TFN Reviewer: Lesson 1 PDF

WHAT IS THEORY? TFN REVIEWER: LESSON 1 is defined as supposition or system of ideas that is DEFINITION OF TERMS proposed to explain a given phenomenon.(K...

WHAT IS THEORY? TFN REVIEWER: LESSON 1 is defined as supposition or system of ideas that is DEFINITION OF TERMS proposed to explain a given phenomenon.(Kozier) an organized system of accepted knowledge that NURSING is... is composed of concepts, propositions, definitions the diagnosis and treatment of human and assumptions intended to explain a set of fact, responses to ACTUAL OR POTENTIAL event or phenomena health problems (ANA, 1980) a set of statement that tentatively describe, the protection, promotion and explain or predict relationships among concepts optimization of health and abilities, that have been systematically selected and preventions of illness and injury, organized as an abstract representation of some alleviation of suffering through the phenomenon (Power and Knapp, 1995) diagnosis and treatment of human response, and advocacy in the care of WHAT IS NURSING THEORY? individuals, families, communities, and NURSING THEORY populations (ANA,2003) (most current definition) a body of knowledge that describes or explains nursing and is used ACCORDING TO THEORISTS to support nursing practice group of interrelated Nursing is the act of utilizing the concepts that are developed from various studies environment of the patient to assist him of disciplines and related experiences and aims to in his recovery. (Nightingale, 1860-1969) view the essence of nursing care. The unique function of the nurse is to an articulated and communicate conceptualization assist the individual, sick or well, in the of invented or discovered reality in or pertaining performance of those activities to nursing for the purpose of describing, contributing to health or his recovery (or explaining, predicting, or prescribing nursing cares. to peaceful death) that he would perform (Meleis, 1991) unaided if he had the necessary strength, has context, content and process (Barnaum, 1994) will or knowledge and to do this in such a ✓ Context – resembles environment to which way as to help him gain independence as nursing act takes place rapidly as possible. (Henderson, 1966) ✓ Content – subject of the theory OTHER DEFINITIONS: ✓ Process – method by which nurse acts in Nursing is caring using nursing theory Nursing is an art PRINCIPLES Nursing is a science a basic generalization that is accepted as true and Nursing is holistic can be used as a basis for reasoning or conduct. Nursing is adaptive CHARACTERISTICS OF THEORY Nursing is concerned with health promotion, health maintenance, and A theory is... health restoration Interrelating concepts in such a way as to create a Nursing is a helping profession... different way of looking at a particular phenomenon Nursing is a caring profession Logical in nature It is practiced with an earnest concern for Generalizable the art of care and the science of health Basis for hypotheses that can be tested It involves a humanistic blend of Enriching the general body of knowledge within scientific knowledge, and the discipline through the studies implemented to holistic nursing practice validate them Consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated  A. THEORETICAL DEFINITION gives meaning to a term in context of a COMPONENTS OF A THEORY theory and permit any reader to assess the 1. CONCEPT validity of a definition A mental idea of a phenomenon are the meaning of a word based on how a A comprehensive idea or generalizations certain theory or relevant literature perceives An idea formulated by the mind or an it to be experience perceived and observed Taken from dictionary, literature, books, building block of a theory encyclopedia, journals, etc. B. CONCEPTUAL DEFINITION TYPES OF CONCEPTS ▪ Concrete - limited by time and space and are Tells how the concept is linked to concrete observable in reality, directly observed, tangible situations and describes set of procedures ✓ Ex: airplane, house that will be performed to assign value for the ▪ Abstract - not clearly observable, directly or concept indirectly and must bedefined in terms of Defines concepts according to how they are observable concepts; intangible used in the study Independent of time and space ✓ Ex. Hospital stay - time during which ✓ Ex: hope, love, desire, care, freedom a person is a registered patient in a ▪ Continuous - permit classifications of dimensions or certain hospital gradation of phenomena on a continuum ✓ Ambulation - to walk from one place ✓ (ex: blood pressure, pain) to another or to move about ▪ Discrete - or noninterval concepts that identify C. OPERATIONAL DEFINITION categories or classes of characteristics ✓ (ex: gender, ethnic background, Are the meaning of a word based on the religion, marital status) method of how it was measured or how the person come up with that perception. TYPES OF CONCEPTS ✓ Ex. Hospital stay – the total number ✓ Pulse oximeter of days as patient, beginning with ✓ Happiness ✓ Female admission day and finishing with ✓ Catholic discharge. ✓ Temperature ✓ Ambulation – Taking six steps ✓ Weight without assistance ✓ Anxiety ✓ Thermometer 3. PROPOSITION ✓ Weighing scale ✓ Pain scale May also be called theoretical statement ✓ Remorse Explains the relationships of different ✓ Table ✓ Married concepts ✓ Oxygen saturation Proposal, plan, scheme, intention, suggestion or offer 2. DEFINITION ✓ Ex: Children do not like to stay in the Composed of various descriptions which convey a hospital because of their injections general meaning and reduces the vagueness in 4. ASSUMPTION understanding a set of concepts It may be: A statement that specifies the relationship A. Theoretical definition or connection of factual concepts or B. Conceptual definition phenomena or those which the researcher or theorist holds as TRUTH and therefore are C. Operational definition excluded from measurement and testing ✓ Ex: all patients who are not able to take good care of themselves need nurses/caregivers  3. Offer a systematic approach to identify questions for study, select variables, interpret findings and validate nursing interventions 5. PURPOSE TYPE OF THEORIES Explains why the theory was formulated and specifies the context and situation in which it According to Scope According to Purpose/Function should be applied 1. Metatheories 1. Descriptive theory 6. MODELS 2. Grand Theories 2. Explanatory theory 3. Middle Range 3. Predictive theory Schematic representations of some aspects of Theory reality 4. Micro-range theory 4. Prescriptive theory ACCORDING TO SCOPE PURPOSES OF THEORIES 1. METATHEORY A. In Practice It refers to a theory about a theory 1. Assist nurses to describe, explain and predict Theories whose subject matters are some everyday experiences. other theories 2. Serve to guide assessment, intervention and ✓ Ex: Humanistic Nursing Theory by evaluation of nursing care Paterson and Zderad 3. Provide rationale for collecting and valid data about the health status of clients, which are 2. GRAND THEORY essential for effective decision making and implementation Broad in scope and complex and therefore 4. Help to establish criteria to measure the quality of require further specification through nursing care research before they can be fully tested 5. Help build a common nursing terminology to use in (Chinn and Kramer, 1999) communicating with other health professionals Intended to provide structural framework 