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learn and solve problems in laboratory Non-Nursing Theories settings. Developmental Theory Cultural Anthropology Human development takes on 3 theoretical...

learn and solve problems in laboratory Non-Nursing Theories settings. Developmental Theory Cultural Anthropology Human development takes on 3 theoretical Margaret Mead (1901-1978) and Ruth perspectives. Benedict (1887-1948) emphasized the ○ Environmentalism experiential factors in development and ○ Organismic Perspective claimed that different patterns of child ○ Psychoanalytic Perspective rearing that reflect diverse cultural values would result in a considerable variety of adult characteristics. Organismic Perspective Stress the importance of factors within the organism itself. People grow to what they make of themselves rather than what the environment makes them. INCLUDES: ○ Naturalism ○ Cognitive Development Theory ○ Humanism Environmentalism ○ Moral Development Theory it emphasizes that people grow to what ○ Maturationism they are made to be by their environments. ○ Ethology British Empirisicism Naturalism John Locke (1632-1704) who believed Jean Jacques Rousseau’s (1712-1778) that the human mind is a “blank slate” at philosophy stresses that children are birth, and that all knowledge of the world innately good unless corrupted by society’s comes to us through our senses. evils. Five stages correspond to the Children are uncivilized creatures who evolution of human nature. need adults to shape them into everything ○ Animal Feelings of pleasure and they will eventually become. pain (0-5 years) ○ Savage sensory awareness (5-12 Behaviorism years) John B. Watson (1878-1958) believed ○ Rational Functioning and that the only way to understand the human Exploration (12-15 years) organism is through objective observation ○ Emotional and Social Interests of behaviors. For him, environmental (15-21 years) experiences imposes itself on the person ○ Spirit Maturity during adulthood throug principle conditioning and reinforcement. Maturationism B.F. Skinner defined operant conditioning Hall believed that the individual as a learning process that depends on development of a child repeats the phases reward and punishment. Reinforcement or of human evolution and describes the perceived consequences of behavior adolescence as a period of “storm & influences the frequency with which the stress” corresponding to a turbulent state behavior occurs. of Western civilization. Albert Bandura (1960s) developed the Gesell emphasized internal biological perspetive known as social learning and factors in development virtually ignoring the key concept is that development is the role of the environment. He advocated guided by the initiation or avoidance of the “Normative Tradition” of developmental behaviour that is modeled by other people. analysis By observing, one can learn how to do something. Cognitive Development Theory Howard and Tracy Lendler Emphasizes internal mental processes and (1950s-1960s) discovered developmental their interactions with the environment. differences in the ways children and adults 1  Cognitive developmentalists like Jean Safety, be it with ambulation or in taking Piaget (1896-1980) attempt to explain how medication, is very important to nursing the individual thinks and how human Social needs are met with visiting hours processes vary. and through the nurse-patient (care giver) relationship. Esteem and self-actualization may or may not be met in the hospital setting The theory provides the blueprint for prioritizing client care according to a hierarchy of needs (McEwen & Wills, 2007) Ethology Describe human behavior/development in Humanism real-life settings. Focus on the dignity and freedom of all Recognize the importance of Human individuals. Humanists like Abraham beings living in harmony with their Maslow (1890-1970), Charlotte Buhler environment. (1893-1974), and Carl Rogers Primary concern is the role of human (1902-1988) rejected the view of human behavior in the survival of human species. nature that emphasizes environmental The contribution of ethology to the study of control and observable actions. Instead, human development centers on the they stressed internal factors and suggestion that human as well as lower self-perception animal behavior may have biological Abraham Maslow’s Hierarchy of Needs origins. Moral Development Theory Lawrence Kohlberg suggested that some people reach a post-conventional level of moral thinking where they think in terms of universal ethical principles which take priority over society’s laws and values. Maslow's theory posits that needs are hierarchical, with physical and psychological needs taking precedence; these needs are arranged in a pyramid, with the most critical at the base. The pyramid's base consists of deficiency needs, which motivate individuals when unmet, while the top level, self-actualization, represents growth needs that few people achieve, often fluctuating Psychoanalytic Perspective between lower-level need Focus on the underlying forces that motivate behavior Application to Nursing Practice Sigmund Freud described a series of psychosexual stages in which The theory focuses on human potential, gratification shifts from one body zone to “gives hope a chance.” another and the child’s maturational level The theory allows the nurse to highlight the determines when the shifts will occur person’s strengths instead of focusing on one’s deficits (McEwen & Wills, 2007). Psychosexual Development Basic needs such as air, food, drink and warmth , are the basic needs of human survival and health. 