NCMA Theoretical Foundation of Nursing PDF

NCMA - THEORETICAL FOUNDATION OF NURSING WEEK 1 and 2 Theoretical Foundation of Nursing - It defines and explains nursing care, and theories by testable statements that are based on facts or an event. EVOLUTION OF NURSING A. Intuitive Period B. A...

NCMA - THEORETICAL FOUNDATION OF NURSING WEEK 1 and 2 Theoretical Foundation of Nursing - It defines and explains nursing care, and theories by testable statements that are based on facts or an event. EVOLUTION OF NURSING A. Intuitive Period B. Apprentice Period C. Educational Period D. Contemporary Period + Intuitive Period (Primitive era - 6th Century) - Nursing was ‘untaught’ and instinctive. - It was performed with no process, as long as you're taking care of someone that is sick, you are considered a Nurse. - Nursing role was instinctive and directed toward comforting - Nursing was a function that belonged to women back in the intuitive period. - Primitive men believed that illness was caused by the invasion of the victim's body of evil spirits. - Believed that medicine man was called shaman or witch doctor having the power to heal using white magic. - Trephining was a famous procedure in the intuitive period. Trephining/ bubutasan sa skull - Cutting a hole in the head of the afflicted/ ill person to let out the evil spirit. Early Theories - Music or singing was often used to chase away spirits. - In some cases trephining was used to let out the evil spirit. Prehistoric Medical Practice Different prehistoric medical practices - Use of mercury = mercury before was a catholic medicine but now it's a poison - Bloodletting with the use of leeches = bloodletting, doctors would remove large quantities of blood in the hope that they could cure a person.  - Lobotomies = Frontal Lobotomy (walter freeman developed the ice pick lobotomy in 1945, Lobotomy consists of cutting away most of the connections to the frontal lobes of the brain. - Heroin for headaches = heroin cough syrup, ‘bayer’ company named the HEROIN in 1898, they marketed a drug as a non addictive cough medicine, - Electroconvulsive therapy (ect) =electroconvulsive therapy (it is used to electrocute someone's head so that it will restart functioning of the body to treat schizo or bipolar order. - Cannibalistic medical practices = corpse medicine (used ground up skull to treat migraine - Radium water = Radium (during the early 1900s radioactive water was sold very quickly, can cure mental illness and even prevent aging - Plombage = Plombage (pebble-like thing, it will treat your tuberculosis but your lungs will stop functioning) - Peg Legs = peg legs (used as artificial legs) = the whirling chair (a chair that is used to spin patients until they pass out, it can cure conditions such as schizophrenia. = arsenic (a well known poison, used to treat arthritis and diabetes. = stink therapy (in the middle ages, the key to fighting the disease was the use of ‘therapeutic Stink” Rise of the Early Civilization and Ancient Cities and their contribution to Medicine Mesopotamia - No distinction between rational science and magic DIAGNOSTIC HANDBOOK - methods of therapy Asipu - Medical Authority/ Exorcist - Healer Prophylaxis- used for prevention of diseases. Mental illness is associated with Deities Egypt -“The Healthiest of all men” -Public Health System Edwin Smith Papyrus - ancient textbook on surgery The Kahun Gynaecological Papyrus - Treats women’s complaints, including problems with conception. King Djoser - The earliest known physician (Chief of Dentist and Physicians) Peeshet - Earliest known woman physician India Atharvaveda - Ancient text dealing with medicine Ayurveda - “Complete knowledge for long life” Charaka and Sushruta - 2 most famous medical textbooks Susrutasamhita - Describes several surgical procedures - = These are the documents that the Indians made in the ancient era to describe and explain different illnesses and ways to diagnose. China Huangdi Neijing - The foundational text of chinese medicine written 5th century to 3rd century BC - basis of traditional chinese medicines, acupuncture and moxibustion. Greece and Roman empire - Wound treatment - The Romans attempted to maintain vigorous health, because illness was a sign of weakness. - Care of the ill was left to the slaves or Greek physicians. Both groups were looked upon as inferior by Roman society. The Apprentice Period (6th Century - 18th Century) - “on the job” training - one of the longest period in Nursing - founder of Religious orders in the 11th century up to 1836 Kaiserswerth Institute for training of Deaconesses/ The Nuns. - The Nuns are the early nurses in the apprentice period. - Nursing performed without any formal education - Founding of religious order The Beginning of Religious War Religious war/ Holy war - is a war primarily caused or justified by differences in religion. The Crusades - They were Holy Wars waged in an attempt to recapture Holy Land from the Turks who denied Christ’s pilgrims permission to visit Holy Sepulchre. Military Religious Orders and their Work Knights of St. John of Jerusalem (Italian) - Also known as “Knight