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Evolution of Nursing Body of knowledge unique only to nursing. Guides the practice of nursing. Highlights of Significant E...

Evolution of Nursing Body of knowledge unique only to nursing. Guides the practice of nursing. Highlights of Significant Events in Nursing History Theory 1859- Nightingale served in the Crimean war Classification of Theories Based on Purpose and set up a holistic system of nursing. factor-isolating theories (descriptive theories) Environmental view of nursing. Notes on factor-relating theories (explanatory theories) Nursing- 1st nursing theory that focuses on situation-relating theories (predictive manipulation of the environment for patient’s theories) benefit; created a timeless legacy for the situation-producing theories (prescriptive nursing profession theories)- 1950s- (1956) Columbia University(top2) Characteristics of Theory school of Nursing offered the first master Logical, simple and generalizable program for nurses Composed of concepts and propositions 1952-1953 Hildegard introduced her theory about interpersonal relations. Nurse-patient Provide the bases for testable hypotheses relationship. Consistent with other validated theories 1960- Nurse practitioner movement at Yale Contribute to body of knowledge University School of Nursing Components of Theory 1970- Several nursing theories had been published/Nursing theories were presented purpose 1980- Nursing theories were revised and concepts and definitions findings that expanded them theoretical statements 1990- Research studies that tested and structure/linkages and ordering expanded nursing theory were numerous assumptions 2000- Less new theories, more revised and updated theories, evidence-based practice Nursing Theory Eras of Nursing Knowledge Nurse is derived from the Anglo-French nurice and the Latin nutrica, both of which mean 1. Curriculum Era nourish. 2. Research Era 3. Graduate Education Era Conceptualization of some aspect of nursing 4. Theory Era reality communicated for the purpose of 5. Theory Utilization Era describing phenomena, explaining relationships between phenomena, predicting consequences or prescribing nursing care, 1. Curriculum Era (1900-1940s) Meleis 2007. - Emphasis: curricular content and the Knowledge based concept; it defines what movement toward the goal of a standardized nursing practice is. curricula Organized body of knowledge what nurses do, - to develop specialized knowledge and higher what nursing is and all concepts of nursing education practices - Expansion of curricula beyond physiological and pathophysiological knowledge to social Provides a way to define nursing as a unique sciences, pharmacology and nursing discipline separate from other disciplines. procedures. The contents were initially included in “Fundamentals” (basic essentials)  then it goes beyond knowledge on patient’s 5. Theory Utilization Era (21st century) illness. - Emphasis: utilization of philosophies, - Difference between medical and nursing view models or theories in practice (theory of patients became distinct because of based nursing practice) Nightingale. - “art of nursing” was changed to “science of - Focus: from theory development to nursing”; Baccalaureate nursing programs in theory application and utilization higher learning emphasis is on science --- using critical thinking and decision Presently, “art and science of nursing” is more making in nursing practice supported. - Emergence of “nursing arts laboratory” - Critical thinking is the intellectually (nursing procedures are practiced in ward-like disciplined process of actively and room); skills lab (science and research) skillfully conceptualizing, analyzing, and evaluating information gathered 2. Research Era (1950-1970s) from observation, experience or reflection as a guide to belief and - Research became the driving force. Nurses action. were encouraged to learn how to conduct Significance of Nursing Theory research, developing the role for nurses for that specialized body of knowledge. Discipline vs Profession - Research is the basis of nursing practice. The accomplishments of the past century led - Emphasis: scholarship; the need to to the recognition of nursing both as an academic disseminate research findings in scholarly discipline and a profession. publications Discipline- academe specific; branch 3. Graduation Era (1950-1970s) of education, department of learning - Curricula for master’s- level preparation or domain of knowledge included nursing research, clinical specialty Profession- practice specific; practice and leadership. specialized field founded on the - Nurses advance to doctorate programs from a