Theoretical Foundations in Nursing - Session #1 PDF

Theoretical Foundations in Nursing BS NURSING / FIRST YEAR STUDENT ACTIVITY SHEET...

Theoretical Foundations in Nursing BS NURSING / FIRST YEAR STUDENT ACTIVITY SHEET Session # 1 LESSON TITLE: Materials: ▪ INTRODUCTION TO NURSING THEORY Pen and notebook ▪ HISTORY & PHILOSOPHY OF NURSING AS SCIENCE ▪ STRUCTURE OF NURSING KNOWLEDGE LEARNING TARGETS: Upon completion of this lesson, you can: 1. Identify the evolution of nursing; 2. Define the different eras of nursing; 3. Identify the similarities and differences of significance of nursing as a discipline and profession; 4. Enumerate the criteria of a profession; 5. Determine the historical views of the nature of science; 6. Differentiate rationalism and empiricism; 7. Define the following structures of nursing knowledge (metaparadigm, philosophy, conceptual models and grand Reference: theories); and, Alligood, M. (2018). Nursing theories and their 8. Apply the following theory development principle. work (9th ed.). Singapore: Elsevier. SUBJECT ORIENTATION Your classroom instructor for this subject, Theoretical Foundations in Nursing, is ____________________________. (You write in this area the vital policies, rules & regulations to be noted in this class. You may also refer to the Course Outline to be distributed by your instructor.) MAIN LESSON You will study and read their book, if available, about this lesson. History of Nursing Theory ✔ This was dated way back when Florence Nightingale began to assume the great significance of providing a clean and healthy environment to achieve recovery of patients and continues up to present. o She also envisioned nurses as a body of educated women who organized service and caring for wounded in wartime (Crimean War) and establishment of Nursing school in London (St. Thomas Hospital) pioneering activities in nursing practice and education. ✔ Nursing evolved through different eras. Profession did not start as what it seemed to be. It started as a vocational course offering only skills during their time. Nursing as a Science: Apprenticeship Model ✔ Nursing practice was based on principles and traditions that were handed down through practice seen by Florence during her time. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 10  ✔ Other references note that this is a practice era dated before the curriculum era where to be a nurse can have a diploma for only 2 years under vocational. Historical Eras of Nursing’s Search for Specialized Knowledge Historical Eras Major Question Emphasis Outcomes Emerging Goal What curriculum Develop specialized Curriculum Era: Courses included in Standardized curricula content should nurses knowledge and higher 1900 to 1940s nursing programs for diploma programs study to be nurses education Research Era: What is the focus for Role of nurses and Problem studies and Isolated studies do not 1950 to 1970s nursing research? what to research studies of nurses yield unified knowledge Carving out an Graduate What knowledge is Nurses have an Focus graduate advanced role and Education Era: needed for the important role in health education on knowledge basis for nursing 1950 to 1970s practice of nursing? care development practice How do these There are many Nursing theoretical Theory Era: Theories guide nursing frameworks guide ways to think about works shift the focus to 1980 to 1990s research and practice research and practice? nursing the patient What new theories are Nursing theory Middle-range theory Nursing frameworks Theory needed to produce guides research, may be from produce knowledge Utilization Era: evidence of quality practice, education, quantitative or (evidence) for quality 21st Century care? and administration qualitative approaches care Fawcett classified nursing models as paradigms with in a more organized / specialized meta- paradigm of: ▪ Person ▪ Health ▪ Environment ▪ Nursing Concepts Significance of Nursing Theory: At the beginning of the 20th century, nursing was not recognized as an academic discipline or a profession. The accomplishments of the past century led to the recognition of nursing in both areas. The terms discipline and profession are interrelated and some may even use them interchangeably; however, they are not the same. It is important to note their differences and specific meaning. DISCIPLINE PROFESSION ✔ Specific to academia and refers to a branch of ✔ Refers to a specialized field of practice founded on the education, a department of learning or a domain of theoretical structure of the science or knowledge of the knowledge. discipline and accompanying practice abilities. ✔ Branch of education; theoretical works leading to higher levels of education and practice. ✔ Knowledge of that discipline and accompanying ✔ Functional Focus (what nurses do) – knowledge practice abilities. focus or what nurses know and how they use them for thinking and decision making while taking care of a ✔ Recognition and respect for their scholarly disciplined patient. (example: Nursing) contribution to the health of society. ✔ Knowledge of persons, health and environment forms the basis for nursing as a discipline ✔ Kuhn – stated, “the study of paradigms is what mainly prepares the student for membership in a particular scientific community with which he / she will practice. By studying and practicing with them, the clients or community involved learn their trade." This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 10 Criteria for the Development of the Professional status of Nursing: 1. Utilizes in its practice a well-defined and well organized body of specialized knowledge. 2. Constantly enlarges the knowledge it uses and improves its techniques of education and service thru scientific method. 3. Entrusts the education of its practitioners to universities/ colleges. 4. Applies knowledge in practical services important to community welfare. 5. Functions autonomously in developing professional policy. 6. Attracts individuals with intellectual and personal qualities of intensifying service. 7. Strives to compensate nurses by providing freedom of action, opportunity for continuous professional growth and economic security. Historical Views of the Nature of Science Epistemology (episteme – knowledge; logos – study of) meaning knowledge, understanding concerned with the theory of knowledge in philosophical inquiry or how knowledge came to be. What is real is also considered knowledge. Branch of philosophy concerned with the nature & scope of knowledge. It is the study of knowledge & justifies beliefs. It questions what knowledge is & how it can be acquired. This aims to discover the meaning of knowledge, & called it the true beginning of philosophy. Philosophical Foundations of Science: RATIONALISM EMPIRICISM Priori reasoning -utilizes deductive; cause to effect or Way of looking at reality using the five senses. general to particular An object is real in so far as seen, felt, smelled, Use use of the rational senses in ensuring the tasted, heard truthfulness of a phenomenon A theory which states that knowledge comes only or Understand the whole first before you can appreciate primarily from sensory experience the lesser parts Fundamental part of scientific method Regards reason as the chief source & test of (experimentations) knowledge Knowledge is based on experience; ex. physical Any view appealing to reason as a source of assessment knowledge or justification (theory-the-research Gather information more and observe facts before approach) finally saying a theory exists. Criterion of truth is not sensory but intellectual & Reynolds, “research-then-theory strategy” deductive (general to specific) It is inductive. (specific to general) ex: lack of social support will lead to hospital ex: collect data → diagnose readmission, "not all" History of Nursing Science: Early 20th century views