NCM 100 Theoretical Foundation in Nursing Prelims 2024-2025 PDF

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA - JONELTA COLLEGE OF NURSING PRELIMS 1ST SEM 2024-2025 NCM 100 - THEORETICAL FOUNDATION IN NURSING...

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA - JONELTA COLLEGE OF NURSING PRELIMS 1ST SEM 2024-2025 NCM 100 - THEORETICAL FOUNDATION IN NURSING PROF. GAYE ALTAVANO OUTLINE At the beginning of the twentieth century, nursing was not recognized as an academic discipline or a profession Introduction to Nursing Theories ○ History of nursing theory 1.2 DISCIPLINE AND PROFESSION ○ Significance of Table 1. Discipline vs. Profession Discipline Profession Discipline Profession History of philosophy of science ○ Rationalism and Empiricism specific to academe and a specialized field of ○ Early twentieth-century views refers to a branch of practice, founded upon ○ Emergent views education, a department the theoretical structure of learning or a domain of the science or Structure of nursing knowledge of knowledge knowledge of that ○ Structure level discipline and ○ Metaparadigm accompanying practice Person abilities. Health Environment Health science Nursing Nursing course ○ Philosophy ○ Conceptual models ○ Theory 2.0 HISTORY AND PHILOSOPHY OF SCIENCE ○ Classification of theories Nursing theorists and their works “Why should nurses be interested in the history and philosophy ○ Nightingale’s theory of environmental of science?” adaptation ➔ As nurses, our practice should be based upon the ○ Watson’s theory of human caring truth. ○ Benner’s stages of nursing philosophies 2.1 RATIONALISM 1.0 INTRODUCTION TO NURSING Rationalism is the view that regards REASON as the chief source and test of knowledge It all began with Florence Nightingale ○ “Mother of Nursing” René Descartes (1596-1650) ○ envisioned nurses as a body of educated The first of the modern rationalists women Knowledge could be attained by reason alone ; No ○ Environmental Theory experience was necessary “A good environment promotes “Cogito Ergo Sum” healing.” ○ I think, therefore, I am World’s Fair in Chicago (1893) ○ 1st national gathering of nurses Priori Reasoning American Journal of Nursing (AJN) (October 1900) Emphasized as the appropriate method for ○ 1st national organ of communication for advancing knowledge. nurses Utilizes deductive logic ○ reasoning from the cause to an effect or 1.1 FOUR HISTORICAL ERAS from a generalization to a particular instance. 1. Curriculum Era (mid 1930s) Example: What should nurses learn to become one? Lack of social support (cause) will 2. Research Era (mid-century) result in hospital readmission Higher education, being curious Doing research (effect) 3. Graduate Education Era Master’s degree programs emerging 2.2 EMPIRICISM 4. Theory Era (1970s) All knowledge is obtained through SENSES – not Nursing Doctoral Programs inherited; Depends on experience: New programs and theory development ○ gathered through the five senses ANNA SANTIAGO 1  He suggested that only by suspending the “natural John Locke (1632–1704) attitude” could philosophy becomes its own distinctive and rigorous science All knowledge, he held, comes from sensation or from phenomenology is a science of consciousness rather reflection than of empirical things Why is empiricism important in Nursing? Phenomenology Because the nature of the nursing practice requires philosophical movement (20th century). predictions and explanations; empiricism has the capacity for direct investigation and description of phenomena as explanation, which is necessary for clinical practice. consciously experienced A philosophy of experience. Table 2. A posteriori vs. a priori 3.0 STRUCTURE OF NURSING KNOWLEDGE a posteriori a priori “from the latter” “from the former” Structural Holarchy of Contemporary Nursing applied only on the basis applied independently of of experience experience. Knowledge empiricism rationalism is a heuristic device that places the five components of contemporary nursing knowledge into a Holarchy based on level of abstraction. 