theoretical structure of the science or wide range of related disciplines as they were knowledge of the discipline and being prepared for research and teaching accompanying practice abilities roles in nursing Significance of Nursing Theory to Profession - Series of conferences bought nurses to exchange ideas that focus on nursing science Nursing is recognized as a profession and theory development today because its development was - Doctoral education began to flourish. guided by the criteria for a profession - BATEY (1977); conceptualization is the The commitment to theory-based greatest limitation of nursing research; theory evidence for practice is beneficial to is a set of related concepts; therefore patients in that it guides a systematic substantive research is essential and knowledgeable care. - Shift of emphasis from research to theory Because theory amplifies knowledge development, this serves as a tool for 4. Theory Era (1980-1990s) reasoning, critical thinking and - Emphasis: nursing theory development decision making in quality nursing (cornerstone of nursing) practice. - Focus: proliferation of nursing literature and Lesson 2: History and Philosophy of Science new nursing journals, national and international nursing conferences, and SCIENCE opening of new nursing doctoral program describes, explains and predicts cause of - Scientific process for production of scientific outcomes of interventions product is discovered  desires to know the unknown and make a ✓ Example problem: formulating significant difference to increase life longevity differential diagnosis from data gathering then devising a list of SCIENTIFIC DISCIPLINE theories to explain the facts Identifies nursing’s unique knowledge for ✓ Research then theory strategy* patient, family and community care Nurses can conduct clinical and basic nursing ✓ Weakness: The world presents an research to establish scientific base for these infinite number of possible care observations; and therefore, scientists become subjective in bringing their TWO PHILOSOPHICAL PERSPECTIVES USED IN own ideas from their experiences to SCIENCE: decide what to observe and what to 1. Rationalism exclude-----PREMATURE CONCLUSION. 2. Empiricism Therefore, it is important not to end the observations too soon. 1. Rationalism Early 20th Century Views of Science and Theory ✓ Reason is the chief source and test of knowledge or justification Philosophers- theory structure; Scientists- empirical research ✓ Criterion of truth is not sensory, but intellectual and deductive (reasoning Observation and experimentation from cause and effect; from general to must be used to test theoretical particular) propositions ✓ Example problem: Reason that lack of POSITIVISM social support (cause) results in Empirical research and logical analysis hospital readmission (effect) (deductive and inductive) are two approaches The causal reasoning is still an assertion until tested that would produce scientific knowledge. and disproven. Hospitalization will be explained first, Theoretical propositions must be tested data gathered through deductive method will be through observation and experimentation subjected to experimental testing to corroborate the Emergent Views of Science and Theory in the late 20th theory. Century ✓ Theory then research strategy. If Empirical knowledge is arranged in different research findings fail to validate the patterns at a given time and in a given culture assertions, then additional research and that humans are emerging as objects of for modifications are made. study ✓ Albert Einstein- a theoretical physicist Science is a continuous process of building who made his rationalist view by research rather than a product of findings. extensively using mathematical Observations are concept laden; influenced by equation in developing his theories the values and ideas in the observer’s mind. which directed research in numerous Concepts and theories set up boundaries and areas specify pertinent phenomena for reasoning about specific observed patterns. 