Emergent of science and theory in the late 20th century Positivism emerged as the dominant view of modern Phenomenological Approach reduces observations or science. text to the meanings of phenomena independent of Modern logical positivists believed that empirical their particular context. This approach focuses on the research and logical analysis were two approaches lived meaning of experiences. that would produce scientific knowledge. ✔ Several authors presented analysis challenging ✔ Philosopher focused on the analysis of theory the positivist position, thus offering the basis for a structure. new perspective in science. ✔ Scientists focused on empirical research. ✔ Empiricists view phenomena objectively, collect ✔ Increasing use of computers which permits the data and analyze it to inductively propose theory. analysis of large data. Interdependence of theory and research Science as a social enterprise In constructing theory, theorists must be "Human beings do science" - Gale. It might be knowledgeable about available empirical findings and anticipated that social, economic, or political factors able to take these into account, because theory is This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 10  concerned with organizing and formalizing available may influence scientific enterprise. It depends on the knowledge of a given phenomenon. funds, popularity of certain ideologies. The theory is subject to revision or maybe abandoned Science progresses by the diversity of dialogue within in favor of an alternative explanation for new the discipline of nursing. The creation of a merged information. paradigm from many paradigms is debated in relationship to the advancement of nursing. Theory Development Process: THEORY - Usually means “mere guess” or Scientifically, theory implies that something An idea that is suggested or unproved has been proven and is generally accepted presented as possibly true but - Literally means “a vision” or “a as being true. An idea or set of ideas that is that is not known or proven to beholding scene” intended to explain facts or events. be true. - Greek word “theoria” A set of statements that tentatively An internally consistent group of relational describe, explain, or predict statements (concepts, definitions & Scientifically theory implies relationships among concepts that propositions) that present a systematic view that something has been have been systematically selected & about a phenomenon & which is useful for proven and is generally organized as an abstract description, explanation, prediction & control accepted as being true. representation of some phenomenon (Bodie & Chitty). (Powers & Knapp). The general principles or ideas that relate to principles or ideas that relate to a particular subject. A creative & rigorous structuring of ideas that project a tentative, Ex. Theory of Evolution purposeful & systematic view of phenomenon. Validation of existing knowledge as well as discovery of new knowledge. We apply theory to describe, explain, predict, or prescribe nursing practice. Categories of Theory Components: CONCEPTS CATEGORIES OF CONCEPTS ✔ are words or phrases Type Meaning Example that are used to represent the Abstract independent of a certain time and place CHS phenomenon Concrete more specific time or place Nursing, Pharmacy observed or they belong or not belong to a particular categories patients, nurses, Discrete experienced or classes of phenomena environment ✔ are the building ▪ Concepts - classifications of dimensions or pain, health – illness blocks of theories, Continuous gradations of a phenomenon across a continuum continuum “ideas” ▪ Degrees or levels in a given continuum ✔ describe & classify Theoretical establish meaning (dictionary) dictionary meaning phenomena Definitions Operational how these concepts are used or will be used within provide Definitions the context of the phenomenon measurement 10 Phases of Concept Building Process: 1. Write a meaningful practice story. 2. Name the central phenomenon in the practice story. 3. Identify a theoretical lens for viewing the phenomenon. 4. Link the phenomenon to existing literature. 5. Gather a story from someone who has lived the phenomenon. 6. Reconstruct the shared story and create mini-saga that captures its message This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 10  7. Identify the core qualities of the phenomenon. 8. Use the core qualities to create a definition. 9. Create a model of the phenomenon 10. Write a mini synthesis that integrates the phenomenon with a population to suggest research direction. Relational Statements Statements in a theory may state definitions or relations among concepts Theoretical Statements Relate concepts to one another; permit analysis Operational Statements Relate concepts to measurements Linkages and Ordering: provide rationale of why theoretical statements are linked; add Linkages of theoretical statements plausibility provides rationale for how measurement variables are linked; Linkages of operational statements permit testability Organization of concepts and definitions into eliminates overlap (tautology) primitive and derived terms Organization of statements and linkages into eliminates inconsistency premises and derived hypotheses and equations SCIENTIFIC LAW vs. THEORY SCIENTIFIC LAWS THEORY ✔ A statement of fact that aims to explain, in brief and ✔ More complex & dynamic; maybe replaced simple terms, an action or set of actions ✔ Explains an entire group ✔ Generally accepted to be true and universal and can ✔ Can be changed or improved without changing the occasionally be expressed in terms of a single overall truth mathematical equation ✔ Developed from the scientific method ✔ SIMPLE, TRUE, UNIVERSAL & ABSOLUTE ✔ ACCEPTED AT TRUE & PROVED ✔ Governs a single action, foundations for all science Hypothesis ✔ Statement based on repeated experimental an educated guess based upon observation observations that describes some aspects of the can be supported or proven false by experimentation universe or continued observation ✔ Always applies under same conditions, & implies that an idea or theory that is not proven but leads to there is a causal relationship involving its elements further study or discussion ✔ ex. Law of Universal Gravitation by Newton an assumption made for the sake of argument\ HAS NOT BEEN PROVED ex. watching excessive amounts of TV reduces a person’s ability to concentrate; smoking leads to lung cancer Contemporary Issues in Nursing Theory Development: ▪ Theoretical Boundaries and Levels to Advance Nursing Science o proposed framework now used without reference to the author for the development of nursing science ▪ Nursing Theory, Practice and Research o Theory-testing research may lead one nursing theory to fall aside as a new theory is developed that explains nursing phenomena more adequately; must continue to advance the discipline. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 10 CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed. 1. Which of the following are/is correct with the following historical eras of Nursing, except? a. Curriculum Era - 1900s to 1920s b. Research Era – 1950s to 1980s c. Graduate Education Era – 1950s to 1980s d. Theory Utilization Era – 21st century ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. What era noted that the outcome of Nursing theoretical works shifted the focus to the patient? a. Curriculum Era b. Graduate Education c. Theory Era d. Theory Utilization ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. This is defined as specific to academia and refers to a branch of education, a department of learning or a domain of knowledge. a. Vocation b. Discipline c. Profession d. None of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. All but one constitutes the following criteria of a profession: a. utilizes in its practice a well-defined and well organized body of specialized knowledge. Relationship between nurse and the patient b. entrusts the education of its practitioners to universities/ colleges c. functions autonomously in developing professional policy d. strives to compensate nurses by providing restriction in action, opportunity for continuous professional growth and economic insecurity ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. Which era has the emphasis of “carving out an advanced role and basis for nursing practice” a. Curriculum Era b. Research Era c. Graduate Education Era d. Theory Era ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 10  6. All of the following are true statements regarding epistemology, except? a. Branch of philosophy concerned with the nature & scope of knowledge. b. It is the study of knowledge & justifies beliefs. c. An idea that is suggested or presented as possibly true but that is not known or proven to be true. d. It questions what knowledge is & how it can be acquired. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. Which of the following differentiates Rationalism from Empiricism? (Select all that apply) a. It is from general to specific b. Knowledge is real when used by the senses c. It uses rational thinking d. Knowledge is based on experience ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. A research then theory approach falls on what principle: a. Rationalism b. Empiricism c. A & B d. None of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. A nurse tries to gather/collect data so the physician can have a diagnosis of the patient. This example falls under what principle? a. Rationalism b. Empiricism c. A & B d. None of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. This is a set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically selected & organized as an abstract representation of some phenomenon. a. Epistemology b. Philosophy c. Theory d. Concepts ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 11. Which of the following is a component of theory development? a. Concepts b. Relational statements c. Linkages and ordering d. All of the above This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 10 ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 12. A type of concept that is more specific time or place. a. Abstract b. Concrete c. Continuous d. Theoretical ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 13. Operational Definition is defined as: a. how these concepts are used or will be used within the context of the phenomenon b. dictionary defined concept c. they belong or not belong to a particular categories or classes of phenomena d. independent of time and or space ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 14. This is a type of relational statements that relate concepts to measurements. a. Theoretical b. Operational c. Relational d. Continuous ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 15. Which of the following is true to theory and scientific law? a. Scientific law governs a single action, foundations for all science while theory can be changed or improved without changing the overall truth. b. Theory is simple, true and universal. c. Scientific law is merely a guess. d. Scientific law is more complex and dynamic. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ RATIONALIZATION ACTIVITY The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 2. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 10 3. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 4. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 5. 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ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 9. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 10. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 11. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 12. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 13. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 14. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 15. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 10 LESSON WRAP-UP You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: CAT: MUDDIEST POINT This technique will help you determine which key points were missed in the main lesson. You will respond to only one question: In today’s session, what was least clear to you? _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 10  Theoretical Foundations in Nursing STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR Session # 2 LESSON TITLE: Materials: ▪ FLORENCE NIGHTINGALE’S ENVIRONMENTAL Pen and notebook THEORY ▪ JEAN WATSON’S PHILOSOPHY & THEORY OF TRANSPERSONAL CARING LEARNING TARGETS: Upon completion of this lesson, you can: 1. Discuss the life of Florence Nightingale as a person & as a nurse; 2. Define the philosophy of nursing according to the view of Nightingale; 3. Describe relevant situations where Nightingale’s theory can be practically applied; 4. Identify the significant contributions of Nightingale to the nursing profession; 5. Familiarize key points of credentials and background of theorist Jean Watson; 6. Define the philosophy of nursing according to the view of Reference: Watson; Alligood, M. (2018). Nursing theories and their 7. Describe the ten clinical processes; and, work (9th ed.). Singapore: Elsevier. 8. Integrate Watson’s theory in the nursing practice. LESSON REVIEW/PREVIEW Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the space provided. You may use the back page of this sheet, if necessary. Have fun! 1. Do you often believe a statement you only heard from someone or you would first validate it in your senses first before you believe a certain occurrence or event? __________________________________________________________________________________________ __________________________________________________________________________________________ 2. Is theory and scientific laws the same? If yes, what are their similarities? __________________________________________________________________________________________ __________________________________________________________________________________________ 3. If you would create a theory? What title would that be? __________________________________________________________________________________________ __________________________________________________________________________________________ MAIN LESSON You will study and read their book, if available, about this lesson. Nursing Philosophies – sets for the meaning of nursing phenomena through analysis, reasoning and logical argument. Are works that provide broad understanding that advances the discipline and its professional application. The history of nursing theory was dated way back when Florence Nightingale began to assume the great significance of providing a clean and healthy environment to achieve faster recovery of patients and continues up to present. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 11 FLORENCE NIGHTINGALE ✔ Nightingale’s (1859-1992) Notes on Nursing presents the nursing theory that focuses on the manipulation of the environment for the benefits of the patient. ✔ Although Nightingale did not present her work as a nursing theory, it has directed nursing practice for over 140 years. She is known as the Mother of Modern Nursing. ✔ Daughter of William Nightingale of Embley Park, Hampshire and was born in Italy, on the 12th day of May, 1820. The Crimean War ▪ In March 1853, the Crimean War broke out between Russia and Turkey. It was during this war where Florence Nightingale volunteered her services and was eventually given permission to take a group of 38 nurses to Turkey. ▪ She found the conditions as: o soldiers lay in filth straw pallets in crowded hallways o rats and insects crawled the floors and walls o hospitals lack basic supplies, such as cots, mattresses, bandages, washbasins, soap, and towels o water was rationed, and available in totally inadequate amounts o wounded armies were wearing unwashed uniforms that were stiff with dirt and gore o diseases such as typhus, cholera, and dysentery were the primary reasons why the death rate was high ▪ She recognized that overcrowding, filth, and poor ventilation all contributed to the illness of the soldiers. ▪ At night, she carried a lamp through the corridors, stopping to help the suffering of the wounded soldiers, for this, she was nicknamed, “The Lady with the Lamp” Post-War Contributions ▪ Nightingale returned to England as a national heroine in 1856 ▪ She published two books: Notes on Hospital (1859) and Notes on Nursing (1859) ▪ She raised enough funds and used this to establish the Nightingale School and Home for Nurses at St. Thomas Hospital. ▪ Nightingale’s work greatly influenced John Stuart Mill’s book on women’s rights. ENVIRONMENTAL THEORY “Nursing is the art of utilizing the patient’s environment for his or her recovery.” Environment – defined as the external conditions and influences affecting the life and development of an organism and capable of preventing, suppressing, or contributing to disease, accidents, or deaths. Components of Environment: ▪ Proper Ventilation. Nightingale believed that nurses have the responsibility to keep the air that the patient breathes pure as the external air without necessarily chilling him. She recognized the possibility that inadequate ventilation may be the source of disease. ▪ Adequate Light. Direct sunlight has quite as real and tangible effects on the human body who has not observed the purifying effect of light, and especially of direct sunlight. ▪ Cleanliness. She advocated taking a bath daily and that nurses should also bathe daily while keeping their duty uniforms clean and their hands washed clean. ▪ Warmth. Nightingale outlined a procedure for measuring the body’s temperature through palpation of, or feeling for the extremities in order to assess for heat loss. One of the nurse’s roles is to manipulate the environment. Positioning the patient, opening the windows, and regulating the room temperature are ways of maintaining this balance. ▪ Quiet. Nightingale described unnecessary noise can actually be harmful to the patient who is ill. ▪ Diet. Nightingale maintained that one of the nurse’s roles is to assess both the meal schedule and its effect on the patient, in addition to assessing the patient’s dietary intake. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 11  ▪ Management. The nurse is actually in control of the environment, physically, and administratively. The nurse is responsible for controlling the environment so that the patient is protected from physical and psychological harm. → Nightingale believed that the nurse continuously controlled the environment even if she is physically absent from caring for the patient because she is still responsible for supervising the other members of the health team who worked on her patient during her absence. Theory in View of Metaparadigms: Nightingale’s view of nursing was comparable to that of motherly instincts. She believed that every woman would be a nurse because nursing is having the responsibility for someone else’s health – a characteristic shared by women, especially mothers. Her “Notes On Nursing” provided guidelines to women who wanted to become nurses and gave advice on how to think like a nurse. Nursing is a Nursing vocation that needs formal learning and application of scientific principles in the care of patients. Nursing personnel were thus having more skill in terms of assessment and reporting of the patient’s health status. At the same time, the nurse is also able to perform nursing interventions that will allow the patient to heal and recover. The person is the patient himself. Patients are the recipient of our care. A passive patient is a patient who depends wholly on the nurse for tasks and control of his environment. The nurse is totally in Person control of the patient and his environment. Nightingale viewed the patient as a person who needed nursing care regardless of the patient’s social worth. Nightingale viewed health as being well. Health is also living up to one’s potential to the fullest extent. Disease and illness are viewed as reparative processes that are instituted by Mother Nature herself Health when the person did not attend to his personal health concerns. Nightingale emphasized the promotion and maintenance of health and prevention of diseases through prudent control of the environment and social responsibility. The environment was viewed as “those elements external to and which affect the health of the sick and healthy person” and included “everything from the patient’s food and flowers to the patient’s Environment verbal and nonverbal interactions.” Central to Nightingale’s theory is the concept of a therapeutic environment that will enhance the comfort and recovery of the patient. Application to Nursing: ▪ Nursing Practice: Ventilation, warmth, quiet, diet, and cleanliness are still important aspects of nursing care. We, nurses, thus need to maintain adequate ventilation, promote adequate and appropriate nutrition, maintain normal homeostatic body temperature, and observe basic hygiene and comfort measures, including environmental sanitations. ▪ Nursing Education: Nightingale had established the St. Thomas Hospital and King’s College Hospital in London, which was able to provide a framework for the establishment of nursing training schools through a universal template that contains principles of nursing training. She also advocated the separation of nursing training from the hospital to a more appropriate learning environment in the school or university setting. ▪ Nursing Research: Nightingale is considered the mother of nursing research because of her interest in the scientific methods of inquiry and statistics. She was able to gather and analyze data efficiently and resourcefully. She was the first to use polar diagrams in presenting study data. The concepts of Nightingale’s theory still serve as a basis for current research. In the 1990s, research studies that tested and expanded nursing theory were numerous. WATSON'S PHILOSOPHY & THEORY OF TRANSPERSONAL CARING “Nursing is the human science of persons and human health – illness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions.” JEAN WATSON ✔ born and grew up in a small town of Welch West Virginia; youngest of the eight children ✔ began developing her theory while she was assistant dean of the undergraduate program at University of Colorado ✔ in 1978-1981, she served as coordinator and director of the PhD program ✔ worked from 11 curative factors to formulate her 10 carative factors ✔ modified 10 factors slightly over time and developed the caritas processes, which have a spiritual dimension and use a more fluid and evolutionary language This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 11  ✔ authorized 11 books which reflect the evolution of her theory of caring o 1st book – Nursing: The Philosophy and Science of Caring (1979), use 10 carative factors but evolved to include “caritas” (connection between caring and love) o 2nd book – Nursing: Human Science and Human Care – A Theory of Nursing (1985), addressed her conceptual and philosophical problem in nursing Transpersonal Caring Relationship ▪ foundational of her theory; it is a special kind of human care relationship ▪ a union with another person-high regard for the whole person and their being in the world ▪ “Caritas” originates from the Greek vocabulary, meaning to cherish and to give special loving attention ▪ Watson uses the term “carative” instead of curative 10 Elements of Carative Factors: Watson introduced the concept of clinical caritas process, which have replaced her carative factors. The following are the translation of the carative factors into clinical caritas processes. CARATIVE FACTORS CLINICAL PROCESSES Humanistic-altruistic system Practice of loving kindness and equanimity (self-control/composure) within context of of value caring consciousness. Being authentically present, and enabling and sustaining the deep belief system and Faith-hope subjective life world of self and the one-being-cared-for. Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self, Sensitivity to self and others opening to others with sensitivity and compassion. Helping-trusting, human Developing and sustaining a helping-trusting, authentic caring relationship. care relationship Expressing positive and Being present to, and supportive of, the expression of positive and negative feelings as a negative feelings connection with a deeper spirit of self and the one-being-cared-for. Creative problem-solving Creative use of self and all ways of knowing as part of the caring process to engage in caring process artistry of caring-healing practices. Transpersonal Engaging in genuine teaching-learning experience that attends to unity of being and teaching-learning meaning, attempting to stay within other’s frames of reference. Supportive, protective, Creating a healing environment at all levels (physical as well as non-physical), subtle and/or corrective mental, environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, physical, societal, and and peace are potentiated. spiritual environment Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials”, which potentiate alignment of mind-body-spirit, wholeness, and Human needs assistance unity of being in all aspects of care, tending to both the embodied spirit and evolving spiritual emergence. Existential-phenomenologic Opening and attending to spiritual-mysterious and existential dimensions of one’s own al-spiritual forces life-death; soul care for self and the one-being-cared-for. Transpersonal caring relationship characterizes a special kind of human care relationship that depends on: ▪ the nurse’s moral commitment in protecting and enhancing human dignity as well as the deeper/higher self ▪ 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 ▪ the nurse’s caring consciousness and connection having the potential to heal since experience, perception, and intentional connection are taking place The term “transpersonal” means to go beyond one’s own ego and the here and now, as it allows one to reach deeper spiritual connections in promoting the patient’s comfort and healing. Finally, the goal of a transpersonal relationship corresponds to protecting, enhancing, and preserving the person’s dignity, humanity, wholeness, and inner harmony. A caring occasion is the moment (focal point in space and time) when the nurse and another person come together in such a way that an occasion for human caring is created. Assistance with the gratification of human needs describes the role of the nurse in promoting wellness and health through the achievement of basic human needs according to Maslow’s hierarchy of needs. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 11 Theory Assertions ✔ The theory acknowledges the unity of the person’s mind-body-spirit. ✔ The mind is the point of access to the body and the spirit. ✔ The spirit relates to a person’s soul, the inner self, the essence of the person, the spiritual self. ✔ It is the spirit that allows the person to transcend the “here and now” coexisting with past, present, and future, all at once through creative imagination and visualization. ✔ Watson ascertains that the care of the soul remains the most powerful aspect of the art of caring in nursing. Major Assumptions ▪ Nurse’s ability to connect with another at this transpersonal spirit to spirit level is translated via means of communication, into nursing human art and acts or intentional caring- healing modalities. ▪ Caring-healing modalities within the context of transpersonal caring/ caritas consciousness potentiate harmony, wholeness and unity of being by releasing some of the disharmony. ▪ Ongoing personal & professional development and spiritual growth. ▪ Nurse’s own life history, previous experiences etc. Are valuable teachers for this work. ▪ Other facilitators are personal growth experiences such as psychotherapy and other models for spiritual awakening. ▪ Continuous growth for developing and maturing within a transpersonal caring model is ongoing. Theory in View of Metaparadigms: Nursing is the human science of persons and human health – illness experiences that are mediated Nursing by professional, personal, scientific, aesthetic, and ethical human care transactions. Personhood (human being) a unity of mind/body/spirit/nature Unitary Transformative Paradigm-Holographic thinking: “…unity within an evolving Person emergent world view-connectedness of all…” three words: Mind, Body, Soul “… humans cannot be treated as objects and that humans cannot be separated from self, other, nature, and the larger universe.” “…illness is not necessarily disease; [instead it is a] subjective turmoil or disharmony within the Health spheres of the person, for example, in the mind, body, and soul, either consciously or unconsciously.” Society – provides the values that determine how one should behave and what goals one should strive toward. Watson stated, “Caring (and nursing) has existed in every society. Every society has Environment had some people who have cared for others. A caring attitude is not transmitted from generation to generation by genes. It is transmitted by the culture of the profession as a unique way of coping with its environment.” Application to Nursing: ▪ Nursing Practice (Administration & Leadership): It calls for administrative practices and embrace caring, even in a health care environment of increased acuity levels of hospitalized individuals, short hospital stays, increasing complexity of technology, and rising expectations in the task of nursing. ▪ Nursing Education: Watson’s writings focus on educating graduate nursing students and providing them with ontological, ethical, and epistemological bases for their practice, along with research directions. Watson’s caring framework has been taught in numerous baccalaureate nursing curricula. ▪ Nursing Research: Watson’s theory to reduce distress experienced by infertile women. Her theory and the application of theory of clinical practice hospital organizations have been their major weakness of research. Nelson and Watson report on studies carried out in seven countries. Implications of the Theory: ▪ One major implication of the theory is in the realm of bedside nursing where nurses of today have particularly begun to neglect. The essence of nursing is in the caring aspect and caring is taking the wholeness, the totality, of the patient in consideration. ▪ More importantly, nurses of today should try to care for a patient for who he is. After all, all of us were created equal and in His likeness. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 11 CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed. 1. Which of the following theorists presents the first nursing theory? a. Florence Nightingale b. Virginia Henderson c. Faye Abdelllah d. Lydia Hall ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. The following are the component of a healthy environment, except: a. Light b. Ventilation c. Warmth d. Management and noise ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 3. Which of the following is true about Florence Nightingale? (Select all that apply) a. The Mother of Modern Nursing b. Called as the Lady with the Lamp c. Named according to her birthplace d. Born August 10, 1820 ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. She defined Nursing as: a. Manipulation of the environment for the benefits of the patient. b. Relationship between nurse and the patient c. Nursing is the art of utilizing the patient’s environment for his or her recovery. d. Nursing is the art of caring for the patient to achieve fast recovery. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 5. This work of Florence provided guidelines to women who wanted to become nurses and gave advice on how to: a. Notes on Hospital b. Notes on Nursing c. Notes on Patients d. Notes on Nurses ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 6. The nurse is actually in control of the environment, physically, and administratively and is responsible for controlling the environment so that the patient is protected from physical and psychological harm. This falls on what component of a healthy environment? This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 11  a. Warmth b. Leadership c. Management d. Quiet ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. Health is defined by Nightingale as? a. Being well and using every power or resource to the fullest extent in living life. b. State of complete physical, mental and social well-being. c. Note merely the absence of disease or infirmity. d. socially determined by the ability to function in a reasonably normal manner. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 8. It was during this war when Nightingale volunteered her services along with 38 other nurses. a. Crimson War b. Crimean War c. Crime War d. None of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. In what component of a healthy environment includes taking a bath daily and that nurses should also bathe daily while keeping their duty uniforms clean and their hands washed clean. a. Warmth b. Light c. Management d. Cleanliness ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 10. All of the following are her major contributions in nursing in terms of education, except? a. Established the St. Thomas Hospital and King’s College Hospital in London to provide a framework for the establishment of nursing training schools b. Advocated the separation of nursing training from the hospital to a more appropriate learning environment in the school or university setting c. Nursing student’s role is to learn the art and science of nursing before being employed in the nursing service d. None of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 11. Where did Jean Watson become a Dean? a. University of Colorado b. University of Florida c. University of Miami d. None of the above This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 11 ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 12. Transpersonal caring involves requires an interaction which includes: a. The nurse’s moral commitment in protecting and enhancing human dignity as well as the higher self. b. 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. c. The nurse’s caring consciousness and connection having the potential to heal since experience, perception, and intentional connection are taking place d. All of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 13. The Humanistic-altruistic system of value corresponds to clinical process: a. Developing and sustaining a helping-trusting, authentic caring relationship. b. Being present to, and supportive of, the expression of positive and negative feelings as a connection with a deeper spirit of self and the one-being-cared-for. c. Creative use of self and all ways of knowing as part of the caring process to engage in artistry of caring-healing practices. d. Practice of loving kindness and equanimity (self-control/composure) within context of caring consciousness. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 14. She defined person as, except: a. Personhood b. Mind-body-soul c. Human can be treated as object and can be separated from self, nature d. Unity of mind body spirit nature ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 15. This is called the moment (focal point in space and time) when the nurse and another person come together in such a way that an occasion for human caring is created. a. Caring occasion b. Caring moment c. A & B d. None of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 16. The theory of Jean Watson constitutes the carative factors turned into clinical processes. Which of the following are the carative factors, except? a. Transpersonal teaching and learning b. Helping-trusting, human care relationship c. Insensitivity to self and others d. Faith-hope ANSWER: ________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 11 RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 17. Included in the carative factor is the Creative problem-solving caring process which evolved into what clinical processes? a. Developing and sustaining a helping-trusting, authentic caring relationship. b. Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for c. Creative use of self and all ways of knowing as part of the caring process to engage in artistry of caring-healing practices d. none of the above ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 18. One concept Watson defined is transpersonal caring which means? a. to go beyond one’s own choices and the others and now b. to go beyond one’s own ego and the here and now c. unity and harmony within the mind, body, and soul d. unity and harmony within the mind, body, and spirit ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 19. Watson believes that the essence of nursing is: a. Communication b. Caring c. Curing d. Critical thinking ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 20. All of the following are true to applications of her theory to the nursing practice, except? a. She emphasizes the advocated the separation of nursing training from the hospital to a more appropriate learning environment in the school or university setting b. The goal of a transpersonal relationship corresponds to protecting, enhancing, and preserving the person’s dignity, humanity, wholeness, and inner harmony. c. Cleanliness, warmth, and quietness are some of the concepts of her theory. d. It is every nurse’s duty and moral obligation to care for his or her patient not by merely looking into and caring for his or her physical disease ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ RATIONALIZATION ACTIVITY The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 11 2. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 3. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 4. 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ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 11. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 12. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 13. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 14. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 15. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 11 16. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 17. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 18. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 19. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 20. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ LESSON WRAP-UP You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: CAT: MINUTE PAPER This strategy provides feedback on whether or not you understand the lesson. Use the space provided in this activity sheet to answer the following questions. Make sure to not miss a tiny detail! How will you apply the theory of Florence Nightingale & Jean Watson in a healthcare facility? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 11 of 11  Theoretical Foundations in Nursing STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR Session # 3 LESSON TITLE: Materials: ▪ PATRICIA BENNER’S STAGES OF NURSING Pen and notebook EXPERTISE ▪ MARILYN ANNE RAY’S BUREAUCRATIC CARING LEARNING TARGETS: Upon completion of this lesson, you can: 1. Highlight the major contributions of Benner and Ray as nursing theorists; 2. Describe the Dreyfus model and differentiate levels of expertise; 3. Apply the theory in nursing settings; 4. Highlight the theorists’ major contributions; 5. Describe the theoretical sources of bureaucratic caring; Reference: and, Alligood, M. (2018). Nursing theories and their 6. Apply the theory in some nursing settings. work (9th ed.). Singapore: Elsevier. LESSON REVIEW/PREVIEW Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the space provided. You may use the back page of this sheet, if necessary. Have fun! 1. True or False: Florence Nightingale came from a wealthy family and her name was derived from her birthplace. Answer: __________ 2. True or False: Her parents wanted her to be a nurse. Answer: __________ 3. True or False: After publishing her books, she got married by the age of 30. Answer: __________ 4. According to Jean Watson, the essence of Nursing is “caring”. How do you define caring in your viewpoint? Answer: ___________________________________________________________________________________ MAIN LESSON You will study and read their book, if available, about this lesson. PATRICIA BENNER: CARING, CLINICAL WISDOM AND ETHICS IN NURSING PRACTICE ✔ born in Hampton, Virginia ✔ obtained a baccalaureate of arts degree from Pasadena College in 1964 ✔ earned Master’s degree in Nursing with major emphasis in medical-surgical nursing from University of California, San Francisco, School of Nursing ✔ has a wide range of clinical experience, including acute medical-surgical, critical care and home health care ✔ noted that experience-based skill acquisition is safer and quicker when it is founded on a sound educational base “Nursing is a caring relationship and practice that cares for and studies the lived experiences of patients on health, illness, and disease, and the relationships among these three elements.” This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 9 "The Nurse - Patient Relationship is not a uniform, professionalized blueprint but rather a Kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life". The Dreyfus Model is situational that describes the five levels of skill acquisition and development: ▪ Novice (0 to 1 year) ▪ Advanced Beginner (1 to 2 years) ▪ Competent (2 to 3 years) ▪ Proficient (3 to 5 years) – intuitive ▪ Expert (>5 years) – clinical eye The model proposes that, as a person improves in skill level, there is a corresponding change in the performance of a given skill. These are: ✔ Movement from reliance on abstract principles and rules to use of past, concrete experience. ✔ Shift from reliance on analytical, rule-based thinking to intuition. ✔ Change in the learner’s perception of the situation from viewing it as a compilation of equally relevant pieces to viewing it as an increasingly complex whole in which some parts stand out as more or less relevant. Passage from a detached observer, standing outside the situation, to one of a position of involvement, fully engaged in the situation. Skill refers to nursing interventions and clinical judgment skills in actual clinical situations. Expertise is developed when the clinician tests and modifies principle-based expectations in the actual setting. Novice Stage ▪ characterized by a person who lacks background experience of the situation he or she is involved in ▪ in order to guide the performance, simple rules and objectives, attributes should be given because the novice will usually have difficulty differentiating relevant and irrelevant aspects of a situation ▪ examples are nursing students and professional nurses who have been assigned to an area totally different from the one they are accustomed to ▪ when the novice has already started coping with enough real situations and has allowed him/her to demonstrate minimally acceptable performance within a given situation, his/her skill level also advances to that of an advanced beginner Advanced Beginner ▪ has enough experience to grasp aspects of a situation but not within the context of the situation ▪ should be guided by rules and are oriented by the completion of tasks ▪ feels highly responsible for managing patient care but will still need the help of other nurses who are more experienced than her ▪ examples are newly registered professional nurses ▪ progresses into a competent level of skill acquisition by learning from actual practice situations and by following the actions of others. Competent Nurse ▪ considerable conscious and deliberate planning which determines the important aspects of present and future situations. ▪ exhibits a sense of mastery, increased level of efficiency, consistency, predictability, and time management. Proficient Nurse ▪ already has a holistic view of a particular situation ▪ the nurse’s performance is guided by maxims by this stage ▪ can already show an intuitive grasp of the situation based on background understanding ▪ can see changing relevance in a given situation including recognition and implementation of skilled responses to the situation as it evolves Expert Nurse ▪ does not rely anymore on the analytical principles of rules, guidelines, and maxims to connect her understanding of the situation to an appropriate action ▪ characterized by the following vital traits: o demonstrate a clinical grasp and resource-based practice This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 9  o possess embodied know-how o see the big picture o see the unexpected Competency – defined as an interpretively defined area of skilled performance identified and described by its intent, functions, and meanings. Experience – the active process of refining and changing preconceived theories, notions, and ideas when confronted with actual situations; it reflects that there is communication between what is found in practice and what is expected. Maxim – a mysterious description of skilled performance. ✔ It requires a certain level of experience to recognize the implications of the instructions. ✔ Paradigm case is a clinical experience that stands out. ✔ It alters the way the nurse will perceive and understand and open new clinical viewpoints and alternatives. Hermeneutics – interpretive; it describes meaningful human activities or phenomena in a careful and detailed manner. ✔ The description is free from analytical assumptions. It is based purely on practical understanding of the phenomena. Theory in View of Metaparadigms: Described as a caring relationship and practice that cares for and studies the lived experiences of Nursing patients on health, illness, and disease, and the relationships among these three elements. It is viewed as a self-interpreting being. The person does not come into the world predefined. He gets defined in the course of living a life. He has an effortless and non-reflective understanding of the self in the world. He is a participant in common meanings and he is embodied. Embodiment refers to the body’s capacity to respond to meaningful situations with 5 dimensions: 1. The unborn complex – the fetus and newborn baby does not yet have any signs of the effects of culture Person 2. The habitual skilled body – refers to the body language of a person as he learned through time by the processes of identification, imitation, and trial and error 3. The projective body – refers to the predetermined action of the body in response to a situation; for example, walking or running 4. The actual projected body – refers to the body’s capacity to fit or be skilled in a given situation; for example, driving an automobile 5. The phenomenal body – refers to the body’s awareness of itself and its ability to imagine and describe touch sensations This is defined as what can be assessed. Well-being is the human experience of health or wholeness. Wellbeing and being ill are understood as distinct ways of being in the world. Health is not merely the Health absence of disease or illness. A person may also have a