Hospitalers” - They founded hospitals Teutonic Knights (German) - Established tent hospitals for the wounded Knights of St. Lazarus - Founded primarily for nursing care of lepers in Jerusalem The Alexian Brothers - They were members of a monastic order founded 1348. - They established the Alexian Brothers Hospital School of Nursing (the largest school of nursing under religious order. - It operated exclusively for men in United States The Rise of Secular Order - In the early 6th century-13th century, if you’re a woman it's either you will become a wife or a mother, education is not famous back in the day, so to have a career or purpose as a woman, a woman should go to convent to become a nun, so that they will become a nurse. - There was the rise of nursing orders for women. Important Nursing Personages St. Clare - Founder of the second order of St. Francis of Assisi St. Elizabeth of Hungary - Known as “ Patroness of Nurses” - The daughter of the Hungarian king, she is a Princess. She lived her life wise despite her wealth Important Nursing Personages St. Catherine of Siena - “The first Lady with the lamp” - She was a hospital nurse, prophetess, researcher and reformer of society and the church. The Rise of Protestantism (1520-1562) Lutherans - The protestants that belonged to the higher, literate class of society. = The rise of Protestantism is the start of the dark period of nursing Dark Period of Nursing 17th to 19th Century - American civil war - Hospitals were closed = If there is a dark period of nursing in 17th-19th century, there is always a light at the end of the tunnel Theodore Fliedner - established the school of nursing in Kaiserswerth, Germany, - (Mother of Nursing) Florence Nightingale had her first formal training for 3 months as a nurse. 1st Training School of Nursing United States of America Bellevue Hospital School of Nursing - Founded in 1873 in New York - It was the first school of nursing in the US Philippines Iloilo Mission Hospital School of Nursing - The very first requirement in a hospital is that it should do the sick no harm - Established in 1906 - first hospital in the Philippines which trained Filipino nurses. FLORENCE NIGHTINGALE (THE MOTHER OF NURSING) - Florence Nightingale is one of the women who doesn’t need to be a Nun to become a Nurse, because she already studied at Kaiserswerth, and brought a big impact to become a Nurse. Nightingale Era - Florence Nightingale - May 12, 1820 - Has wealthy english parents - “The mother of modern Nursing” and “ Professional Nurse Pioneer”, “The Lady with the Lamp” - Her most famous work was during the Crimean War (1854-1856), - She is the one who notices own nursing theory that hospitals should be clean, nurses should wash their hands when cleaning other people's wounds, etc. - 1820-1910 “The very first requirement in a hospital is that it should do the sick no harm.” - Florence Nightingale is called “Lady with the Lamp”, because she used to visit every patient in the ward using a lamp. Education Period (18th - 20th Century) - Florence Nightingale was one of the pioneers in establishing the idea of nursing schools from her base at St. Thomas Hospital, London in 1860 when she opened the “Nightingale Training School for Nurses”, now part of King’s College London. - The education of recruits involved a year of practical instruction in the wards, supplemented with courses of lecturing, and followed by two years of lecturing, and followed by two years of work experience in the hospital. Concept in the Nightingale system of Education 1. Government funds should be allocated to nursing education - First nurse political activist 2. Training schools of Nursing should be in close affiliation with hospital 3. Professional nurses should train nurses 4. Nursing students should be provided with residence near their training hospitals - Written orders of doctors were insisted - Nurses should go with doctors during their rounds 5. All nurses must be trained in a regular civil hospital 6. Training was fundamentally on the apprenticeship model: hands-on, in the wards, under the ward sister 7. Classes, given by the medical doctors, augmented training in the wards 8. The “home sister” or “mistress of probationers” organized the training 9. District nurses had to be hospital trained (or they would not see enough serious cases) 10. Midwifery nurses had to be hospital trained 11. Training was required for administrative positions 12. Probationers kept diaries and case notes of their work, examined by the matron, and home sister, and often by Nightingale. 13. A major component of training was moral: ethical standards for patient care 14. Technical training had to be updated 15. A probationers home should be provided, with a private room for each, comfortable (common) living 16. Responsibility for probationers health and safety, including rules to prevent septicemia and ongoing monitoring of probationers health. 