2.2 EARLY 20TH CENTURY VIEWS Positivism first used by Comte dominant view of modern science (Gale, 1979). Modern logical positivists believed that empirical research and logical analysis (deductive and inductive) were two approaches that would produce Figure 1. scientific knowledge (Brown, 1977). Nursing Paradigm Deductive and Inductive Reasoning Patterns or models used to show a relationship among the existing theoretical works in nursing. Table 3. Deductive and Inductive Reasoning Deductive Reasoning Inductive Reasoning Metaparadigm Most general statement of a discipline and function General to specific Specific to general THE FOUR METAPARADIGM CONCEPTS OF 3.1 NURSING 2.3 PEOPLE OF 20TH CENTURY VIEWS EHE A. Person Receives nursing care Paul Michael Foucault (1973) ○ Physical, mental, and social Published his analysis of the epistemology patients/clients and the (knowledge) of human sciences from the 17th to the community 19th century. ○ Foucault's entire philosophy is based on the assumption that human knowledge and B. Environment existence are profoundly historical. Internal and external condition of environment that “What is most human about man is his history” impacts a patient’s health Alfred Schutz (1967) C. Health main area: people grasp the consciousness of others level/degree of patient’s wellness in all aspects: while living within their own streams of consciousness ○ Physical, psychological, mental, spiritual, ○ "lifeworld" = people create social reality intellectual, and emotional under the constraints of preexisting social and cultural factors and structures D. Nursing Attributes of the individual providiing the care ○ the interactions and the interventions the Edmund Husserl (1859 to 1938) nurse provided founder of phenomenology; 20th century 2  Calculate relationships between properties and how 3.2 WHAT IS PHILOSOPHY IN NURSING? they occur 4. Prescriptive “Situation-producing theories” Philospohy is an attitude toward life and reality that Testing new nursing interventions evolves from each nurse’s beliefs. B. Depending on range/scope/generalisibility of principle Significance of Philosophy in Nursing To achieve intellectual enlightenment 1. Metatheory To exercise both understanding and value judgments Theory of theory Governs their methods through logic and ethics Identifies phenomena through an abstract concept 2. Grand theory Framework for addressing complex ideas and 3.3 CONCEPTUAL MODELS concepts about nursing 3. Middle range theory Set of concepts integrated into a meaningful Precise and analyses a particular situation with a configuration limited number of variables ○ Theory of disease causation (Agent, Host, 4. Practice Theory Environment), Communication Model, Explores one particular situation found in nursing Maslow's Hierarchy needs. Identifies explicit goals and details how these goals ○ Neuman Systems Model will be achieved ○ Orem Self-Care Framework C. Based on philosophical underpinnings ○ Roper-Logan-Tierney Model of Nursing ○ Roy Adaptation Model 1. Needs theories Motivational model that explains the needs for 3.4 THEORY achievment, power, and affiliation 2. Interaction theories Ideas that projects a tentative purposeful and An approach that focuses on bodily behaviors and systematic view of phenomena environmental contexts rather than mental processes Abstract statement formulated to predict, explain, or ○ Nurse and patient interaction describe the relationships among concepts. 3. Outcome theories Controlling and directing patient care using their knowledge of the human physiological and Why do nurses use theory in everyday practice? behavioral systems Organize, understand, and analayze patient data 4. Humanistic theories Make decisions about patient care Emphasizes empathy and stresses the good in human Plan patient care behaviors Predict outcomes of care Evaluate patient outcomes “Practicing nurses who despise theory are condemned to Characteristics of Theory performing a series of tasks-either at the command of a 1. Logical, simple, and generalized physician or in response to routines and policies”. 2. Composed of concepts and prepositions --Curtin, 1989 3. Provide the bases for testable hypothesis 4. Consistent with other validated theories 5. Contribute to body of knowledge 4.0 FLORENCE NIGHTINGALE 6. Ethical and moral to guide nurses 7. Can describe, predict, explain or be used to control a phenomenon BORN: May 12 1890 : Florence, Italy 8. Coordinated and less fragment care DIED: August 13 1910 : 90 y/o, U.K. Pioneer of professional nursing Theory: Environmental adaptation theory 3.5 CLASSIFICATION OF THEORIES “Mother of nursing” / “The Lady with the Lamp” Her focus is on healing, not just caring for the sick. ○ She believed symptoms which were thought A. Depending on function/purposes to be of disease were actually responses to negative environmental stimuli 1. Descriptive “Factor-isolating theories” Identify and describe major concepts of phenoma Notes on Nursing: What It Is and What It Is Not 2. Explanatory Book published in 1859 to guide nurses “Factor-relating theories” give hints on nursing to those entrusted with the Examine how properties relate and affect discipline health of others. 