2. Empiricism Theories play a significant role in determining ✓ Sensory experience is the source of what the scientist observes and how it is knowledge interpreted. ✓ inductive (from data gathering to History and Philosophy of Science generalizations ); collection of facts Rationalism - This can be described as the precedes formulation of theory-then-research approach generalizations  the theory comes first, this approach to formulating general theoretical statements knowledge development can also be called often called “grounded theory” or research-to- deductive or a priori reasoning. theory approach Empiricism - is a philosophy of science which Deduction (Rationalism) - This process moves believes that knowledge is derived entirely from general to specific reasoning. It from sensory experience. establishes truth by theoretical derivation can be described as the research-then- having two or more relational statements theory approach. used to explain a phenomenon. Abstract theoretical relationships are used to derive specific empirical hypothesis.; theory-to- Early twentieth Century views- During the research approach first half of this century, philosophers focused on the analysis of theory structure, Retroduction (POSITIVISM) - This combines whereas scientists focused on empirical both induction and deduction. The origin of research. Positivism, a term first used by idea which does not establish truth but Comte, emerged as the dominant view of suggest lines of thought worthy of exploration modern science. Modern logical positivists and testing. believed that empirical research and logical Metaparadigm of nursing analysis (deductive and inductive) were two approaches that would produce scientific The components of nursing are described in a knowledge. metaparadigm Emergent views of science and theory in the Nursing has a model or paradigm that late twentieth century - published his analysis explains the linkages of science, philosophy, of the epistemology (knowledge) of human and theory that is accepted and applied by sciences from the seventeenth to the discipline. nineteenth century. His major thesis stated A metaparadigm is the global perspective that empirical knowledge was arranged in of a discipline that identifies the primary different patterns at a given time and in a phenomena of interest to that discipline given culture and that humans where and explains how the discipline deals with emerging as objects of study. In The those phenomena in a unique manner. Phenomenology of the Social World, Schutz It assists in the articulation and refinement of argued that scientists seeking to understand the nursing phenomenon being explored. the social world could not cognitively know an Nursing metaparadigm directs the activity of external world that is independent of their the nursing profession own life experiences. A phenomenological Metaparadigm approach reduces observations or text to the meanings of phenomena independent of their Most global perspective of a discipline; states the context. This approach focuses on the lived relations between or among the concepts meaning of experiences Structure of Nursing Knowledge Structure of Theory Development Theory development or theory building is a process that primarily follows logical reasoning involving induction, deduction and retroduction Induction (Empiricism) - This process moves from specific to general reasoning. Particular events are observed and analyzed as basis for Metaparadigm of Nursing describe concepts of: CONCEPTUAL MODELS OF NURSING (Paradigm or framework) person Conceptual models of nursing identify environment abstract concepts and describe their health relationships to the phenomena of nursing central concern to the discipline; not limited to a particular type of patient or situation Provide framework for recording effect of nursing The primary distinction between a conceptual model and theory is their level of abstraction. NURSING THEORIES (Paradigm or framework) NURSING METAPARADIGM More specific than a conceptual model Model that explains the linkages of science, philosophy, and theory. Conceptualization of reality that pertains to nursing to describe, explain, predict or prescribe nursing 1. Person- human being or person: individuals, care families, communities, and other groups who Nursing Philosophy are participants in nursing, (is the recipient if the nursing care, main focal point of nursing) Nursing Philosophy- Set forth the general Take in consideration when providing care: meaning of nursing and nursing phenomena gender, through reasoning and the logical values and belief, presentation of ideas. lifestyle and religion Classification OF Nursing Theory Based on Scope 2. Health - Human process of living and dying philosophical (world view) or metatheory (Udan, 2020) grand theory - degree of wellbeing or wellness that a ·middle range theory client experience practice theory - Includes promote care, comfort like healthy lifestyle LEVEL OF NURSING THEORY BASED ON SCOPE or LEVEL OF ABSTRACTION 3. Environment - Human beings significant others and physical surroundings that are Levels of Nursing Theory associated with persons health (Udan, 2020) 4. Nursing - actions taken by the nurses on 1. Philosophical (world view) or behalf or in conjunction with persons, and the metatheory goals of nursing actions 2. Grand