17. Certificates and letters of reference had to be dated and were relevant only for a short time 18. A matron should have a housekeeper under her so that she could concentrate on the nursing and the nurse training 19. The superintendent herself must have the highest knowledge of nursing, be herself resident in the hospital, make the training in nursing her first object, and be herself a trained nurse of the highest order. Contemporary Period (21st Century) Nursing after World War 1 - The development of nursing starts with war, because every war there will always be a lot of people dying, wounded and casualties. - The silver lining of the great war - Volume of patients drastically change the role of nurses - The nurses performed triage as patients, in the emergency room - Dependent to independent nursing practice - Good infection control and care - Mobilizing women and women empowerment - Nurses earned the respect of those they served with, and they were decision makers. Nursing after World War 2 / II - New opportunities for women: wartime and the american workforce - Nurses on the front lines - The scars of war: PTSD in WWII Nurses (Post Traumatic Stress Disorder)Rise of the BSN Curriculum The Degree of Bachelor of Science in Nursing: 1941-1951 - Because of Dean Julita V. Sotejo’s thesis, BS in Nursing, had a structured nursing curriculum. The First Colleges of Nursing in the Philippines University of Sto. Tomas - College of Nursing (1946) - The bureau of Private Schools permitted UST to grant the title Graduate Nurse to the 21 students who were of advanced standing from 1948 up to the present. Manila Central University - College of Nursing (1947) - The MCU Hospital first offered BSN and Doctor of Medicine degrees in 1947 and served as the clinical field for practice.  University of the Philippines Manila - College of Nursing (1948) - The idea of opening the college began in a conference between Miss Sotejo and UP president. The university approved the curriculum, and Miss Sotejo was its first dean. Nursing in Today’s Society - Change is the only constant thing in the world - “ Nursing is caring” (womb to tomb) - “Nursing is an Art” - “Nursing is the gentle art of caring.” - Recipient of Nursing- Patients, community, family, clients and co workers. Scope of Nursing 1. Promoting health and wellness 2. Preventing Illness 3. Restoring Health 4. Care for the dying Roles and Functions of the Nurse today 1. Caregiver 2. Communicator 3. Teacher 4. Client Advocate 5. Counselor 6. Change Agent 7. Leader8. Manager 9. Case Manager 10. Expanded Career Roles Expanded Career Roles for Nurses 1. Nurse Practitioner 2. Clinical Nurse Specialist 3. Nurse Anesthetist 4. Nurse midwife 5. Nurse research 6. Nurse administrator 7. Nurse educator 8. Nurse entrepreneur  WEEK 3 INTRODUCTION TO NURSING THEORY -Difference between discipline and a profession -Significance of a Nursing Theory -Significance for the Nursing Discipline -Significance for the Nursing Profession ANALYSIS OF THEORY - Clarity - Simplicity - Generality - Accessibility - Importance HISTORY OF NURSING IN THE PHILIPPINES - Mysticism and Superstitions - Herbolarios - Filipinos who became sick were usually cared for by the female family members Early Care of the Sick - Mangkukulam - Good Midwives Health Care During the Spanish Regime - In 1578, male nurses were acknowledged as Spanish Friars assistants for caring sick individuals in the hospital. These male nurses were referred to as practicante. EARLIEST HOSPITALS Hospital Real de Manila (1577) - Founded by Gov. Francisco de Sande - Was established mainly to care the Spanish King’s soldiers San Lazaro Hospital (1578) - Founded by Juan Clemente - Built exclusively for patients with leprosy Hospital de Indios (1586) - Established by Franciscan Order Hospital de Aguas Santas (1590) - Established in Laguna - Founded by Brother J. Bautista of the Franciscan Order San Juan de Dios Hospital (1596) - Founded by Brotherhood of Misericordia - Administered by the Hospitaliers of San Juan de Dios EMERGENCE OF THE FILIPINA NURSES Josephine Bracken - Wife of Jose Rizal - Field hospital in an estate house in Tejeros - She provide nursing care day and night Rosa Sevilla de Alvero - Converted their houses into quarters for the Filipino soldiers - American war broke out in 1899 Dona Hilaria de Aguinaldo - Wife of Emilio Aguinaldo - Organized Filipino Red Cross under the inspiration of Mabini Dona Maria Agoncillo de Aguinaldo - Second wife of Emilio Aguinaldo - President of the Filipino Red Cross in Batangas Melchora Aquino - Was called “Tandang Sora” - Nursed the wounded Filipino soldiers and gave them shelter and food  Capitan Salome - Revolutionary leader in Nueva Ecija - Provided nursing care to the wounded when not in combat Agueda Kahabagan - Revolutionary leader in Laguna - Provided nursing services to her troops Trinidad Tecson - “Ina ng Biak-na-Bato” - Stayed in hospital at Biak na Bato to care for her wounded soldiers = What are the things that brought about change? - Americans began training the first Filipino Nursing Students in 1907 Hospital School of Nursing’s Formal Training (1901-1911) - Pensionado Act of 1903 (Act 854) - Allowing Filipino nursing students to study in the United States. Among the first wave of nurses who went to the United States. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906) - Miss Rose Nicolet - New England Hospital for Women and Child in Boston, Massachusetts, Graduate - The first superintendent for nurses - 1944 graduate, took the first Nurses Board Examination at Iloilo MIssion Hospital Saint Paul’s Hospital School of Nursing ( Manila, 1907) - It provided general hospital services - Opened its training school for nurses in 1908 - Mother Melanie as superintendent - Miss Chambers as Principal Philippine General Hospital School of Nursing (Manila, 1907) - 1906, Mary Coleman Masters - An educator advocated for the idea of training Filipino girls for the profession of nursing - She first opened a dormitory for girls enrolled at the philippines normal hall and university of the philippines St. Luke’s Hospital School of Nursing (Quezon City, 1907) - In 1907, the school opened with three girls admitted - Three girls had their first year in combined classes with the PGH School of Nursing and St. Paul’s Hospital School of Nursing  - Miss Helen Hicks was the first principal - Mrs. Vitaliana Beltran was the first Filipino Superintendent of nurses - Dr. Jose Flores was the first medical director of the hospital Mary Johnston Hospital and School of Nursing (Manila, 1907) - In 1907, Sister Rebecca Parrish together with registered nurses Rose Dudley and Gertude Dreisbach, organized the Mary Johnston School of Nursing. - The nurses’ training course began with three Filipino young girls fresh from elementary as their first students The Start of Nursing Practice (1911-1921) - Promulgation of Act No. 2493 which amends medical law (act no. 310) allowing the regulation of nursing practice transpired during this period - In 1919, the first true nursing law was enacted through act 2808. - During this period the Board examiners for nursing was also created. - The first nursing board examination was given in 1920 - The first executive officer of the Board Examiners for Nurses is a physician. Mary Chiles Hospital School of Nursing (Manila, 1911) - The hospital was established by Dr. WN Lemon in a small house on Azcarraga. - In 1913, Miss Mary Chiles of Montana donated a large sum of money with which the present building at Gastambide was bought. San Juan de Dios Hospital School of Nursing (Manila, 1913) - 1913, through the initiative of Dr. Benito Valdez, the board of inspectors and the executive board of the hospital passed a resolution to open school of nursing - The school has been run by the Daughters of Charity since then. - Sister Taciana Tinanes was the first Directress of the School Emmanuel Hospital School of Nursing (Capiz, 1913) - 1913, the American Baptist Foreign Mission Society sent Dr. PH Lerrigo to Capiz for the purpose of opening a hospital, Miss Rose Nicolet assisted him - The school offered a 3 year training course for an annual fee of Php. 100.00. - Miss Clara Pedroso was the first principal Southern Islands Hospital School of Nursing (Cebu, 1918) - The hospital was established in 1911 under the Bureau of Health. - The school opened in 1918 with Anastacia Giron-Tupas as the organizer. Miss Visitacion Perez was the first principal. A MUCH ESTABLISHED PROFESSIONAL ORGANIZATION: 1921-1931 The Filipino Nurses Association was established The Philippine Journal of Nursing - Amendment of certain sections of the Act 2008 was conducted in 1922 under Act 3025 passed by the 5th Legislature - An Act Regulating the Practice of Nursing Profession in the Philippine Islands, which necessitates all nurses who are practicing the profession to register yearly - In 1929, the organization also became a member of the International Council of Nurses  Public Health Nursing Development: 1931 -1941 - In 1933, the nursing institution increased their requirement. - This period, they have implemented that to enter nursing education an applicant must be able to complete secondary education. - The first collegiate nursing graduates of the Philippines graduated from the University of the Philippines School of Public Health Nursing in 1938. Proliferation of Nurses as a Workforce: 1951-1971 - The Philippines Nursing Law was approved under the Republic Act No. 877 on June 19, 1953 - Further amendment was created in 1966 which limits that practice of among nurses 21 years old and above - Celebration of Nurses Week which was proclaimed by President Carlos P. Garcia under the Proclamation No. 539. Nursing Profession Development (1971-2001) - The Presidential Decree No. 223, establishment of the agency, Professional Regulation Commision. - The Philippine Nursing Act of 1991 was also amended under Republic Act No. 7164 - Nursing Certification Council in 1999, under the Board of Nursing through Resolution No. 14 which supervises the new programs’ implementation conducted by Specialty Certification Boards. Improvement also prompted the start of Advanced Practice Nursing (APN) in the Philippines. The Philippine Nursing Act of 2002 was enacted under the Republic Act. No. 9173 - Which entails changes on existing policies under Republic Act No. 7164. - These changes underscore on the requirements for faculty and Dean of the Colleges of Nursing, as well sa the conduct for