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THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Overview of Nursing...

THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Overview of Nursing Profession | Week 1 - Lesson 1 Responsibility 1: Implements strategies/ policies Nursing as a Profession related to informed consent as it applies in multiple Nursing was developed from vocational to professional contexts (Alligood, 2014) Responsibility 2: Utilizes the nursing process in the An occupation requiring specialized knowledge interdisciplinary care of clients that empowers the clients A specialized field of practice, which is founded upon and promotes safe quality care. the theoretical structure of the science or knowledge of Responsibility 3: Maintains complete and up to date that discipline and the accompanying practice abilities. recording and reporting system. Responsibility 4: Establishes collaborative relationships Criteria of A Professional Nurse with colleagues and other members of the team to 1. Utilizes in its practice a well-defined and well- organized enhance nursing and other health care services. body of specialized knowledge that is on the intellectual level Responsibility 5: Promotes professional and personal of higher learning. growth and development. 2. Constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the use II. Beginning Nurse’s Role on Management and of the scientific method. Leadership 3. Entrusts the education of its practitioners to institutions of higher education. Responsibility 1: Demonstrates management and 4. Applies its body of knowledge in practical services that are leadership skills to provide safe and quality care. vital to human and social welfare. Responsibility 2: Demonstrates accountability for safe 5. Functions autonomously in the formulation of professional nursing practice. policy and in the control of professional activity thereby. Responsibility 3: Demonstrates management and 6. Attracts individuals of intellectual and personal qualities leadership skills to deliver health programs and services who exalt service above personal gain and who recognize effectively to specific client groups in the community their chosen occupation as a life work. setting. 7. Strives to compensate its practitioners by providing Responsibility 4: Manages a community/village based freedom of action, opportunity for continuous professional growth, and economic security. health facility/ component of a health program or a nursing service. Responsibility 5: Demonstrates ability to lead and supervise nursing support staff. 2012 National Nursing Core Responsibility 6: Utilizes appropriate mechanisms for Competency Standards networking, linkage building and referrals. I. Beginning Nurse’s Role on Client Care Responsibility 1: Practices in accordance with legal III. Beginning Nurse’s Role on Research principles and the code of ethics in making personal and Responsibility 1: Engages in nursing or health related professional judgment. research with or under the supervision of an experienced researcher. RA 9173 PHILIPPINE NURSING ACT OF 2002 Responsibility 2: Evaluates research study/report Bon RES. No. 220 S. 2004 utilizing guidelines in the conduct of a written research Implementing rules and regulations of RA 9173 critique. ICN code of ethics Responsibility 3: Applies the research process in Legal aspects in the practice of nursing The patient’s bill of improving client care in partnership with a quality rights improvement/ quality assurance/ nursing audit team. International Code Of Nursing Ethics Nurses have four fundamental responsibilities, to promote health, to prevent illness, to restore health and to alleviate suffering. Inherent in nursing is respect for human rights including cultural rights, the right to life and choice, to dignity and to be treated with respect. THEORETICAL FOUNDATIONS IN NURSING 1 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Theoretical Foundation In Nursing (Introduction and Overview) | Week 2 - Lesson 2 Concept Components and Characteristics of a Theory An idea or complex mental image of a phenomenon (Chinn and Kramer,1999) (objects, property, or event) The major components of theory Component Characteristics Labels used to identify phenomenon Building blocks of theories Should be stated Phenomena of interest (Kaplan, 1964 as cited by explicitly or at least be Purpose Alligood, 2014) identifiable in the text or An empirical phenomenon or any abstraction of how a the theory person perceived an object that is not physically present or observed Should be linguistically Concepts It enhances one’s capacity to understand phenomena expressed as it define the meaning of a word Meaning of concepts are conveyed in theoretical definitions; these Definitions Types of Concept: definitions give character to the Abstract theory - These are the concepts that are indirectly observe or intangible Concepts are structured into a - Doesn’t have physical reference Relationships systematic form that links each Ex. Freedom, good and evil, love, concept with others feminine, success, morality The relationships are linked to form Concrete a whole when the ideas of the theory - These are directly observed or Structures interconnect; structure makes it tangible possible to follow the reasoning of the theory Theory Refer to underlying truths that These are made by concepts determine the nature of concepts, These are asset of inter related concept that give a Assumptions definitions, purpose, relationship, systematic view of a phenomenon. and structure; may not be explicitly Could be an observable fact or event stated It is explanatory and predictive in nature Is a group of related concepts that propose that guide Nursing Theory our practice Is a group of related concepts that derive from nursing It is a set of logically inter-related concepts, statements, models and other disciplines. preposition, questions that have been derived from your It guides practice, education, and research (Alligood, philosophical beliefs of a specific data 2014; Chinn & Kramer, 2011; Fawcett, 2005; Meleis. From which questions or hypothesis can be deduced, 2007) tested, and verified Note: Nursing as an art relies on knowledge gained from Characteristics of a Theory practice and reflection of past experiences. 1. Theory can correlate concepts in such a way as to As a science, it is based on scientifically tested generate a different way of looking at a certain fact of knowledge that is applied in the practice setting. phenomenon 2. It must be logical in nature Purposes of Nursing Theory 3. It should be simple but generally broad in nature 4. It can be the source of hypotheses that can be tested for it to be elaborated. 5. It contributes in enriching the general body of knowledge through the studies implemented to validate them. 6. Theory can be used by practitioners to direct and enhance their practice. 