2  Provides a way to understand the many influences on the whole person and the possible impact of change of any part of the whole. Ludwig von Bertalanffy and Peter Checkland We all work within and between a variety of systems: ○ Structural systems: (e.g., a road network) ○ Functional systems: (e.g., academic department) ○ Social systems: (e.g., work group) ○ Information systems: (e.g., a class or course) General Systems Theory: Key Concepts Erik Erickson described eight stages of Parallels are found in different scientific psychosocial development between disciplines, with certain principles common infancy and old age. Each stage involves to all systems. the resolution of a particular crisis, A systems approach facilitates achieving balance between extremes and understanding of complex phenomena by crisis emerges according to maturationally clustering information and clarifying based time table. relationships between different elements. Defining a System System: A set of components or units interacting with a boundary that filters both the kind and rate of flows of inputs and outputs to and from the system (Hall and Weaver, 1985). General Systems Theory (GST): ○ Purpose, Content, Process: Breaking down the “whole” and analyzing the parts. ○ Relationships between the parts of the whole are examined to learn how they work together. General Systems ○ A system is made up of separate components. The parts rely on Theory one another, are interrelated, share a common purpose, and together form a whole. Systems Theory ○ Input: Information that enters the system. Concerned with elements and interactions ○ Output: The end product of a among all the factors/variables in a system. situation. ○ Feedback: The process through Interactions between the person and the which the output is returned to the environment occur continuously, creating system. complex, constantly changing situations. 3 Von Bertalanffy (1969, 1976) - General depending on specific premises. This is referred to as Transactional Modes. Systems Theory Assumptions All systems must be goal-directed. Transactional Modes (Bredemeier, Hall A system is more than the sum of its parts. & Weaver, 1985) A system is ever-changing, and any change in one part affects the whole. 1. Gemeinschaft: Based on the premise that Boundaries are implicit, and human the system and the environment are systems are open and dynamic. committed to each other. 2. Legal-Bureaucratic: When the system Types of Systems and its environment respond to each other because "It is their duty" or "It is the Closed Systems: Fixed relationships policy". among system components and no 3. Team-Cooperative: When the system, interaction with the environment. Not of subsystem, and the environment recognize concern to IT. that each subsystem has something to Open Systems: Interact with their contribute to achieve a common goal. environment, have dynamic interaction of 4. Bargaining: When a system has needs components, and can be self-regulating. and goals different from those of its subsystem or its environment, it can negotiate to meet these needs and goals. Examples of Systems 5. Coercion: In a system, makes use of favors, threats, or deception to obtain what Human Organizations as Open is necessary for the system’s survival. Systems: ○ Boundaries are permeable, continually engaging in importing, The System Boundary transforming, and exporting matter, energy, information, and Boundary Importance: Boundaries mark people. the interface between systems, allowing ○ Human organizations are at the the exchange process of high end of the complexity scale input-throughput-output to occur. due to these characteristics. Boundary Maintenance (Thompson and McEven): 1. Competition: When two Basic Elements of Any System functional components share a common relationship with a third 1. Goal party. 2. Environment 2. Co-Optation: When leadership 3. Control elements in one system attempt 4. Input to take over another. 5. Process 3. Bargaining: When an agreement 6. Output exists between two systems 7. Feedback concerning the exchange of goods and services. The Systems Process 4. Coalition Formation: When two systems become committed to Structure and Function: A system should joint decisions. be able to perform three essential processes. System States (Hall & Weaver, 1985) 1. Adaptation to the Environment 2. Decision-Making about Negentropy: Achieved by a process called Resource Allocation feedback mechanism. 3. Integration of System Parts Equifinality: The tendency to reach a In order to carry out the system processes, characteristic final state from different the system must decide whether or not to initial states in various ways based on the exchange matter, energy, or information dynamic interaction. 4  Steady State: Certain processes allow a 5. Identification of the methods that system to achieve some constancy in the the reference group uses to bring input-output exchange. about change. 6. The actual process of change. Application to Nursing Practice Planned Change GST is a universal theory: E.g., a Multidisciplinary approach in health care. Lewin identified three stages of change: GST views human beings as holistic 1. Unfreezing and goal-directed: E.g., Roy Adaptation Involves finding a Model. method of making it GST views persons as open systems: possible for people to let Striving to maintain harmony and balance go of an old pattern that between their internal and external was counterproductive in environment. some way. ○ Examples: 2. Movement Neuman’s Health Care Involves a process of Systems Model change in thoughts, Johnson’s Behavioral feelings, behavior, or all Systems Model three, that is in some Imogene King’s way more liberating or Interpersonal System more productive. Hildegard Peplau’s 3. Refreezing Model Establishing the change as a new habit so that it becomes the “standard operating procedure.” Without this stage of Theories of Change refreezing, it is easy to backslide into the old The Change Theory ways. People grow and change throughout their Planned Change: Freezing Theory lives. Growth and change are evident in the Change occurs whenever the forces in a dynamic nature of basic human needs and given field are unequal. how they are met. During unfreezing, conditions are viewed Change happens daily, subtly, and as stable or “frozen.” continuously, and can be manifested in Change begins with a felt need, a plan that both everyday occurrences and more maximizes driving forces and minimizes disruptive life events. restraining forces. Kurt Lewin (1962) Planned Change: Movement Phase Developed the Change Theory which The goal of the movement phase is to identifies the following six components: achieve the desired change. 1. Recognition of the area where This is when change is implemented. change is needed. 