TFN Module 2 Content -Nursing Philosophies.docx (2).pdf

ANGELES UNIVERSITY FOUNDATION Angeles City COLLEGE OF NURSING NCM 0100 THEORETICAL FOUNDATION IN NURSING 1st Semester, A.Y. 2024-2025...

ANGELES UNIVERSITY FOUNDATION Angeles City COLLEGE OF NURSING NCM 0100 THEORETICAL FOUNDATION IN NURSING 1st Semester, A.Y. 2024-2025 MODULE 2 Different Views of Person, Health, Environment, and Nursing Nursing Philosophies Module Overview The metaparadigm for nursing is a framework for the discipline that sets forth the phenomena of interest and the propositions, principles, and methods of discipline. The metaparadigm is very general and is intended to reflect agreement among the different concepts in nursing practice. It is considered as the most abstract level of nursing knowledge and closely mirrors beliefs held about nursing. The metaparadigm offers a context for developing conceptual models and theories. Much of the theoretical work in nursing focused on articulating relationships among the four major concepts: person, environment, health, and nursing. Learning Outcomes: Upon completion of this module, the student should be able to: 1. Provide appropriate evidence-based nursing care based on variety of theories and standards relevant to health and healing 2. Ensure a working relationship with the client and/or support system based on patient care competencies through safe and quality nursing care, communication, collaboration and teamwork, and health education Learning Objectives At the end of the discussion, the students will be able to: 1. Define nursing philosophy 2. Relay the life of Florence Nightingale and her contributions in the nursing profession 3. Describe Nightingale’s Environmental Theory 4. Relay who Patricia Benner is and her contributions in the nursing profession 5. Describe Benner’s Levels of Expertise and Seven Domains of Nursing practice 6. Relay who Jean Watson is and her contributions in the nursing profession 7. Describe Watson’s Transpersonal Caring Theory and the Ten Carative Factors Definition of Key Terms Before going through this module, the student is advised to read the following terms: Caring - the essence of nursing and the dominant, unifying, and distinctive feature of nursing". Communication - the process of sharing information or the process of generating and transmitting meanings Environment - the external and internal surroundings that influence or affect the person Health - a state of complete physical, mental, and social well being, not merely the absence of disease or infirmity that is influenced by political, economic, socio-cultural, and environmental factors Nursing - the art and science of caring for individuals, families, groups, or community Person - the recipients of care; can be an individual, family, or community Philosophy - the second knowledge structure level that specifies the definitions of the metaparadigm; they are works that specifies philosophical approaches to nursing A. Nursing Philosophies Florence Nightingale About the author Florence Nightingale was born on May 12, 1820 in Florence, Italy. She belonged to a well-educated, affluent, aristocratic Victorian family. Her parents, Edward and Frances Nightingale, named their daughter after her birthplace – Florence, Italy. She belonged to a large extended family, although the immediate family included only Florence and her elder sister, Parthenope. Nightingale was educated in mathematics, languages, religion, and philosophy. (Alligood, 2022) In 1837, Nightingale wrote about her calling in her diary: “God spoke to me and called me to His service.” On July 6, 1851, she was accepted for training at Fliedner School of Nursing in Kaiserswerth, Germany, a Protestant religious community with a hospital facility. At the end of 3 months, she was declared trained as a nurse. On November 5, 1854 (Crimean War), at the request of her friend, Sir Sidney Herbert, Secretary at War, Nightingale went to Scutari, Turkey. She went there to: 1. Provide trained nurses to take care of wounded soldiers 2. Address the environmental problems After the war, Nightingale returned to England to great recognition from the royal family, the soldiers who had served in and survived the Crimean war, their families, and the families of those who died at Scutari. She was awarded funds in recognition of this work, which she used to establish a nursing school at St. Thomas Hospital and King’s College Hospital in London. With this, Florence Nightingale’s reputation as the founder of modern nursing was established. (Alligood, 2022) During her lifetime, Nightingale’s work was recognized through the many awards she received from her country and from many other countries. One of her famous works, published in 1859, "Notes on Nursing: What it is, What it is not" includes her ideas on Environmental Theory. She was able to work and continued her writings until her 80’s until she lost her vision; she died in her sleep on August 13, 1910 at South St. Park Lane, London. (Alligood, 2022) Because of her contributions in the establishment of nursing as profession, Florence Nightingale were given the following titles: >The First Nursing Theorist >The Lady of the Lamp >The Mother of Modern Nursing Concepts of "Environmental Theory" Nightingale used her understanding of the incidence and prevalence of disease, and her powers of observation to develop an approach to nursing. Her main focus was the control of the environment of individuals and families, both healthy and ill, as a