7. It must be consistent with other validated theories, laws, and principles but will leave open unanswered issues that need to be tested. THEORETICAL FOUNDATIONS IN NURSING 2 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 I. Education Grand Nursing Theories Prepare students for practice as members of the Are works derived from nursing philosophies, professional community. conceptual models, and other grand theories that are Studying the models or paradigms is an orientation to generally not as specific as middle-range theories. the approaches used in practice. Works of Levine, Rogers, Orem, and King are some of It is by studying theories and practicing with them that the theories under this category. students learn their trade. Middle-Range Theories Theories provide general focus for curriculum design Are precise and answer specific nursing practice and Theories also guide curricular decision-making questions. They address the specifics of nursing Theories enhance the status of nursing profession situation within the perspective of the model or theory II. Research from which they are derived. Examples of this are the Offer a framework for generating knowledge and new Middle-Range theories of Mercer, Reed, Mishel, and ideas Barker. Helps connect the perceived gap between theory and practice Nursing Paradigm Offer a systematic approach to identify questions for Conceptual Models study, select variables, interpret findings, and validate Conceptual Framework nursing interventions. Meta-Paradigm III. Clinical Practice Is the general statements of discipline and functions is Guide critical thinking of nurses a framework in which the more restricted structure of Represent status of nursing as a discipline and conceptual model developed profession Much of the theoretical work in nursing focused on Used a framework for structuring nursing practice with articulating relationship among the 4 major concept predictable outcomes and deriving new middle range which are: theories to test in nursing research Person or client Development of nursing knowledge or nursing science Recipient of nursing care including individuals, families, Serves to guide assessment, intervention and groups, and communities. evaluation of nursing care. Refers to as being composed of physical, intellectual, It will assist to describe, explain and predict everyday biochemical, psychosocial needs; a human energy field; experience a holistic being in the world; an Provide rationale for collecting reliable and valid data open system, and a being who is greater than sum of his about the health status of clients which are essential for parts. effective decision-making Environment Help to establish criteria to measure the quality of The internal and external surroundings that affect the nursing care client including people in the physical environment, such Help build a common nursing terminology to use in as families, friends, and significant others. communicating with other health professionals Refers to the external elements that affect the person; Enhance autonomy of nursing through defining its own internal and external conditions that influence the independent functions organism, significant others with whom the person Facilitates reflection, questioning, and thinking about interacts; an open system with what nurses do boundaries that permit the exchange of matter, energy, Introduction to any framework encourages nurses to and information, with human beings. reflect on questions, and think about what they do Health provide and invaluable service. The degree of wellness or well-being that the client experiences. Classification Of Theory (Alligood, 2017) Is the ability to function independently; successful Nursing Philosophy adaption to life’s stressors, achievement of one’s full life The most abstract type and sets forth the meaning of potential; and unity of mind, body, and soul. nursing phenomena through analysis, reasoning, and Nursing logical presentation. Works of Nightingale, Watson, ray, The attributes, characteristics, and actions of the nurse and Benner are categorized under this group. providing care on behalf of, or in conjunction with, the Nursing Conceptual Model client. Are comprehensive nursing theories that are regarded Is a science, an art, and practice discipline, and by some as pioneers in nursing. These theories address involves caring. Goals of nursing include care of the well, the nursing metaparadigm and explain the relationship care of the sick, assisting of self-care activities, helping between them. Conceptual models of Levine, Rogers, individuals attain their human potential, and discovering Roy, King, and Orem are under this group. and using nature’s laws of health. THEORETICAL FOUNDATIONS IN NURSING 3 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Florence Nightingale | Week 2 - Lesson 3 Major Problems That Florence Nightingale Noticed While Taking Care Of The Wounded Soldiers Lack of sanitation and presence of filth Few chamber pots Contaminated water Contaminated bed and linens Overflowing cesspools Frostbite Lice infestation Wound infections She was called as "The Lady of the Lamp", as immortalized in the poem "Santa Filomena" (Longfellow, 1857) At night she carried a lamp while taking rounds from room to room to look after her patients This earned her the affectionate title of "Lady with the Lamp" Her belief that action for the benefit of others is a primary way of serving God served as the foundation for History defining her nursing work as a religious calling. Also known as the Founder of Modern Nursing She was born on May 12, 1820. Environmental Theory From Affluent, Aristocratic Victorian Family of Edward Nightingale did not subscribe to the germ theory but and Frances Nightingale she very clearly understood the concept of contagion She came from a rich family and contamination through organic materials from the She was named after her birthplace, "Florence Italy" patient or the environment, as observe in her work. She was a Victorian Leader She believe that disease was a reparative process and Nightingale was tutored in Mathematics, language, that the manipulation of the patient's surroundings, religion, and philosophy by his father ventilation, warmth, light, diet, cleanliness, and noise are According to Sir Thomas Cook, she was a linguist, had necessary for proper nursing care and health of the a vast knowledge of science, mathematics, literature, patient. and arts. Nightingale did not used the term "environment". She She is well read in philosophy, history, politics, and used the term surroundings in her writings. economics. She is well informed about workings of the government and political science that’s why she was able to apply all the knowledge she gain in her practice In 1837 in her diary: "God spoke to me and called me to his service" She was a Unitarian who believe that action for the benefit of others is a primary way of serving God. In 1851, she completed her training at Kaiserworth, Germany as a nurse In 1853, she became the superintendent of the Hospital for Invalid Gentlewoman in London. In 1854, during the Crimean War, Nightingale received a request from Sidney Herbert (a family friend and Secretary of War) to provide trained nurses to care for wounded soldiers. THEORETICAL FOUNDATIONS IN NURSING 4 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Five Essential Components of Metaparadigm Environment Health Person Pure Air/ Proper Ventilation Nightingale referred to the person as a patient Greatest concern of Nightingale Nurses performed tasks to and for the patient and "keep the air he breathes as pure as external air, controlled the patient's environment to enhance without chilling him" (Nightingale, 1969 as cited by recovery. Alligood 2014) Passive patients Recognizes this as a source of disease and Health recovery Defined as being well and using every power that Light the person has to the fullest extent in living life. Direct sunlight is needed by patients She envisioned the maintenance of health through Nurses were