2. Analysis of a situation to Planned Change: Refreezing Phase determine what forces exist to maintain the problem and what The goal of the refreezing phase is the forces are working to change it. stabilization of the change. 3. Identification of methods by which Change must continuously be practiced change can occur. until it becomes familiar. 4. Recognition of the influence of group mores or customs on change. Ronald Lippitt’s Change Theory 5  Identifies eight general phases of the Learning Theories change process: 1. Development of a need for Learning theories and models explain how change. people learn. 2. Establishment of a change relationship. 3. Working towards change. Learning Theories 4. Clarifications or diagnosis of the client system’s problem. 1. Bandura’s Social Learning Theory 5. Examination of alternative routes 2. Hochbaum, Rosenstock, and Becker’s and goals; establishing goals and Health Belief Model intentions of action. 3. Green’s PRECEDE Framework for 6. Transformations of intentions into Health Education Planning and actual change efforts. Evaluation 7. Generalization and stabilization of 4. Knowles’ Adult Learning Theory change. 8. Achieving a terminal relationship. Historical Perspectives Chin and Benne’s Change Strategies Learning is the product of stimulus conditions and the responses that (1976) follow. Respondent conditioning by Ivan Pavlov Developed three general strategies for (Classical or Pavlovian conditioning) effecting changes in human systems: emphasizes the importance of stimulus 1. Empirical-Rational Strategies: conditions and associations formed in the People are rational beings and learning process. will follow reason once it is revealed to them. 2. Normative-Re-Educative Behaviorist Learning Strategies: Change will occur when people are brought to 1. Classical Conditioning: Learning based change their normative on pairing of conditioned and orientations to old patterns and unconditioned stimuli resulting in a develop commitments to new conditioned response. ones. 2. Operant Conditioning: Learning based 3. Power-Coercive Strategies: on consequences, meaning behavior that Based on the application of power is rewarded is most likely to be repeated. in some form. Basis of Behaviorism Richard Walton’s Social Change Strategies (1969) Operant Conditioning by B.F. Skinner focuses on the behavior of the organism and the reinforcement that occurs after the Developed two strategies of social change: response. 1. Power Strategy: To command ○ Positive reinforcement enhances attention and establish a basis for the likelihood that a response will a quid pro quo, people must be repeated. threaten others with harm, loss, ○ Negative reinforcement or inconvenience, or punishment involves the removal embarrassment. of an unpleasant stimulus through 2. Attitude Change Strategy: escape or avoidance Involves overtures of love, trust, conditioning. and gestures of goodwill, all intended to result in attitude change and concomitant behavior Cognitive Learning change. Cognitive learning theorists stress the importance of what goes on inside the learner. 6  E.C. Tolman (1930): Learning can be Health Belief Model faster in the presence of a reward; mental or cognitive maps can be made to reach a Perceived Susceptibility: Perceived goal. threat. Perceived Severity: The seriousness of Cognitive Learning the condition. Perceived Benefits: Effectiveness of The Gestalt perspective emphasizes the treatment. importance of perception in learning. Perceived Costs: Barriers to action. Cognitive learning and information Cue to Action: Triggers to take action. processing perspectives emphasize thinking processes, reasoning, information processing, and memory. Theory of Reasoned Action Social Learning Theory Developed by Fishbein and Ajzen in Albert Bandura developed SLT. 1975. SLT states that there is a continuous and Suggests that perceived social norms play reciprocal relationship between: a role in determining motivation. 1. A person’s behavior. Motivation to act is a product of perceived 2. The environmental consequences group norms and personal beliefs about of that behavior. the action. 3. The cognitive processes going on inside the person. The PRECEDE-PROCEED Framework Social Cognitive Theory Developed by Lawrence W. Green in 1980. SLT was later called Social Cognitive A comprehensive model for planning and Theory. evaluating health education and health According to Bandura, behavior is promotion programs. determined by expectancies and Recognizes health promotion as an incentives: extension of health education. 1. Environmental cues: Beliefs about how events are connected. The PRECEDE Model 2. Outcome Expectation: Opinions about how individual behavior is PRECEDE: Predisposing, Reinforcing, and likely to influence outcomes. Enabling Causes in Educational Diagnosis 3. Efficacy expectation or and Evaluation. self-efficacy: One’s own The model is intended for planning and competence to perform the evaluation of health education and behavior needed to influence addresses disjointed planning. outcomes. 4. Incentive (or reinforcement): The value of a particular object or The 7 Phases of PRECEDE outcome. 1. Social Diagnosis: Quality of life in a community. Health Belief Model 2. Epidemiological Diagnosis: Identifying specific health problems. Originally proposed by Godfrey M. 3. Behavioral Diagnosis: Identifying specific Hochbaum in 1958 as a theoretical model health-related behaviors. of preventive health behavior. Later 4. Educational Diagnosis: Identifying developed by Rosenstock (1966) and factors affecting health behaviors. further modified by Becker (1974). ○ Predisposing Factors: Attitudes, Suggests that the decision to change beliefs, values, and perceptions. behavior is influenced by the evaluation of ○ Enabling Factors: Barriers its feasibility and benefits weighed against created by societal forces. its costs. 7  ○ Reinforcing Factors: Feedback ○ A person with ideas, needs, received from others. intentions, information, and a 5. Administrative Diagnosis: Developing reason for communicating. and implementing health education 2. A message: programs. ○ A coded, systematic set of 6. Evaluation: Process evaluation, impact symbols representing ideas, evaluation, and outcome evaluation. purpose, intentions, and feelings. 