6. Enhance autonomy of nursing by defining its own for broad, abstract ideas about nursing independent functions (Fawcett, 1995) 7. Nursing theories provide better understanding for nurses of the nature of their jobs. ✓ ex: Self-Care Theory by Dorothea ✓ Example: Trans-cultural Nursing Theory Orem, emphasizes the importance of learning how to ✓ System’s Model Theory by Betty deal with patients from different cultures and Neuman (physical, physiological, serves as guide for nurses to respect the ✓ psychological, mental, social, cultural, different values and beliefs of diverse people. developmental, & spiritual) B. In Education 3. MIDDLE RANGE THEORY 1. Provide a general focus for curriculum design A least abstract level of theoretical knowledge because they include details 2. Guide curricular decision making specific to nursing practice Known to have a ✓ Ex: program objectives, course objectives, narrower and detailed focus compared to course description, clinical phenomena criteria grand theories ✓ Ex: Psychodynamic theory by Hildegard C. In Research Peplau ✓ Human-to Human Relationship Model 1. Offer a framework for generating knowledge and – Joyce Travelbee new ideas ✓ Transcultural Theory in Nursing by 2. Assist in discovering knowledge gaps in specific field Madeleine Leininger of study ✓ Model of Health by Margaret Newman 4. MICRO-RANGE THEORY/PRACTICE THEORY ✓ Most concrete and narrow in scope ✓ Situation specific & limited to particular populations/fields of practice  ✓ Laurente's theory (1996) validates and ACCORDING TO PURPOSE/FUNCTION explains the different nursing management in the emergency room in 1.DESCRIPTIVE THEORY/ FACTOR-ISOLATING THEORY relieving anxiety among its clients Describes, observes and names concepts, NURSING PARADIGM/ METAPARADIGM properties and dimensions Identifies and describes the major concepts of Patterns or models used to show a client phenomena but does not explain how or why the relationship among the existing theoretical concepts are related works in nursing\ Purpose: to provide observation and meaning regarding the phenomena Metaparadigm comes from 2 Greek words ✓ EX: What are the factors that influence a. “meta” - with smoking behavior among teenagers? b. “paradeigma” - patterns 2. EXPLANATORY THEORY/FACTOR-RELATING THEORY MAJOR CONCEPTS OF NURSING THEORIES/ Relates concepts to one another, describe the NURSING PARADIGM interrelationships among concepts or propositions and specify the associations or relationships among Person concepts refers to all human beings ✓ Ex: What is the relationship between the Recipients of nursing care attitude of students toward their course and They include individuals, families, their academic performance? communities and groups ✓ A research study about the factors affecting newborns in failing to thrive Environment 3.PREDICTIVE THEORY/SITUATION-RELATING THEORY includes factors that affect individuals internally and externally Achieved when the relationships of concepts under basic settings where nursing care is a certain condition is able to describe future provided outcomes consistently Generated and tested using experimental research Health ✓ Ex: Predictors in the NLE performance addresses the person’s state of well- ✓ A theoretical model based on the observation being of the effects of unsanitary environmental the holistic level of wellness that the condition on the recovery of the post-operative person experiences patients Nursing 4.PRESCRIPTIVE THEORY/ SITUATION-PRODUCING ACTIVITIES The interventions of the nurse rendering care in support of, or in cooperation with Those that prescribe activities necessary to reach the client defined goals Central to all nursing theories Address nursing therapeutics and consequences of Describes what nursing is, what nurses do interventions and how nurses interact with clients Commonly used in testing new nursing interventions ✓ Ex: What measures can be proposed to improve academic performance of nursing students?  Five Criteria in Evaluating a Theoretical Work Should give direction to research and (Chinn and Kramer, 1991) practice, create new ideas and ought to 1. CLARITY distinguish the focus of nursing to other professions Consistency, semantics and structure “How important is the theory?” Identify the major concepts and their sub “Does the theory have a significant concepts contribution to nursing knowledge?” Words should be defined operationally or conceptually TFN REVIEWER: LESSON 2 Diagrams should be clear and consistent all HISTORY OF NURSING THEORY through out Assumptions should be consistent with the Beginning of nursing theory development can defined goals of the theory (“Is the theory be traced back to Florence Nightingale clearly stated?”)(“How clear is the theory?”)(“Is To develop NURSING as an academic discipline it usually understood?” and a profession, a body of knowledge to guide nursing practice is essential. 2. SIMPLICITY Theory development is significant to develop a Theory has few concepts body of substantive knowledge to guide Parsimony – elegant in simplicity but extensive nursing practice to establish nursing as a in content profession and an academic discipline. (“How simple is the theory?”) 3. GENERALITY NURSING THEORIES Examine the scope of concepts and goals within Plays vital role in guiding critical thinking the theory in nursing practice The more limited the concept and goal is, the Provide the nurse with patient focus and less general the theory becomes framework to sort patient data in The broader the scope of the theory, the greater practice its significance Guides both thinking and nursing action (“How general is the theory?”) Informs practice and also that practice (“How broad is the scope of the theory?”) informs theory “Theory without practice is empty and 4. EMPIRICAL PRECISION practice without theory is blind.” The The degree in which the defined concepts are backbone of clinical care observable in actual setting HIGHLIGHTS AND SIGNIFICANT EVENTS Can be measured by the pieces of evidence that support the theory 1. Nightingale (1859/1992), “Notes on Nursing: (“Is the theory testable?”) What it is and What it is not” presents the first (“How accessible is the theory?”) nursing theory that focuses on the manipulation of the environment for the benefit of the patient 5. DERIVABLE CONSEQUENCES 2. The Columbia School - The 1950s The need to Theory and practice are meaningfully related, prepare nurses at the graduate level for nursing theory should lead itself to research administrative and faculty positions was testing which would result to additional recognized Columbia University’s Teachers College knowledge that would guide practice developed graduate education programs to meet these functional needs  ✓ M. ROGERS (1970) - An Introduction to the Theoretical Basis of Nursing ✓ KING (1971) - Toward a Theory for Nursing: The first theoretical conceptualizations of General Concepts of Human Behavior nursing science came from graduates of these ✓ D. OREM (1971) - Nursing: Concepts of programs (Peplau, Henderson, Hall, and Practice Abdellah) ✓ M. LEVINE (1973) - Introduction to Clinical Theorists of the Columbia School operated Nursing from a biomedical model that focused ✓ B. NEUMAN (1972) - A Model for Teaching primarily on what nurses do, that is their Total Person Approach to Patient Problems functional roles. They considered patient (with R.J. Young) problems and needs to be the practice focus. ✓ B. NEUMAN (1974) - The Betty Neuman Independent