instructed to move and position the prevention of disease via environmental control patients to expose them to sunlight and social responsibility Pure Water Environment Lack of access to pure water leads to disease To assist nature in healing the patient Cleanliness Environmental improvements would affect the sick Nightingale believe that dirty environment (floors, poor people both their bodies and mind carpets, walls, and bed linens) was a source of The five components infection through the organic matter it contained Her admonition to nurses, both providing care in She advocated bathing patient on a frequent, even home and hospitals, was to create and maintain a daily, basis at a time when this practice was not the therapeutic environment that would enhance norm comfort and recovery of patient. Required nurses to bathe daily, wear clear Nursing clothing, and wash hands frequently. Nursing is being responsible for someone else's Efficient Drainage life Presence of organic material create a dirty area "What nursing has to do.. Is to put the patient in Appropriate handling and disposal bodily the best condition for nature to act upon him" excretions and sewage was required to prevent (Nightingale, 1859/1992) contamination of the environment. Other Concepts Goal of Nursing Warmth To facilitate "the body's reparative process" by Manipulation of environment through the use of good fire to manipulating the client's environment. produce warmth, opening windows, and properly positioning Framework the patient in the room. Manipulate the client's environment to include appropriate Quiet noise, nutrition, hygiene, light, comfort, socialization, and Noise created by physical activities in the environment hope. (room) was to be avoided by the nurse because it could harm Florence Nightingale became a heroine in Great Britain as the client. a result of her work in Crimean War. Her depiction of the very Diet poor sanitary conditions in the hospital wards at Scutari is She believed that patient with chronic illnesses could be overwhelming. starved to death She fought the bureaucracy for food, bandages, fresh Nurse should assess dietary intake as well as meal bedding, and cleaning supplies for the soldiers or patients. schedule and its effect on the patient She spent the years after the Crimean war establishing schools of nursing and influencing public policy by lobbying her acquaintances about several of her concerns. Petty Management After the war , she returned to England, she was awarded Was a term used to denote that the nurse was in funds in recognition of her work, which she used to establish control of the environment both physically and a teaching institution for nurses at St. Thomas Hospital and administratively King's College Hospital in London. Ex. Protecting the patient from receiving Her principles and rules serves the foundation of nursing upsetting news, seeing visitors who could practice negatively affect recovery, and from Should continue to be recognized as the brilliant and creative founder of modern nursing experiencing sudden disruptions in sleep. She was the first nursing theorist Florence Nightingale work formed the foundation for Her reports describing health and sanitary condition in professional nursing and distinguished nursing from the Crimea and England identify her as an outstanding scientist work of domestic servants. and empirical researcher She was an English social reform, statistician and the Her dependence on observable data to support her founder of the modern nursing position, it can be said that Nightingale was the First Nurse ResearcherAwards and Later Life THEORETICAL FOUNDATIONS IN NURSING 5 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Awards and Later Life Nightingale was the first woman to be granted the order of Merit and the Royal Red Cross by no less than the Queen Victoria of Great Britain. She was the second most famous British person, after the queen herself Recipients of the award are entitled to use the post-nominal letters (OM, RRC) on their names. She was a manager and a trainer of nurses during the Crimean War, in which she organized care for wounded soldiers In 1860 she laid the foundation of professional nursing with the establishment of her nursing school at St. Thomas Hospital in London. It was the first secular nursing school in the world, and is now part of King's College London She was able to work into her eighties and died in her sleep on August 13, 1910 at the age of 90. The news of her death spread across the world, and she instantly became a celebrated and legendary person. Applications on Nightingale Theories Cleanliness Proper disposal of garbage Strict implementation of "Tapat ko, Linis ko" Program Regular collection of garbage Awareness of Environmental Sanitation Reduce/ Reuse/ Recycle Materials Frequent Handwashing Efficient Drainage Declogging of sewerage system as necessary Avoid throwing of garbage along the road or anywhere Maintenance of efficient drainage is a must Proper monitoring of factory and chemical wastes disposal Pure Air Plant more trees Monitoring of vehicle smoke emission Monitoring of factory smoke emission Support clean air act Awareness on global warming phenomenon Support biodiesel fuel utilization Utilization of wind and solar energy Proper transport of garbage disposal Pure Water Monitoring of probability of water Boil water when doubt Use commercially prepared drinking water Monitoring of proper sewerage system, and proper waste disposal Assure pipeline consistency Conserve water THEORETICAL FOUNDATIONS IN NURSING 6 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Margaret Jean Harman Watson| Week 2 - Lesson 4 Theory of Caring Development Watsons developed the basic caring nursing process, while writing a baccalaureate textbook. She published Nursing: The Philosophy and Science of Caring in Revised in (Fawcett & DeSanto-Madeya, 2013) This initial publication established the carative factors in nursing, and were renamed in 2001 to Clinical Caritas Process (Wagner, 2010) Another hallmark in Watson’s exploration and development of the science and art of caring is her book, Postmodern Nursing and Beyond (1999). Theory of Caring focuses on the interpersonal and transpersonal relationship between nurse and other (self, patient, family, society, universe) “Human caring is the moral ideal of nursing” (Fawcett & DeSanto-Madeya, 2013) Ten Carative factors and Caritas Processes (Simplified) 1. Embrace (Loving-Kindness) Sustaining humanistic-altruistic values by practice of History loving-kindness, compassion and equanimity with self/others. Margareth Jean Harman Watson was born on June 10, 2. Inspire (Faith-Hope) Being authentically present, enabling faith/hope/belief 1940 and died on October 14, 2018 at the age of 78. system; honoring subjective inner, life-world of self/others. She was born and grew up in Welch, West Virginia 3. Trust (Transpersonal) She is an American nurse theorist and nursing Being sensitive to self and others by cultivating own spiritual professor who is well known for her “Philosophy and practices; beyond ego-self to transpersonal presence. Theory of Transpersonal Caring”. 4. Nurture (Relationship) She has also written numerous texts, including Developing and sustaining loving, trusting-caring Nursing: The Philosophy and Science of Caring. relationships. Watson’s study on caring has been integrated into 5. Forgive (All) education and patient care to various nursing schools Allowing for expression of positive and negative feelings — authentically listening to another person's story. and healthcare facilities all over the world. 