3. Predictive “Situation-relating theories” 4.1 NIGHTINGALE’S CONCEPTUALIZATION OF 3  Keep the room free from dust, dirt, mildew, and HEALTH dampness. Focuses on the care of patient rather than the 4. Health and Houses nursing process remove garbage or garments from the area air and water are clean and free from odor and that there is plenty of light 5. Noise noise level should be minimum refrain from whispering outside the door 6. Bed and Bedding Assess bed for dampness, wrinkles, soiling and height ○ Wrinkles may cause irritation 7. Personal cleanliness Keep client clean and dry Maintain skin moisture 8. Variety Figure 2. Nightingale’s Conceptualization of Health Stimulate variety Visitors and stimulationg conversations 1. Human Being Flowers, cards, pictures, books, and puzzles 2. Environment 9. Chattering hopes and advices Poor environment = poor health Avoid personal talk Alter environment for healing to occur Talk to a patient as a person 3. Health 10. Taking food One must maximize optimal potential to be in a Assess client’s diet healthy state Take note of the amount client ingested Nightingale said that disease was a reparative 11. What food process Types of food client wants 4. Nursing “...it is generally the fault not of the disease, but of 12. Petty management Continuity of care the nursing.” – Nightingale Documentation of care 13. Observation of the sick Observe and record the client Nightingale’s model is philosophically consistent Make alterations in plan of care if needed with Maslow’s Hierarchy of Needs that we use Notes must be factual and not merely opinions today Nightingale included in her theory, what we know today as the nursing process 5.0 JEAN WATSON (1940-PRESENT) “Caring Theory” ○ published in 1979 ○ revised in 1985 and 1988. Created a non-profit foundation: ○ Watson Caring Science Institute (2008) Theory Development Inductive Set out to prove theory through research Deductive Writing of original theory based on experience Theory Overview Figure 3. The philosophy of caring and science examines the relatedness of ALL and includes: NIGHTINGALE’S 13 CANONS NURSING ○ human science 4.2 PROCESS AND THOUGHT ○ human caring processes ○ Experiences ○ Phenomena 1. Ventilation and Warmth client’s body temperature room temperature Evolution of Theory room for fresh air (or adequate ventilation) Foundation for this theory was first published in 1979 Assess for foul odors The original theory included 10 Carative Factors 2. Light Adequate light Sunlight works best 3. Cleanliness of rooms and walls 10 CARATIVE FACTORS 4  1 st 3 Carative factors form the “philosophical foundation” for the science of caring. administering ‘human care 4 th to 10th Carative factors spring from the essentials,’ which potentiate foundation laid by these first three. alignment of mind body spirit, wholeness, and unity of being in all aspects of CLINICAL CARITAS PROCESS care” 10 Carative Factors transitioned to the 10 “Caritas Processes” as Watson progressed her work 10. “The allowance for “Opening and attending to Caritas means “to cherish” existential spiritual mysterious and phenomenological forces” existential dimensions of one’s own life-death; soul CARATIVE FACTORS AND CARITAS care for self and the 5.1 one-being cared for” PROCESSES Table 4. Carative factors and caritas processes 5.2 FOUR MAJOR CONCEPTS CARATIVE FACTORS CARITAS PROCESS 1. Human Being 1. “The formation of a “Practice of loving-kindness holistic being with complex needs including physical, humanistic altruistic system and equanimity within the psychological, psychosocial of values” context of caring 2. Environment consciousness” containing both internal and variables that we as caregivers can manipulate 2. “The instillation of “Being authentically present 3. Health faith-hope” and enabling and sustaining A high level of overall