of the Columbia theorists, Health-Care Systems Model: A Total Person Johnson suggested that nursing knowledge is Approach to Patient Problems based on a theory of nursing diagnosis that is ✓ SR. C. ROY (1976) - Introduction to Nursing: different from medical diagnosis An Adaptation Model ✓ M. NEWMAN (1979) - Theory Development 3. The Yale School - The 1960s in Nursing The focus of theoretical thinking moved from a ✓ J. WATSON (1979) - Nursing: The problem/need and Functional role focus to the Philosophy and Science of Caring relationship between the nurse and the 5. The 1980s patient. The Yale’s School theoretical position was Many nursing theories were revised based on influenced by the Columbia Teacher’s School the research findings that expanded them graduates who became faculty members there ✓ D. JOHNSON (1980) - The Behavioral System (Henderson & Wiedenbach) Model for Nursing Theorists of the Yale School view nursing as a ✓ M. LEININGER (1980) - Caring: A Central process rather than an end in itself. Their Focus of Nursing and Health Care Services theories look at how nurses do what they do ✓ M. LEININGER (1981) - The Phenomenon of andhow the patient perceives his or her Caring: Importance, Research Questions, situation. and Theoretical Considerations Orlando (Nursing process) and Wiedenbach ✓ M. LEININGER (1985) - Transcultural Care (the helping art of Clinical Nursing) Diversity and Universality: A Theory of Levine presented her 4 conservation principles Nursing of nursing ✓ M. LEININGER (1988) - Leininger’s Theory of Yale faculty- Dickoff, James, Wiedenbach Nursing: Culture Care Diversity and presented a definition of nursing theory and Universality goals for theory development in nursing ✓ R. PARSE (1981) - Man-living-health: A Federal funds were made available for doctoral Theory for Nursing study for nurse educators. The resulting ✓ H. ERICKSON, E. TOMLIN, M. SWAIN (1983) - doctorally-prepared individuals became the Modeling and Role Modeling next wave of nurse theorists 6. 1990s 4. The 1970 Many research studies tested and expanded Many nursing theories were presented. Many nursing theory theories have been revised since their original “Nursing Science Quarterly” devoted presentation exclusively to the presentation of nursing theory-based research findings and theoretical topics  THE ERAS OF NURSING KNOWLEDGE 1. CURRICULUM ERA (1900-1940S) Efforts to understand the nature of the knowledge needed for the practice of nursing are evident from an emphasis on curricular content and the movement ✓ BOYKIN, S. SCHOENHOFER (1993) - Nursing as Caring toward high goal of standardized ✓ BOYKIN, S. SCHOENHOFER (1993) - Evolving Theories ✓ KING (1995a) - A systems Framework for Nursing curricula ✓ KING (1995b) - The Theory of Goal Attainment The difference between a medical view of the patient ✓ KING (1997) - King’s Theory of Goal Attainment in and the view of the nurse are visible. Practice Nursing began to embrace science in the curricula ✓ LEININGER (1996) - Culture Care Theory, Research Nursing procedures were taught and practiced in a and Practice ward-like room called a “nursing arts” laboratory, ✓ M.E. LEVINE (1996) - The Conservation Principles: A later, when nursing curricula emphasized science and Retrospective research, rooms were referred to as “skills lab” ✓ B. NEUMAN (1995) - The Neuman: Systems Model, “Art of Nursing” was changed to “Science of Nursing” 3rd ed. with the emergence of baccalaureate nursing ✓ B. NEUMAN (1996) - The Neuman Systems Model in Research and Practice programs; “art and science of nursing” is more ✓ M.A. NEWMAN (1994) - Health as Expanding supported in the present times Consciousness, 2nd ed. 2. Research Era (1950-1970s) ✓ M.A. NEWMAN (1997) - Evolution of the Theory of Nurses saw the need for nursing research which led Health as Expanding Consciousness to the research era ✓ D.E. OREM (1991) - Nursing: Concepts of Practice, Research became the driving force; nurses 4th ed. conducted research and developed specialized body of ✓ D.E. OREM (1995) - Nursing: Concepts of Practice, knowledge 5th ed. Research alone was needed to generate the body of ✓ D.E. OREM (1997) - Views of Human Beings Specific knowledge or science to form a basis for nursing to Nursing ✓ R.R. PARSE (1992) - Human Becoming:Parse’s Theory practice of Nursing Emphasized scholarship & the need to disseminate ✓ R.R. PARSE (1995) - Illuminations: The Human research findings in scholarly publications Becomg Theory in Practice and 1960s-1970s - new emphasis on graduate education ✓ Research that included research emerged ✓ R.R. PARSE (1996) - The Human Becoming Theory: Research & graduate education eras seem to Challenge in Practice overlap; this explains the relationship between theory ✓ R.R. PARSE (1997) - The Human Becoming Theory: & research The was, is, and will be Doctorate education began to flourish. The driving ✓ R.R. PARSE (1998) - The Human Becoming School of force was the need to develop a specialized body of Thought ✓ H.E. PEPLAU (1997) - Peplau’s Theory of knowledge and the conclusion that the knowledge Interpersonal Relations should be developed by nurses prepared in the ✓ M. ROGERS (1990) - Nursing: Science of Unitary, discipline of nursing Irreducible, Human Beings: Update Rogers (1970) advocated that nurse needed ✓ M. ROGERS (1992) - Nursing Science and the Space framework that addressed the phenomena of concern Age for the discipline of nursing to frame their research ✓ SR. C. ROY (1997) - Future of the Roy Model: and develop nursing knowledge Challenge to Redefine Adaptation Published their nursing frameworks: ✓ J. WATSON (1997) - The Theory of Human Caring: A. Johnson (1980) D. Neuman (1972) Retrospective and Prospective B. King (1971) E. Orem (1971) ✓ J. WATSON (1999) - Postmodern Nursing and Beyond C. Levine (1967) F. Rogers (1970) D. Roy (1970) Evidence of the recognition of the need for a nursing theoretical approach Batey (1977) identified conceptualization as the greatest limitation of published nursing research Understanding that a theory is a set of related concepts  5. THEORY UTILIZATION ERA (21ST CENTURY) Nursing has moved into a new era of utilization of philosophies, models or theories in practice and referred to 3. GRADUATE EDUCATION ERA (1950-1970S) as theory-based nursing practice. 1960-1970s- curricula for master’s level preparation included Shift from theory development to theory application and courses in nursing research, clinical specialty utilization recognizes the importance of a framework for practice and critical thinking and decision-making in professional nursing leadership practice Nurses started to advance with doctorate Critical thinking- “intellectually disciplined process of programs from a wide actively and skillfully conceptualizing, applying, analyzing, range of related disciplines as they were synthesizing, and/or evaluating information gathered from, being prepared for research or generated by, observation, experience, reflection, and teaching roles in nursing reasoning, or communication, as a guide to belief and Series of conferences brought nurses action” together to exchange ideas and evaluate what had been learned in their SIGNIFICANCE FOR THE DISCIPLINE AND PROFESSION doctorate programs in DISCIPLINE- specific to academia and refers to a branch of other fields that could address nursing’s education, a department of learning, or a domain of knowledge-building needs knowledge. 