6. Deepen (Creative Self) She gained her Master’s degree in psychiatric-mental Creatively problem-solving-'solution-seeking' through caring health nursing (1966) at the University of Colorado. process; full use of self and artistry of caring-healing Same university in 1973, she got her Doctorate in practices via use of all ways of educational psychology and counseling. knowing/being/doing/becoming. She has been a faculty and administrative positions like 7. Balance (Learning) nursing dean or director, founder, and president in Engaging in transpersonal teaching and learning within the different organization. context of caring relationships; staying within other's frame of reference; shift toward coaching models for expanded health/wellness. Philosophy and Theory of Transpersonal 8. Co-create ( Caritas Field) Caring (Theory of Nursing Care) Creating a healing environment at all levels; subtle Emphasizes dignity and the person as a whole, not an environment for energetic authentic caring presence. object or diagnosis. 9. Minister (Humanity) Describes “ Transpersonal Caring Relationship” as a Reverentially assisting with basic needs as sacred acts, foundational to her Theory; it is a “special kind of human touching mindbodyspirit of spirit of other; sustaining human care relationship – a union with another person – high dignity. regard for the whole person and their being-in-the-world” 10. Open (Infinity) Opening to spiritual, mystery, unknowns — allowing for (Watsons,1999) miracles. “Caring is the essence of nursing and the most central and unifying focus for nursing practice” THEORETICAL FOUNDATIONS IN NURSING 7 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Watson’s Ordering of Needs Nursing Lower order needs (biophysical needs) Nursing consists of knowledge, thought, values, The need for food and fluid philosophy, commitment, and action, with some The need for elimination degree of passion (Watson 1988) The need for ventilation Is interested in understanding health, illness, and Lower order needs (psychophysical needs) the human experience The need for activity-inactivity Is concerned with health promotion, restoration, The need for sexuality and illness prevention Nursing as a human science of people and human Higher order needs (psychosocial needs) health-illness experiences that are mediated by The need for achievement professional, personal scientific, aesthetic, and The need for affiliation ethical human care transactions. Higher order need (intrapersonal-interpersonal need) The need for self-actualization Environment/Society Watson states that: Nursing Assumption to the Theory “Caring (and nursing) has existed in every society. Every society has had some people who have cared Caring can be effectively demonstrated and practiced for others. A caring attitude is not transmitted form only interpersonally generation to generation by genes. It is transmitted by the Caring consists of carative factors that results in the culture of the profession as a unique way of satisfaction of certain human needs. coping with its environment.” Effective caring promotes health and individual or family growth. Caring responses accept the patient as he or she is Integration of Jean Watson’s Theory now, as well as what he or she may become. of Caring into Nursing Practice A caring environment is one that offers the Establish a caring relationship with patients development of potential while allowing the patient to Treat patients as holistic beings choose the best action for him or herself at a given point Display unconditional acceptance in time. Treat patients with positive regard A science of caring is complementary to the science of Promote health through knowledge and intervention curing. Spend uninterrupted time with patient The practice of caring is central to nursing. Metaparadigm Person Human being is a valued person in and of him to be cared for, respected, nurtured, understood, and assisted. A person is greater than and different from the sum of its parts. Health She defined health as “unity and harmony within the mind, body, and soul” and is associated with the degree of congruence between the self as perceived and the self as experienced”, (Watson, 1988) Originally from WHO as, “The positive state of physical, mental, and social well-being with the inclusion of three elements: Health as a high level-all physical, mental, and social functioning Health as a general adaptive- maintenance level of daily functioning and absence of illness. Environment Society provides the values that determine how one should behave and what goals one should strive toward. THEORETICAL FOUNDATIONS IN NURSING 8 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Patricia Benner | Week 2 - Lesson 5 generally, this level applies to nursing students, but Benner suggested that a nurse at higher levels of skill in one area of practice could be classified at the novice level if placed in an unfamiliar area or situation Advance Beginner The person can demonstrate marginally acceptable performance having coped with enough real situations to note, or to have pointed out by a mentor, the recurring meaningful components of a situation The person has enough experience to grasp aspects of the situation Nurses functioning at this level are guided by rules and are oriented by task completion They have difficulty grasping the current patient situation in terms of the larger perspective However, clinical situations are viewed by nurses at this level as a stage of their abilities They feel highly responsible for managing patient care, yet they still rely on the help of History those more experienced Born on August 31, 1942, in Hampton, Virginia Most newly graduated nurses are placed in this 1964 - earned her Bachelor of Arts in Nursing from level Pasadena College Competent 1960 - worked in nursing field Through learning from actual practice 1970-1975 - Research associate at the University of situations and by following the actions of others, California at San Francisco School of Nursing advance beginner moves to this level Typified by considerable conscious and Published Books deliberate planning that determines which » From Novice to Expert: Excellence and aspects of the current and future situations are Power in Clinical Nursing Practice important and which can be ignored » Nursing Pathways for Patient Safety Consistency, predictability and time » The Primacy of Caring management are important, and gaining a sense Co-authored Books of mastery through planning and predictability is » Expertise in Nursing Practice: Caring, the accomplishment Clinical Judgment, and Ethics There is an increased level of efficiency but the » Clinical Wisdom in Critical Care: A focus is on time management and the nurse’s Thinking-in-Action Approach organization of the task world The competent nurse may display 5 Levels Of Skills Acquisition And hyper-responsibility for the patient, often more Skills Development than is realistic, and may exhibit an ever-present Novice - rule follower and critical view of the self This stage is most pivotal in clinical learning The person has no background experience of the situation in which he or she is involved because the learner must begin to recognize Context-free rules and objective attributes must patterns and determine which elements of the be given to guide