3. An encoder: PRECEDE to PROCEED Model ○ The mechanism for expressing or translating the purpose of the communication into the message. PROCEED: Policy, Regulatory, and 4. A channel: Organizational Constructs in Educational ○ The medium for carrying the and Environmental Developments. message. Reviews and reconciles resources like 5. A decoder: personnel, time, and finances. ○ The mechanism for translating the message into a form that the Adult Learning Theory recipient can use. 6. A receiver: Developed by Malcolm Knowles (1967). ○ The target or recipient of the Andragogical theory is based on four main message. assumptions: 1. Changes in Self-Concept. Model of Communication 2. The Role of Experience. 3. Readiness to Learn. Communication is diverse, ranging from 4. Orientation to Learning. mass media, popular culture, and Adults learn best when learning is language to individual and social behavior. problem-centered, meaningful, and The term "Communicare" means "to make experiential. common." There are two main schools of thought Psychodynamic Learning explaining communication: 1. Process School: Sees A theory of motivation emphasizes communication as the emotions rather than cognition and transmission of messages, responses. including theories by Shannon Stresses the importance of conscious and and Weavers (1949) and unconscious forces in guiding behavior, Newcombs (1953). personality conflicts, and the enduring 2. Semiotic School: Uses impact of childhood experiences. semiotics, or the science of signs and meanings, as its main Humanistic Learning method of study, focusing on text and culture. The humanistic perspective on learning assumes each individual is unique and that The Semiotic School all individuals have a desire to grow positively. A radically different approach that emphasizes communication as the generation of meaning. Semiotics or semiology is the study of signs and the way they work, founded by Theories of American logician and philosopher C.S. Pierce and Swiss linguist Ferdinand de Communication Saussure. In semiotics, the receiver, also called the 1. An (interpersonal) source: reader, plays an active role in determining meanings based on cultural experience, attributes, and emotions. 8 Information Theory 4. Body Stance: Includes posture, arm or leg configuration, and distribution of body Communication includes all procedures by weight, conveying interpersonal attitudes which one mind may affect another. and emotional states. The process begins with a source selecting a message out of all possible Paralanguage messages. The transmitter is the voice mechanism producing the signal, which is Involves the use of silence to convey transmitted through air. The receiver interest, sympathy, or respect. decodes the message and reconstructs it, Silence, accompanied by head nods or passing it on to a destination. 'uh-hum', encourages the speaker to Noise: Anything added to the signal that is continue. not intended by the information source. Entropy: The uncertainty or Non-Verbal Modes of Communication disorganization of communication associated with the freedom of choice in Haptics: The study of touch in constructing a message. communication. Touch sends powerful Entropy Redundancy: The portion of the messages, significantly affecting emotional message not determined by the sender's and physical health. free choice. Chronemics: The study of how people use time in communication. The way a Non-Verbal Communication nurse conducts activities in a patient’s room conveys non-verbal messages. Non-verbal communication conveys Proxemics: The study of the distances information about the speaker's identity, people maintain between themselves and emotions, attitudes, intentions, or social others, and how they defend their position. territories. Space expands or contracts It also manages the kind of relationship based on the situation. one person wants with another, using tone Privacy and Respecting Boundaries: of voice, posture, facial expression, and Involves distance zones like intimate, gestures. personal, social, and public zones, based on the level of personal contact or Non-Verbal Modes of Communication formality. Physical Appearance: Body Functional-Professional Touch characteristics under voluntary control, like hair, clothes, and body adornment, and Social-Polite Touch: Used in greetings those less controllable, like height and like handshakes. weight. This can indicate physical health, Friendship-Warmth Touch: Used in hugs personal grooming, or social status. or back slapping among friends. Body Movement (Kinesics): The study of Love-Intimacy Touch: Involves tight hugs body movement in communication, and kisses between lovers or close including facial expressions, gestures, and relatives. body stance. Sexual-Arousal Touch: Used by lovers. Categories of Kinesics Factors Influencing Personal Space 1. Facial Expression: Conveys emotional 1. Personal preference messages like happiness, sadness, fear, 2. The relationship between the or concern. communicators 2. Eye Contact: A special type of facial 3. The nature of the topic discussed expression that usually effects rapport with 4. Cultural heritage of the participants a patient. 5. The nature of the communication context 3. Gestures: Involves hands, arms, feet, and head, indicating emotional arousal or Types of Territory specific states. 9  Public Territory: Open to anyone, like ○ Important aspects include the parks or hospitals. state of ego maturity and the Interactional Territory: Reserved space quality of its structure. for particular people during specific Expanded Crisis Theory periods. Applied Crisis Theory Home Territory: Space in which individuals live and work, like classrooms Basic Crisis Theory or patient rooms. Caplan: Assessment based on three additional areas: 1. Capacity to withstand stress and Crisis Intervention anxiety and maintain equilibrium. 2. Degree of reality recognized and Theories faced in problem-solving. 