4. THEORY ERA (1980-1990S) PROFESSION- refers to a specialized field of practice Began with a strong emphasis on founded on the theoretical structure of the science or development knowledge of the discipline and accompanying practice 1980-1990- nursing theory development abilities stimulated phenomenal growth, which has been noted to be cornerstone of the For the significance of theory for the discipline of development of the discipline of nursing nursing is that the discipline is dependent on theory for Coupled with the research era, led to the its continued existence- that is nursing can be a understanding of the scientific process for the vocation, or nursing can be a discipline with a production of a scientific product professional style of theory-based practice. Proliferation of nursing literature and new The theoretical works have taken nursing to higher nursing journals, national and international levels of nursing conferences and opening of new education and practice as nurses moved from nursing doctoral program is evidence of functional focus with emphasis on what nurses do, to a growth in this era Fawcett proposed a metaparadigm patient focus, emphasizing what nurses know for understanding of nursing knowledge based on thought, decision-making and action Kuhn’s ideas, for the discipline of nursing, Knowledge of persons, health and environment proposing the boundaries of nursing forms the basis for recognition of nursing as a knowledge to be person, environment, discipline, and this knowledge is taught to those who health, and nursing enter the profession Nursing theory is vital to the practice of professional nursing. Nursing is recognized as a profession today because its development was guided by the criteria for a profession Nursing as an academic discipline depends on the existence of nursing knowledge. Nursing theories led to the recognition of nursing as an academic discipline and a profession. Nursing theory is vital to the practice of professional nursing.  Epistemological view that “regards reason as the chief source and test of knowledge’ or any view appealing to reason as a source of knowledge or justification Nursing is recognized as a profession Methodology or a theory in which the criterion of truth is not today because its development was guided sensory but intellectual and deductive by the criteria for a profession 2. EMPIRICISM Nursing as an academic discipline depends on the existence of nursing Scientific knowledge can be derived only from sensory knowledge. experience Nursing theories led to the recognition of Inductive method, based on the idea that the collection of nursing as an academic discipline and a facts precedes attempts to formulate generalizations (research- profession. then-theory strategy) inductive inquiry Nursing theories ushered the development of a body of substantive knowledge to guide nursing practice to establish nursing as a profession and an academic discipline Nursing theories play vital role in guiding critical thinking in nursing practice HISTORY, PHILOSOPHY, AND SCIENCE Science is a method for describing, explaining, and predicting causes or outcomes of interventions Scientific activity has helped to establish 3. EARLY 20TH CENTURY VIEWS OF SCIENCE AND THEORY the evidence we use to guide practice in the delivery of nursing care 1st half of the 20th century, philosophers focused on the We desire to know the unknown, and analysis of theory structure, whereas scientists focused on identify the cause, the effect, and the empirical research significant difference that an intervention Positivism, a term used by Comte, emerged as the dominant can make to increase the longevity of life view of modern science Being a scientific discipline means identifying nursing's unique knowledge for Modern logical positivists believed that empirical research the care of patients, families, and and logical analysis were 2 approaches that would produce communities scientific knowledge The logical empiricist argued that theoretical propositions PHILOSOPHICAL PERSPECTIVE USED IN must be tested through observation and experimentation. This SCIENCE perspective rooted in the idea that empirical facts exist independently of theories and offer the only basis for 1. RATIONALISM objectivity in science. Objective truth exists independently of Epistemological view that “regards reason the researcher, and the task of science is to discover it, which is as the chief source and test of knowledge’ an inductive method or any view appealing to reason as a source of knowledge or justification Methodology or a theory in which the criterion of truth is not sensory but intellectual and deductive  Empirical - can either be observed or experienced through the senses 4. EMERGENT VIEWS OF SCIENCE AND THEORY Abstract - not observable, such as hope or caring IN THE LATE 20TH CENTURY METAPARADIGM A new perspective in science emerged as several authors presented analyses, challenging 2 greek words the positivist position meta - “with Foucault presented his major thesis which believes that empirical knowledge was arranged paradigm - “patterns” in different patterns at a given time and in a Most global perspective of a discipline given culture and that humans were emerging as Fawcett global concepts that identify the objects of study phenomenon of central interest to a discipline, the In 1977, Brown argued for an intellectual global propositions that describe the concepts, and revolution in philosophy that emphasized the the global propositions that state the relations history of science was replacing formal logic as between or among the concepts the major analytical tool in the philosophy of NURSING PARADIGM science. One of the major perspectives in the new philosophy emphasized that science was a are patterns or models used to show a clear process of continuously building research rather relationship among the existing theoretical works in than a production of findings. nursing. Are patterns or models used to show a clear Brown proposed that theories play a significant CONCEPTS role in determining what the scientist observes and how it is interpreted. 1. PERSON Nurses used evidence-based science to support These are human beings, individuals, families, the intervention Performed in the care of communities, and other groups who are participants patients. in nursing. The recipient of nursing care like individuals, THEORETICAL WORKS IN NURSING ARE families, and communities CATEGORIZED AS 2. ENVIRONMENT Are external and internal aspects of life that A. Philosophies- most abstract influence the person. B. Conceptual models Human being’s significant others and physical surroundings as well as local, regional, national, and C. Theories worldwide, cultural, social, political, and economic D. Middle-range theories Conditions that are associated with human being’s health CONCEPT 3. HEALTH Term/label that describes a phenomenon or Health is defined as the degree of wellness or well- group phenomena being that the client experiences. The holistic level of wellness that a person may be a word or phrase that summarizes experiences. ideas, observations & experiences to provide a Human processes of living and dying mental image for the purpose of facilitating communication and understanding about the phenomena can be empirical or abstract  Examples of Nursing Philosophy: Nightingale’s Philosophy of Nursing (1946) “What is 4. NURSING Nursing?” The nurse’s attributes, characteristics, and Nursing: What it is and What it is not?” actions provide care on