Theoretical Foundations of Nursing PDF Notes

Theoretical Foundations of Nursing NOTES By : Jamie Beatier Lizar Dr. Fely Transfiguration Lim R N,...

Theoretical Foundations of Nursing NOTES By : Jamie Beatier Lizar Dr. Fely Transfiguration Lim R N, ,. M A N.. , D N M.. 10 MODULES : 71 Introduction to 1 Nursing Theory 3 the. 2 History , components of Theory 3 Nursing Metaparadigm. Environmental Theory 4 Florence Nightingale : 72. J. Jean Watson : Theory of Human caving 6. Patricia Benner : Caring , Clinical Wisdom , Midterm 7 Conceptual model-Levine 73. s. Dorother Ovem(? ) : Self-Cone Theory 9. Imogeneking : Theory of Goal Attainment Sister Callista Roy Adaptation Model of 10 Nursing. : "Betty Neuman : Systems Model 74 Ernestine Wiedenbach Helping Art 12. of Clinical Nursing : Virgima Need Henderson Nursing Theory 73 : 1s. 14. Ida Jean Orlando : Nursing Process Theory Glen Abdella ProblemsTheory 15. Fage : 21 Nursing 76 Relations. 16 Hildegard Peplau : Interpersonal Theory 17. Dorothy Johnson : Behavioral Systems Model 77 Anne Boykin & Savina 0 Schoenhofer Theory of Nursing Caring. : as 18 : 3 A model for transforming practic 19. Josephine Patterson & Idezad : Humanistic Nursing Theory 20. Margarette Newman : Health as Expanding Consciousnes Now J Pender Health Promotion Model 7 g 21 Finals. : 22. Madeline Leininger : Culture Care Theory of Diversity and Universality 23. Kathazine Kolcaba : Theory of comfort & 24 Cornelia M. Ruland Shiely Moore : Peaceful End-of-life Theory > 9. 25. Lydia Hall : Care , Cure , Core Theory. 26 Joyce Travelber : Human to Human Relationship Eimbeth Lear & Linda Pugh Theory Unpleasant Symptom : 27. of. 28 Carmencita Sister Adaquin : Prepare Me Retirement and Roll Discontinuitie Theory 718 29. lefty G. Kuan : GRADING SYSTEM 40 % Quizzes - Attitude/Behavior-10 % at end May Quiz every of the · Kasama Recit jStudent-Centered Activities - 10 %. Major Exams - 40 % - meeting 1001. · 13 mim. Grace Period & Final Grack · 8 absences = 20 % FA Attendana-10 % Midterm-40 % % Finals 20 - roo  HISTORY OF NURSING THEORY GRADUATE EDUCATION ERA - The history of professional nursing began with Florence Nightingale - Coincided with the research era. - Nightingale envisioned nurses as a body of educated women at a time - A Master's degree in nursing emerged. when women were neither educated nor employed. - Nursing master’s programs began to include courses in concept - After her time serving for the wounded in Scutari during the Crimean development and nursing models, introducing students to early War, Nightingale’s vision and establishment of a School of Nursing at St. nursing theorists and knowledge development processes. Thomas’ Hospital in London marked the birth of modern nursing. - The baccalaureate degree began to gain wider acceptance as the - Her pioneering activities in nursing practice and education and her education level for professional nursing and nursing attained subsequent writings became a guide for nursing schools and hospitals recognition as an academic discipline at the beginning of the 20th Century. - In the 1970s, nursing continued to make the transition from vocation to profession. DURING THE MID-1800S, - Nightingale recognized the unique focus of nursing and clarified a THEORY ERA distinction between nursing knowledge and medical knowledge. - Natural outgrowth of research and graduate education. - Nightingale described that a nurse’s proper function as putting - Important precursor: general acceptance of nursing as a profession patients in the best condition for nature (God) to act upon them and and an academic discipline. set forth the following: - Doctoral education in nursing began to develop with a strong - Care of the sick is based on knowledge of people and their emphasis on theory development and testing surroundings — a different knowledge used by physicians in their - Accelerated as early work developed as frameworks for curricula and practices. advanced practice began to be recognized as theory. DURING THE 1950S - 1980s: a time of major developments in nursing theory that have been - Nursing leaders began serious discussions of the need to develop characterized as a transition from a pre paradigm to the paradigm nursing knowledge apart from medical knowledge. period of nursing. - Until the proposal of nursing as a science, nursing practice was based - Fawcett’s seminal proposal of a nursing metaparadigm of four mainly on principles and traditions handed down through an global nursing concepts as an organizing structure of existing apprenticeship model of education and hospital procedure manuals. frameworks - Nursing practice reflected its vocational heritage more than its - Classifying nursing models as paradigms bordered by the professional vision. metaparadigm concepts of person, environment, health, and nursing systematically united nursing theoretical works for the discipline. CURRICULUM ERA - In the last decades of the 20th century, emphasis shifted from learning - Addressed what content nurses should study to learn how to be a about the theorists to using the theoretical works to generate research nurse. questions, guide practice, and organize curricula. - Emphasized what courses nursing students should take, with the goal - Theory development emerged as a process and product of professional of arriving at a standardized curriculum. scholarship and growth among nurse leaders, administrators, - By the mid 1930s, a standardized curriculum had been published and educators, and practitioners who sought higher education. adopted by many diploma nursing programs where nursing was taught - Fitzpartick and Whall (1983), “nursing is on the brink of an exciting at the time. new era” - When the idea of moving nursing education from hospital-based diploma programs to colleges and universities began emerging. THEORY UTILIZATION ERA - In the second half of the 20th century, diploma programs began - Gave way to new levels of development and use of nursing theory for closing and nursing education programs opened in colleges and evidence-based professional practice. universities. - Middle-range theory and the value of a nursing framework for thought - The curriculum era emphasized course selection and content for and action in nursing practices was realized nursing programs. - Shift in emphasis to the application of nursing theory was extremely important for theory-based nursing, evidence-based practice, and RESEARCH EMPHASIS ERA future theory-development. - Began