major component of nursing care. When one or more aspects of the environment are out of balance, the client uses increased energy to counter the environmental stress. The theory focuses on the physical environment, which she mentioned being influenced by the social and psychological environment of the individual. NIGHTINGALE CANONS: 1. HEALTH OF HOUSES = closely related to the presence of pure air, pure water, efficient drainage, cleanliness, and light 2. VENTILATION AND WARMTH = it is essential "to keep the air he breathes as pure as the external air without chilling him"; noxious air affect the client's health; temperature should not be too warm or too cold 3. LIGHT = "light has quite as real and tangible effects upon the human body"; take the patient outside for direct sunlight; keep the rooms well lighted 4. NOISE = "unnecessary noise, or noise that creates an expectation in the mind is that which hurts a patient"; sudden noise, thoughtless chatter, and whispering in a patient's room should be avoided 5. CLEANLINESS OF ROOMS, WALLS, AND BEDDINGS = "the greater part of nursing is preserving cleanliness"; dirty environment is a source of infection; removal of dust should be done with the use of damp cloth; beddings should be changed and aired frequently; a clean room is a healthy room 6. PERSONAL CLEANLINESS = "it is necessary to keep the pores of the skin free from all obstructing secretions"; unwashed skin poisoned the patient; this concept is also extended to nurses, in that, "every nurse ought to wash her hands very frequently during the day" 7. VARIETY = is vital to patient's recovery; beautiful objects, brilliant colors, cut flowers, reading, needle work, writing, and pets may alleviate suffering 8. NUTRITION AND TAKING FOOD = provision of different variety of food indicated for the patient's condition is vital for the patient's early recovery; frequent small servings may be more beneficial to the patient; no business should be done while patient is eating 9. CHATTERING HOPES AND ADVICES = "leave off this practice of attempting to cheer the sick by exaggerating their probabilities of recovery"; giving false hope is disturbing to the patient because this causes them to worry and become fatigued 10. PETTY MANAGEMENT = assure that "what you do when you are there, shall be done when you are not there"; the patient's environment should be well-managed to protect the patient from physical and psychological harm 11. OBSERVATION OF THE SICK = "the most important practical lesson that can be given to nurses is to teach them what to observe and how to observe"; there should be precise, specific and individualized questions and observations to provide appropriate actions.  Nightingale's 4 Major Concepts Person Health Environment Nursing >In most of FN's writings, >Nightingale > Fitzpatrick and > a spiritual she referred to the defined "health as Whall described calling person as a patient. She being well and using Nightingale's believed that "nurses every power that the concept of > "nursing is performed tasks to and person has to the environment as having the for the patient and fullest extent". She "those elements responsibility for controlled the patient's saw disease as a that can be someone else's environment to enhance reparative process manipulated to health" recovery". Hence, the that nature instituted place a patient in person is described as a from a want of the best possible > Nightingale passive patient in this attention. She condition" wrote Notes on relationship. believed that Nursing to However, there are prevention of > it includes both provide women specific references to the disease through physical and with guidelines patient performing self environmental psychological for providing care when possible. The control will greatly component nursing care and nurse was specifically uplift maintenance physical to give advice on instructed to ask the of health - she component: how to "think like patient about his or her called it modern ventilation, light & a nurse" preferences, however, Public Health warmth, nutrition, the nurse was in control Nursing and the room temperature, of the patient's more modern and activity environment. concept of health psychological promotion. component: >Physical, intellectual, avoiding emotional, and social chattering hopes and spiritual being and advices, and unable to manipulate the providing variety environment to promote health. Patricia Benner About the Author Patricia Benner was born in Hampton, Virginia and spent her childhood in California, where she received her early and professional education. She obtained her BSN degree from Pasadena College in 1970, she earned a master’s degree in nursing, with her major emphasis in medical-surgical nursing from the University of California, San Francisco University of California. Benner has a wide range of clinical experience including acute medical-surgical, critical care, and home health care. Benner’s thinking was influenced by the work of Virginia Henderson. Her work has also been influenced to a large degree by the work of Hubert Dreyfus, a professor at the University of California. Huber Dreyfus developed the Dreyfus model of skill acquisition, which Benner later adapted to clinical nursing practice. Concepts of "Stages of Expertise: From Novice to Expert" Benner studies clinical nursing practice in an attempt to discover and describe the knowledge embedded in nursing practice. She emphasizes the a person may difference in knowing