theory- broad scope and highly -Nurses attribute like the ultimate abstract goal of nursing is to IMPROVE PATIENT CARE 3. Middle range theory-fewer concepts and propositions; limited nursing PHILOSOPHIES OF NURSING view, for empirical testing and practice Theoretical works that address one or 4. Practice theory- most detailed, more metaparadigm concepts; concrete and specific answers questions like:  Practice Theory a. Situation specific theories b. The least complex and action oriented c. Limited to specific populations or field of practice i. Ex: Pain management in post op patients META THEORY ii. Postpartum depression a. Theories whose subject matters are some other iii. Klaus and Kennel maternal and infant theories bonding theory Ex: Nursing Philosophies Classification of Theories Based on Purpose/Functions b. Highest level of theory in complexity factor-isolating theories (descriptive theories) c. Very difficult for practical application factor-relating theories (explanatory theories) i. Metatheory of Transcendence in 2002 by Wilkins situation-relating theories (predictive theories) integration of the disciplines of nursing and psychology and exhibiting a multidisciplinary situation-producing theories (prescriptive relevance theories) GRAND THEORY TYPES OF NURSING THEORY BASED ON FUNCTION a. Consists of conceptual frameworks defining DESCRIPTIVE THEORIES broad perspectives for nursing practice They describe, observe, and name i. Nursing Conceptual Models concepts and properties but they do not explain interrelationships among b. Lacks operational definition concepts. i. Sr. Callista Roys Adaptation Model First and most important level of ii. Orems Self Care Theory theory development iii. Nightingales Environmental Theory Example: literature review, phenomenology, case MIDDLE RANGE THEORY study/demographic study, a. Contains limited numbers of concepts and are ethnography limited in scope EXPLANATORY THEORY b. Highly specific in nursing Explains how or why concepts are c. Easier to apply as framework for research studies related i. Benners Stages of Nursing Expertise Can be viewed in relation to other phenomena 1. Novice- Start of career Second level of theory development 2. Advance Beginner- may experience Developed by correctional research 3. Expert- 50 years in service Example: theory of spirituality-based ii. Leininger Culture Diversity Theory Nursing practice by Nardi & Rodha ii. Theory of Comfort by Katherine Kolcaba  PREDICTIVE THEORY Crimean War –Along with 38 nurses, they travelled to Turkey to assist in providing care describes precise relationships for wounded soldiers where they were faced between concepts with overcrowded barracks and atrocious predicts occurrence of a phenomenon sanitary conditions. third level of theory development Despite daunting opposition by army physicians, Nightingale instituted a system of describes future outcomes care that reportedly cut casualties from 48% to consistently 2% within approximately 2 years. Nightingale PRESCRIPTIVE THEORY found out that more than the wounds, the causes of soldiers’ morbidity were: highest level of theory development open sewers addresses nursing therapeutics and lack of cleanliness, pure water, fresh consequences of interventions to air, and wholesome food prevent occurrence of a phenomenon She became known as the “Lady with the Lamp” from her nightly excursions through the prescribes activities necessary to wards to review the care of the soldiers. control possible causes When she returned home, she eventually example: pain management strategies began the Nightingale School of Nursing at St. Thomas which marked the beginning of NURSING PHILOSOPHIES professional nursing. “Founder of Modern Nursing”- because of her LESSON 1: ENVIRONMENTAL THEORIES intense work in reforming nursing. FLORENCE NIGHTANGLE Nightingale’s 12 canons central to the environment “In a nurturing environment, the body could repair model of nursing itself. “- nightingale, 1800 1. HEALTH OF HOUSES 2. VENTILATION AND WARMING Born in May 12, 1820 in Florence Italy; from a 3. LIGHT wealthy Victorian family 4. NOISE Privately educated in the classical tradition of 5. VARIETY her time by her father, and from an early age, 6. BED AND BEDDING she was inclined to care for the sick and 7. CLEANLINESS OF ROOMS AND WALLS injured 8. PERSONAL CLEANLINESS At age 24, she decided to help the suffering 9. NUTRITION AND TAKING FOOD masses and desired for hospital work. Though 10. CHATTERING HOPES AND ADVICES initially opposed by her family and the society, 11. OBSERVATION OF THE SICK she attended nursing programs in 12. PETTY MANAGEMENT Kaisersworth, Germany in 1850 and 1851 at THEORY ON HUMAN CARING Institution of Deaconesses, where she completed what was at that time the only JEAM WATSON formal nursing education available. She “THE FACT REMAINS THAT WE HOLD studied for 3 months then went back to the ANOTHER’S LIFE IN OUR HANDS.”