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THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena INTRODUCTION ESTEEM Esteem for oneself and THEORY desire for reputation or Organized, coherent, and systematic...

THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena INTRODUCTION ESTEEM Esteem for oneself and THEORY desire for reputation or Organized, coherent, and systematic respect from others. articulations of statements related to SELF-ACTUALIZA The need to reach one’s TION full potential. significant questions. Explains why something is happening (e.g. why is the Earth revolving around the sun?) How is this theory relevant to Nursing Practice? NURSING as a PROFESSION. refers to a Prioritizing Patient Needs specialized field of practice founded on the Assist in Nursing Care Planning theoretical structure of the science or Consideration of Activities of knowledge of the discipline and accompanying Daily Living (ADLs) practice abilities. Studying for the licensure examination NURSING as a DISCIPLINE. Discipline refers CHANGE THEORY to a branch of education, a department of Kurt Lewin learning, or a domain of knowledge. Father of Social Psychology NURSING as an ART. "People grow and change throughout their lives. NON-NURSING THEORISTS/IES "Change happens daily. RELEVANT TO NURSING PRACTICE "Reactions to change are grounded in the basic human needs for self. esteem, safety and HUMAN NEEDS THEORY security." Abraham Maslow Defined behavior as a dynamic balance of forces working in opposing A motivational theory in psychology Major Assumptions: comprising a five-tier model of human needs, People grow and change throughout their often depicted as hierarchical levels within a lives. pyramid Change happens daily. Also known as "Hierarchy of Needs" Reactions to change are grounded in the basic human needs for self-esteem, safety and security. Change involves modification or alteration. Driving Forces - factors that push in a direction that causes change to occur. Restraining Forces - factors that counter the driving forces HIERARCHY OF NEEDS: Equilibrium - a state where driving forces are equal to PSYCHOLOGICAL Biological requirements for human survival. restraining forces and no change occurs. SAFETY Needs about keeping us - can be raised or lowered by changes that safe from harm. occur between the driving and restraining LOVE AND Belonging, love and forces. BELONGINGNESS affection. 1 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena 3 STAGES OF CHANGE: surrounding environment. As the conscience, it includes our sense of right and wrong, UNFREEZING recognition of the need for maintaining taboos specific to the child's change. internalization of parental culture. If the CHANGE shift of behavior towards a requirements of the superego are not followed, STAGE new and more healthful feelings. pattern. REFREEZE establishing the change as the new habit 5 STAGES OF PSYCHOSEXUAL long-term solidification of DEVELOPMENT IN CHILDREN: the new pattern of behavior. Stage 1: Pleasure = mouth (sucking ORAL (birth -18 and oral satisfaction) 6 Components Identified: months) Later, infant begins to 1.Recognition of the area where change is realize that mother/parent is needed. something separate from self 2. Analysis of a situation to determine what Disruption in availability of forces exist to maintain the situation and what parent (e.g. inadequate forces are working to change it. bonding or chronic illness) could have an impact on the 3. Identification of methods by which change infant's development can occur. 4. Recognition of the influence of social norms Stage 2: Pleasure = anal zone or customs on change. ANAL (12-18 Toilet training (child is 5. Identification of the methods that the months to 3 trained to delay gratification years) to meet parental and societal reference group uses to bring about change. expectations) 6. The actual process of change. Stage 3: Pleasure = genitals PHALLIC (3 - 6 Penis envy (girl) PSYCHOSEXUAL DEVELOPMENT years) Oedipal (boy) and Electra Sigmund Freud (girl) Complex A psychoanalytic model of personality Child attempts to resolve development where there are 2 internal Forces conflict by identifying with that essentially drive psychological change in the parent of the same sex the child: sexual (Libido) and aggressive Stage 4: Sexual urges are energies LATENCY (6 - repressed and channeled into Structure of the psyche: 12 years) other activities (productive ID, EGO, and SUPEREGO and socially acceptable) Stage 5: Sexual urges awaken and Id GENITAL are directed to an individual (Puberty to outside the family circle - Instinctual needs and drives (unconscious) Adulthood) Unresolved prior conflicts surface during adolescence Ego If conflicts are resolved, the - Mediates between Id and Superego person becomes capable of (conscious). having mature adult sexual Anxiety = results from conflict between Id and relationship Superego. Defense Mechanism to protect itself from Id's Fixation impulses - persistent focus on an earlier psychosexual Superego stage - based upon the internalization of the world view, norms, and mores children absorb at a young age from their parents and the 2 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena INTERPERSONAL THEORY e (9-12 years) Preoccupations (child-play Harry Stack Sullivan at being a grown-up, overtly or covertly, to ward off punishment and anxiety) Also called Transactional