how, a practical knowledge from knowing what, a know how to do this but not theoretical explanation; she stated that “an individual may know how before the knowing its development of a theoretical explanation. She further mentioned that clinical explanation practice is an area of inquiry and a source of knowledge development. Thus, by behind that phenomenon studying clinical practice, nurses can uncover new knowledge (Alligood, 2022). Benner adapted the Dreyfus model of skill acquisition to clinical nursing practice. The performance level can be determined only by consensual validation of expert judges and the assessment of the outcomes of the situation. She further defines skill and skilled practice to mean implementing skilled nursing interventions and clinical judgment skills in actual clinical situations (Alligood, 2022). Related and also important in the study of Benner’s theory is an understanding of ethics in clinical practice. According to her, conduct is a product of an individual relationship with the patient that involves engagement in a situation. FROM NOVICE TO EXPERT: EXCELLENCE AND POWER IN CLINICAL NURSING PRACTICE Five Levels / Stages of Skill Acquisition and Development in Nursing: 1. Novice tell me what to do and ill do it The person has no background experience of the situation in which he or she is involved. He also has difficulty discriminating between relevant and irrelevant aspects of a situation. For this reason, context-free rules are needed to guide their action. In general, this is the level in which nursing students belong. (Alligood, 2022) 2. Advanced Beginner what else do you want me to do. promt by the situation. no confidence yet. The person has sufficient experience to easily understand aspects of the situation. He can demonstrate marginally acceptable performance when a mentor points out the meaningful component of the situation. Nurses at this level are guided by rules and oriented by task completion. Nurses view clinical situations as a test of their abilities and the demands of the situation placed on them rather than in terms of the patient's needs and responses. Benner places most newly graduated nurses at this level. (Alligood, 2022) confidence in what you do, organize tasks, knowing what to do. guided by both rules and own. 3. Competent nurses with 2-3 experiences. In this stage, the nurse demonstrates conscious and deliberate planning to identify which aspects of the current and future situations are important and which can be ignored. He considers consistency, predictability, and time management as essential components and a sense of mastery is acquired through planning and predictability. Nurse's time management and organization of tasks are more important rather than on timing in relation to the patients' needs. (Alligood, 2022)  This stage is the most essential in clinical learning because the learner must know how to recognize patterns and identify which element of the situation needs attention and which ones to ignore. The competent nurse devises new rules and reasoning procedures for a plan while applying learned rules for action on the basis of the relevant facts of that situation. To become proficient or skillful, the competent nurse must allow the situation to guide responses. (Alligood, 2022) what data to get, what info is useful. can see what happens, what happened wrong, foresee 4. Proficient consequences. knowing what techniques, what guideline to use. more patient interaction. The proficient nurse perceives the situation as a whole (the total picture) rather than in terms of aspects and the performance is guided by maxims. The nurse demonstrates a new ability to see changing relevance in a situation including the recognition and the implementation of skilled responses to the situation as it evolves. They no longer rely on the preset goals of the organization and they demonstrate an increased confidence in their knowledge and abilities (Alligood, 2022). At this stage, the nurse has the ability to turn the focus away from self and toward the patient. 3-5 years of experience. 5. Expert works by intuition, knowing what condition the patient is in. The 5th & last stage is accomplished when the expert performer no longer relies on analytical principle (rule, guideline, and maxim) to connect his or her understanding of the situation to an appropriate action. The expert nurse possesses an intuitive grasp of the problem without losing time considering a range of alternative diagnosis and solutions. There is a qualitative change as the expert nurse "knows the patient" - knowing typical patterns of responses and knowing the patient as a person. (Alligood, 2022) B. Seven Domains of Nursing Practice 1. The Helping Role Domain >establishing a healing relationship, providing comfort measures, and inviting active patient participation and control in care 2. The Teaching-Coaching Function Domain >timing and coaching, readying patients for learning, motivating change, assisting with lifestyle alterations, and negotiating agreement on goals 3. The Diagnostic and Patient-Monitoring Function Domain >competencies in ongoing assessment and anticipation of outcomes 4. The Effective Management of Rapidly Changing Situations Domain >contingency management and ability to assess and manage care during crisis situations 5. The Administering and Monitoring Therapeutic Interventions and Regimen Domain >preventing complications during drug therapy, wound management, and hospitalization checking progress of the patient. 