during the mid 20th century. - The use of nursing philosophies, models, theories, and middle-range - Nurses began to participate in research, and research courses were theories for the thought and action of nursing practice contributes included in nursing curricula in early graduate nursing programs. important evidence for quality care - 1970s: evaluation of the first 25 years of the journal Nursing Research - Pickler (2018) stress the importance of using theory and being explicit revealed that nursing studies lacked conceptual connections and about the theory one is using theoretical frameworks. - Theory is relevant in the history of nursing’s progress toward - Milestones in the evolution of nursing theory: specialized nursing knowledge. That knowledge contributes to the recognition and appreciation of the significance of nursing as a - Awareness of the need for conceptual framework and theory profession and a discipline. development, - The standardization of curricula for nursing master’s education by the National League for Nursing accreditation for baccalaureate SUMMARY OF HISTORICAL ERAS and higher-degree education Historical Major Emphasis Outcomes Emerging - Decision that doctoral education for nurses should be in nursing. Era Question Goal Curriculum What Courses Standardized Develop  SIGNIFICANCE FOR THE PROFESSION Era curriculum included curricula for specialized (1900-1940) should in the diploma knowledge - Profession: refers to a specialized field of practice, founded on the student nursing programs and higher theoretical structure of a science or knowledge of that discipline and nurses program. education accompanying practice abilities. study? - Bixler and Bixler set a criteria for a profession tailored to nursing in the American Journal of Nursing Research What is the Role of Problem Isolated Era focus of nurses studies and studies to Criteria for Development of Professional Status of Nursing (1950s-1970s) nursing and what studies of not yield research? to nurses unified 1. Utilizes in its practice a well-defined and well-organized body of research knowledge specialized knowledge that is on the intellectual level 2. Constantly enlarges the body of knowledge it uses and improves its Graduate What Carving Nurses have Focus techniques of education and service through use of the scientific Education knowledge out an an important graduate method (1950s-1970s) is needed advanced role in health education on 3. Entrusts the education of its practitioners to institutions of higher for the role and care knowledge education practice of basis for development 4. Applies its body of knowledge in practical services vital to human nursing? nursing and social welfare practice 5. Functions autonomously in the formulation of professional policy and thereby in the control of professional activity ] Theory Era How do There are Nursing Theories 6. Attracts individuals with intellectual and personal qualities of (1980-1990s) these many ways theoretical guide exalting service above their chosen occupation as a life work frameworks to think works shift nursing 7. Strives to compensate its practitioners by providing freedom of guide about the focus of research and action, opportunity for continuous professional growth, and research nursing the patient practice. economic security. and practice? - Professional nursing requires a systematic approach that is focused on Theory What new Nursing Middle-range Nursing the patient, and the theoretical works provide perspectives for the Utilization theories are theory theory may frameworks patient. Era needed to guide be from produce - Contributions of global theorists present nursing as a discipline and (21st produce research, quantitative knowledge provide a knowledge structure for further development Century) evidence practice, or qualitative (evidence) for quality education, approaches. for quality care? and care. administr ation SIGNIFICANCE OF NURSING THEORY - At the beginning of the 20th century, nursing was not recognized as an academic discipline or a profession - Discipline and Profession are interrelated - Discipline: a branch of knowledge or field of study taught and researched as a branch of higher learning; specific to an academia and refers to a branch of education - Profession: refers to an occupation with preparation in specific knowledge in higher learning and the performance of a practice; a specialized field of practice, founded on the theoretical structure of the science or knowledge of that discipline and accompanying practice abilities. - Discipline and profession are inextricably linked, but failure to separate them from each other anchors nursing in a vocational rather than a professional view SIGNIFICANCE FOR THE DISCIPLINE - Discipline: is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge - Conceptualization of a nursing paradigm (person, environment, health, and nursing) as a structure of knowledge clarified the relationships of the collective works of major nursing theorists as conceptual frameworks and nursing paradigms - The significance of theory for nursing is that the discipline is dependent on theory for its continued - The theoretical works have taken nursing to higher levels of education and practice as nurses move from a functional focus to a patient focus - Functional Focus: emphasis on what nurses do - Patient Focus: emphasis on what nurses know about human beings and their health - Every field of knowledge or discipline includes theoretical knowledge, therefore nursing as an academic discipline depends on the existence on nursing knowledge  THEORY RELATIONAL STATEMENTS - A belief, policy, or procedure proposed or followed as the basis of action - Define the relationship between two or more concepts. - Theoria (gk) - to speculate - The chains that link concepts to one another - Organized information about a set of related concepts that may be established or speculative in nature CONCEPTUAL FRAMEWORK - will guide us toward the proper path - An analytical tool that is used to get a comprehensive understanding of a phenomenon COMPONENTS OF A THEORY - It can be used in different fields of work and is commonly used to visually explain the key concepts or variables and the relationships CONCEPT between them that need to be studied - Concipere (lt) - “to conceive” ↳ Building blocks of theories - Consists of concepts that are placed within the logical and sequential - Building blocks of thoughts design - Description of an event, situation, or