Nursing Licensure Exam IN A GLANCE 1909 - 3 female graduated as “ qualified medical - surgical nurses” 1919 - The 1st Nurses Law (Act # 2808) - Enacted regulating the practice of the nursing profession in the Philippines Islands (June and December Boards) 1920 - 1st board examination for nurses was conducted by the Board of Examiners (Theoretical and Practical) 1921 - Filipino Nurses Association was established as the National Organization of Filipino Nurses 1953 - Republic Act 877, known as the “Nursing Practice Law” was approved. HISTORY OF PHILOSOPHY AND SCIENCE - Rationalism - Empiricism - Early 20th Century Views - Emergent Views HISTORICAL VIEWS OF THE NATURE OF SCIENCE What is science, knowledge and truth ? EPISTEMOLOGY - Branch of philosophy concerned with the theory of knowledge in philosophical inquiry RATIONALISM AND EMPIRICISM - Two competing philosophical foundations of science - Have evolved in the era of modern science with several variations RATIONALISM - Rationalist Epistemology (scope of knowledge) - Emphasizes the importance of a priori reasoning as the appropriate method for advancing knowledge - Deductive Reasoning (CAUSE AND EFFECT) - Theory-then-research strategy - Innate, reason and deduction - Case/Application -poor hand washing technique will result in spreading diseases to all patients EMPIRICISM - View is based on the central idea that scientific knowledge can be derived that scientific knowledge can be derived only from sensory experience - Inductive Reasoning - COLLECTION OF FACTS precedes attempts to formulate generalizations - Research-then-Theory strategy - Gathering of facts through experience and observation, and then formulating theories - Case/Application -Differential Diagnosis Patient – 31 years old, productive cough for 2 weeks, low grade fever occurring every afternoon, vital signs all in normal range. Weight, clinical observation. Diagnostics – X-ray (clear) Sputum Test (Negative) History – Smoker for 15 years, 1 pack of cigars everyday. EARLY TWENTIETH CENTURY VIEWS OF SCIENCE AND THEORY - During the first half of this century, philosophers focused on the analysis of theory structure, whereas scientists focused on empirical research POSITIVISM - A term first used by Comte, emerged as the dominant view of modern science - The logical empiricists offered a more lenient view of logical positivism and argued that theoretical propositions must be tested and through observation and experimentation - The scientist first sets up an experiment; observes what occurs reaches a preliminary hypothesis to describe the occurrence; runs further experiments to test the hypothesis and finally corrects or modifies the hypothesis in light of the results FOUCAULT (1973) - Empirical knowledge was arranged in different patterns at a given time and in a given culture and that humans were emerging as objects of study. - The Phenomenology of the Social World, Schutz (1967), argued that scientists seeking to understand the social world could not cognitively know an external world that is independent of their own life experiences - A phenomenological approach reduces observations or text to the meanings of phenomena independent of their particular context. This approach focuses on the lived meaning of experiences BROWN (1977) - Set forth a new epistemology challenging the empiricist view proposing that theories play a significant role in determining what the scientist observes and how it is interpreted.  - An elderly patient has been in a trauma and appears to be crying. The nurse on admission observes that the patient has marks on her body and believes that she has been abused; the orthopedist has viewed an x-ray and believes that the crying patient is in pain due to a fractured femur that will not require surgery only a closed reduction; the chaplain observes the patient crying and believes the patient needs spiritual support GALE (1979) - Answered by proposing that the scientist is able to perceive forceful intrusions from the environment that challenge his or her a priori mental set, thereby raising questions regarding the current theoretical perspective. ACCORDING TO H. BROWN IN 1977 - Theory determines what observations are worth making and how they are to be understood, and observation provides challenges to accepted theoretical structures. - The continuing attempt to produce a coherently organized body of theory and observation is the driving force of research, and the prolonged failure of specific research projects leads to scientific revolutions VIRGINIA HENDERSON - November 30,1897 - Kansas City, Missouri, USA “ The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health, or its recovery (or to peaceful death) that he would perform undenied if he had the necessary strength, will or knowledge” - Died in 1996 at the Connecticut Hospice in Branford, Connecticut, aged 98 - Early education was at home in Virginia with her aunts and her uncle at his all boys school - In 1921, Henderson graduated from the US Army School of Nursing in Washington, D.C. - Henderson’s career in public health nursing began in 1921 at Henry Street Settlement in Manhattan, New