6. The Monitoring and Ensuring the Quality of Health Care Practices Domain >maintenance of safety, continuous quality improvement, collaborative and consultation physicians, self-evaluation, and management of technology the patient knows what he should do.  7. The Organizational and Work-Role Competencies Domain >priority setting, team building, coordinating, coping with staff shortages, and providing for continuity u cant work independently. u should adjust when the situation needs. Benner's 4 Major Concepts Person Health Environment Nursing >a self-interpreting >the lived experience >"situation" >caring relationship, being, that is, the of being healthy and because situation an "enabling person does not being ill (health is conveys a social condition of come into the world what can be environment with connection and predefined but gets assessed; whereas social definition concern" defined in the well-being is the and course of living a human experience of meaningfulness > caring practice life (Alligood, 2022). health or wholeness) whose science is >being situated guided by the moral >the person is >well-being and being and situated art and ethics of embodied, meaning ill are understood as meaning which is care and that the body has distinct ways of being defined by the responsibility the capacity to in the world person's engaged respond to interaction, caring relationship - connection & concern meaningful >health is described interpretation and situations as not just the understanding of caring and nursing are interdependent. absence of disease the situation. This "4 Major Aspects nursing practice and illness. (A means that each -understanding of Understanding" person may have a person's past, concepts and provides that the person disease and not present, and direction for nursing must deal with: experience illness future influence practice. 1. The role of the because illness is the the current situation human experience of situation. 2. The role of the loss or dysfunction, body whereas disease is 3. The role of what can be personal concerns assessed at the 4. The role of physical level. temporality Jean Watson About the Author Jean Watson was born in 1940 in the Appalachian Mountains of West Virginia. After graduation from the Lewis-Gale School of Nursing, she married her husband and moved to Colorado where she continued her nursing education at the University of Colorado. Watson later held both faculty and administrative positions in the School of Nursing at the University of Colorado Health Sciences Center. During her career, Watson has worked to restructure nursing education through the development of nursing curriculum in human caring, health, and healing. She has also worked to establish the Center for Human Caring at the University of Colorado, which has a commitment to develop and use knowledge of human caring and healing as the basis of clinical practice and nursing scholarship. Concepts of “Transpersonal Caring Theory” According to Watson, the goal of nursing is to facilitate individuals in gaining a higher degree of harmony within the mind-body-spirit; such harmony generates self knowledge, self-reverence, self-healing, and self-care process through human-to-human caring process and caring transactions when youre sick, the mind would worry, the spirit wont have CONCEPTS: peace. 1. Transpersonal Caring Relationship -a human-to-human connectedness occurring in a nurse-patient encounter wherein “each is touched by the human center of the other.” It is further elaborated as a situation wherein the nurse enters into the life space or phenomenal field of another person and is able to detect the other person’s condition of being, feels this condition within self, and responds in such a way that the person being cared for has a release of feelings, thought, and tension. 2. Ten Carative factors -These are factors that characterize the nursing caring transaction occurring within a given caring moment or occasion. Watson notes that the carative factors are not intended to be a checklist, but to be a philosophical and conceptual guide for nursing. The 10 Carative factors are: 1. Formation of a humanistic- altruistic system of values -it begins developmentally at an early age with values shared with the parents. It is mediated through one’s own life experiences and exposure to the humanities. 2. Instillation of faith-hope -it is essential to both the caritive and the curative processes. It facilitates the promotion of holistic nursing care and positive health. When modern science has nothing further to offer the person, the nurse can continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual. 3. Cultivation of sensitivity to one’s self and to others -explores the need of the nurse to begin to feel an emotion as it presents itself. Development of one’s own feelings is needed to interact genuinely and sensitively with others. Striving to become sensitive makes the nurse more authentic, which encourages self-growth and self-actualization, in both the nurse and those with whom the nurse interacts. The nurses promote health and higher-level functioning only when they form person to person relationships. 4. Establishing a helping-trust relationship -a trusting relationship promotes and accepts the expression of both positive and negative feelings. The strongest tool is the mode of communication, which establishes rapport and caring.  