experience - Represents less formal structure and used for studies in which - words/phrases that identify and establish structure and boundaries existing theory is inapplicable or insufficient for the phenomena and ideas generated by phenomena - Based on specific concepts and propositions derived from empirical - ABSTRACT CONCEPTS: abstract concepts are mentally constructed observation and intuition independent of a specific time or place - May deduce theories from a conceptual framework - Indirectly observed or intangible - Ex: love, care, freedom THEORETICAL FRAMEWORK - CONCRETE CONCEPTS: directly experienced and relate to a particular - It is the structure that can hold or support a theory of a research study time or place ↳ be perceived by the 3 senses can - The theoretical framework introduces and describes the theory which - Directly observed or tangible explains why the research problem under study exists - Ex: nurse, mother, fever - The theory provides a point of focus for attacking the unknown in a specific area IDEA - Idein (gk) - “to see” - Product of intellectual thought about the origin of a phenomenon NURSING THEORIES - Anything that describes a concept - Organized frameworks of concepts and purposes designed to guide the - the thinking process before the conceptualization of a phenomenon. practice of nursing PHENOMENON - Developed to explain and describe the nursing care, guide nursing practice and provide a foundation for clinical decision-making - Phainomen (gk) - “a thing appearing” - Provide a way to define nursing as a unique discipline that is separate - Fact or event of scientific interest susceptible to scientific description from other disciplines and explanation - Nursing theories affect everyday nursing practice, by: - Observable fact or event between objects, events, or ideas - An event regarding the idea - Helping nurses use critical thinking skills, analytical skills, and - should be able to be explained scientifically improve concept comprehension - Improving patient care, patient outcomes, and nurse-patient PROPOSITION communication - Proponere (lt.) - “to put forth” - Nursing theories have made a strong and lasting impact on the - idea that us Ba the starting point for making a case or investigation education, training and development of professional nurses - identifies the direction of a relationship between concepts - As the nursing profession continues to evolve and define itself, new - may affirm or deny a predicate of a sentence nursing theories will be needed to guide nurses practicing at bedside - a statement that proposes a relationship between concepts. PRINCIPLE PURPOSES OF NURSING THEORY IN EDUCATION - Principium (lt) - “a beginning” - Defined as a comprehensive and fundamental law, doctrine, or - Provides a general focus for curriculum design assumption - Determines curriculum content and order of subjects - A truth, built on facts, which is foundational to other truths - Develop specialized knowledge and higher education ASSUMPTION PURPOSES OF NURSING THEORY IN RESEARCH - Sumere (lt) - “to take” - Offers framework and approach in the development of nursing - Defined as something taken as being true or factual and use as a knowledge starting point for a course of action or reasoning - Provided research focus and design - Factors that may or may not be constant in a hypothesis PURPOSES OF NURSING THEORY IN PRACTICE HYPOTHESIS - Assists nurses to describe, explain, and predict everyday experiences - A tentative explanation for an observation, phenomenon, or scientific - Establishes common terminologies problem that can be tested by further investigation - Provides knowledge in nursing practice - NULL HYPOTHESIS: testing the likelihood of a statement being true in - Carving out an advanced role for nursing practice order to decide whether to accept or reject our alternative hypothesis - ALTERNATIVE HYPOTHESIS: determine whether or not to accept or reject the statement based on the likelihood of the null hypothesis being true  ANALYSIS FOR NURSING THEORIES - The attributes, characteristics, and actions of the nurse providing are on behalf of or in conjunction with, the client CLARITY - The goal of nursing theories is to improve patient care - “How clear is this theory?” - A word should be defined carefully and specifically according to the PHILOSOPHY framework (philosophy, conceptual model, or theory) within it is - Sets forth the meaning of nursing phenomena through analysis, developed reasoning, and logical presentation of concepts and ideas Types of Definition : operationalhowthetermis essay SIMPLICITY CONCEPTUAL MODELS - “How simple is this theory?” - Sets of concepts that address the phenomena central to nursing - A theory should be sufficiently comprehensive, presented at a level of propositions that explain the relationship among them abstraction to provide guidance, and have as few concepts as possible with simplistic relations to aid clarity GRAND THEORY - Concepts that derive from a conceptual model and propose a testable GENERALITY proposition that tests the major premise of the model - “How general is this theory?” - General - Speaks of the scope of application and the purpose within the theory NURSING THEORY ↳ questions to be answered by your research - Testable propositions from philosophies, conceptual models, grand ACCESSIBILITY theories, abstract nursing theories or theories from other disciplines. - “How accessible is this theory?” Theories are less abstract than grand theory and less specific than components in the survey Form - Addresses the extent to which Analyzed empiric indicators for the concepts can middle-range theory be identified and to what extent the purposes of the theory can be attained MIDDLE-RANGE THEORY - Theory’s capacity to “generate hypotheses and be subjected to - Concepts most specific to practice that propose precise testable empirical research” nursing practice questions and include details such as patient age group, family situation, health condition, location of patient, and action IMPORTANCE of the nurse - “How important is this theory?” - Nursing theories lend itself to research testing, and research testing THE FUTURE OF NURSING THEORY leads to knowledge for practice - Nursing theoretical systems give direction and create understanding - Nursing theory guides research and practice, generated new ideas, and in practice, research, administration, and education. differentiates the focus of nursing from that of other professions NURSING PROCESS : CHARACTERISTICS OF A NURSING THEORY Assessment (IPPA) 1. - Nursing knowledge is developed ↳ through inspection/observation - Understands nursing actions through frameworks I through palpation - Research follow theory for direction ↳ through percussion ↳ through auscultation - Serves as a validation for nursing practice. 