behalf of or in conjunction with the client. Watson’s Philosophy of Nursing (1979) “Nursing: The The interventions of the nurse rendering Philosophy and Science of Caring” care in support or in cooperation with the client. Benner’s Philosophy of Nursing (1984)- From Novice to Actions taken by the nurses on behalf of or Expert in conjunction with human beings, and the goals or outcomes of nursing actions; the CONCEPTUAL MODELS OF NURSING process on which encompasses activities Composed of abstract and general concepts and that are referred to as assessment, diagnosis propositions that provide a frame of reference for (labeling), planning, intervention and members of the discipline evaluation This frame of reference determines how the world is PHILOSOPHIES IN NURSING viewed by the members of a discipline and guides the members as they propose questions and make PHILOSOPHY in general terms, it consists of observations relevant to the discipline the general laws that furnish the rational A set of concepts and statements that integrate the explanation of anything. concepts into a meaningful configuration (Lippit, It is known to be the next knowledge level 1973; Fawcett, 1944) after metaparadigm. It specifies the definition of metaparadigm ASSUMPTION – accepted as truth and represent the concepts in each of the conceptual models values and beliefs of the theory or concepts framework of nursing. form the basis for defining concepts and framing It sets forth the meaning of phenomena propositions (Meleis, 2007) through analysis, reasoning, and logical o Ex: The assumption that all patients who are argument. not able to take good care of themselves need Set forth the general meaning of nursing and nurses or caregivers. nursing phenomena through reasoning and the logical presentation of ideas PROPOSITION- a statement about a concept or a Broad and address general ideas about statement of the relation between two or more concepts. nursing Explains the relationships of different concepts. Contribute to the discipline by providing Also called THEORETICAL STATEMENTS direction, clarifying values, and forming a o Ex:children who do not want to stay in foundation for theory development hospital fear injections Theoretical works that address one or more metaparadigm concepts and are of Conceptual Models of Nursing philosophical nature Models containing abstract concepts that are not Address questions such as directly observable and that are not limited to a particular type of patient, situation, or event. What is nursing? They provide a framework for recording the effects What is the nature of human caring? of nursing What is the nature of nursing practice? Helps to provide consistency in nursing practice by What is the social purpose of nursing facilitating communication and provides a mechanism practice? for engaging in a systematic approach to nursing research, education and practice  Nursing Theory More specific than a conceptual model Examples of Nursing Model: (Meleis) a conceptualization of some aspect of reality 1. Johnson’s Behavioral System Model (1980) (invented or discovered) that pertains to nursing. The conceptualization is articulated for the purpose of 2. King’s Conceptual System- developed Theory describing, explaining, predicting or prescribing of Goal Attainment nursing care. 3. Levine’s Conservation Model (1967, 1991) May be derived from existing conceptual models of nursing 4. System Model (1982, 1989, 1995, 2002) May also evolve from a perception of ideal nursing practice 5. Orem’s Conceptual Model (1971, 1980, 1985, 1991, 1995, 2001) Various theories represent different realities and address different aspects of nursing (Meleis, 2007) 6. Roger’s Science of Unitary Human Beings (1970, 1986, 1990, 1992) Examples of Nursing Theory: 7. Roy’s Adaptation Model (1980, 1984) 1. Orlando’s Theory of Nursing Process (1961, 1990) THEORY AND NURSING THEORIES 2. Theory of Effective Nursing Practice (1961) Theory 3. Theory of Nursing Process (1990) 4. Modeling and Role-Modeling Nursing Theory (Erickson, An organized, coherent and systematic Tomlin, and Swain, 1983) articulation of a set of statements related to significant questions in a discipline that 5. Mercer’s Theory of Becoming a mother are communicated in a meaningful whole…discovered or invented for 6. Leininger’s Theory of Culture Care Diversity and describing, predicting or prescribing events, Universality situations, conditions, or relationships 7. Parse’s Theory of Human Becoming (Alligood, 2010) An organized system of accepted 8. Newman’s Theory of Health as Expanding knowledge that is composed of concepts, Consciousness propositions, definitions and assumptions intended to explain a set of fact, event or phenomena. The explanation begins with an educated guess but when sufficient observations support that guess it becomes a theory. e.g. Relationship between smoking and lung cancer Heavy smoking = Lung cancer ANALYSIS OF THEORY But some heavy smokers do not have Analysis, critique and evaluation are methods used to lung cancer some nonsmokers have study nursing theoretical works critically lung CA. Until proof is found, a theory Is carried out to acquire knowledge of theoretical exists that heavy smoking predispose a adequacy person to develop lung CA. An important process and the first step in applying nursing theoretical works to education, research, administration or practice An important process for learning, for developing research projects and for expanding the science associated with the theoretical works of nursing in the future  Facilitates testing because the empirical indicators provide linkage to practice for testability and ultimate use of a theory to describe and test aspects of CRITERIA USED FOR ANALYSIS OF NURSING practice (Chin and Karmer, 2015) CONCEPTUAL MODELS AND THEORIES 5. Importance (Derivable Consequences) Chin and Kramer (2015) says that the central question is “Does this theory 1. Clarity- refers to the consistency in terms of create understanding that is important to nursing?” terminology and structure Because research, theory and practice are closely “How clear is the theory?” related, nursing theory leads itself to knowledge for A word be defined specifically according practice to the framework (philosophy, Nursing theory guides research and practice, conceptual model, theory or middle- generates new ideas, and differentiates the focus of range theory) within it is used nursing from other service profession Clarity and consistency are facilitated with “How important is this theory? diagrams and examples The logical development and type of TFN REVIEWER: LESSON 3 structure used should be clear, and assumptions should be stated clearly and be THE LIFE AND WORKS OF FLORENCE consistent with the goal of theory (Chin and FLORENCE NIGHTINGALE Kramer, 2015) “Matriarch of Modern Nursing” 2. Simplicity “First Nursing Theorist” A theory should be sufficiently comprehensive presented at a level of “The Lady with the Lamp” abstraction to provide guidance, and have as “Founder of Modern Nursing” few concepts as possible with a simplistic relation as possible to aid clarity “Nurse Statistician” “How simple is the theory?” “Angel of the Crimean War” 3. Generality- refers to the scope of the Was born in Florence, Italy on May 12, 1820 concepts and the purpose of the theory and is Died in her sleep on August 13, 1910 at the age of 90 reflected in the question, A linguist, with vast knowledge in science, “How general is this