Analysis Theory Father of Interpersonal Psychiatry or Early Erotic need (opposite sex) Interpersonal Psychoanalysis Adolescence and need for intimacy (12-14 years) (member of same sex) Sullivan explained the role of interpersonal If both needs are not relationships and social experiences in divorced = homosexual shaping personality orientation The purpose of all behavior is to get needs Late Full complement of met through interpersonal interactions and to Adolescence interpersonal relations decrease or avoid anxiety gradually takes form (14-21 years) Sullivan explained the importance of current Stabilized self system life events to psychopathology Adulthood Anxiety A person has ascended all steps and has been - Occurs when one experiences TENSION from transformed largely by means of interpersonal real or imaginary threats to one's security relations. Personification GENERAL SYSTEMS THEORY - Mental image we form of ourselves, and Ludwig Von Bertalanffy others based on our interpersonal relationships A system is made up of separate Self system components. The parts rely on one another, - Protective measure that individuals create to are interrelated, share a common purpose, avoid anxiety and together form a whole 3 Types of Self: "In every SYSTEM, there is environment, input, Good Me output, throughput, feedback, and a boundary" Bad Me Not Me OPEN vs CLOSED system - Open system exchange information, energy, The theory identifies Six (6) or matter within the environment, while closed Developmental Stages called Epochs or systems do not Heuristic stages in development wherein significant relationships impact personality Principle of HOLISM development. - the whole is greater than the sum of its parts 6 DEVELOPMENTAL STAGES: INTERDEPENDENCE Infancy (birth Relationship with caregiver - the elements within a system are to 18 months) parent interdependent, meaning that changes in one element can lead to changes in others Childhood (18 Emergence to language to months to 6 appearance of the need for playmates EQUILIBRIUM/HOMEOSTASIS years) - Systems strive for balance (equilibrium), but Juvenile Era School years constant changes from the environment may (6-9 years) Social subordination to lead to adaptations to maintain stability authority outside family (homeostasis) Becomes competitive and cooperative Preadolescenc Conception of Gender 3 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena THEORY OF PSYCHOSOCIAL Failure to develop trust will DEVELOPMENT result in fear and a belief that Erik Erikson the world is inconsistent and unpredictable No child is going to develop a All individuals must overcome or resolve the 8 sense of 100% trust or 100% Stages of Psychosocial Conflicts successfully doubt. to adjust well to the environment. Successful development at Social experience has an impact across the this stage = balance whole life span. between 2 forces results to the People experience a conflict that serves as a development of HOPE) turning point in development which are Stage 2: Focused on children centered on either developing a psychological Autonomy vs developing a greater sense of quality or failing to develop the quality. During Shame & personal control (changing their this time, the potential for personal growth is doubt (Early clothes and feeding themselves, high but so is the potential for failure. fppd and toy preferences) - Childhood sense of autonomy 2-3 years) Starts to gain little The Developmental Tasks in Erikson's Eight independence, basic actions on Stages of Life: their own, and making Everyone encounters a certain crisis that decisions about what they contributes to the psychosocial growth at each prefer level of development. Toilet training is a vital part of When we experience a crisis, we are left with this process no choice but to face it and think of ways to Learning to control one's resolve it. Failure to overcome such a crisis may bodily functions leads to a lead to significant impact on our psychosocial feeling of control and a sense of development. independence Individuals need to accomplish a particular Successfully complete this task before successfully completing the stage stage: Feel secure and confident Unsuccessful: Sense of 8 STAGES OF PSYCHOSOCIAL inadequacy and self-doubt CONFLICTS: Achieving a balance between autonomy and shame and Stage 1: Infants must learn how to doubt would lead to will (to act Trust vs trust others who care for their with intention, within reason Mistrust basic needs) and (Birth to 18 Parents are the first and most limits) Months) important person to teach an Stage 3: Important event: Exploration infant about trust Initiative vs (asserting control and power Babies view the outside world over the environment) Guilt as threatening Conflicts begin to arise (Childhood Threat can be replaced by between child's desire to trust, and they gain a sense of 3-5 years) explore and the limits placed on security and begin to learn to his/her behavior trust the people around them Successful at this stage: Feel depending on how they are capable and able to lead others treated by the people around Failure to acquire these skills: them Sense of guilt, self-doubt, and Caregivers who are lack of initiative (these may inconsistent, emotionally also occur if caregiver's unavailable or rejecting, responses are too punitive) contribute to feelings of When an ideal balance of mistrust 4 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena individual initiative and Stagnation positive change for the benefit willingness to work with others (Adulthood of other people) is achieved, the ego quality 40-65) Success: leads to feelings of known as PURPOSE emerges. usefulness and accomplishment Stage 4: Important event: School Failure: feeling unproductive/ Industry vs (coping with new social and shallow involvement in the Inferiority academic demands) world (School Age Children mature, level of Virtue: CARE 6-11 years) self-awareness increases, more Stage 8: Important Event: Reflection competitive Ego Integrity on life (looking back on how Want to do things that other well people lived their life) vs Despair children of the same age can do Success: leads to feelings of (Maturity 65 Self-confidence is developed satisfaction about life and to death) when they make the effort to WISDOM (virtue) perform a task and succeed Failure: regret/fear, bitterness If they fail, they tend to feel that they are inferior to others Children begin to develop a COGNITIVE DEVELOPMENT THEORY sense of pride in their Jean Piaget accomplishments and abilities through social interactions Focused on reasoning/thinking process Feeling of competence and (intellectual operations). These are related to belief in their skills are the ways how people learn to understand the developed by children who are world they live encouraged and commended by parents and teachers Little or no encouragement PERIODS OF INTELLECTUAL from parents, teachers, or peers DEVELOPMENT: will doubt their abilities to be I. Exploration of successful SENSORIMOTOR environment (sucking, Successful balance at this hitting, looking, grasping, (birth to 2 yrs) stage leads to COMPETENCE kicking) Stage 5: Important event: Adolescence Object Permanence is Identity vs (Establishment of sense of self, developed (18 months) Role personal values, goals) II. Can think with the use of Confusion Success: strong sense of PREOPERATIONA symbols and mental (Teenage identity and security about who L images (can be observed they are and future direction (2 to 7 yrs) through their play) Years 12-18 Failure: unsure of place in Egocentric (child sees years) society, confusion about future objects and persons from Virtue: FIDELITY only their own point of Stage 6: Important event: view) Intimacy vs Relationships Parallel Play - children Isolation (Young adutts need to form engaging in activities intimate, loving relationships side-by-side without a (Young with other people) common goal Adults 19-40) Success: leads to strong Imitation and relationships make-believe plays - ways Failure: loneliness and isolation to represent experience Virtue: LOVE Stage 7: Important event: Work and/or Generativity Parenthood (creating/nurturing vs things that will outlast them - having children/creating 5 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena III. Children achieve the I. Child's sense of morality CONCRETE ability to perform mental PRECONVENTIONA is externally controlled/ OPERATIONAL operations (E.g. think focused on external about an action that was L/PREMORAL (7 to 11 yrs) consequences that previously performed certain actions may physically) bring: Can count and - Stage 1: Obedience and understand what each Punishment Orientation number represents (avoid punishment) Can describe process - Stage 2: Instrumental without actually Orientation ("What's in it performing it for me?" - incentive) Reversibility (mentally reverse the direction of Il. Sense of morality is tied thoughts) CONVENTIONAL to personal and societal relationships: Seriation when children - Stage 3: Good boy, can classify objects Nice Girl Orientation according to their (approval from others) quantitative dimensions) - Stage 4: Conservation - ability to Law-and-Order see objects or quantities Orientation (accepting as remaining the same rules because of their despite a change in their importance in physical appearance. maintaining a functional society) IV. More far-reaching FORMAL problem solving, can think about abstract and III. Person's sense of OPERATIONS theoretical subjects POST-CONVENTION morality is defined in (11 yrs to terms of more abstract With capacity to reason AL Adulthood) principles and values: with respect to possibilities - Stage 5: Social Contract Orientation THEORY ON MORAL DEVELOPMENT (world holds different opinions, rights and Lawrence Kohlberg values; laws are social contracts for the welfare Moral development is the ability of an of the people) individual to distinguish right from wrong and - Stage 6: to develop ethical values on which to base Universal-Ethical Principle Orientation his/her actions a person has his own How is our morality developed? self-chosen ethical What affects our perceptions about what is principles of conscience right and wrong? that will help determine Or proper conduct? appropriateness of According to Kohlberg, an individual goes action. This includes through 3 levels of moral development: moral reasoning that takes the perspective of - Premoral/Preconventional every person or group - Conventional that can be affected by a - Post-conventional decision highest stage of functioning, but Kholberg claims that not all people will reach this stage. 