2 Nursing Diagnosis - Evaluate practice outcome and client response 3. Planning 4. Implementation METAPARADIGMS OF NURSING THEORIES 5. Evaluation - A.K.A conceptual framework or conceptual model - provides different views of nursing according to the characteristics of models 3 MAJOR COMPONENTS OF THEORY · Identified by Dr. Jacqueline Fawcelt 1. Concepts and Definitions PERSON. 2 Relational Statements - A.K.A the client or human beings - The recipient of nursing care and may include individuals, patients, 3. Order and Linkages groups, families, and communities - Bio-psycho-social being who presents as an integrated whole HEALTH - Defined as the degree of wellness or wellbeing that the client experiences - State of wholeness or integrity of the individual, his parts and his modes of functioning - The ability to function independently regarding activities of daily living (ADL) ENVIRONMENT - A.K.A situation - Internal and external surrounds that affect the client - Sub-component of man and may act in a positive or negative way upon the client NURSING - A profession focused in helping clients to prevent, solve, alleviate or cope with problems associated with ADL  : ENVIRONMENT THEORY Birth-May 12 , 1828 BACKGROUND - The British Royal Sanitary Commission was founded in reaction to - Nightingale came from a well-educated, wealthy, victorian family that Nightingale’s report lives in Derbyshire - Nightingale used a polar diagram to show the number of unnecessary - Her father taught her math, languages, religion, and philosophy which deaths in Crimean British military hospitals influenced her future - Nightingale could record, communicate, order, code, conceptualize, - (1837) Florence, at age 17, quoted “God spoke to me and called me to His infer, analyze, and synthesize research service) - She realized that she wanted to be a nurse, later on MAJOR ASSUMPTIONS - She completed her nursing training in 1851 at the age of 31, in NURSING Kaiserwerth Germany - Nursing is being responsible for someone else’s health - Notes on Nursing (1859) provided women with guidelines and advice in CREDENTIALS “how to think like a nurse” - She was employed to examine hospital facilities, reformatories, and - Trained nurses need additional scientific principles and observation charitable institutions employed Siya agad - skills to report to patient’s health status - She then became the superintendent of the Hospital for Invalid Gentlewomen in London HEALTH - During the Crimean War, she deployed to Scutari, Turkey along with a - Being well and living life to the fullest extent group of 34 women to soldiers ; walking in corridors a with lamp - Disease and illness is a reparative process - She was nicknamed,Provided. care “Lady of the Lamp” - Environmental control and social awareness - Addressed the unsafe treatment environments - Using their education to spread awareness of various diseases and - Soldiers recovered but faced diseases how the mass can prevent its infection - Florence Nightingale also got critically ill with Crimean Fever - Florence was commended by Queen Victoria herself and the soldiers PERSON - She started schools and hospitals worldwide from funds she received. ↳ - Person as a patient - While critically ill, she wrote 15,000 to 20,000 letters to people made her the pioneer of - Believed persons as individual meaninf to care for them with the - Brief observations, and plans for change in healthcare patient’s unique preferences modern musing - Nightingale worked until her 80s until she lost her vision - The nurse was in control of and responsible for the patient’s - Died: August 13, 1910, at 90 years old environment NOTABLE WRITINGS ENVIRONMENT Surroundings - term niya. - Notes on Matter Affecting the Health. Efficiency, and Hospital - Nursing was to assist nature in healing the patient Administration Notes on Hospitals - The patient should create a therapeuic environment that enhances - Notes on Nursing comfort and recorvery - Report on Measures Adopted for Sanitary Improvements in ndia - Poor environment = poor health - What it is and What is not - Nightingale hoped that nurses become an instrument in changing the social status of the poor by improving their physical conditions THEORETICAL SOURCES FOR THEORY DEVELOPMENT - Nightingale’s parents were initially against her learning mathematics, THEORETICAL ASSERTIONS but her parents eventually allowed her to take classes from recognized mathematicians. - Integral factors in the development of Nightingale’s theory: Nightingale believed that disease was a reparative process - Personal Values - Diseases were nature’s effort to remedy a process of poisoning or - Societal Values decay, or it was a reaction aginst the conditions in which the person is - Professional Values placed - With her family’s social status, she had access to powerful people like - The word “Nature” to suggesst that it was synonymous with God family friends - Her friendship with Dickens gave her a platform to discuss social and Nightingale was totally committed to nursing education (training) healthcare issues and influenced her nursing philosophy and concepts - Nurses needed to be excellent observers of patients and the - Nightingale’s nursing philosophy was influenced by the following: environment - John Stuart Mill - In addition, she believed that nurses should use common sense in - Benjamin Jowett practice, coupled with observation, perseverance, and ingenuity - Edwin Chadwick L thinking patient Nurser use critical in aiding a - Harriet Marineau Nightingale didn’t embrace the Germ Theory - Her religious affiliation shared her nursing perspective - Nightingale didn’t beliebe the Germ Theory. However, she clearly - The Catholic-Anglican conflicts in the British Empire may have understood the concept of contagion and contamination impacted her belief that nursing should be a secular profession - For her, the Germ Theory opposes her belief that sanittion, goodhygiene, and approporate manipulation of the environment could prevent USE OF EMPIRICAL EVIDENCE infection. - Nightingale published her studies on social reform, nursing, and