disease but not an illness. ▪ Illness is the human lived experience of loss of function or dysfunction. ▪ A disease is a state that can be assessed physically. Benner talked about situations instead of environment. Situation is described as the social Environment environment with a social definition and meaningfulness. Each person’s past, present, and future, including their own personal meanings, habits, and perspectives, influence the present situation. Application of the Theory: ▪ Benner’s contribution to the nursing profession is the use of phenomenal approaches to nursing practice. ▪ Phenomenal approaches have resulted in the development of clinical promotion ladders, new graduate orientation programs, and clinical knowledge development seminars. ▪ Her model is instrumental in differentiating knowledge development and career progression in nursing. This allowed nursing educators to realize that learning needs at the early stages of clinical knowledge development are different from those required at later or higher stages. ▪ It is important to understand that different employees will have different levels of skills. ▪ It is important to emphasize the importance of learning the skill of involvement and caring through practical experience, articulation of knowledge with practice, and the use of narratives in undergraduate education. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 9  ▪ It is important for nursing students and professional nurses alike to learn through experience or by experiential learning. ▪ Learning by experience will allow you to gain mastery of a given skill. MARILYN ANN RAY ✔ 1958 – went to LA, CA work at OB-Gyn, ER, CCU ✔ 1960 – US Citizen, US Air Force- flight nurse, clinician, administrator, educator, researcher with a rank of Colonel. The first nurse to go to the Soviet Union with the Aerospace Medical association ✔ 1965 – BSN-MSN in MCN at the University of Colorado; Dr. Madeleine Leininger, a nurse anthropologist, influenced Ray's life. ✔ 1973 – went back to Canada to be with her family, faculty in McMaster University ✔ 1989 – appointed as an Eminent Scholar at Florida Atlantic University and continues as Professor Emeritus ✔ Her research interests continue to focus on nurses, nurse administrators and patients in critical care and intermediate care, and in nursing administration in complex hospital organizational cultures Theoretical Sources: ▪ Dr. Leininger – transcultural nursing and ethnographic-ethnonursing research methods. ▪ Hegel – posited the interrelationship among thesis, antithesis, and synthesis. ▪ Chaos Theory – describes simultaneous order and disorder, and order within disorder. Ray compares change in complex organizations with this creative process and challenges nurses to step back and renew their perceptions of everyday events, to discover the embedded meanings. Major Concepts & Definitions: ▪ Holography – everything is a whole in one context and a part in another, with each part being in the whole and the whole being in the part ▪ Caring – a complex transcultural, relational process grounded in an ethical, spiritual context (charity and right action, love as compassion in response to suffering and need and justice or fairness of what to be done) ▪ Spirituality – involves creativity and choice and is revealed in attachment, love, and community o Spiritual- Ethical caring for nursing focuses on the facilitation of choices for the good of others ▪ Educational – formal and informal educational programs, use of audiovisual media to convey information and other forms of teaching and sharing information ▪ Physical – related to the physical state of being, including biological and mental patterns (mind and body) ▪ Social-Cultural – ethnicity & family structures, intimacy with friends and family, communication; social interaction and support. ▪ Legal – meaning of caring include responsibility and accountability; rules and principles to guide behaviors such as policies, procedures informed consent; right to privacy ▪ Technological – nonhuman resources, like machinery to maintain the physiological well-being of the patient, diagnostic tests, knowledge and skills needed to utilize these resources ▪ Economic – includes money, budget, insurance systems, limitations and guidelines imposed by managed care organizations, allocation of human and material resources to maintain services ▪ Political – power structure within health care administration, pattern of decision making in the organization; role and gender stratification among health care providers; competition for scarce human and material resources Major Assumptions: ▪ The meaning of caring is highly differential, depending on its structures (social-cultural, educational, political, economic, physical, technological, legal) ▪ Caring is bureaucratic as well as spiritual/ ethical, given the extent to which meaning can be understood in relation to the organizational structure ▪ Caring is the primordial construct and consciousness of nursing This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 9 Theory in View of Metaparadigms: holistic, relational, spiritual and ethical caring that seeks the good of self and others in complex Nursing community, organizational and bureaucratic cultures a spiritual and cultural being. are created by God, the Mystery of Being and engage co-creatively to Person find meaning and value. provides a pattern of meaning for individuals, families, and communities. Beliefs and caring practices Health about illness and health are central features of culture. a complex spiritual, ethical, ecological, and cultural phenomenon. It embodies knowledge and conscience about the beauty of life forms and symbolic systems or patterns of meaning. These Environment patterns are transmitted historically and are preserved or changed through caring values, attitudes, and communication. Application to Nursing: ▪ Nursing Practice (Administration & Leadership): The theory of Bureaucratic Caring has direct application for nursing. We are challenged to integrate knowledge, skills and caring. This synthesis of behaviors and knowledge reflects the holistic nature of the theory. This shows that nurses, patients, and administrators value the caring intentionality that is co-created in the nurse-patient or administrator-nurse relationship. This can transform the working environment, fostering ethical choices, respect, and trust, resulting to successful organizations ▪ Nursing Education: Useful in nursing education in terms of its broad focus on caring in nursing and its conceptualization of the health care system. Interconnectedness of all things ▪ Nursing Research: Particularly significant because it is grounded in the philosophy of humanism and caring, and it encourages nurses to utilize phenomenological-hermeneutics through the lens of caring Implications of the Theory: Clarity major structures are defined clearly, consistent with definitions commonly used by practicing nurses Simplicity the theory simplifies the dynamics of complex bureaucratic organizations the theory addresses the nature of nursing as caring, "What is the nature of caring in nursing?”, "What Generality is the nature of nursing practice as caring?". Philosophies are broad and provide direction for the discipline has undergone continued revisions based largely on research, empirical precision is high with Accessibility concepts grounded in observable reality issues that confront nurses today include economic constraints in the managed care environment and Importance the effects of these constraints (staffing ratio) on the nurse patient relationship CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed. 1. This describes simultaneous order and disorder, and order within disorder. Ray compares change in complex organizations with this creative process and challenges nurses to step back and renew their per