York - She was the first full-time nursing instructor in Virginia where she worked at the Norfolk Presbyterian Hospital from 1923 to 1929. THREE LEVELS OF NURSE-PATIENT RELATIONSHIPS 1. A substitute for the patient 2. A helper to the patient 3. A partner with the patient  Through the interpersonal process, the nurse must get “inside the skin” of each of her patients in order to know what help is needed. Henderson conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs THE NURSING NEED THEORY 1. Breathe Normally 2. Eat and drink adequately 3. Eliminate body wastes 4. Move and maintain desirable postures 5. Sleep and rest 6. Select suitable clothes; dress and undress 7. Maintain body temperature within a normal range by adjusting clothing and modifying the environment 8. Keep the body clean and well groomed and protect the integument 9. Avoid dangers in the environment and avoid injuring others 10. Communicate with others in expressing emotions, needs, fears or opinions 11. Worship according to one’s faith 12. Work in such a way that there is a sense of accomplishment 13. Play or participate in various forms of recreation 14. Learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities. HENDERSON'S DEFINITION OF NURSING - Virginia Henderson viewed the patient as an individual who requires help toward achieving independence and completeness or wholeness of mind and body. - Her work is based on (1) Thorndike, an American psychologist, (2) her experiences with the Henry House Visiting Nurse Agency, (3) experience in rehabilitation nursing, and (4) Orlando’s conceptualization of deliberative nursing action - Henderson emphasized the art of nursing and proposed 14 basic human needs on which nursing care is based. Her contributions include defining nursing, delineating autonomous nursing functions, stressing goals of interdependence for the patient and creating self-help concepts. - Through the interpersonal process, the nurse must get “inside the skin” of each of her patients in order to know what help is needed. The Metaparadigm of Nursing Need Theory Person - Individuals have basic needs that are components of health.  Health - The theory's definition of health is based on an individual's ability to function independently as outlined in the fourteen components. Environment - The environment is made up of settings in which an individual learns unique patterns for living. All external conditions and influences that affect life and development. Nursing - The nurse is expected to carry out a physician's therapeutic plan, but individualized care is the result of the nurse's creativity in planning for care. THE MOTHER OF PSYCHIATRIC NURSING - Hildegard Peplau’s Interpersonal Relations Theory emphasized the nurse-client relationship as the foundation of nursing practice. - It gave emphasis on the give-and-take of nurse-client relationships that was seen by many as revolutionary. - Peplau went on to form an Interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment and the nurse passively acting out doctor’s orders. Phases in the Nurse-Patient Relationship Orientation Phase Identification Phase Exploitation Phase Resolution Phase FAYE ABDELLAH - Faye Glenn Abdellah is recognized as a leader in the development of nursing research and nursing as a professions within the Public Health Service - She was named a “living legend” - She views nursing as an art and a science that mold the attitude, intellectual competencies and technical skills of the individual nurse into the desire and ability to help individuals cope with their health needs ABDELLAH’S TYPOLOGY OF 21 NURSING PROBLEMS 1. To maintain good hygiene and physical comfort 2. To promote optimal activity: exercise, rest, sleep 3. To promote safety through prevention of accident, injury, or other trauma and through prevention of the spread of infection 4. To maintain good body mechanics and prevent and correct deformity 5. To facilitate the maintenance of a supply of oxygen to all body cells Abdellah’s Typology of 21 Nursing Problems 6. To facilitate the maintenance of nutrition for all body cells 7. To facilitate the maintenance of elimination 8. To facilitate the maintenance of fluid and electrolyte balance 9. To recognize the physiologic responses of the body to disease conditions—pathologic, physiologic, and compensatory 10. To facilitate the maintenance of regulatory mechanisms and Functions 11. To facilitate the maintenance of sensory function 12. To identify and accept positive and negative expressions, feelings, and reactions 13. To identify and accept interrelatedness of emotions and organic illness 14. To facilitate the maintenance of effective verbal and nonverbal communication 15. To promote the development of productive interpersonal relationships 16. To facilitate progress toward achievement and personal spiritual goals 17. To create or maintain a therapeutic environment 18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs 19. To accept the optimum possible goals in the light of limitations, physical and emotional 20. To use community resources as an aid in resolving problems that arise from illness 21. To understand the role of social problems as influencing factors in the cause of illness 10 STEPS TO IDENTIFY THE CLIENT’S PROBLEMS 1. Learn to know the patient 2. Sort out relevant and significant data 3. Make generalizations about available data in relation to similar nursing problems presented by other patients 4. Identify the therapeutic plan 5. Test generalizations with the patient and make additional generalizations 6. Validate the patient’s conclusions about his nursing problems 7. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior 8. Explore the patient’s and family’s reaction to the therapeutic plan and involve them in the plan 9. Identify how the nurses feels about the patient’s nursing problems 10. Discuss and develop a comprehensive nursing care plan 11 NURSING SKILLS 1. Observation of health status 2. Skills of communication 3. Application of knowledge 4. Teaching of patients and families 5. Planning and organization of work 6. Use of resource materials 7. Use of personnel resources 8. Problem solving 9. The direction of work of others 10. Therapeutic use of the self 11. Nursing procedure LYDIA HALL Core, Care, and Cure Model/Theory Hall used three interlocking circles to represent aspects of the patient and nursing functions. The Core- represents the inner feelings and management of the person. The Care- represents the patient’s body The Cure-represents the disease that affects the patient’s physical system Core, Care, and Cure Model/Theory The three circles change in size and overlap in relation to the patient’s phase in the disease process. A nurse functions in all three circles but to different degrees. For example, in the care phase, the nurse gives hands on bodily care to the patient in relation to activities of daily living such as toileting and bathing. In the cure phase, the nurse applies medical knowledge to treatment of the person, and in the core phase, the nurse addresses the social and emotional needs of the patient for effective communication and a comfortable environment. IDA JEAN ORLANDO - Orlando’s nursing theory stresses the reciprocal relationship between patient and nurse. What the nurse and the patient say and do affects them both. Orlando’s theory focuses on how to produce improvement in the patient’s behavior. Evidence of relieving the patient’s distress is seen as positive changes in the patient’s observable behavior. Orlando may have facilitated the development of nurses as logical thinkers. Nursing Process Theory The Deliberative Nursing Process has five stages: assessment, diagnosis, planning, implementation, and evaluation. Nurses use the standard nursing process in Orlando’s Nursing Process Discipline Theory to produce positive outcomes or patient improvement. The goal of this model is for a nurse to act deliberately rather than automatically. The nurse will have a meaning behind the action. This nursing process is use to different patients with different problems, and can be stopped at any time, depending on the patient’s progress or health. This makes Orlando’s theory universal for the nursing field. 5 STEPS IN THE NURSING PROCESS 1. Assessment 2. Nursing Diagnosis 3. Planning 4. Implementing 5. Evaluating Structure of Nursing Knowledge 5 components 1. Metaparadigm 2. Philosophies 3. Conceptual Models 4. Theories 5. Empirical Indicators The components of the structural hierarchy are made up of concepts and propositions Concept- is a word or phrase that summarizes the essential characteristics or properties of phenomenon. Proposition- is a statement about a concept or a statement of the relation between two or more or different concepts. Metaparadigm The first component of the structural hierarchy of knowledge It is the most abstract component of the structural hierarchy The concepts and propositions of a metaparadigm are admittedly extremely global and provide no definitive direction for such activities as research and clinical practice. WEEK 4 FLORENCE NIGHTINGALE The Environmental Theory - Florence Nightingale is often considered the first nurse theorist. - Defined nursing more than 100 years ago as the “Act of utilizing the environment of the patient to assist him in his recovery” Linked health in 5 environmental factors (pure/fresh air, pure water, efficient drainage, cleanliness, light) Stress the importance of keeping the client warm, maintaining a noise-free environment, and attending to the client’s diet in terms of assessing intake, timelines of the food, and its effect on the person. 10 aspects of The Environmental Theory 1. Patients should have clean air and a temperature-controlled environment 2. Patients should have access to direct sunlight and not be subjected to unnecessary noise, especially when sleeping 3. Rooms should be kept clean 4. Hospital facilities should be well-constructed 5. Bedding should be changed and aired frequently 5. Patients should be kept clean and nurses should wash hands frequently. 