healthcare, demonstrating her statistical skills. Nightingale did not explicitly discuss the caring behavior of nurses but - Environment to patient it is clearly shown in her experiences/examples - Environment is the main factor that created illness to a patient - Nightingale wrote little information about her interpersonal - She emphasized the positive aspects of having a comfortable relationships but she did explain how it can influence the patient’s environment as well as its potential of harming a patient reparative processes - According to Nightingal, manipulation of such is needed: - However, her experience in Crimea became a piece of evidence of caring - Elimination of possible contamination and contagion behaviors. These behaviors are considered a blueprint for - Exposure to fresh air transpersonal meanings and models of caring - Proper lighting and warmth - Warner and White (2010) explore and analyze “caring relationships” in - Quietness Nightingale’s own writing. This historical study contributes to our - Nightingale discussed the concept of observation extensively, for understanding of how Nightingale described our modern concept of guidance and evaluation of the caring. - Studies also showed that in today's time, anecdotal evidence of the SIMPLICITY caring and compassionate behaviors of modern nurses was - The Nightingale Theory is descriptive and explanatory highlighted in the media during the COVID-19 pandemic of 2020. GENERALITY Nightingale believed that nurses should be moral agents - Nightingale’s belief have guided nurses worldwide - Nightingale emphasized the importance of nurses as moral agents - Nurse, patient, and environment remain important in modern nursing - She also emphasized the need for clear and concise-decision making between nurses and physicians, stating that indecision or changing the mind is more harmful to patients than making a decision ACCESSIBILITY - Researchers analyzed how Nightingale defined nursing as an ethical - Nightingale’s concepts are still usable to both qualitative and profession and the ethical practices embedded in nursing. quantitative approaches of today FORM OF LOGIC IMPORTANCE - nightingale used inductive reasoning to extract las of health, disease, - Nightingale’s writings direct the nurse to take action on behalf of the and nursing from her observations and experiences patient that encompasses the areas of - She developed her logical thinking and inductive reasoning abilities - Practice because of her education as a child particularly in the field of - Research philosophy and mathematics. - Education - Her training as a superintendent and experiences in Crimea influenced her nursing principles. ACCEPTANCE BY COMMUNITY - Nightingale’s theory is timeless and universal. - Its impact on the nursing community is still evident in today’s society. - This theory focuses on providing patients with the five essential components of environmental health: - Pure air - Pure water - Adequate lighting - Cleanliness - And efficient drainage - The foundation of many different nursing theories and practices - Transformations in society - Empowered nurses to assume a holistic role encompassing both the patient's immediate environment and administrative aspects. - Preparation of students into nurses through training; scientific and practical experiences. - Firm believer in separating practice and education - Her approaches to nursing are more philosophical, and teachings on nursing and patient care are still applied today FURTHER DEVELOPMENT - Provides guidance for nursing care while depicting what nursing is and what nursing is noe C - Hardy (1987) said that Nightingale formulated a grand theory, which is an abstract heavy theory that tackles the C entirety of nursing behavior - Tourville and Ingalls (2003) even described it as the living tree of all theories CRITIQUE CLARITY - Nightingale’s work addresses three major relationships - Nurse to patient relationship - Nurse to environment  ↳ Margaret Jean Harman Watson PERSONAL BACKGROUND 10.“Allowance for existential-phenomenological-spiritual forces” - Born and grew up in the small town of Welch, West Virginia in the = CARATIVE PROCESS -Evolved from Carative Factors 1940s. 1. “Practice of loving-kindness and equanimity within the context of - In 1997, an accidental injury resulted in the loss of her left eye. caring consciousness” - Married Douglas Watson and moved to his native state of Colorado in 2. “Being authentically present and enabling and sustaining the deep 1961. In 1998, she lost her husband. belief system and subjective life-world of self and one being cared for” EDUCATIONAL BACKGROUND 3. “Cultivation of one’s own spiritual practices and transpersonal self, - Attended high school at Lewis Gale School of Nursing in Virginia. going beyond the ego self” - Continued nursing education at the University of Colorado. 4. “Developing and sustaining a helping trusting an authentic caring - In 1964, earned a baccalaureate degree in nursing. relationship” - 1966, Master’s degree. 5. “Being present to, and supportive of, the expression of positive and - 1973, Doctorate in educational psychology and counseling. negative feelings as a connection with deeper spirit and self and the - In the 1980s, Watson, and colleagues established the Center for Human one being cared for” Caring at the University of Colorado 6. “Creative use of self and all ways of knowing as part of the caring - Watson Caring Science Institute (WCSI) was established by Watson process; to engage in the artistry of caring-healing practices” from groundwork laid by the Center for Human Caring 7. “Engaging in a genuine teaching-learning experience that attends to - Watson Endowed Chair in Caring Sciences was established at the unity of being and meaning, attempting to stay within others’ frame University of Colorado. of reference” - From 1983-1990, she was a dean of the University of Colorado School of 8. “Creating a healing environment at all levels (physical as well as Nursing and associate director of Nursing Practice at the University nonphysical, subtle environment of energy and consciousness, Hospital. whereby wholeness, beauty, comfort, dignity, and peace are AWARDS potentiated).” 9. “Assisting with basic needs, with an intentional caring - 15 honorary degrees and 12 from international universities. consciousness, administering ‘human care essentials,” which - In 1993, she received the National League for Nursing award. potentiate alignment of mind body spirit, wholeness, and unity of - 1998, recognized as a distinguished nurse scholar by New York being in all aspects of care” University. 