3. Stock of coping mechanisms used to maintain balance Offers immediate help to establish equilibrium. The immediate goal is to reinforce the Types of Emotional Crisis (Baldwin, individual’s strengths and minimize 1978) weaknesses, moving from a passive and dependent state to an adult independent 1. Dispositional Crises: Arise from state in a short period. problematic situations where intervention is not directed at the emotional level. 2. Anticipated Life Transition Crises: History: Crisis Intervention Relate to normal life transitions over which the person may or may not have control. Lindemann (1944): Formally developed 3. Crises Resulting from Traumatic Stress: Crisis Intervention for handling bereaved Precipitated by externally imposed fire victims. stressors that are unexpected and Caplan: Elaborated on this, becoming the uncontrolled. father of modern crisis treatment 4. Maturational or Developmental Crises: measures. Involve struggle with deep-seated Parad, Rapoport, Jacobson, and unresolved issues related to achieving Aguilera: Refined crisis theory and emotional maturity. developed treatment models for crises in 5. Psychopathological Crises: A marital family conflicts and suicide pre-existing psychopathological condition prevention. precipitates the crisis or complicates resolution. Characteristics of Crisis 6. Psychiatric Emergency Crises: Severe psychiatric disorder with severe 1. Presence of danger and opportunity. impairment; poses danger to self or others. 2. Complicated symptomatology. 3. Seeds of growth and change. Phases of Crisis 4. No panaceas or quick fixes. 5. The necessity of choice. 1. First Phase: A rise in anxiety in response 6. Universality or idiosyncrasy. to trauma, where the individual tries to use usual coping mechanisms. Theories of Crisis and Crisis 2. Second Phase: Characterized by Intervention increased anxiety due to failure in coping. 3. Third Phase: Continued escalation of Basic Crisis Theory: anxiety, leading the person to seek help. ○ Asserted that impediments to life 4. Fourth Phase: The active state of crisis goals that cannot be overcome where inner resources and support through customary behaviors lead systems are inadequate to crises. Expanded Crisis Theory 10  Disequilibrium during a crisis can be Applied Crisis Theory understood by accessing unconscious thoughts and past emotional experiences. 1. Equilibrium Model: An early childhood fixation can explain why ○ Lindemann (1944), Caplan an event becomes a crisis. (1961), Leitner (1974): Focus on maintaining pre-crisis stability. Theoretical Contributions to Expanded ○ Emotional state during equilibrium Crisis Theory leads to stability and psychological mobility. ○ Emphasizes the use of coping Psychoanalytic Theory (Freud): mechanisms and problem-solving Emphasizes unconscious factors in crisis. approaches. Systems Theory: Focuses on 2. Cognitive Model: interrelationships and interdependence ○ Crises are rooted in faulty among people and events. thinking about events or Ego-Analytic Theory (Hartmann): situations. Emphasizes adaptation and its effects on ○ The goal is to change views and later life. beliefs about crisis events. Adaptational Theory: Crisis is sustained 3. Eclectic Crisis Intervention Model: through maladaptive behaviors; resolution ○ Gelliland, James, Bowman, occurs when behaviors are changed to Thorne adaptive ones. ○ Integrates concepts and Adaptational Psychodynamics (Rado): strategies from various Focuses on the immediate present while approaches. acknowledging the developmental past. ○ Major tasks include identifying Interpersonal Theory: Crisis resolution valid elements from different depends on self-belief, self-actualization, systems and keeping an open and confidence in overcoming the crisis. mind. Epigenetic Development (Erikson): 4. Psychosocial Transition Model: Development follows an orderly sequence ○ Adler, Erikson, Minuchin dependent on previous stages. ○ States that people are products of their hereditary endowment and Chaos Theory in Crisis the learning from their social environment. Chaos: The result of overwhelming ○ Significant others assist the anxiety. individual in welcoming Crisis: Chaos becomes self-organizing; challenges. the client is unable to identify patterns or preplan solutions. Experimentation: Involves trial and error, false starts, and dead ends to cope with the crisis. GENDER THEORIES Balancing Factors Affecting Gender Concept And Issue In Health Equilibrium (Aguilera and Messick, 1942) SEX: The biological attribute that differentiates men and women. 1. Perception of the Event: The extent to GENDER SOCIALIZATION: The process which the event is seen as a threat or a by which men and women learn and challenge. acquire their roles, responsibilities, 2. Situational Support: Dependable persons qualities, and behaviors. in the environment who can help solve Gender Norms: Powerful mechanisms problems. that control human behavior (Strassen 3. Coping Mechanisms: Established 1992). patterns of response to cope with stressful situations. Gender Self-Concept 11  A child learns self-concept by interacting Offers a reasonable explanation for the with the environment, family, and peer origin of gender roles and demonstrates group. the functional utility of assigning tasks PLAY: Considered a significant part of based on gender. gender socialization that teaches children how to relate to their environment. Conflict Theory ○ The most crucial period in the formation of gender identity is Reflects Marxian (Karl Marx) ideas about from ages 3 to 6 years old. During class conflict and the relationship between this period, boys tend to receive the exploiter and the exploited. more negative reinforcement for Women are subordinate to men in the gender-inappropriate behavior autocracy of the household. from parents. Men’s economic advantage provides the basis for gender inequality. Gender Relation Symbolic Interactionism The importance of gender in understanding health practices and illness Aims to understand human behavior by experiences is increasingly recognized. analyzing the critical role of symbols in Key to this work is a better understanding human interaction. of the application of gender relations. This is certainly relevant to the discussion The influence of masculinities and of masculinity and femininity. femininities and the interplay within