performance situation warrant attention and which can be There is difficulty discerning between relevant ignored They devise new rules and reasoning and irrelevant aspects of a situation procedures for a plan while applying learned rules for action on the basis of the relevant facts of the situation THEORETICAL FOUNDATIONS IN NURSING 9 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Proficient Metaparadigm The performer recognizes the most salient Nursing aspects and has an intuitive grasp of the Described as an “enabling condition of connection situation based on background understanding and concern” which shows a high level of emotional Nurses at this level demonstrate a new ability involvement in the nurse-client relationship to see changing relevance in a situation Viewed nursing practice as the care and study of including the recognition and the implementation the lived experience of health, illness, and disease of skilled responses to the situation as it evolves and the relationships among these three elements They no longer rely on present goals for Person organization and they demonstrate an increases Stated that “a self-interpreting being, that is, the person does not come into the world predefined but gets defined in confidence in their knowledge and abilities the course of living a life. A person also has... an effortless There is much more involvement with the and non-reflective understanding of the self in the world. The patient and family person is viewed as a participant in common meanings.” This stage is a transition into expertise Believed that there are significant aspects that make up a Expert person; She had conceptualized the major aspects of The expert performer no longer relies on understanding that the person must deal with as: analytical principle (rule, guide and maxim) to The role of the situation The role of the body connect her or his The role of personal concerns The role of temporality understanding of the situation to an appropriate Goal: Overcome the Cartesian dualism, the view that the mind and body are distinct, separate entities action The expert nurse as having an intuitive grasp Embodiment - capacity of the body to respond to of the situation and as being able to identify the meaningful situations region of the problem without wasting consideration on a range of alternative 5 Dimensions of the body (Merleau, Ponty & Dreyfus) diagnoses and solutions The unborn complex - the body of the fetus There is a qualitative change as the expert The habitual skilled body - what you socially learn performer “knows the patient”, meaning knowing The projected body - act in a specific situation typical patterns of The actual projected body - the projection of a person is flexible and varied to fit the situation responses and knowing the patient as a person The phenomenal body - awareness of itself with the ability Key aspects of the expert nurse’s practice are: to imagine and describe kinetic situations. A clinical grasp and resource-based practice The nurse must attend to all these dimensions of the Embodied the know-how body and seek to understand the role of embodiment in Seeing the big picture particular situations of health illness and recovery. Seeing the unexpected The expert nurse has the ability of pattern Health recognition on the basis of deep experiential Focused “on the lived experience of being healthy and ill” background Defined health as what can be assessed. While well-being is the human experience of health or wholeness. Meeting the patient’s actual concerns and Well-being and being ill are recognized as different ways of needs is of utmost important, even if it means being in the world planning and negotiating for a change in the Health is described as not just the absence of disease and plan of care illness. Also, a person may have a disease and not There is almost a transparent view of self experience illness because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level. Environment » Used the term “situation” instead because it suggests a social environment with social definition and meaning. » Used the phenomenological terms of being situated and situated meaning, which are defined by the person’s engaged interaction, interpretation and understanding of the situation THEORETICAL FOUNDATIONS IN NURSING 10 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Major Concepts and Definitions Aspects of a Situation » The recurring meaningful situational components recognized and understood in context because the nurse has previous experience Attribute of a Situation » Measurable properties of a situation that can be explained without previous experience in the situation Competency » It is “an interpretively defined area of skilled performance identified and described by its intent, functions, and meanings” Domain » An area of practice having a number of competencies with similar intents, functions and meanings Exemplar » An example of a clinical situation that conveys one or more intents, meanings, functions, or outcomes easily translated to other clinical situation Experience » An active process of refining and changing preconceived theories, notions, and ideas when confronted with actual situations; implies there is a dialogue between what is found in practice and what is expected Maxim » Cryptic description of skilled performance that requires a certain level of experience to recognize the implications of the instructions Paradigm Case » A clinical experience that stands out and alters the way the nurse perceives and understands future clinical situations » Paradigm cases create new clinical understanding and open new clinical perspectives and alternatives Salience » A perceptual stance or embodied knowledge whereby aspects of a situation stand out as more or less important THEORETICAL FOUNDATIONS IN NURSING 11 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Martha Rogers | Week 3 - Lesson 6 She begun publishing Rogerian Nursing Science News, a members’ newsletter to disseminate theory developments and research studies In 1993, The journal of Rogerian Nursing Science begun publishing journal annually She died on March 13, 1994 Rogers publication includes 3 books and more than 200 articles. She lectured in 46 states including the districts of Columbia, Puerto Rico, Mexico, Netherlands, China, Newfoundland, Colombia, Brazil and other countries Published Books 1961: Educational Revolution in Nursing 1964: Reveille in Nursing 1970: An Introduction to the Theoretical Basis of Nursing Theory of Unitary Human Beings Theory of Unitary Human Beings In 1970, Roger’s Conceptual Model of Nursing was “Professional practice in nursing seeks to promote based on the set of basic assumptions that describes the symphonic interaction between man and environment, to life process in human beings which are the following: strengthen the coherence and integrity of human field, Wholeness and to direct and redirect pattering of the human and Openness environmental fields for realization of maximum health Unidirectionality potentials.” (Rogers, 1970, p.122) Pattern Organization Sentience About the Theorist Thought Martha Rogers was born on May 12,1914 in Dallas, According to this theory, any change in the pattern and Texas organization of mind and his environment is transmitted She is an American Nurse, researcher, theorist, and by waves. This pattern emerges as an observable event author widely known for developing the science of in the life of a man. Thus, better