theory?” mathematics, literature and arts Rogers’ (1986) theory of accelerating change Well-read in philosophy, history, politics and is an example of an abstract theory from economics which numerous middle-range theories have Well-informed about the workings of government and been generated political science The first nurse educator 4. Accessibility (Empirical Precision)- addresses Most recognized name in the field of nursing the extent to which empiric indicators for the Her environmental theory changed the face of concepts can be identified and to what extent nursing to create sanitary conditions for patients to the purpose of the theory can be attained (Chin get care and Kramer, 2015) AWARDS: “How accessible is this theory?” Accessibility is vital to developing nursing Order of Merit (OM) research to test a theory Royal Red Cross (RRC) by Queen Victoria of Great Britain  3. HEALTH “Being well and using every power that the person THEORETICAL SOURCES OF NIGHTINGALE’S has to the fullest extent “in living life THEORY Envisioned the maintenance of health through prevention of disease by environmental control and Education social responsibility Literature “Being well and using every power that the person Intellectuals has to the fullest extent “in living life Religious Beliefs Envisioned the maintenance of health through METAPARADIGM IN NURSING prevention of disease by environmental control and social responsibility 1. NURSING DISEASE: “a reparative process that nature instituted The act of utilizing the environment of a from a want of attention” patient to assist him in his recovery She believed that prevention of disease through Notes on Nursing – provided essential environmental control will uplift health. principles for rendering and implementing 4. ENVIRONMENT an efficient and effective nursing care She believed that every woman, at one time She believed that the sick, poor people would benefit in her life, would be a nurse in the sense from environmental improvements that address their that nursing is having the responsibility for physical and mental aspects. someone’s health. She stressed that nurses have a special role in She also instilled an ideal attitude of uplifting the social status of the poor by improving thinking and acting like a nurse. their living situation. Wrote, “Notes on Nursing”, to provide Those elements external to and which affect the women with guidelines for caring for their health of the sick and healthy person loved ones at home and to give advice on Surroundings - anything that can be manipulated to how to “think like a nurse.” place the patient in the best possible condition for The nurse assesses the patient situation, nature to act identifies a need, implements a plan of Nursing was to assist nature in healing the patient care, re-evaluates the situation, and finally changes the plan to better serve the patient. She expected nurses to use their powers of observation in caring for patients. 2. PERSON Predominantly described a passive patient but whenever self-care is possible, the nurse should ask about the patient's preference. Believed that nurses should consider the patient's preferences But should perform tasks to and for the patient as well as control the patient's environment to facilitate easy recovery  Outcomes and Planning Planning is focused on modifying the environment to enhance the client’s ability to respond to the disease process Desired outcomes are derived from the environmental model, ex. Being comfortable, clean, dry, in the best state for nature to work on Implementation Takes place in the environment that affects the client and involves taking action to modify that environment All factors of the environment should be considered, including noise, air odors, bedding, cleanliness, light-- all the factors that place clients in the best position for nature to work upon them Evaluation Based on the effect of the changes in the environment on the client’s ability to regain his health at the least expense of energy Observation is the primary method of data collection used to evaluate the client’s response to the intervention TFN REVIEWER: LESSON 4 JEAN WATSON’S THEORY OF TRANSPERSONAL CARING JEAN WATSON (1979-1985) PHILOSOPHY AND SCIENCE OF CARING Caring in nursing conveys physical acts but embraces the mind-body-spirit as it reclaims the embodied spirit as its focus of attention NURSING PROCESS Assessment Addresses how nurses care for their patients and how that caring translates into better health plans to help Ask the client what is needed or wanted patients get healthy Observation. She used precise and specific observations concerning all aspects of the client’s physical health and environment BACKGROUND Nursing Diagnoses Born in Southern West Virginia Earned BSN in 1964; MS in Psychiatric Mental Health The client’s response to the environment and Nursing in 1966 and PhD in educational psychology not the environmental problem and counseling in 1973 Reflects the importance of the environment to A distinguished Professor and Director of Center of health and well-being of the client Human Caring School of Nursing, University of Colorado Health Science Center, Denver. Founder of the original Center for Human Caring in Colorado and is a Fellow of the American Academy of Nursing Served as Dean of Nursing at the University of Health Sciences Center Past president of the National League for Nursing  3. HEALTH AWARDS/HONORS Refers to unity and harmony within the mind, body, and soul ✓ International Kellog Fellowship in Associated with the degree of congruence between Australia self as perceived and as experienced ✓ Fulbright Research Award in Sweden ✓ 6 Honorary Doctoral degrees THREE ELEMENTS ✓ 3 International Honorary Doctorates A high level of over-all physical, mental, and social (Sweden, United Kingdom, Quebec, functioning Canada) A general adaptive-maintenance level of daily Nursing: The Philosophy and Science of functioning Caring The absence of illness ✓ foundation of Watson’s theory of nursing, published in 1979 4. NURSING A human science of people and human health-illness (1988) Nursing: Human Science and experiences that are mediated by professional, Human Care personal, scientific, aesthetic and ethical human care METAPARADIGM transactions 1. PERSON PHILOSOPY AND SCIENCE OF CARING SEVEN (7) BASIC ASSUMPTIONS Viewed holistically wherein the body, mind and soul are interrelated; each part Caring can be effectively demonstrated and practiced a reflection of the whole, yet the whole is interpersonally greater than and different from the sum Effective caring promotes health and individual or of parts family growth The person possesses 3 spheres of being- Caring responses accept a person not only as he or body, mind and soul she is now but as what he or she may become Human being – valued person in and of A caring environment is one that offers the him to be cared for, respected, nurtured development of potential while allowing the person and understood and assisted to choose the best action for himself or herself at a A fully functional integrated self given point in time Caring is more healthogenic than is curing 2. ENVIRONMENT The practice of caring is central to nursing Provides the values that determine how CARATIVE FACTORS one should behave and what goals one TEN (10) CARATIVE FACTORS “CLINICAL CARITAS” should strive toward PROCESS(CCP) Values are affected by change in social, cultural and spiritual arenas which in turn affects the