and between them manifests within relations Feminist Sociological Theory and interactions among couples, family members, and peers to influence health Feminism is an inclusive worldwide behaviors and outcomes. movement to end sexism and sexist Sociologists describe sex-role oppression by empowering women. socializations: There is a move to erase the ○ INSTRUMENTAL: Socialization race-class-gender disparity and provide a for men is characterized by link. competitiveness, aggressiveness, leadership, wielding power, and Gender Socialization & Nursing accomplishing tasks. ○ EXPRESSIVE: Socialization Historically, nursing is a profession for includes learning to nurture, women. affiliate, and be sensitive to the Its founders were women with an needs of others. exceptional gift for social reform. Many of their efforts were directed Gender Concept And Health specifically at the welfare of women and children (Shea 1990). Issue According to Flanelly (1984), the conflict for the nurse (male or female) is how to Theoretical Perspectives on Gender strike a balance between caring traits often Roles considered to be intrinsically female and ○ 1. Functionalism the skills and leadership abilities usually ○ 2. Conflict Theory thought of as characteristically male. ○ 3. Symbolic Interactionism Thus, the nurse must be able to acquire ○ 4. Feminist Sociological Theory and exhibit both masculine and feminine characteristics. Functionalism Gender as a Predictor of Health Suggests that separate gender roles for women and men are beneficial. The ideological foundation for gender Society maintains order by assigning inequality in many third-world countries is different tasks to men and women. patriarchy, defined as a “set of social 12  relations with a material base that enables 5. Take women’s problems and men to dominate women.” symptoms seriously. Make a This is reinforced by various thorough assessment rather than institutions—economic, political, social, prematurely deciding on a legal, and religious—all of which physical or psychological emphasize women’s inferior position in diagnosis or judging her as a society. hypochondriac. These have implications for women’s 6. Routinely ask women about health status and health behaviors in the current or past abuse. Abuse can event of illness (Okojie 1994). be physical, emotional, or sexual. 7. Learn about incidences, causes, and physical and emotional Women’s Health consequences of violence against women to improve diagnosis, Women’s health problems include those treatment, and care. which affect their physical, social, and mental well-being, as well as those which lead to female mortality. Gender Sensitivity Compounding health problems is the lack of access to health care, including lack of This is being aware of and being open and access to information and health facilities. responsive to issues that have something It has also been recognized that women to do with the social relations between are treated in an inferior way by health women and men within specific societies professionals and therefore are hesitant to and cultures. seek treatment. Health providers must develop themselves to have gender sensitivity and gender awareness. Strategies to Reduce Gender Inequalities in Health Given women’s disadvantaged position in society, reducing gender inequalities INTERLINKING requires measures and/or policies to reduce discrimination against women RELATIONSHIPS OF which are woven into the political, cultural, economic, and religious fabric of society FACTOR AFFECTING (Okojie 1994). Robinson (1994) suggested steps in HEALTH providing the best possible care to female patients: Physical Dimension 1. Be aware of your own socialization and possible Genetic make-up, age, developmental sex-role biases that may affect level, race, and sex are all part of an your attitude toward female individual’s physical dimension and patients. strongly influence health status and health 2. Avoid using patronizing, practices. demeaning, or sexist language. 3. Be aware of socio-cultural Examples: stresses on women. The fact that they perform multiple roles in the The toddler just learning to walk is prone to home, community, and society fail and injure himself. renders women vulnerable to The young woman who has a family health hazards, both physically history of breast cancer and diabetes and and psychologically. therefore is at a higher risk to develop 4. See women’s help-seeking these conditions. behaviors as an opportunity for preventive healthcare: encourage Emotional Dimension them to give priority to their health. 13  How the mind and body interact to affect lifestyle, family, and culture. Low-income body function and respond to body groups are less likely to seek health care conditions also influences health. to prevent or treat illness; high-income Long-term stress affects the body systems, groups are more prone to stress-related and anxiety affects health habits; habits and illness. The family and the conversely, calm acceptance and culture to which the person belongs relaxation can change body responses to determine patterns of living and values illness. about health and illness that are often unalterable. Examples: Examples: Prior to a test, a student always has diarrhea. The adolescent who sees nothing wrong Extremely nervous about a surgery, a man with smoking or drinking because his experiences severe pain following his parents smoke and drink. operation. The person of Asian descent who uses Using relaxation techniques, a young herbal remedies and acupuncture to treat woman reduces her pain during the an illness. delivery of her baby. Spiritual Dimension Intellectual Dimension Spiritual and religious beliefs are important The intellectual dimension encompasses components of the way a person behaves cognitive abilities, educational background, in health and illness. and past experiences. These influence a client’s responses to teaching about health Examples: and reactions to health care during illness. They also play a major role in health Roman Catholics require baptism for both behaviors. live births and stillborn babies. Jehovah’s Witnesses are opposed to blood Examples: transfusions. An elderly woman who has only