physical, mental and social the deep belief system and functioning subjective lifeworld of self and one being cared for” 4. Nursing “Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring 3. “The cultivation of “Cultivation of one’s own health”. sensitivity to one’s self and spiritual practices and ○ holistic health care = central to the practice to others” transpersonal self going of caring in nursing beyond the ego self” 5.3 WATSON’S HIERARCHY OF NEEDS 4. “Development of a “Developing and sustaining helping-trust relationship” a helping trusting authentic caring relationship” 1. Lower-order biophysical needs or survival needs 2. Lower-order psychophysical needs or functional 5. “The promotion and “Being present to, and needs acceptance of the supportive of, the expression 3. Higher order psychosocial needs or integrative needs expression of positive and of positive and negative 4. Higher order intrapersonal-interpersonal need or negative feelings” feelings as a connection with growth-seeking need deeper spirit and self and the one-being-cared for” LOWER-ORDER BIOPHYSICAL NEEDS OR SURVIVAL 6. “The systematic use of the “Creative use of self and all NEEDS scientific problem solving ways of knowing as part of The need for food and fluid method for decision making” the caring process; to The need for elimination engage in the artistry of The need for ventilation caring-healing practices” 7. “The promotion of “Engaging in genuine LOWER-ORDER PSYCHOPHYSICAL NEEDS OR transpersonal teachinglearning experience FUNCTIONAL NEEDS teaching-learning” that attends to unity of The need for activity being and meaning, The need for inactivity attempting to stay within The need for sexuality others’ frame of reference” 8. “The provision of “Creating healing HIGHER ORDER PSYCHOSOCIAL NEEDS OR supportive, protective, and environment at all levels INTEGRATIVE NEEDS (or) corrective mental, (physical as well as The need for achievement physical, societal, and nonphysical, subtle The need for affiliation spiritual environment” environment of energy and consciousness, whereby wholeness, beauty, comfort, HIGHER ORDER INTRAPERSONAL-INTERPERSONAL dignity, and peace are NEED OR GROWTH-SEEKING NEED potentiated)” The need for self-actualization 9. “The assistance with “Assisting with basic needs, gratification of human with an intentional caring 6.0 PATRICIA BENNER needs” consciousness, 5  “Novice-Expert Model” or “Benner’s Stages of “To be situated implies that one has a past, present, Clinical Competence” and future and that all of these aspects… influence Influenced by a Martin Heidegger the current situation.” - Dr. Benner ○ German philosopher 4. Nursing Caring relationship, an “enabling condition of ○ studied existentialism, ontology, and connection and concern.” -Dr. Benner metaphysics in the 20th century An Influential Nurse in the Development of the Profession of Nursing ▪ adapted from the Dreyfus Model of Skill Acquisition. 6.1 NOVICE TO EXPERT ➔ Levels of Nursing experience She described 5 levels of nursing experience as: A. NOVICE no background experience beginner to profession or nurse changing area of practice. nursing students ○ new graduates ○ nurses who return to the workplace B. ADVANCED BEGINNER can demonstrate marginally acceptable performance guided by rules and oriented by task completion. C. COMPETENT two to three years in the same area of nursing begin to recognize patterns and determine which elements of the situation warrant attention and which can be ignored devises new rules and reasoning procedures while applying learned rules D. PROFICIENT After three to five years in the same area of nursing “The nurse possesses a deep understanding of situations as they occur, less conscious planning is necessary, critical thinking and decision making skills have developed” E. EXPERT Five years or greater in the same area of nursing No longer relies on an analytic principle Operates from a deep understanding of the total situation. 6.2 FOUR DOMAINS OF NURSING PARADIGM 1. Client/Person “The person is a self interpreting being, that is the person does not come into the world predefined but gets defined in the course of living a life.” 2. Health What can be assessed, whereas well-being is the human experience of health or wholeness. 3. Environment/Situation Situation conveys a social environment with social definition 6