10.“Opening and attending to spiritual-mysterious and existential - In 2013, the American Academy of Nursing inducted Watson as a dimensions of one’s own life-death; soul care for self and the “Living Legend” their highest honor. one-being-cared for” - Has been involved in international projects and has most recently word meaning love and Compassion presented in Jordan, Uruguay, Canada, Japan, the UK, and Greece. glt. BOOKS 10C CARITAS PROCESSES - 1st book: Nursing: The Philosophy and Science of Caring (1979) 1. Sustaining Humanistic-Altruistic Values by Practicing - 2nd book: Nursing: Human Science and Human Care–A Theory of Loving-Kindness, Compassion, and Equanimity with Self (EMBRACE) Nursing (1985) 2. Being Authentically Present; Enabling Faith, Hope, and Belief System; - 3rd book: Postmodern Nursing and Beyond (1999) Honoring Subjective Inner, Life- World of Self/Other. (INSPIRE) - 4th book: Instruments for Assessing and Measuring Caring in Nursing 3. Being Sensitive to Self and Others by Cultivating Own Spiritual and Health Sciences (2002) Practices, Beyond Ego-Self to Transpersonal Presence (TRUST) - 5th book: Caring Science as Sacred Science (2005) 4. Development and Sustaining Loving, Trusting- Caring Relationship (NURTURE) 5. Allowing for Expression of Positive and Negative Feelings—Listening WATSON’S THEORY OF HUMAN CARING Authentically to Another Person’s Story (FORGIVE) - “Nursing is concerned with promoting health, preventing illness, caring 6. Creative Problem-Solving - ”Solution-Seeking” Through Caring for the sick, and restoring health. Process, Full Use of Self and Artistry of Caring-Healing Practices via - focuses on health promotion, as well as the treatment of diseases. Uses of All Ways of Knowing/Being/Doing/Becoming (DEEPEN) - The philosophy covers every aspect of nursing, with a focus on the 7. Engage in Transpersonal Teaching and Learning Within the Context of interaction between the caregiver and the care recipient. a Caring Relationship, Staying Within the Other’s Frame of Reference - The theory is applied through what are called carative factors or Caritas (BALANCE) processes. 8. Creating a Healing Environment at All Levels, a Subtle Environment = may compassion empathy - Curing versus Caring for Energetic, Authentic Caring Practice (CO-CREATE) elimination of o disease Nurse-Patient Interactions ; enhances caring 9. Reverentially Assisting With Basic Needs as Sacred Acts, Sustaining 3 CARATIVE FACTORS Human Dignity (MINISTER) 10.Opening and Attending to the Spiritual, Myster, Unknowns – Allowing Es 1. “The formation of a humanistic - altruistic system of values” 2. “The instillation of faith-hope” for Miracles (OPEN) 3. “The cultivation of sensitivity to one’s self and to others” Differentiates muses to doctors 4. “Development of a helping-trusting human caring relation” MAJOR ASSUMPTIONS 5. “The promotion and acceptance of the expression of positive and - Moral commitment, intentionality, and Caritas consciousness by the negative feelings” nurse to protect, enhance, and potentiate human dignity, wholeness, 6. “Systematic use of a creative problem-solving caring process” and healing, thereby allowing a person to create or concrete his or her 7. “The promotion of transpersonal teaching- learning” own meaning for existence. 8. “The provision of supportive, protective, and (or) corrective mental, - The conscious will of the nurse affirms the subjective and spiritual physical, societal, and spiritual environment” significance of the patient while seeking to sustain caring in the midst 9. “The assistance with the gratification of human needs” of threat and despair Es more abstract tong carative - The nurse seeks to recognize, accurately detect, and connect with the - Many hospitals seeking Magnet status are meeting these challenges inner condition of the spirit of another through the genuine presence by using Watson's theory of human caring for administrative change and by being centered in the caring moment EDUCATION - The nurse’s ability to connect with another at this transpersonal - Watson's writing focus on educating graduate nursing students spirit-to-spirit level - Her theory taught in numerous baccalaureate nursing currciula - The caring-healing modalities within the context of transpersonal - Watson's Caring Science Institute (WSCI) offers numerous trainings caring/Caritas consciousness potentiate harmony, wholeness, and and educational materials unity of being by releasing some of the disharmony - "Caring Science, Mindful Practice" teaches participants both about - Ongoing personal and professional development Watson's theory and introduces principles of mindful practice - The nurse’s own life history - Watson's Caring in the Digital World provides a guide for teaching and - Other facilitators are personal growth experiences such as caring in the digital environment psychotherapy RESEARCH - Continuous growth for developing and maturing within the - Qualitative, naturalistic, and phenomenological methods have been transpersonal caring model is ongoing. identified as particularly relevant to the study of caring - Watson suggests that a combination of qualitative-quantitative THEORETICAL ASSERTIONS inquiry may be useful for futher exploration NURSING - Researchers are providing statiscal validation supporting the impact of - Nursing consists of "knowledge, thought, values, philosophy, the theory commitment, and action, with some degree of passion." - Wide topics were researched - Curing as the elimination of disease - Calls upon nurses to go beyond procedures, tasks, and techniques FURTHER DEVELOPMENT - Focused on human care process - Jean Watson is working with more than 20 different countries that are - Humans cannot be treated as objects and humans cannot be involves in caring science education separated from self, other, nature, and the larger universe. - The paradigm is a guide honoring the whole person PERSON - WSCI continues to grow with innovative national and international - Views the person as "a unity of mind/body/spirit/nature" partnerships - Her views of humanity emphasize the interconnectedness of self, other, and source of existence. - More emphasis on humans as whole spiritual beings, fully connected and evolving the Source with an infinite field of universal consciousness and Cosmic Love" HEALTH - Watson's