a third-grade education needs teaching about a complicated diagnostic test. A young college student with diabetes who Introduction to Nursing follows a diabetic diet but continues to drink beer and eat pizza with friends Theory several times a week. Theory: The doctrine or principles Environmental Dimension underlying an art as distinguished from the practice of that particular art. It can also be The environment has many influences on a formulated hypothesis or opinion not health and illness. Housing, sanitation, based on actual knowledge, or a climate, and pollution of air, food, and provisional statement or set of explanatory water are aspects of the environmental propositions that purports to account for or dimension. characterize some phenomenon. Theoretical Statement: Describes the Examples: relationship between two or more concepts. Increased incidence of asthma and respiratory problems in large cities with smog. Characteristics of a Theory Socio-Cultural Dimension Systematic, logical, and coherent (orderly reasoning, no contradictions). Health practices and beliefs are strongly Creative structuring of ideas (mental influenced by a person’s economic level, images of one’s experiences and creating 14  different ways of looking at a particular Purposes of Nursing Theory event or object). Tentative in nature (changes over time or 1. Guides and Improves Nursing Practice: evolves, but some remain valid despite the Theory provides a goal for nursing care, passage of time). making nursing practice more effective and efficient. It helps to focus the goals, Components/Elements of Theory making nurses more confident about their practice. 2. Guides Research: According to Meleis, the primary use of theory is to guide research. It validates and modifies the theory. 3. Contributes to the Development of the Discipline's Body of Knowledge. 4. Enhances Communication: The theory helps in enhancing communication within the discipline. Significance of Theory as a Discipline 1. Purpose: Why is the theory formulated? Conceptualization for Nursing Research 2. Concepts: The building blocks of Projects: It helps in the development of theory—ideas, mental images of a conceptual frameworks for nursing phenomenon, event, or object derived from curricula. an individual’s experience and perception. Guides Curriculum Content: Theory 3. Major Concepts: Can include nursing, structures curriculum content. person, health, or environment. Guides the Teaching of Nursing 4. Definitions: Give meaning to concepts, Practice: which can be either descriptive or ○ Focuses on what nurses know procedural (stipulate the use of terms and how they use knowledge to within the theory). guide their thinking and 5. Propositions: Expressions of relational decision-making while statements between and among the concentrating on the patient. concepts. Can be expressed as ○ Emphasis on knowledge about statements, paradigms, or figures (also how nurses function known as theoretical assertions). ○ Concentrated on the nursing 6. Assumptions: Accepted "truths" that are process basic and fundamental to the theory, Provides Perspective: It gives nurses a including value assumptions regarding perspective on the patient. what is good, right, or ought to be. Driving Force for the Development of the Nursing Profession: Theory-based practice is beneficial to the patient as it provides a systematic, knowledgeable approach to nursing practice. Significance of Theory as a Profession Useful Tool for Reasoning, Critical Thinking, and Decision-Making in Nursing Practice: ○ Organizes patient data. ○ Understands and analyzes patient data. 15  ○ Helps make decisions about WAYS OF KNOWING nursing interventions. ○ Assists in planning patient care. Empirics ○ Predicts outcomes of care. Ethics ○ Evaluates patient outcomes. Esthetics Personal EMPIRIC KNOWING MetaParadigm and Ways The science of nursing. of Knowing Objective, abstract, quantifiable. Can be verified with testing. Arranged into theories. FOUR KEY CONCEPTS: NURSING Case knowledge (biomedical model). PARADIGM Concerned with “monitoring of disease and therapeutic responses.” META PARADIGM (meta - more comprehensive or Quantitative research uncovers this type of transcending; paradigm - philosophical or knowing. theoretical framework): Based on the assumption that what is known is accessible through the physical Person: The recipient of nursing care. senses: seeing, touching, and hearing. Environment: Physical and social. ○ Reality exists and truths about it Health: A process or state. can be understood. Nursing: Goals, roles, and functions. Draws on traditional ideas of science. Expressed in practice as scientific KNOWING AND KNOWLEDGE competence. ○ Competent action grounded in Knowing: Refers to the way of perceiving scientific knowledge, including and understanding self and the world. theories and formal description. Knowledge: Refers to knowing that is ○ Involves conscious expressed in a form that can be shared problem-solving and logical and communicated to others. reasoning. ○ Nursing theory. CARPER's WAYS OF KNOWING Positivist science. ○ Knowledge is systematically It is considered to be the epistemology of organized into general laws and nursing. theories. It was written in 1975 and has been the Source of this knowledge foundation of nursing knowledge since ○ Research then. ○ Theory Other ways of knowing have been proposed. ETHICAL KNOWING Why Develop Patterns of Knowing? The component of moral knowledge in nursing. The aim of Carper’s theory was to: Based on the values of the profession. Choosing, justifying, and judging actions Formally express nursing knowledge. based on duty, rights, and obligations. Provide a professional and discipline Universal values to the profession as well identity. as personal values of the nurse. Convey to others what nursing contributes Guides and directs how nurses conduct to healthcare. their practice. Create expert and effective nursing Requires: practice. ○ Experiential knowledge of social values. ○ Ethical reasoning. Focus is on: 16  Matters of obligation - what ought to be Awareness of self in a relationship. done. Does not require mediation through Right, wrong, and responsibility. language. Ethical