- Watson, service of her family. 2005 After 2 years, in 1853 when she received her father’s endowment, she moved to London “We are the light in institutional darkness, and in this model we get to return to the light of our humanity”- and she became the Superintendent of the Watson, 2012 Hospital for Invalid Gentlewomen; where she instituted many changes to improve patient care. Rather than giving new nursing knowledge, she reforms hospital environments.  Born in 1940 in West Virginia finished BSN, MSN and PhD degree at University of Colorado Nursing Professor and Chair in Caring in Caring LESSON 3 STAGES OF NURSING EXPERTISE Science at School of Nursing at University of (NACPE, FNE) Colorado Health Sciences Center then became PATRICIA BENNER Dean and President of National League for Nursing “effective delivery of patient/ family care requires 1979- Nursing: The Philosophy And Science collective attentiveness and mutual support of good Of Caring practice embedded in a moral community of 1988- Nursing: Human Science And Human practitioners…however, such endeavors must be Care comprised of individual practitioners who have skilled know how, craft, science and moral Watson’s philosophy of human caring imagination to create and instantiate good practice. “Nursing is both human science and an art, and as “- benner, 1999 such cannot be considered qualitatively continuous Born as Patricia Sawyer in August 1942 with traditional, reductionist, scientific in Hampton, Virginia methodology.” She earned a bachelor's degree Major elements: from Pasadena College in 1964. She earned a Master's Degree in Nursing in 1970 and a PhD Carative factors-guide for nursing core (in in 1982 from the University of California, San contrast with medicine’s conventional curative Francisco. factors) Benner decided to become a nurse while “caring with love” working in a hospital admitting department from “caritas” which means to cherish, during college. She has been a staff nurse in appreciate and give special attention MS Ward, ER, CCU, ICU. She is an Transpersonal caring relationship - internationally noted researcher and lecturer. foundation of her theory; a special kind of Benner is known for one of her nine human care relationship- a union with books, From Novice to Expert: Excellence and another person- high regard for the whole Power in Clinical Nursing Practice (1984). person and their being in the world Benner was named a Living Legend of the Nursing goal: to facilitate individual in gaining American Academy of Nursing in 2011. a higher degree of harmony within the mind- body-spirit; such harmony generates self- Philosophical Sources knowledge, self-reverence, self-healing and Benner believes that knowledge accrues over self-care processes through human to human time in a practice discipline and that caring process and caring transactions articulation research is necessary; which she defines as describing, illustrating and giving language to taken-for-granted areas of practical wisdom, skilled know-how, and notions of good practice.  One of her first philosophical distinctions is differentiating between practical and The level of efficiency is increased, but the theoretical knowledge. Practical knowledge focus is on time management and the (know-how) which may elude precise abstract organization of the task rather than on formulation; theoretical knowledge (know- timing in relation to patient’s needs that) which results to theoretical Active teaching and learning is important formulations. “Theory is derived from practice, for stage transition and practice is extended by theory.” This is the most pivotal in clinical learning “Experience based skill acquisition is safer and because the learner begins to recognize quicker when it rests upon a sound patterns and determine which elements educational base.” of the situation warrant attention and 5 Stages of Nursing Practice which can be ignored. He can devise new rules and procedures for a plan. NOVICE Emotional responses (exhilaration and Person has no background experience of the remorse) are formative stages of esthetic situation in which he or she is involved; appreciation/ moral compass of good context free rules and objective attributes are practice necessary. PROFICIENT There is difficulty discerning between relevant and irrelevant aspects of a situation Person perceives the situation as a whole Nursing student level; nurses transferring to rather than in terms of aspects; new