understanding of human unitary human beings. experience should be possible Her landmark book is an introduction to the theoretical basis of nursing Postulation: Martha Elizabeth Rogers is the oldest children among Human beings are dynamic energy fields integral with four children of Bruce Taylor Rogers and Lucy environmental fields. Mulholland Keener Rogers Soon after her birth, her family returned to Knoxville, Tennessee where she began her college education Four Building Blocks In 1936, she received her nursing diploma from 1. Energy field - Constitutes the fundamental unit of both the Knoxville General Hospital School of Nursing living and non-living. Field is a unifying concept. Energy In 1937, she obtained a bachelor of science degree signifies the dynamic nature of the field from George Peabody College in Nashville Tennessee. According to Rogers, Energy fields are infinite and one In 1945, her other degree is Master’s of arts degree in dimensional. The two fields under Energy field are: public health nursing supervision from Teachers College, 1.Human Field Columbia University, New York. - Defined as an irreducible, indivisible, pandimensional, energy field identified by pattern and manifesting And also Masters of Public arts degree in 1952 characteristics that are specific to the whole and that cannot In 1954, she finished Doctor of Science degree in John be predicted from knowledge of the parts. Hopkins University, Baltimore 2.Environmental Field In 1979, she became a Professor Emerita - Defined as an irreducible, pandimensional energy field In 1988, colleagues and students joined her in forming identified by pattern and integral with the human field. Both the Society of Rogerian Scholars (SRS) fields change continuously, creatively and integrally. THEORETICAL FOUNDATIONS IN NURSING 12 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 2. Universe of Open Systems Five Assumptions (1970) Holds that energy fields are infinite, open, and integral with “Man is unified whole possessing his own integrity and one another manifesting characteristics more than and different from the Human and the environmental field are in continuous sum of his parts” (energy field) (p. 47). process and are open systems “Man and his environment are continuously exchanging matter and energy with one another” (openness) (p. 54). 3. Pattern “The life process evolves irreversibly and unidirectionally The distinguishing characteristics of an energy field and is along the space-time continuum” (helicy) (p. 59). perceived as a single wave. “Pattern and organization identify man and reflect his The nature of the patterns changes continuously, innovative wholeness” (pattern and organization) (p. 65). innovatively, and these changes give identity to the field “Man is characterized by the capacity for abstraction and Manifestations of pattern have been described as unique imagery, language and though, sensation, and emotion” and refer to behaviors, qualities, and characteristics of the (sentient, thinking being) (p. 73). field. Theoretical Assertion 4. Four Dimensionality “The life process is homeodynamic.... these principles As a nonlinear domain without spatial or temporal attributes postulate the way the life process is and predict the nature of Provides for an infinite domain without limit its evolving” (p. 96) Principles of Change Metaparadigm Helicy Nursing - Describes spiral development in continuous, non repeating, Is a learned profession and innovative patterning. Focuses on the people and the world in which they live, as - Describing the nature of change evolved from probabilistic to it encompasses people and their environments. unpredictable, while remaining continuous and innovative The art of nursing is the creative use of the scientific of Resonancy nursing for human betterment - Patterning changes with the development from lower to “Professional practice in nursing seeks to promote higher frequency, that is, with varying degrees of intensity. symphonic interaction between human and environmental - Embodies wave frequency and energy field pattern evolution. fields, to strengthen the integrity of the human field, and to Integrality direct and redirect patterning of the human and - “reflects the unity or wholeness of humans and their environmental fields for realization of maximum health environment” (Jarrin, 2012, p. 14). potentials” Person Application of Theory as an open system in continuous process with the open system that is the environment https://youtu.be/7AXMpmJHzxg?si=rjnZTLL0Gm9fpoEG Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of its parts. Health Health and illness are manifestations of pattern and are considered to denote behaviors that are of high value and low value Passive health to symbolize wellness and absence of disease and major illness. Environment An irreducible, pandimensional energy field identified by pattern and manifesting characteristics different from those of the parts Environmental fields are infinite and change is continuously innovative, unpredictable, and characterized by increasing diversity. THEORETICAL FOUNDATIONS IN NURSING 13 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Dorothea Orem | Week 3 - Lesson 7 Self-Care Nursing Theory Self-care is a human regulatory function that individuals must, with deliberation, perform themselves or must have performed for them too maintain life, health, development, and well being (Alligood, 2014). SCDNT’s Philosophical Emphasis is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they’re able. This theory is mainly used in rehabilitation and primary care or other settings in which patients are encouraged to be INDEPENDENT. Composed of the following interrelated theory: Theory of Self-care Theory of Self-Care Deficit Theory of Nursing Systems Classified as: wholly compensatory Partially compensatory Supportive-educative According to Dorothea Orem: “Caring in nursing conveys physical acts, embraces the mind-body-spirit as it reclaims the embodied spirit as its focus of attention.” About the Theorist Was born in July 15, 1914 in Baltimore, Maryland Earned her nursing diploma from the Providence Hospital Metaparadigm School of Nursing in Washington, D.C. in 1930’s. She went on Orem’s theory addresses client’s self- care needs. It is to complete her Master’s of Science in Nursing in 1945, both defined as a goal- oriented activities that are set towards from the Catholic University of America in Washington, D.C. generating interest in the part of the client to maintain life and In 1982, she was a member of group of nurse theorists who health development. presented Patterns of Unitary Man (Humans), the initial The theory is aimed towards making the clients perform framework for nursing diagnosis, to the North American self-care activities in order to live independently. Nursing Diagnosis Association (NANDA). One of the America’s foremost nursing theorists Nursing She was involved in nursing practice, nursing service and According to Orem, nursing is helping clients to establish or nursing education identify ways to perform self-care activities. Nursing actions She worked as a staff nurse, private duty nurse, nurse are geared towards the independence of the client educator, nurse administrator, and nurse consultant. Orem defines nursing as a human service and it is based Orem’s Self-Care Theory focuses on each “individual’s ability on values. It is a distinguished human service since its focus to perform