6. Patients should be offered a variety of scenery, such as new books or flowers, to prevent boredom 7. Nurses should be positive but not offer false hope to patients or make light of their illness 8. Patients should be kept clean and nurses should wash hands frequently 9. Offer a variety of small meals instead of large ones, and do not do patient care while patient is eating as it is distracting 10. Consider not only the individual patient but the context of where he or she lives Nightingale isolated 5 factors essential in securing an individual’s health; these include pure air, pure water, efficient drainage, cleanliness and light. Nursing Nightingale’s view on nursing is one that is largely intertwined by factors pertaining to the environment. Nightingale believed that many of the symptoms and sufferings of patients were not directly related to their disease or ailment, but rather consequences of poor environmental condition. JEAN WATSON “ We are the light in institutional darkness, and in this model we get to return to the light of our humanity” - Dr. Jean Watson - June 10, 1940 - Present - Margaret Jean Harmon - Grew up in the small town of Welch, West Virginia, in the Appalachian Mountains. - The youngest of eight children, and was surrounded by extended family - High School in West Virginia, graduated in 1961 at Lewis Gale School of Nursing in Roanoke, Virginia Watson bases her theory for nursing practice on the following 10 carative factors. - Each has dynamic phenomenological component that is relative to the individuals involved in the relationship as encompassed by nursing  THE SEVEN 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 only as he or she is now but as what he or 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 cursing. A science of caring is complementary to the science of curing. 7. The practice of caring is central to nursing TRANSPERSONAL CARING THEORY METAPARADIGM PERSON - Watson uses interchangeably the terms human being, person, life, personhood, and self. She views the person as “ a unity of mind/body/spirit/nature” HEALTH - Defined health as “ unity and harmony within the mind, body, and soul” - Associated with the “degree of congruence between the self as perceived and the self as experienced” Environment - Watson speaks to the nurse’s role in the environment as “attending to supportive, protective, and or corrective mental, physical, societal, and spiritual environments” Nursing - “Nursing in concerned with promoting health, preventing illness, caring for the sick and restoring health” MARILYN ANNE RAY - 1938 - PRESENT THEORY OF BUREAUCRATIC CARING INSPIRATION ORIGIN WHAT IS IT? THESIS ANTI - THESIS \ MAJOR CONCEPTS AND DEFINITION - Caring - Spiritual - ethical caring - Educational - Physical - Social cultural - Legal - Technological - Economic - Political METAPARADIGM - Nursing - Person - Health - Environment WEEK 5 PATRICIA BENNER - Patricia Sawyer Benner is a nursing theorist, academic and author. - She is known for one of her books, From Novice to Expert: Excellence and Power in Clinical Nursing Practice. - August 1942 - She went on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982 - started college at Pasadena City College where she received her bachelor's degree in nursing, in 1964. KAI MARTINSEN PHILOSOPHY OF CARING - Inspiration - Origin - What is it? MAJOR CONCEPTS AND DEFINITION - Care - Professional Judgment and Discernment - Moral Practice is Founded on Care - Person - Oriented Professionalism  - Sovereign Life Utterances - The untouchable zone - Vocation - The eye of the heart - The registering eye METAPARADIGM - Nursing - Person - Health - Environment KATIE ERIKSON - Born in November 18, 1943, in Jakobstad, Finland - A graduate in Helsinki Swedish School of Nursing in 1965 MAJOR CONCEPTS AND DEFINITION CARITAS - Which is the fundamental motive of caring science, also constitutes the motive for all caring. It means that caring is an endeavor to mediate faith, hope and love through tending, playing and learning CARING COMMUNICATION - Constitutes the context of the meaning of caring and is the structure that determines caring reality. - Characterized by intensity and vitality, and by warmth, closeness, rest, respect, honesty, and tolerance THE ACT OF CARING - Contains the caring elements (faith, hope, love, tending, playing, and learning) - Involves the categories of infinity and eternity, and invites to deep communion. - The Act of Caring is the art of making something very special out of something less special CARITATIVE CARING ETHICS - Comprises the ethics of caring, the core of which is determined by the caritas motive. Erikson makes a distinction between caring ethics and nursing ethics - Deals with the basic relation between the patient and the nurse. - Nursing ethics deal with the ethical principles and rules that guide my work or my decisions. “ Caring ethics is the core of nursing ethics” DIGNITY - Constitutes one of the basic concepts of caritative caring ethics INVITATION - Refers to the act that occurs when the career welcomes the patient to the caring communion. - “Suffering is a unique, isolated total experience and is not synonymous with pain” THREE DIFFERENT FORMS OF SUFFERING - Suffering related to illness - Suffering caused by care or absence of caring - Suffering related to life