6 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena NURSING PHILOSOPHIES ENVIRONMENT Anything that can be Set forth the general meaning of nursing and manipulated to place a phenomena through reasoning and the logical patient in the best possible presentation of ideas condition for nature to act. Contains both physical and psychological components: ENVIRONMENTAL THEORY - Physical: ventilation, Florence Nightingale warmth, light, nutrition, medicine, stimulation, room Nightingale's Environmental Theory viewed temperature, activity, etc. the manipulation of the physical environment - Psychological: avoiding as a major component of nursing care. chattering hopes and Her Philosophy in Nursing is advices, and providing variety ENVIRONMENT-oriented: PERSON One who is receiving care; "Nursing ought to signify the proper use of a dynamic and complex fresh air, light, warmth, cleanliness, quiet, and being. Has physical, intellectual, the proper selection and administration of emotional, social, and diet - all at the least expense of vital power to spiritual components the patient" (Nightingale, 1969) HEALTH "Healthy is not only to be well, but to be able to use well every power we have" Major Areas of the physical, social, and Health promotion and psychological environment that the nurse prevention, in addition to could control: nursing patients from illness to health Health of Houses Ventilation and warming Light NURSING A spiritual calling The SCIENCE OF Noise ENVIRONMENTAL Variety MANAGEMENT Bed and bedding Nurses assist nature to Cleanliness of rooms and walls repair the patient Personal cleanliness Nutrition and taking food Nursing Chattering hopes and advices Nurses were to use common sense, Observation of the sick observation, and ingenuity to allow nature to Petty Management effectively repair the patient. "Observation may always be improved with MAJOR ASSUMPTIONS OF training-will seldom be present without NIGHTINGALE'S ENVIRONMENTAL training; for otherwise the nurse does not know PHILOSOPHY ON: what to look for" Accepted as truth and represent the values Different types of nursing: and beliefs of the theory or conceptual - Nursing proper (nursing the sick) framework - General nursing (health promotion) - Midwifery nursing 7 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena There are carative factors CARITATIVE CARING THEORY “If there is light in the soul, Katie Eriksson There will be beauty in the person. Explains the science of caring If there is beauty in the person, Suffering can just be DRAMA There will be harmony in the house. Rootg If there is harmony in the house, Invitation for Communion There will be order in the nation, Nurse-Patient relationship There will be peace in the world.” - Chinese Proverb Suffering of human - Inseparable part of human life 10 CARITAS PROCESSES HUMAN - body, soul & spirit (wholeness) SUSTAINING HUMANISTIC-ALTRUISTIC VALUES by practice of loving-kindness, SUFFERING CAN BE: compassion and equanimity with self ENDURABLE - still in a state of health UNDEURABLE - paralyzed and unable to grow BEING AUTHENTICALLY PRESENT, enabling faith/hope/belief system; honoring subjective inner, life-world of self/others. SUFFERING CAN BE ALLEVIATED THROUGH: Being SENSITIVE TO SELF AND OTHERS by Charity (caritas) cultivating own spiritual practice beyond Faith ego-self to transpersonal presence. Hope Developing and sustaining loving, Expressed through tending, playing & learning trusting-caring relationships. RECONCILIATION ALLOWING FOR EXPRESSION OF POSITIVE the patient is able to establish their wholeness AND NEGATIVE FEELINGS - authentically based on what is lost listening to another person’s story wholeness was affected based on suffering Creatively wholeness based on what is left from the PROBLEM-SOLVING-’SOLUTION-SEEKING’ suffering through caring process; full use of self and artistry of caring-healing practices via use of SUFFERING > ALTERNATIVE SUFFERING all ways of knowing/being/doing/becoming. > RECONCILIATION Engaging in TRANSPERSONAL TEACHING AND LEARNING within context of caring TRANSPERSONAL CARING THEORY relationship; staying within other’s frame of Jean Watson reference-shift toward coaching model for A person/human is body, mind and spirit expanded health/wellness. Believes that all people are interrelated and Creating a HEALING ENVIRONMENT at all have energy fields these are something we levels; subtle environment for energetic cannot see authentic caring presence. Interrelated with something we cannot feel or see Reverentially ASSISTING WITH BASIC NEEDS Caring moment AS SACRED ACTS touching mind, body and 8 THEORETICAL FOUNDATION IN NURSING 1st Sem | MIDTERMS | Belicena spirit of others, sustaining human dignity. OPening to SPIRITUAL, MYSTERY, AND UNKNOWNS-allowing for MIRACLES. STAGES OF NURSING EXPERTISE Patricia Benner NOVICE Zero experience, Inflexible, needs to be told what to do E.g. Nursing student ADVANCED With some experience, BEGINNER have knowledge and the know-how but not enough in-depth experience New grads in their first job COMPETENT 2-3 years of experience, Can see long-term effects of decision-making Improved organization and efficiency of tasks, Can create deliberate plan May still lack prioritization and move slowly PROFICIENT Can anticipate patient needs based on past experiences Can see both the "big picture" and intricacies of the situation EXPERT Extensive experience No longer reliant on rules to govern decision making Very developed sense of intuition Expert level in prioritization and no hesitation in actions Able to analyze and solve problems when things get tough 9