perception of the person and 1. Practice of loving kindness and equanimity toward self can lead to stress and other within context of (caring consciousness) Caring has existed in every society. caritas consciousness A caring attitude is not transmitted from The formation of a humanistic-altruistic system of generation to generation by genes. It is values transmitted by the culture of the Begins developmentally at an early age with values profession as a unique way of coping with shared with the parents its environment. Mediated through one’s own life experiences, the learning one gains and exposure to the humanities Is perceived as necessary to the nurse’s own maturation which then promotes altruistic behavior towards others  5. Being present to, and supportive of, the expression 2. Being authentically present, enabling, of positive and negative feelings as a connection with sustaining, and honoring faith, hope, and deep deeper spirit of self and the one-being-cared for belief system and the inner subjective world of The expression of feelings, both positive and self/other negative Faith-hope According to Watson, “feelings alter thoughts and Essential to both carative and curative behavior, and they need to be considered and processes allowed for in a caring relationship When modern science has nothing further to Such expression improves one’s level of awareness offer the person, the nurse can continue to use Awareness of the feelings helps to understand the faith-hope to provide a sense of well-being behavior it engenders though beliefs which are meaningful to the 6. Creative use of self and all ways of knowing as part individual of the caring process to engage in artistry of caring- 3. Cultivation of one’s own spiritual practices and healing practices/caritas transpersonal self, going beyond ego self, The systematic use of the scientific problem-solving opening to others with sensitivity and method of decision making compassion Scientific problem-solving method- the only method Cultivation of sensitivity to oneself and to that allows for control and prediction, and that others permits self-correction Explores the need of the nurse to begin to feel 7. Engaging in genuine teaching-learning experience an emotion as it presents itself. that attends to unity of being and meaning, attempting Development of one’s own feeling is needed to stay within other’s frame of reference to interact genuinely and sensitively with others Promotion of Interpersonal teaching-learning Striving to become sensitive, makes the nurse The caring nurse must focus on the learning process more authentic, which encourages self-growth as much as the teaching process and self-actualization, in both the nurse and Understanding the person’s perception of the those with whom the nurse interacts situation assists the nurse to prepare a cognitive The nurses promote health and higher-level plan functioning only when they form person-to- 8. Creating healing environment at all levels (physical person relationship and non-physical), subtle environment of energy and 4. Developing and sustaining a helping-trusting, consciousness, whereby wholeness, beauty, comfort, authentic caring relationship dignity and peace are potentiated Establishing a helping-trust relationship Provision for a supportive, protective and/or Strongest tool is the mode of corrective, mental, physical, socio-cultural and communication, which establishes rapport spiritual environment and caring Watson divides these into external and internal She has defined the characteristics needed variables, which the nurse manipulates in order to in the helping-trust relationship- provide support & protection for the person’s congruence, empathy, warmth mental & physical well-being Communication involves verbal, nonverbal Watson suggests that the nurse also must provide and listening in a manner which connotes comfort, privacy, and safety as part of this carative empathetic understanding factor. 9. Assisting the basic needs, with an intentional caring consciousness, administering “human care essentials,” This factor helps the nurse to reconcile and mediate which potentiate alignment of mind-body- incongruity of viewing the person holistically while at spirit, wholeness and unity of being in all the same time attending to the hierarchical ordering aspects of care; tending to both the of needs. embodied spirit and evolving spiritual The nurse assists the person to find the strength or emergence courage to confront life or death. Assistance with the gratification of human needs PHILOSOPY AND SCIENCE OF CARING It is grounded in a hierarchy of needs MAJOR ASSUMPTIONS similar to that of Maslow’s 1. Transpersonal Caring Relationship She has created a hierarchy which she believes is relevant to the science of Characterizes a special kind of human care relationship caring in nursing that depends on According to her, each need is equally a. The nurse’s moral commitment in protecting and important for quality nursing care and enhancing human dignity as well as the the promotion of optimal health. All the deeper/higher self needs deserve to be attended to and b. The nurse’s caring consciousness communicated valued. to preserve and honor the embodied spirit, therefore, not reducing the person to the moral status of an object c. The nurse’s caring consciousness and connection having the potential to heal since experience, perception and intentional connection are taking place 2. Caring Occasion/Caring Moment The moment when the nurse and another person come together in such a way that an occasion for human caring is created TFN REVIEWER: LESSON 5 10. Opening and attending to spiritual- PATRICIA BENNER: FROM NOVICE TO EXPERT mysterious and existential dimensions of Patricia Benner was born on August 1942 at Hampton, one’s own life-death; soul care for self and Virginia the one-being-cared-for Benner decided to become a nurse while working in a Allowance for Existential- hospital admitting department during college. phenomenological forces She earned an associate degree in nursing from Pasadena Phenomenology is a way of City College simultaneously with a bachelor's degree from understanding people from the way Pasadena College in 1964. things appear to them, for their Benner earned a master's degree in nursing from UCSF in frame of reference 1970 and a PhD from the University of California, Berkeley Existential psychology is the study in 1982. of human existence using Benner joined the nursing faculty at University of phenomenological analysis. California, San Francisco (UCSF) in 1982 Early in her academic career, Benner led the Achieving Methods of Intraprofessional Consensus, Assessment and Evaluation Project (AMICAE Project)  Clinical Wisdom and Interventions in Critical Care: A Thinking-in-Action Approach She was well known due to her influential book, From Novice to Expert: Excellence "The utility of the concept of skill acquisition lies in and Power in Clinical Nursing Practice, in helping the teacher understand how to assist the learner 1984, based on her work with the AMICAE in advancing to the next level" (McClure, 2005) Project FROM NOVICE TO EXPERT She worked as a staff nurse in the areas of Medical-Surgical, emergency room, Dr. Benner categorized nursing into 5 levels of coronary care, intensive care units, and capabilities: novice, advanced beginner, competent, home care proficient, and expert. Currently, her research includes the study She believed experience in the clinical