self-care, defined as ‘the practice of activities that is on persons with inabilities to maintain continuous provision individuals initiate and perform on their own behalf in of healthcare. maintaining life, health, and well-being.” An art through which the practitioner of nursing gives She died on June 22, 2007 (at the age of 92), at her specialized assistance to persons with disabilities of such a residence on Skidaway Island, Georgia. character that greater than ordinary assistance is necessary to meet daily needs for self-care and to intelligently participate in the medical care they are receiving from 1st Book physician. Nursing: Concepts of Practice (1971) Subsequent editions of the same book were published in 1980, 1985, 1991, 1995, and 2001 Person Human being who functions biologically, psychologically, Received honorary Doctor of Science Degree in 1976 symbolically, and socially. Are very much different from other living things in terms of their capacity Can reflect upon events, themselves, and their environment. Have potential for learning and development Capable for self-knowledge THEORETICAL FOUNDATIONS IN NURSING 14 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Can engage in deliberate actions, interpret experiences, Therapeutic Self-care Demand and perform beneficial actions These are the summation of all activities needed to Able to meet self-care needs (requisites) alleviate the existing disease or illness by methods As an individual, patient, multiperson unit, self-care agent, appropriate for the dependent-care agent following: - Controlling or managing the factors identified in Environment the requisites, the values of which are regulatory Has two dimensions: of human functioning (sufficiency of air, water, Environmental: physical, chemical and biological features and food) - Atmosphere, pollutants, weather conditions, pets, infectious organism, etc. - Fulfilling the activity element of the requisites Development: socioeconomic features (maintenance, promotion, prevention, and - Family & community provision) - Gender and age roles, cultural roles, and cultural Self-Care Agency prescriptions of authority The complex acquired ability of mature and maturing persons to know and meet their continuing requirements Major Concepts and Definitions for deliberate, purposive actions to regulate their own human functioning and development (Orem, 2001). Self-care Agent Is an activity that promotes a person’s well-being. It is Is the individual who is engaged in meeting the needs performed by persons who are aware of the time frames of a person or a person who has the power to engage in on behalf of maintaining life, continuing personal a course of action. development and a healthy functional living. Dependent Care Agent Self-care Requisites Maturing adolescents or adults who accept and fulfill Are insights of actions or requirements that are person the responsibility to know and meet the therapeutic must be able to meet and perform in order to achieve self-care demand of irrelevant others who are socially well-being. dependent on them or to regulate the development or The two elements of self-care requisites are: exercise of these persons’ self-care agency. 1. The factor to be controlled or managed to Self-care Deficit keep as aspects of human functioning and A relationship between the human properties of development within the norms compatible with therapeutic self-care demand and self-care agency in life, health, and health personal well-being and; which constituent developed self-care capabilities within 2. The nature of the required action self-care agency are not operable or inadequate for Universal Self-care Requisites knowing and meeting some or all components of the Eight self-care requisites common to men, women, and existent or projected therapeutic self-care demand children (Alligood,2014) are the follows: Nursing Agency 1. Maintenance of a sufficient intake of air. Is a set of established capabilities of a nurse who can 2. Maintenance of sufficient intake of food. legitimately perform activities of care for a client. It helps 3. Maintenance of sufficient intake of water. a person achieve their health care demand. 4. Provision of care associated with elimination Nursing Design processes and excrements. These are professional functions that must be 5. Maintenance of balance between activity and performed by the nurse in order to meet clients' needs. rest It serves as a guideline of needed and foreseen results. 6. Maintenance of balance between solitude and Nursing Systems social interaction. These are series and sequences of deliberate practical 7. Prevention of hazards to human life, human actions of nurses performed at times in coordination with functioning, and human well-being. actions of their patients. 8. Promotion of human functioning and Helping Methods development within social groups in accordance From a nursing perspective, it is a sequential series of with human potential, known human limitations, actions, which, if performed, will overcome or and the human desire to be normal. compensate for the health-associated limitations of Health Deviation Self-care Requisites persons to engage in actions to regulate their own These self-care requisites exist for persons who are ill functioning and development or that of their dependents. or injured, who have specific forms of pathological 1. Acting for or doing for another conditions or disorders, including defects and disabilities, 2. Guiding and directing and who are undergoing medical diagnosis and 3. Providing physical or psychological support treatment. 4. Environment that supports personal development 5. Teaching THEORETICAL FOUNDATIONS IN NURSING 15 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 3 Classification of Nursing Systems 1. Wholly Compensatory Application of Orem’s Theory into Practice - The nurse or caregiver does all the care for the patient. Patients are unable to care for themselves. 2. Partly Compensatory - Patients can do some care for themselves but still relies on the nurse or caregiver for assistance. 3. Supportive-Educative - Patients learns to provide care for themselves on their own without any assistance from the nurse or caregiver. Orem’s Basic Nursing System Integration Of Orem’s Theory Into Practice Collect Data in Six Areas 1. The health goals within the context of life history, lifestyle, and health status. 2. The person’s requirements for self-care 3. The person’s health status 4. The physician’s perspective of the person’s health status 5. The person’s perspective of his or her health 6. The person’s capacity to perform self-care Nursing Diagnosis & Care Plans The nurse designs a system that is wholly or partly compensatory or supportive- educative. The two actions are: 1. Bringing out a good organization of the components of patients’ therapeutic self-care demands. 