definition of health was derived from WHO later on, she defined health as “unity and harmony within the mind, body, and soul” ENVIRONMENT - Nurse’s role in the environment as “attending to supportive, protective, and or corrective mental, physical, societal, and spiritual environments” - In broad view of environment she said, "the caring science is not only for sustaining humanity, but also for sustaining the planet." - "Healing spaces can be used to help others transcend illness, pain, and suffering" LOGICAL FORM - Theory contains broad ideas that address health-illness phenomena - Caring - body of nursing knowledge as a separate science - 1979, more on clarifying the relationship of the person of the nurse and the person of the patient Erik Abraham - Has foundational support by Carl Rogers, Erikson, and Maslow - Incorporated of postmodern paradigm shift - Replace with postmodern approach leading it to be more holistic, humanistic, open system APPLICATION BY THE NURSING COMMUNITY PRACTICE - Watson's theory has been validated in outpatient, inpatient, and community health clinical setting - Attending Nursing Caring Model (ANCM) exemplified the application of Watson Caring Science to Practice - Continues to be applicable and transformative in hospital systems - Used both internationally and nationally Hospitals can apply for and attain a national designation as a National Caring Science Affiliate ADMINISTRATION AND LEADERSHIP - Calls for administrative practices and business models to embrace caring - Nurses follow their own professional practice model rather than short-term solutions  FACTS ABOUT BENNER NOVICE - Born in August 1942 -- Hampton, Virginia - No experience - Worked as an admitting clerk - Inflexible - Graduated from Pasadena College Batch 1964 - Have theoretical knowledge only - In 1970, Master's Degree in nursing. - Rule follower - Has a Ph.D. and a published dissertation ADVANCED BEGINNER - had a range of clinical experience - Has experience with real situations - Chief Development Officer for educatingnurses.com - Has at least 1-2 years of experience - Director of the Carnegie Foundation for the Advancement of Teaching - Past experience guide actions (ability to recognize recurrent National Nursing Education situations) - Honorary fellow of the Royal College of Nursing COMPETENT - 2008 -- Ranked 4th most influential nurse ↳ - Good time management confident nurse - 2011 -- awarded as a living legend by American Academy of Nursing - 2-3 years experience - Possess the expertise and ability to manage can handle many ABOUT BENNER’S THEORY unexpected occurrences that arise in clinical nursing - Benner is a well-known researcher on health, stress coping, and skill PROFICIENT acquisition. - Guided by maxims ruler and guidelines - - The theory from novice to expert was commemorated in 2002 by The - Has a holistic understanding Institute for Nursing Healthcare Leadership - Uses experience to anticipate needs - Awarded an acknowledgment for 20 years of collecting and extending EXPERT clinical wisdom, experiential learning, and caring practices - Has a broad range of experience - Flexible SOURCES TO BENNER’S THEORY - No longer relies on principle (maxims, rules, and guidelines) to connect - Influenced by Virginia Henderson his/her comprehension of the circumstance to the appropriate path of - Studied clinical nursing practice in an attempt to discover and action describe the knowledge embedded in nursing practice - Articulation Research - “describing, illustrating, and giving language to USE OF EMPIRICAL EVIDENCE taken-for-granted areas of practical wisdom, skilled knowhow and notions of good practice. 1. The helping role - Practical knowledge vs. Theoretical Knowledge Philosophy of experience 2. The teaching-coaching function - Hubert Dreyfus introduced Benner to Phenomenology. 3. The diagnostic and patient monitoring function - Used the Dreyfus Model of Skill Acquisition in her theory 4. Effective management of rapidly changing situations (flexibility) 5. Administering and monitoring therapeutic interventions and regimens 6. Monitoring and ensuring the quality of health care practices THEORY EXPLANATION 7. Organizational work role competencies. - Benners’ theory describes five levels of skill acquisition and development. (novice, advanced beginner, competent, proficient, and MAJOR ASSUMPTIONS expert) - There are no interpretation-free data - Benner novice to expert was derived from the Dreyfus Model of Skill - There are no nonreactive data Acquisition Clinical knowledge > - Skill > Experience - Meanings are embedded in skills, practices, intentions, expectations, - - Nurses develop skills and clinical knowledge over time through quality and outcomes education and a multitude of experiences. - Primordial understanding — Heidegger (1962). - Benner identified the Dreyfus model as the two interrelated aspects of - The meanings embedded in skills, practices, intentions, expectations, practice from advanced beginner to expert and outcomes cannot be made completely explicit - Clinicians at different levels of practice live in different worlds, - Humans are integrated, holistic beings. recognizing and responding to different situated needs for action - Clinicians develop an agency, or the sense of responsibility toward the patient, and evolve into fully participating members of the healthcare IN VIEW OF THE METAPARADIGMS team. NURSING - Described as an “enabling condition of connection and concern” FIVE LEVELS OF SKILL ACQUISITION - Viewed nursing practice as the care and study of the lived experience of health, illness, disease, and the relationships among these three elements PERSON - “self- interpreting being that is, the person does not come into the world predefined but defined in the course of living a life.” - To overcome the Cartesial Dualism - the body and mind are distinct, separate entities - A person must deal with these aspects:  - Role of the situation - Role of the body - Role of personal concerns - Role of temporality - Believes that a person is embodied HEALTH - Focused on “the lived experiences of being healthy and ill” - Defined health as what can be assessed, while well-being is the human experience of health or wholeness ENVIRONMENT SITUATION - ferm niya - Used the term “SITUATION” instead of “ENVIRONMENT” - Also used the phenomenological terms “ being situated” and “situated meaning” - “Personal interpretation of the situation is bounded by the way the individual is in it” (Benner & Wrubel, 1989 p. 84) THEORETICAL ASSERTIONS - There is always more to any situation than theory predicts or describes. - Benner used a hermeneutical approach to uncover the knowledge in clinical nursing practice. - Dunlop (1986) had comments on this approach. - As such, the competencies within each domain are in no way intended as an exhaustive list. - Benner examined the role of narrative accounts in understanding the notion of good or ethical caring in expert clinical nursing practice. - One of the relationship statements included in Benner’s work is that clinical knowledge develops over time, and each clinician develops a personal repertoire of practice knowledge that can be shared in dialogue with other clinicians LOGICAL FORM - Benner used the Dreyfus model of skill acquisition to better understand skill acquisition in clinical nursing practice. - Benner was able to identify the performance characteristics and teaching-learning needs inherent at each skill level. - The goal of Benner’s research is to bring meanings and knowledge embedded in skilled practice into public discourse. FURTHER DEVELOPMENT - The separation of academic coursework from clinical learning developed over time. - The ever-increasing complexity of technology and clinical nursing practice coupled with the separation between education and practice sets the stage for new graduate nurses to face a major transition upon graduation. - Benner states the importance of study recommendations - Benner initiated an educational newsletter to share Educating Nurses: A Call for Radical Transformation (2010)  CREDENTIALS AND BACKGROUNDS - Organismic Response (Holistic Response): Integrated and holistic - Private duty nurse (1944) wherein it involved the entire bio-psycho-social-spiritual organism S- Response to Fear (Flight or Fight): Adreonocortical-sympathetic - Civilian nurse in the U.S. Army (1945) EitherFace - Preclinical instructor of Physical Sciences - Cook County School of reactions thar are most primitive biological responses, activated fear or run Nursing (1947-1950) away. whenever a major threat is determined to exist or actually not - Director of nursing - Drexel Home in Chicago (1950-1951) - Inflammatory-Immue Response: as a primary mechanism of - Surgical supervisor - University of Chicago Clinics (1951-1952) healing and protection against an organism’s environmental - Surgical supervisor - Henry Ford Hospital in Detroit (1956-1962) irritants and pathogens - Response to Stress: Upon Selye’s (1956) model of Adaptive Stress Received numerous honors, including: Response, the point is characterized by predictable behavioral anf biological responses to various major or nonspecific stressors - Charter fellow - American Academy of Nursing (1973) - Sensory Response: individual experience of perception - Honorary Member- American Mental Health Aid to Israel (1976) components in the external environment through rendered biologic - Honorary recognition - Illinois Nurses Association (1977) sensory stimuli - First recipient of the Elizabeth Russell Belford Award for Excellence in teaching - Sigma Theta Tau (1977) 4 MAJOR CONSERVATION PRINCIPLES - Both the 1st and 2nd edition of her book "Introduction to Clinical - Conservaton of Energy: from the concept of Energy Balance and First Nursing" (Levine, 1969a, 1973) received American Journal of Nursing Law of Thermodynamics, adaptation efforts to conserve energy are Book of the Year awards reflected and sustained in clinical manifestations of illness and - Her book "Renewal for Nursing" was translated to Hebrew (Levine, 1971c) healing. - Was listed in Who's Who in American Women (1977-1988) - Conservation of Structural Integrity: Restoring the body's structure, - Was listed in Who's Who in American Nursing (1987) preventing physical breakdown, and contributing to healing. - Conservation of Personal Integrity: Focuses on thetheinteraction patient's comistent need => - Was active in theory development and encouraged questions and knowledging betweenon the respectpatient self awarenesand and the nurse, trying to promote social research about her theory after her retirement (Levine, 1996) self determination , - Was a frequent presenter of programs, workshops, seminars, and connectivity that nurses intervene to maintain relationships. panels and a prolific writer regarding nursing education - Conservation of Social Integrity: Focuses on the interaction between - Developed a conceptual organizational structure for teaching the patient and the nurse, trying to promote social connectivity that medical-surgical nursing nurses intervene to maintain relationships. - Addressed the goal of the four conservation principles in "Holistic Nursing" (Levine 1969) IN VIEW OF METAPARADIGMS NURSING THEORETICAL SOURCES - “Human Interaction” (Levine, 1973) - Beland (1971) - Theory of Specific Causation and Multiple Factors - Unique knowledge and scientific knowledge (Levine,1988) - Gibson’s (1966) - Definition of Perceptual Systems - Nursing promotes conservation of wholeness and integrity (Levine, - Erikson’s (1964, 1968) - Differentiation Between Total and Whole 1989) - Selye‘s (1956) - Stress Theory - Because of the uniqueness of each individual, nursing care for each - Bates’ (1967) - Model of External Environment patient must be highly individualized. (Levine,1971) - Nightingale (1992) - Contribution to distinguishing ‘guardian activity’ - Nursing interventions are based on the four conservation principles for nurses to ‘save lives and increase health and comfort’. and are both therapeutic and supportive in nature. - Other influences: - “Nursing is a profession as well as an academic discipline, always - Goldstein (1963) practiced and studied in concert with all of the disciplines that - Hall (1966) together form the health sciences.” (Levine,1965) - Sherrington (1906) PERSON - Dubos (1961, 1965) - Holistic, upon wholeness and integrity, along identity and self-worth. - System of systems, and in its wholeness expresses the organization of USE OF EMPIRICAL EVIDENCE all contributing parts. - Countless scientific principles. - Wholeness - healthy, integrated individual. - Research and widely supported evidence. - Health - from Anglo-Saxon word 'hal' , meaning, whole. - Well-researched, evidence-based scientific principles for creation of - Integrity - encompasses wholeness of the individual and the sense of activities. independence and selfhood. - Every individual has a unique range of adaptive responses, simply