Midterm 7-14 (1).pdf

Midterm Study Guide Why do nurses use theories? ● Nurses use theories to help guide care and provide a foundation for clinical decision-making ● They play an important role in nursing evolution ● Nurses use theories because they provide frameworks to guide the nursing practice, grow professionally,...

Midterm Study Guide Why do nurses use theories? ● Nurses use theories to help guide care and provide a foundation for clinical decision-making ● They play an important role in nursing evolution ● Nurses use theories because they provide frameworks to guide the nursing practice, grow professionally, and improve care ● Nurses use them to help prioritize, approach issues and work Metaparadigm ● Environment ● Person ● Nursing ● Health Theory Types ● Grand theory ○ Very abstract theorizing ○ Has a broad scope ○ Provide a structural framework for broad and abstract ideas about nursing ● Middle-range theory ○ Has a more limited scope and is less abstract than grand theories ○ Addresses specific concepts ○ Concepts tend to cross different nursing disciplines ■ Eg: administration, clinical, teaching ● Descriptive theory ○ Describes and speculates on why a phenomenon occurred ○ Explains, relates, and sometimes can predict concerns in nursing practice ○ Not very direct but is used to help explain client assessments and guide future nursing practices ● Prescriptive theory ○ Addresses nursing interventions and predicts consequences of specific interventions ○ Designate the prescription, occurrence, and consequences ○ It is action-oriented, which ensures the validity and predictability of nursing interventions ● Practice theory ○ Is situation specific ○ Has a narrow scope ○ Focuses on the patient population at a specific time Nursing theories ● Mcgill Model ● ● ● ○ Practice-based theory ○ Uses systematic thinking and focuses on health promotion ○ Focuses more on overall health rather than illness and disease ○ Recommends lifestyle changes ○ Promotes family goals, strength over weakness ○ How nursing compliments medicine Martha Rogers Model (unitary human beings) ○ Is a grand theory ○ People of not just people but energy fields ○ Focuses on the life process ○ Helps patients reach maximum health ○ Focuses on life process as a continuum Sister Calista Roy Theory (adaptation) ○ Is a grand theory ○ The thinking and feeling people use ○ Conscious awareness and choice to create human and environmental integration ○ Focuses on adaptation ■ Physiological needs, self-concept, role function, and interdependence ○ The goal of nursing is to facilitate adaptation within this theory Patricia Benner Theory (novice to expert) ○ Is a middle-range theory ○ Changing climate of healthcare needs ■ experienced nurses, given increased needs and technologies ○ Starts at novice, beginner-advanced, competent, proficient, then expert ○ Research that interviewed and observed senior nurses and student nurses to confirm Who is Dr Jean Watson ● She created the theory of transpersonal caring ● It contains 10 caritas ○ Embrace ○ Inspire ○ Trust ○ Nurture ○ Forgive ○ Deepen ○ Balance ○ Co-create ○ Minister ○ Open Who is Sister Simone Roach ● She created the caring theory ● Has 7 C’s ○ ○ ○ ○ ○ ○ ○ Compassion ■ Supportive, purposeful, genuine Competence ■ Gain and understand knowledge Confidence ■ Builds a trusting relationship Conscience ■ Moral awareness Commitment ■ Following through with something Comportment ■ Attitude and how you compose yourself Communion ■ Honouring each other in the world ■ Professional self-hood Why is comportment important to nursing? ● Comportment is important in nursing because it directly affects patient care, communication, and professionalism, contributing to a positive patient experience and upholding the integrity of the nursing profession Evidence-Informed Practice ● Evidence-informed decision-making uses available evidence, research creates new knowledge, and quality improvement enhances healthcare processes. ● Evidence-informed practice considers patient values alongside evidence, while evidence-based practice relies on clinical guidelines. ● Research is vital for improving patient care and advancing nursing. ● Nurses must navigate research literature to stay current and ensure evidence relevance. ● Research evidence involves formulating questions, searching, appraising, synthesizing, and applying findings. ● Qualitative research explores experiences, quantitative uses numbers, and mixed methods combine both. ● Levels of evidence ○ 1. Most reliable - systematic reviews of 3 or more RCT ○ 2. One or two well-designed RCT ○ 3. One or more well-designed and controlled trials