2. Selection of combination of ways of helping that will be effective and efficient in compensating for/overcoming patient’s self-care deficits. Conceptual framework of Orem’s Theory Implementation & Evaluation Nurse assists the patient or family in self- care matters to achieve identified and described health and health-related results. Collecting evidence in evaluating results achieved against results specified in the nursing system design. Actions are directed by the etiology component of nursing diagnosis. THEORETICAL FOUNDATIONS IN NURSING 16 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Sister’s Callista Roy | Week 3 - Lesson 8 Stimulus Is any factor that provokes a response Three Classes of Stimulus: 1. Focal Stimuli Immediately confront the person The internal or external stimulus most immediately confronting the human system 2. Contextual Stimuli All other stimuli present that contribute to the effect of the focal stimulus Are all environmental factors that present to the person from within or without but which are not the center of the person’s 3. Residual Stimuli Environmental factors whose effects are unclear in a given situation Major Concepts System As set of parts connected to function as a whole for some purpose and that does so by virtue of the interdependence of its parts Also have inputs, outputs, control, and feedback About the Theorist processes She was born on October 14, 1939 in Los Angeles, California Adaptation Her theory is known as adaptation model The process and outcome whereby thinking and feeling She is a member of sisters of saint joseph of person as individuals or in groups, use conscious Carondelet awareness and choice to create human and In 1963, she gained her Bachelor’s of Science in environmental integration. Nursing at Mount St. Mary’s College in Los Angeles, California Adaptation Level In 1966, she gained her master’s degree on nursing in Represents the condition of the life processes University of California, Los Angeles described on three levels as integrated, compensatory, In 1973, she got her master’s in sociology in University and compromised. of California A constantly changing point, made up of focal, In 1977, she got her doctorate in sociology in University contextual, residual, which represent the person’s own of California standard of the range of stimuli to which one can While working towards her master’s degree, she was respond with ordinary adaptive responses. challenged by a seminar of Dorothy Johnson to develop a conceptual model for nursing Adaptation Problem She was used to work as a pediatric staff nurse and Broad areas of concern related to adaptation she had noticed the great resiliency of children and their Describes the difficulties related to the indicators of ability to adopt in response to major physical and positive adaptation psychological challenge. She was impressed by Areas of concern for the nurse related to adapting adaptation of those children in an appropriate conceptual person or group framework for nursing. Roy was also an educator and a dearest at the same Coping Processes time Are innate or acquired ways of interacting with the changing environment. Acquired Coping Mechanisms Are developed through strategies such as learning The experiences encountered throughout life contribute to customary responses to particular stimuli THEORETICAL FOUNDATIONS IN NURSING 17 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Regulatory Subsystem Group Identity A major coping process involving the neural, chemical, Reflects how people in groups perceive themselves and endocrine systems based on environmental feedback Comprised of the following: Cognator Subsystem 1. Interpersonal relationships A major coping process involving four 2. Group self-image cognitive-emotive channels 3. Social milieu 1. Perceptual and information processing 4. Culture 2. Learning 3. Judgement Role Function Mode 4. Emotion It focuses on the roles the person occupies in society Defined as a set of expectations about how a person Adaptive Responses occupying one position behaves toward a person That promote integrity in terms of the goals of human occupying another person systems Instrumental Behavior - actual physical performance of a behavior Ineffective Responses Expressive Behavior That do not contribute to integrity in terms of the goals - the feelings, attitudes, likes, or dislikes that a of the human system person has about a role or about the performance of a Role Integrated Life Process Basic need is social integrity – the need to know who is Adaptation level at which the structures and functions in relation to others so that one can act. of a life process are working as a whole to meet human The roles of function are: needs 1. Primary role - determines the majority of behavior engaged in by the Physiological-Physical Mode person during a particular period of life, determined by age, The physiological mode is associated with the physical sex, and developmental stage and chemical processes involved in the function and 2. Secondary role activities of living organisms. - are those that a person assumes to complete the task associated with the developmental stage and primary stage Five needs of Physiological Integrity 3. Tertiary role 1. Oxygenation - are normally temporary in nature, freely chosen by the 2. Nutrition individuals, and may include activities such as clubs or 3. Elimination hobbies 4. Activity and rest 5. Protection Interdependence Mode The physical mode is the manner in which the It focuses on close relationships of people and their collective human adaptive system manifests adaptation purpose, structure, and development relative to basic operating resources, participants, physical facilities and fiscal resources. The basic need of Two Relationships: physical mode is operating integrity. 1. With the significant others, persons who are the most important to the individual. 2. With support systems, others contributing to meeting Self-Concept-Group Identity Mode interdependence needs. It focuses specifically on the psychological and spiritual aspects of the human system Two major areas of interdependence behaviors: Self-concept is defined as the composite beliefs and 1. Receptive behavior feelings about oneself at a given time and is formed from 2. Contributive behavior internal perceptions and perceptions of other’s reaction Apply respectively to the receiving and giving love, Components respect and value in the interdependent relationships 1. Physical Self The basic need of interdependence mode is relational - Involves sensation and body image integrity 2. Personal Self - made up of self-consistency, self- ideal or expectancy and the moral- ethical-spiritual self The basic need underlying the individual self-concept mode has been identified as psychic and spiritual integrity THEORETICAL FOUNDATIONS IN NURSING 18 THEORETICAL FOUNDATIONS IN NURSING MIDTERMS Bachelor of Science in Nursing | First Year (1st Semester) S.Y: 2023-2024 Perception Environment Is the interpretation of a stimulus and the conscious All conditions, circumstances, and influences surrounding appreciation of it. and affecting the development and behavior of persons or Links the regulator with the cognator and connects the groups with particular consideration of the mutuality of adaptive modes persons and earth resources that and residual stimuli Scientific Assumption Theoretical Assertions Systems of matter and energy progress to higher levels of complex self- organization. Consciousness and meaning are constructive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans, by their decisions, are accountable for the integration of creative processes. Thinking and feeling mediate human action System relationship include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships. Persons and environment transformations are created in human consciousness. Integration of human and environmental meanings results in adaptation Philosophical Assumption Persons have mutual relationships with the world and God Human meaning is rooted in the omega point convergence of the universe