area/ department which is completely performance is guided by maxims foreign to them Knows the salient aspect and has an intuitive grasp of the situation based on ADVANCED BEGINNER background understanding Person can demonstrate marginally Uses skilled responses; more involved in acceptable performance; guided by a mentor; patient and family care, without relying on has enough experience to grasp aspect of the preset organizational goals situation, but not in a larger perspective Demonstrates increased confidence in Clinical situations are viewed as test of their their knowledge and abilities abilities and demands of the situation rather EXPERT than in terms of patient needs and responses Rule guided; task completion oriented Person no longer relies on analytical Advanced beginners feel highly responsible for principle (rule, guideline, maxim) to managing patient care, yet still rely on the connect an understanding of the situation help of those who are more experienced to an appropriate action Graduate nurses level With an intuitive grasp of the situation, able to identify problem without losing COMPETENT time despite range of alternative diagnosis Conscious and deliberate planning that and solutions determines the aspects of current and Knows the patient well as a person with future situations that are important and typical pattern of responses; with almost a can be ignored transparent view of the self Consistency, predictability, time Meeting the patient’s actual concerns and management are important in competent needs is of utmost importance, even if it performance means planning and negotiating a change With sense of mastery through planning of care and predictability; with hyper- Key aspects: responsibility of the patient which is realistic, and may exhibit an ever-present Demonstrating clinical grasp and resource and critical view of self based practice Possessing embodied know how  Seeing the big picture program in health sciences, and a four- Seeing the unexpected year postgraduate studies program leading to a doctoral degree in health Benner’s Domain of Nursing Practice sciences. 1. The Helping Role Domain Under Eriksson’s leadership at Helsinki - Establishing a healing relationship, providing Swedish School of Nursing, she developed comfort measures, and inviting patient a leading educational program in caring participation and control in care science and nursing. She integrated 2. The Teaching- Coaching Function Domain research in education. Toward the end of - Timing, readying patients for learning, the 1980, nursing science became a motivating, assisting with lifestyle alterations university subject in Finland. and negotiating goal agreement Eriksson’s Nursing Philosophy 3. The Diagnostic and Patient-Monitoring Function - Caritas as an aspect of nursing practice was - Ongoing assessment and outcome introduced to recent nursing literature in 1989 anticipation by Katie Eriksson as the caritas motive, a 4. The Effective Management of Rapidly motive proposed to guide all human caring in Changing Situations Domain society at-large and particularly in nursing. - Contingently matching demands with -. Eriksson (1990) argues that caritas is caring resources; crisis management care in its original form; "caring which is based on 5. The Administering and Monitoring human love", having "a real interest in doing Therapeutic Interventions and Regimen something for another person, by attending, Domain in a deep sense feeling responsible for - Preventing complications during drug therapy, another person. It is human love and mercy, it wound management and hospitalization is willingness to serve another person". 6. The Monitoring and Ensuring the Quality - Eriksson (1997) also describes caritas as "a of Healthcare Practices Domain vaccine for the weary, implying that nurses - Maintenance of safety, continuous quality draw on caritas for their own health from a improvement, collaboration and consultation spiritual source within themselves. with physicians and other healthcare team 7. The Organizational and Work-Role Competencies Domain - Priority setting, team building, coordinating and providing for continuity care LESSON 4 THEORY OF CARITATIVE CARING KATIE ERIKSSON “SUFFERING THAT OCCURS AS A RESULT OF A LACK OF CARITATIVE CARE IS A VIOLATION OF HUMAN DIGNITY”–ERIKSSON, 1992 Born 1943 in Jakobstad, Finland,. After taking nursing in 1965 at Helsinki Swedish School of Nursing, she completed Public Health Nursing in 19667 at the same school. She became a nursing instructor at Helsinki Swedish Medical Institute. She currently works as a professor of health sciences at Abo Akademi University in Vaasa, where she built a master’s degree