without randomization ○ 4. One or more well-designed case controls or cohort studies ○ 5. systematic reviews of descriptive and qualitative studies (meta-synthesis) ○ 6. Single descriptive or qualitative studies ○ 7. Least reliable - opinions of authorities and or reports of expert committees ● Ethical rules protect participants, research integrity, and validity. Qualitative research ● More subjective phenomenon ● ● ● Measures experiences Does not give information on the cause Non-numeric data ○ Interviews, observations Quantitative research ● Experimental ● Descriptive survey designs ● Data analysis ● Numbers and statistics ● Measure and or quantify phenomenon’s ● Testing hypotheses and generalizing results ○ Conducting a survey Strength-based theory ● Focuses on strengths rather than weaknesses ○ Look at the whole person ○ What is working with the patient ○ Uses resources that are available ● Approaches ○ Patient-centred ■ Sensitive to patients' needs ○ Empowerment movement ■ Enhance people's abilities to meet their own needs and control their own lives ○ Health promotion and prevention ■ Self-care ■ Preventative measures ○ Collaborative partnerships ■ Partners in care ■ More patient involvement ■ Collaboration ● Values ○ Health and healing ■ Central goal ○ Uniqueness ■ No two people are alike ○ Holism and embodiment ■ Interconnectedness ○ Subjective reality and created meaning ■ Constructs narratives into reality ○ Self-determination ■ Listen and advocate ○ Person and environment are integral ■ People grow in environments that draw on their strengths ○ ○ learning, readiness, and timing Collaborative partnership ■ nurse/patient collaboration Deficit Approach ● Negative views on things ● The person becomes a diagnosis ● It is easier to inflict pain on someone if we are detached from the patient ● The caregiving aspect of nursing is replaced with medical tasks ● Problem-focused Relational Inquiry ● Relational Inquiry is an approach to research or problem-solving that prioritizes the exploration of relationships and connections between variables, concepts, or individuals to gain a deeper understanding Relational Orientation ● Way of thinking and focusing your attention ○ Intrapersonal ■ Individual's self-awareness and understanding of their own beliefs, values, and emotions in relation to others and the situation ● What do you think is going on with a person ○ Interpersonal ■ Focuses on the dynamics and quality of interactions and connections between individuals, acknowledging the significance of effective communication, empathy, and collaboration ● How people are acting: ignoring, prioritizing ○ Contextual ■ Considers what is going on around people and situations ● Cultural, social, and environmental factors which shape and impact interactions Inquiring Action ● Inquiring Action means asking questions of others, about others, and of yourself ● A wider and deeper understanding ● Identifying what is significant and relevant How does relational inquiry affect patient/family, nurses and healthcare system ● Relational inquiry improves communication, personalized care, job satisfaction, and healthcare quality ● Interrelated forces and normative patterns ● Failure to provide excellent care ● Draws more attention to well-being ● Enhances the capacity and power of people to have meaningful lives How can nurses engage as a relation inquirer ● Relational inquiry benefits patients, nurses, and the healthcare system by improving communication, personalized care, job satisfaction, and healthcare quality ● Curiosity ○ Open to questions ○ Open to not knowing and then going to learn ● Complexity and uncertainty ○ Risky business ○ Look at situations from different perspectives ● Vulnerability ○ Willing to be uncomfortable Nursing ethics ● Nursing Values ○ Providing safe, compassionate, competent, and ethical care ■ Building these requires a conscious effort ○ Promoting health and well-being ■ Provide care ○ Promoting and respecting informed decision-making ■ Understanding the nurse/patient power differential and informing them of their choices with no bias ○ Preserving dignity ■ Recognize and respect the intrinsic worth of each person ○ Maintaining privacy and confidentiality ■ Information obtained must be kept in the context of a professional relationship ○ Promoting justice ■ Safeguarding human rights, equity and fairness, promoting public good and not discriminating ○ Being accountable ■ Accountable for our actions and answerable for their practice What is ethics ● What is right and what is wrong behaviour based on what you think you ought to do or ought not to do ● In Alberta, nurses use the