surroundings - 3 spheres of being: body, mind & spirit - New definition: energetic, vibrational field - A valued person in and of himself/herself to be integral with the person cared for, respected, nurtured, understood & - A nurse creates a “scared space” for the parson assisted cared for. - A fully functional integrated self Health Nursing: Transpersonal Nursing-Caring- - Unity & harmony of body, mind, spirit Healing - Process of adapting, coping & growing - To help persons gain higher degree of harmony - A search to connect what is seen (physical) and within mind-body-spirit unseen (divine) - The greater the degree of genuineness & Illness – turmoil/disharmony within the 3 spheres; can sincerity of a nurse, the greater the efficacy of lead to disease caring Disease – disharmony between the person & - Compassionate human service & care environment Processing the Contents Theory of Transpersonal Caring and the Nursing Process Assessment What statements will you ask/say to ✓ Observe, identify and review explore a patient’s phenomenal field? problems (This will also help establish a caring ✓ Formulate hypothesis moment) Plan ✓ Determine what data to be 1. ____________________________ collected and how on whom ✓ Determine variables to be 2. ____________________________ examined/measured Intervention ✓ Direct action and 3. ____________________________ implementation of care ✓ Collection of data from subjects 4. ____________________________ Evaluation ✓ Examine effects of intervention 5. ____________________________ based on data ✓ Determine outcomes ✓ Generate additional hypothesis  Patricia Benner’s Stages of Nursing Expertise and Nursing Philosophies “Nursing is an integrative science that studies the relationships between mind, body and human worlds. It is concerned with far more than the cognitive structure of formal /mental properties, such as attitudes and belief systems of the mind-brain, and the physiology and pathophysiology of the body as a system of cells, tissues and organs. Nursing is concerned with the social sentient body that dwells infinite human worlds; that gets sick and recovers; that is altered during illness, pain and suffering; and that engages with the world differently upon recovery.” History and Background Born in Hampton, Virginia BSN, Master’s Degree in Medical-Surgical Nursing, PhD Book author, researcher, lecturer Staff nurse in the areas of medical-surgical, emergency room, coronary care, intensive care unit, and home care Major Concepts: The NOVICE TO EXPERT MODEL (Five Levels of Nursing Experience) 1. Novice 1.1. Stage of skill acquisition 1.2. No background experience of the situation difficulty discerning between relevant and irrelevant aspects of a situation 1.3. Applies to student nurses 1.4. Nurses who are completely foreign to new nursing area 2. Advance Beginner 2.1. Able to demonstrate marginally acceptable performance 2.2. Has enough experience to grasp aspects of the situation 2.3. Guided by rules and oriented by task completion 2.4. Most newly graduated nurses 3. Competent 3.1. Learned from actual practice situations by following actions of others 3.2. Conscious and deliberate planning 3.3. Consistency, predictability & time management 3.4. Sense of mastery acquired through planning and predictability 3.5. Increased level of efficiency but focus is on time management rather than timing in relation to patient’s needs 3.6. Begins to recognize patterns and determine which situation needs attention and which can be ignored 3.7. Learns to decide what is relevant even without rules 4. Proficient 4.1. Perceives the situation as a whole 4.2. Performance guided by maxims 4.3. Recognizes the most salient aspects and has an intuitive grasp of the situation based on background understanding 4.4. Demonstrate a new ability to see changing relevance in a situation including recognition and implementation of skilled responses to the situation as it evolves 4.5. Much more involvement with the patient and family 4.6. Demonstrate increased confidence in knowledge and abilities 5. Expert 5.1. Demonstrates a clinical grasp and resource-based practice 5.2. Possess embodied know-how 5.3. Sees the big picture 5.4. Sees the unexpected Philosophy in Nursing: 7 DOMAINS OF NURSING PRACTICE DOMAINS DEFINITION NURSING ACTIONS (As a Nurse, I will….) The Helping Role Competencies r/t establishing a healing relationship, providing comfort measures, & inviting active patient ______________________________ participation & control in care The Teaching- Timing, readying patients ______________________________ Coaching Function for learning, motivating, ______________________________ change, assisting with ______________________________ lifestyle alterations, & ______________________________ negotiating agreement on goals ______________________________ The Diagnostic and Competencies in ongoing ______________________________ Patient-Monitoring assessment and ______________________________ Function anticipation of outcomes The Effective Ability to contingently Management of match demands with Rapidly Changing resources and to assess & Situations manage care during crisis ______________________________ situations The Administering Competencies r/t and Monitoring preventing complications Therapeutic during drug therapy, Interventions and wound