setting is key to of nursing practice in intensive care units nursing because it allows a nurse to continuously and nursing ethics expand their knowledge base and to provide holistic, Patricia Benner's research and theory competent care to the patient. work provides the profession of nursing Her research was aimed at discovering if there were with what we now know as the Novice to distinguishable, characteristic differences in the Expert model, also known as Benner's novice's and expert's descriptions of the same clinical Stages of Clinical Competence. incident. Benner's work as applied to the nursing NOVICE profession is adapted from the Dreyfus Model of Skill Acquisition. The person has no background experience of the situation in which he or she is involved. AWARDS There is difficulty discerning between relevant and Benner was named a Living Legend of the irrelevant aspects of the situation. American Academy of Nursing in 2011. Beginner to profession or nurse changing area of The Living Legends designation honors practice (Frisch, 2009) individuals with "extraordinary Generally, this level applies to nursing students. contributions to the nursing profession, These inexperienced nurses function at the level of sustained over the course of their instruction from nursing school. careers." They are unable to make the leap from the classroom In 1994, Benner was awarded honorary lecture to individual patients. fellowship of the Royal College of Nursing Often, they apply rules learned in nursing school to all FRCN (hon) for her contribution to nurse patients and are unable to discern individual patient education. needs. These nurses are usually new graduates, or those AS AN AUTHOR nurses who return to the workplace after a long Dr. Benner is the author of books including: absence and are re- educated in refresher programs. From Novice to Expert Beginner with no experience The Primary of Caring Taught general rules to help perform tasks Interpretive Phenomenology: Rules are context-free, independent of specific cases, Embodiment, Caring, and Ethics in Health and applied universally and Illness Rule-governed behavior is limited and inflexible The Crisis of Care o Ex. “Tell me what I need to do and I’ll do Expertise in Nursing Practice: Caring, it.” Clinical Judgement, and Ethics Caregiving  PROFICIENT After three to five years in the same area of nursing the nurse moves into the Proficient Stage. ADVANCED BEGINNER "The nurse possesses a deep understanding of The advance beginner stage in the Dreyfus situations as they occur, less conscious planning is model develops when the person can necessary, critical thinking and decision-making skills demonstrate marginally acceptable have developed." (Frisch, 2009) performance having coped with enough real The performer perceives the information as a whole situations to note, or to have pointed out by (total picture) rather than in terms of aspects and mentor, the recurring meaningful performance. components of the situation. Proficient level is a qualitative leap beyond the Nurses functioning at this level are guided by competent. rules and oriented by task completion. Nurses at this level demonstrate a new ability to see Still requires mentor or experienced nurse to changing relevance in a situation including the assist with defining situations, to set recognition and the implementation of skilled priorities, and to integrate practical responses to the situation as is it evolves. knowledge (English, 1993) Perceives and understands situations as whole parts Demonstrates acceptable performance More holistic understanding improves decision- Has gained prior experience in actual making situations to recognize recurring meaningful Learns from experiences what to expect in certain components situations and how to modify plans Principles, based on experiences, begin to be EXPERT formulated to guide actions This stage occurs after five years or greater in the COMPETENT same area of nursing (experienced nurses changing After two to three years in the same area of areas of nursing practice may progress more quickly nursing the nurse moves into the Competent through the five stages) Stage of skill acquisition. The expert performer no longer relies on an analytic The competent stage is the most pivotal in principle (rule, guideline, maxim) to connect her or his clinical learning because the learner must understanding of the situation to an appropriate begin to recognize patterns and determine action. which elements of the situation warrant The expert nurse, with an enormous background of attention and which can be ignored. experience, now has an intuitive grasp of each The competent nurse devises new rules and situation and zeroes in on the accurate region of the reasoning procedures for a plan while problem without wasteful consideration of a large applying learned rules for action on the basis range of unfruitful, alternative diagnoses and of the relevant facts of that situation. solutions. Typically, a nurse with 2-3 years’ experience The expert operates from a deep understanding of the on the job in the same area or in similar day- total situation. to-day situations No longer relies on principles, rules, or guidelines to More aware of long-term goals connect situations and determine actions Gains perspective from planning own actions Much more background of experience based on conscious, abstract, and analytical Has intuitive grasp of clinical situations thinking and helps to achieve greater Performance is now fluid, flexible, and highly efficiency and organization proficient Different levels of skills reflect changes in 3 aspects of skilled performance: ✓ Movement from relying on abstract principles to using past concrete experiences to guide actions ✓ Change in learner’s perception of situations as whole parts rather than in separate pieces ✓ Passage from a detached observer to an involved performer, no longer outside the situation but now actively engaged in participation METAPARADIGM PERSON/CLIENT "The person is a self- interpreting being, that is the person does not come into the world predefined but gets defined in the course of living a life." HEALTH Dr. Benner focuses on the lived experience of being healthy and being ill. Health is defined as what can be assessed whereas wellbeing is the human experience of health or wholeness. Wellbeing and being ill are understood as distinct ways of being in the world. ENVIRONMENT/SITUATION Benner uses situation rather than environment because situation conveys a social environment with social definition. "To be situated implies that one has a past, present, and future and that all of these aspects... influence the current situation." Dr. Benner NURSING Nursing is described as a caring relationship, an "enabling condition of connection and concern." -Dr. Benner "Caring is primary because caring sets up the possibility of giving and receiving help." Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care and responsibility. Dr. Benner understands that nursing practice as the care and study of the lived experience of health, illness, and disease and the relationships among the three elements. Caring is primary because caring sets up the possibility of giving and receiving help.”.Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care and responsibility. She understands that nursing practice as the care and study of the lived experience of health, illness, and disease and the relationships among the three elements.