codes of nursing. Engagement - active empathetic Confronting and resolving conflicting participation of the nurse as a “knower.” values, norms, interests, or principles. Means being authentic – incorporating that Sources: theory of interpersonal relationships until it ○ Nursing’s ethical codes and is second nature. professional standards. The “A-HA” experience. ○ An understanding of different Concerned with becoming self-aware. philosophical positions: Self-awareness grows over time through Consequentialism. interactions with others. Deontology. Used when nurses engage in the Duty. therapeutic use of self in practice. Social justice. Scientific competence, moral/ethical practice, insight, and experience of ESTHETICS KNOWING personal knowing. Personal reflection. The art of nursing. Informed by the response of others. Intangible essence of what nursing is. Openness to experience. Attends to the uniqueness of “contextual wholeness” rather than a particular Other Ways of Knowing moment. Anticipation of outcome rather than just Experience (Experiential): evaluation of select intervention. ○ Benner's "Novice to Expert." Expressive, intuitive, and creative aspects ○ Knowing how or of nursing. “knowledge-as-ability” vs. Difficult to verbalize (expert nurse actions knowing that (Carper’s view done before the actual event - “How did according to Benner). Skill-based. they know that?”). Intuition: Expressed through: ○ Non-rational thought processes of ○ Actions, bearing, conduct, feeling or sensing. attitudes, narrative, and ○ Not logically explained, results interaction. with vast amounts of experience. ○ Knowing what to do without Unknowing: conscious deliberation. ○ Position of openness to Involves: understand the worldview of the ○ Deep appreciation of the meaning patient (client-centered). Leads to of a situation. empathy and understanding of ○ Moves beyond the surface of a the patient’s perspective. situation. Sociopolitical: ○ Often shared without conscious ○ Seeks to understand the ‘wherein’ exchange of words. of nursing as a practice ○ Transformative art/acts. profession. ○ Brings together all the elements ○ Understanding of what nursing is of a nursing care situation to by the public and what society create a meaningful whole. and its politics are by nurses. Perceives the nature of a clinical situation and interprets this information. Responds with skilled action. Uses the nurse’s intuition and empathy. Based on the skill of the nurse in a given situation. PERSONAL KNOWING Acceptance of self that is grounded in self-knowledge and confidence. 17  ○ Impact on Theory and Development Process Research: Proliferation of and Scope of Theory in approaches to theory development. Nursing Application of theory in practice was frequently Stages of Knowledge Development in underemphasized. Emphasis on procedures Nursing used to acquire knowledge, with 1. Silent Knowledge (Civil War 1868) attention to ○ Source of Knowledge: Blind methodology, evaluation obedience to medical authority. criteria, and statistical ○ Impact on Theory and procedures for data Research: Little attempt to analysis. develop theory; research was 5. Constructed Knowledge (1980s) limited to the collection of ○ Source of Knowledge: epidemiologic data. Integration of different types of 2. Received Knowledge (World War II - knowledge (intuition, reason, and Late 1940s) self-knowledge). ○ Source of Knowledge: Learning ○ Impact on Theory and through listening to others. Research: ○ Impact on Theory and Nursing theory should Research: be based on prior Theories were borrowed empirical studies, from other disciplines. theoretical literature, Nurses with non-nursing client reports, and the doctoral degrees relied nurse scholar's intuition on educators, or related knowledge. sociologists, psychologists, physiologists, and Evolution of Nursing Science anthropologists. Research was primarily Nursing science has evolved since the educational or 1960s as a pursuit to be understood as a sociologic. scientific discipline. 3. Subjective Knowledge (1950s) The unique contribution of nursing to ○ Source of Knowledge: patient care, families, and communities is Internalized authority and a new acknowledged. sense of self emerged. ○ Impact on Theory and Types of Theories in Nursing Research: A negative attitude 1. According to Range: toward borrowed ○ Grand Theory: theories and science Broad conceptual emerged. frameworks reflect wide Focus on defining perspectives for practice nursing and developing and ways of describing, theories about and for explaining, predicting, nursing. and looking at nursing Research focused on phenomena. They are the nurse rather than the most complex and clients and clinical broadest in scope. situations. Examples: Henderson’s 4. Procedural Knowledge (1970s) "The Nature of Nursing," ○ Source of Knowledge: Includes Levine’s "The Four both separate and connected Conservation Principles knowledge. 18  of Nursing," Roy’s Interaction between "Adaptation Model," and nurse and client within Orem’s "Self-Care." the broader dimensions (Marriner-Tomey) of environment, time, ○ Middle Range Theory: space, culture, and Less complex and diversity. narrower in scope than Examples: Theories by grand theory. A more Neuman and Leininger. workable level is the middle range. more limited in scope and fewer variables, and testable Focuses on more specific aspects, such as chronic illness as a stressor in the family. Examples: Peplau’s "Psychodynamic Nursing" and Orlando’s "Nursing Process Theory." ○ Micro Theory: The least complex, dealing with narrow aspects of reality. Specific theoretical statements that are operational for both research and practice purposes. deal with a small aspect of reality, generally a set of theoretical statements. 2. According to Orientation or Focus: ○ Client-Centered Theories: those focused on the needs and problems that clients have which are met, resolved, or alleviated by nursing interventions. Examples: Theories by Nightingale, Abdellah, Henderson, Orem, Roy, Levine, Hall, and Pender. ○ Nurse-Client Dynamics: Focus on interaction between the nurse and client. Examples: Theories by Peplau, Watson, King, and Orlando. ○ Nurse-Client-Environment Dynamics: 19