management, and ______________________________ Regimens hospitalization  The Monitoring and Competencies with regard Ensuring the to maintenance of safety, Quality of Health continuous quality Care Practices improvement, collaboration & consultation with ______________________________ physicians, self-evaluation & management of technology The Organizational Competencies in priority and Work-Role setting, team building, Competencies coordinating & providing for continuity ______________________________ Metaparadigm ASituation (Environment) Person - Person’s engaged interaction, - A self-interpreting being, defined in interpretation and understanding of the course of living a life the situation Health Nursing - Focus: “Lived experience of being - A caring relationship healthy & being ill” - A caring practice whose science is - Can be assessed guided by the moral art ethics of - Well-being – human experience of care & responsibility health  Katie Eriksson’s Theory of Caritative Caring Caritative caring means that we take caritas into use when caring for the human being in health and suffering. Caritative caring is a manifestation of the love that just exists. Caring communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering of the patient History and Background Born: November 18, 1943 in Jakobstad, Finland Main areas of work: teaching & research Forerunner of basic research in caring science Developed leading educational program in caring science and nursing Major Concepts and Definitions Caritas ✓ Love and charity; unconditional love ✓ Fundamental motive of caring science ✓ An endeavor to mediate faith, hope and love through tending, playing & learning Caring Communion ✓ A form of intimate connection that characterizes caring ✓ Characterized by intensity & vitality, warmth, closeness, rest, respect, honesty, and tolerance ✓ Creating possibilities for the other The Act of Caring ✓ The art of making something very special out of something less special Caritative Caring ✓ Caring ethics deals with the basic relation between the Ethics patient & the nurse ✓ Basic ethical categories: human dignity, caring communion, invitation, responsibility, good & evil, virtue & obligation Dignity ✓ Absolute dignity - granted human being through creation ✓ Relative dignity – influenced & formed Invitation ✓ The act that occurs when the career welcomes the patient to the caring communion Suffering ✓ Human being’s struggle between good & evil in a state of becoming ✓ Unique, isolated total experience ✓ Not synonymous with pain Suffering r/t illness, ✓ r/t illness – connected with illness & treatment to care & to life ✓ r/t care – suffering caused of care or absence of care; violation of patient’s dignity ✓ r/t life – not to be taken seriously, not to bewelcome, being blamed, being subjected to the exercise of power Suffering of human ✓ the “patient” is a suffering human being and patiently being endures Reconciliation ✓ the drama of suffering ✓ implies a change through which a new wholeness is formed of the life the human being has lost in suffering ✓ prerequisite to caritas Caring culture ✓ “environment”  ✓ Based on traditions, rituals, and basic values Major Assumptions 1. Axioms: fundamental truths 1.1. The human being is a fundamental entity of body, soul & spirit. 1.2. The human being is fundamentally a religious being. 1.3. The human being is fundamentally holy. Human dignity means accepting the human obligation of serving with love, of existing for the sake of others. 1.4. Communion is the basis for all humanity. Human beings are fundamentally interrelated to an abstract and/or concrete other in a communion. 1.5. Caring is something human by nature, a call to serve in love. 1.6. Suffering is an inseparable part of life 1.7. Health is more than the absence of illness. Health implies wholeness and holiness. 1.8. The human being lives in a reality that is characterized by mystery, infinity, and eternity 2. Theses: fundamental statements concerning general nature of caring science 2.1. Ethics confers ultimate meaning on the caring context. 2.2. The basic motive of caring is the caritas motive. 2.3. The basic category of caring is suffering. 2.4. Caring communion forms the context of meaning of caring and derives its origin from the ethos of love, responsibility and sacrifice 2.5. Health means a movement in becoming, being and doing while striving for wholeness and holiness which is compatible with endurable suffering 2.6. Caring implies alleviation of suffering in charity, love, faith & hope. Metaparadigm 3.Environment A Human Being 4. - Ethos: home/place where one feels - An entity of body, soul & spirit 5. at home 6. - A religious being - Caring culture - Constantly in change, hence never 7. 8. in a state of full completion 9. - Dual tendencies: being and non- 10. being Health Nursing - Soundness, freshness & well-being - Love & charity or caritas - Becoming: a movement toward a - Inner force: mission to care deeper wholeness and holiness Processing the Contents Case study: A 75-years old female client is diagnosed with end-stage breast cancer which metastasized to the brain, lungs, and bones. She is complaining of severe pain. After giving the prescribed pain reliever, she was able to verbalized feelings of comfort. As a nurse, how can you show your care to this client?