This relationship involves: 4.1. Congruence -being real, honest, genuine, and authentic 4.2. Empathy -ability to experience and thereby, understand the other person’s perceptions and feelings and to communicate those understanding 4.3. Non-Possessive warmth -demonstrated by moderate speaking volume, a relaxed, open posture, and facial expressions that are congruent with other communications 4.4. Effective communication -has cognitive, affective, and behavior response components. It also includes verbal, nonverbal and listening in a manner which connotes empathetic understanding. 5. The expression of feelings, both positive and negative -the sharing of feelings is a risk-taking experience for both the nurse and patient because “feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship”. The nurse must be prepared for either positive or negative feelings shared by the patient. Awareness of the feelings helps to understand the behavior it engenders. 6. Systematic use of the scientific problem-solving method for decision making -the scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. It is similar to the research process in that it is systematic and organized 7. Promotion of interpersonal teaching-learning -it separates the concept of caring from curing. The caring nurse must focus on the learning process as much as the teaching process. It shifts the responsibility for wellness and health to the patient. The nurse facilitates this process to enable the patient to provide self-care, determine personal needs, and provide opportunities for their personal growth. 8. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment -Watson divides these into external and internal variables, which the nurse manipulates in order to provide support and protection for the person’s mental and physical well-being. The external and internal environments are interdependent. Internal environment includes the mental and spiritual well-being and socio-cultural beliefs of an individual. The external environment includes comfort, privacy, safety, and clean surroundings. 9. Assistance with the gratification of human needs -it is based on a hierarchy of need similar to that of the Maslow’s. Each need is equally important for quality nursing care and the promotion of optimal health. Lower order needs must be satisfied first before attempting to attain higher-order needs.  These needs are ordered as: 9.1. Lower order needs (biophysical needs) -the need for food and fluid -the need for elimination -the need for ventilation 9.2. Lower order needs (psychophysical needs) -the need for activity-inactivity -the need for sexuality 9.3. Higher order needs (psychosocial needs) -the need for achievement -the need for affiliation -intrapersonal-interpersonal need -the need for self-actualization 10. Allowance for existential-phenomenological forces -Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. Thus, the nurse assists the person to find the strength or courage to confront life or death. 3. Caring Occasion/ Caring Moment -occurs whenever the nurse and others come together with their unique life histories and phenomenal field in a human-to-human transaction. Watson’s 4 Major Concepts Person Health Environment Nursing Human being >Watson adds the >According to >“Nursing is concerned with refers to “a valued following three Watson, caring promoting health, preventing person in and of elements to WHO (and nursing) illness, caring for the sick him or herself to definition of has existed in and restoring health”. be cared for, health: every society. >It focuses on health respected, A high level of >A caring promotion and treatment of nurtured, overall physical, attitude is not disease. She believes that understood and mental and social transmitted holistic health care is central assisted; in functioning from to the practice of caring in general a A general generation to nursing. philosophical view adaptive generation. of a person as a maintenance level >It is >“a human science of fully functional of daily transmitted by persons and human integrated self. functioning The the culture of health-illness He, human, is >absence of the profession experiences that are viewed as greater illness (or the as a unique mediated by professional, than and different presence of way of coping personal, scientific, esthetic from, the sum of efforts that leads with its and ethical human his or her parts”. its absence) environment. transactions”. REFERENCES Alligood, M.R. (2022) Nursing theorists and their work. 10th Edition. Elsevier Singapore Pte. Ltd Butts, J.B. and Rich K.L. (2021) Philosophies and theories for advanced nursing practice. 4th Edition. Jones and Bartlett Pub.; Sudbury, MA. Chinn, Peggy L. (2021). Knowledge development in nursing: theory and process. 11th Edition. Mosby Elsevier. Fundamentals of nursing models, theories, and practice. 2 Edition. nd Mosby Elsevier. McEwen, M and Wills, E (2023). Theoretical basis for nursing. 6th Edition. Wolters Kluwer, Philadelphia Peterson, Sandra J. (2020)Middle range theories: application to nursing research and practice. 5th Edition. Mosby Elsevier. Walker, L. and Avant K. (2019) Strategies for theory construction in nursing. 6 th Edition. Prentice Hall; Boston, USA. Prepared by: (SGD) Sarah S. Nares, RN., MN Module Contributor: Rochelle G. Gumabon R.N., M.N. NCM 0100 Instructor Peer Reviewed by: Mary Angelica P. Bagaoisan, RN., MAN NCM 0100 Instructor Reviewed by: Debbie Q. Ramirez, R.N., Ph.D. Assistant Dean, College of Nursing Approved by: Zenaida S. Fernandez, R.N., Ph.D. Dean, College of Nursin