Canadian Nurses Association Code of Ethics Nursing Ethics vs. Research Ethics ● Nursing ethics ○ Concerned with ethical behaviour and decision-making by nurses. ○ Guides how nurses provide patient care and interact with patients. ○ Emphasizes patient rights, dignity, and ethical choices in clinical practice. ○ Governed by professional nursing organizations and codes of ethics. ● ○ Focuses on the nurse-patient relationship and direct patient care. Research Ethics ○ Primarily pertains to the ethical conduct of research studies. ○ Focuses on the treatment of research participants in studies. ○ Includes principles like informed consent, confidentiality, and minimizing harm. ○ Regulated by professional organizations, government agencies, and ethics committees. ○ Applies to planning, conducting, and reporting research involving human subjects or animals. Principles that guide ethical decision-making ● Autonomy ○ Ability to make your own decisions ○ We need to respect our patient's wishes ○ Informed decision-making ● Beneficence ○ Promoting good for your patients ○ Guiding difficult decisions ■ Eg: the surgery is scary, but we believe it is the best option for you because… ● Nonmaleficence ○ To do no harm ○ Trying to balance risk and benefits ■ Eg: giving the anti-nausea medication with medication that has a nausea side effect ● Justice ○ Being fair ○ Social justice ■ Eg: the sickest person in the waiting room gets treatment first ■ Equal distribution of care and other resources Critical thinking ● Identifying the key points and analyzing/ evaluating them, then interpreting them into how you would use them and or drawing a conclusion ● Using critical thinking techniques makes you a better thinker ● Use of evidence-informed knowledge and clinical decision-making How do nurses use critical thinking? ● Help us solve problems by understanding the issue, analyzing and finding evidence for strategies and solutions and choosing and using one solution to resolve the issue ● An essential part of providing safe and holistic care Critical Thinking ● Ask questions ● Be well informed ● Being honest in facing personal biases ● willingness to reconsider and think differently about issues ● Apply logic ● Intuition ● Creativity ● Knowledge ● Skills ● Experience ● Knowing your resources Critical thinking skills ● Interpretation ● Analysis ● Inference ● Evaluation ● Explanation ● Self-regulation Critical thinking depositions ● Truth-seeking ● Open-mindedness ● Analyticity ● Systematicity ● Self-confidence ● Inquisitiveness ● Maturity Component ● Specific knowledge base ○ The discipline of nursing and using the body of knowledge in nursing (well-being, health promotion) ● Experience in nursing ○ Experiences teach you skills ○ Learn how to deal with people and the nurse we want to be ● Critical thinking competencies ○ General critical thinking competencies ■ Scientific method ■ Problem-solving ■ Decision making ○ Specific critical thinking competencies ■ Diagnostic reasoning ● ● ■ Clinical inference ■ Clinical decision-making ○ Specific critical thinking competencies in nursing ■ Use of nursing process ■ Or clinical judgment model Attitudes for critical thinking ○ Being curious ○ Are you interested in helping the patient ○ Attitude determines the success of critical thinking Standards for critical thinking ○ Intellectual standards ○ Professional standards ■ Ethical criteria ■ Criteria for evaluation ■ Professional Responsibility Clinical judgment ● The conclusion, interpretation, or the decision that nurses make ● This needs to be holistic, and the nurse needs to understand all aspects of the situation Sensemaking ● How individuals make sense of complex social dynamic environments and phenomena, develop mental representations of these phenomenons, and use these representations to guide our actions ● Organizing the chaos in life ● Finding patterns ● Discovering connections ● Daily choices ● Self-management activities Why do people engage in sensemaking? ● People engage with sensemaking to address gaps and build bridges, and return to the habitual mode once continuity in their understanding is restored Components of sensemaking ● Sensemaking mode ○ People engage with sensemaking because they can examine different properties and construct explanations that will allow them to select the right action ● Habitual mode ○ Allows individuals to utilize preexisting mental models that reflect their experiences shaped by psychological, social, cultural, and economic factors ○ ○ Default state that individuals maintain and attempt to return to after engaging in sensemaking Has 3 phases ■ Perception ■ Inference ■ Action