Theoretical Foundation of Nursing - Week 2 & 3 Lecture PDF

**Theoretical Foundation of Nursing** **Week 2** **Philosophy** - Beliefs and values that define a way of thinking. Generally known and understood by a group or discipline. **Theory** - A belief, policy, or procedure proposed or followed as the basis of action. - Refers to a logi...

**Theoretical Foundation of Nursing** **Week 2** **Philosophy** - Beliefs and values that define a way of thinking. Generally known and understood by a group or discipline. **Theory** - A belief, policy, or procedure proposed or followed as the basis of action. - Refers to a logical group of general propositions used as principles of explanation. - It is also used to describe, predict, or control phenomena. **Concepts** - Concepts are often called the building blocks of theories. They are primarily the vehicles of thought that involve images. **Models** - Are representations of the interaction among and between the concepts showing patterns. They present an overview of the thinking behind the theory - May demonstrate how theory can be introduced into practice. **Conceptual Framework** - Is a group of related ideas, statements, or concepts. - It is often used interchangeably with the **conceptual model** and with **grand theories**. **Proposition** - Are statements that describe the relationship between the concepts. **Domain** - Is the perspective or territory of a profession or discipline. **Process** - Are a series of organized steps, changes or functions intended to bring about the desired result. **Paradigm** - Refers to a pattern of shared understanding and assumptions about reality and the world; worldview or widely accepted value system. **Metaparadigm** - Most general statement of discipline and functions as a framework in which the more restricted structures of conceptual models develop. - Much of the theoretical work in nursing focused on articulating relationships among for major concepts. Four Major Concepts of Nursing Metaparadigm: - **Person** -- is the recipient of nursing care and may include individuals, patient, groups, families, and communities. - **Environment** -- the internal and external surrounds that affect the client. - **Health** -- the degree of wellness or well-being that client experiences. - **Nursing** -- the attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with the client. The ultimate goal of nursing theories is to improve patient care. **History of Nursing Theories** - The first nursing theories appeared in the late 1800s when a strong emphasis was placed on nursing education. Theorists - **Florence Nightingale** -- *Environmental Theory. 1860* - **Hildegard Peplau** -- Theory of Interpersonal Relations. *Nurse-Client relationship. 1952* - **Virginia Henderson** -- *Nursing Need Theory*. Nurse's role as assisting sick or healthy individuals to gain independence in meeting 14 fundamentals. 1955 - **Faye Abdellah** -- Typology of *21 Nursing Problems.* Disease-centered approach to a patient-centered approach. 1960 - **Ida Jean Orlando** -- *Nursing Process Theory*. Reciprocal Relationship Between Patient and Nurse and viewed the professional function of nursing as finding out and meeting the patient's need for help. 1962 - **Dorothy Johnson** -- *Behavioral System Model*. Fostering the efficient and effective behavioral in the patient to prevent illness. 1968 - **Martha Rogers** -- *Unitary Human Being. 1970* - **Dorothea Orem** -- *Self-Care Theory*. It is required of the client is unable to fulfill biological, psychological, developmental, or social needs. 1971 - **Imogene King** -- *Theory of Goal Attainment*. Nurse-patient and patient's environment is for meeting goals towards good health. 1971 - **Betty Neuman** -- *Systems Model*. Stress reduction is the goal of her theory. 1972 - **Sr. Callista Roy** -- *Adaptation Model*. Viewed the individual as a set of interrelated systems who strives to maintain the balance between these various stimuli.1979 - **Jean Watson** - *Human Caring or Philosophy of Caring*. Humanistic aspects with scientific knowledge and nursing practice. 1979 Core Values - **Love of Country -** Prevention & enrichment of environment and cultural heritage. - **Love of People** -- Respect for the dignity of each person regardless of race, creed, color, and gender. - **Caring the Core of Nursing** -- Compassion, conscience, competence, confidence, and commitment. - **Love of God** **Nursing Theories as Applied to Various Areas of Nursing Practice** **Week 3** **Florence Nightingale** - Defined as Nursing as putting the person in the best condition for nature to act, focus was on health and natural healing process, and not one disease and reparation; creating an environment providing conditions for natural healing. **Nursing** - A professional discipline. - A field focused on human health and healing through caring (Smith, 1994). **Ther Knowledge of Discipline** - Nursing Science - Art - Philosophy - Ethics **Application in Practice** - American Nurses Association identifies six Standards of practice: Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation (2004). These identified as nursing process. **Critical Thinking** - Is the disciplined art of ensuring that you use the best thinking you are capable of in any set of circumstances (Paul and Elder, 2002). - Five components by Katoka-Yohira and Saylor, 1994) are: - **Special Knowledge Base** - **Experience** - **Competencies** - **Attitudes** - **Standards** **'The nursing process represents one form of critical thinking'** **Nursing Theory in Clinical Practice** 1. **Florence Nightingale** - Believes the force for healing resides within the human being and if the environment is supportive, humans will seek to heal themselves. 2. **Hildegard E. Peplau** - Focused on Interpersonal Relationship between Nurse and Patient. - **Nurse-Patient Relationship:** - **Orientation Phase** -- engaging the client in explanations and information, and question and answer. - **Identification Phase** -- the client works interdependently, expresses feelings, and begins to feel stronger. - **Exploitation Phase** -- the client makes full use of services offered. - **Resolution Phase --** the client no longer needs professional services and gives up dependent behavior. The relationship ends. 3. **Virginia Henderson** - First defined nursing as doing for other what they lack the strength, will, or knowledge to do for themselves and identified 14 components of care; it is guide to identify the lack of a person's need. 4. **Dorothea E. Orem** - Identified three theories of Self-Care, Self-Care Deficit, and Nursing Systems. - The ability of a person to meet daily requirements is known as Self-Care. - Carrying out those activities is Self-Care Deficit. - Parents serve as dependent care agents for their children - Ability to provide Self-Care is influenced by not limited to age, gender, and developmental state. 5. **Dorothy E. Johnson** - Stated nursing's area of concern is the Behavioral System - It consists of: Subsystem are attachment or affiliative, Dependency, Ingestive, Eliminative, Sexual, Aggressive, and Achievement. 6. **Ida Jean Orlando** - Described a disciplined nursing process. The process is initiated by patient's behavior. - The behavior engenders a reaction in the nurse, described as an automatic perception, thought, or feeling. - The nurse shares the reaction with the patient, identifying it as the nurse's perception, thought, or feeling, and seeking validation of the accuracy of the reaction. 7. **Lydia E. Hall** - Believed the persons over the age of 16 who were past the acute stage of illness required a different focus for their care. - *Care, Core, Cure* - Activities in the care circle belong solely to nursing and involve bodily care and comfort. - Activities in the core circle are shared with all members of the health care team and involve the person and therapeutic use of self. - The cure circle focuses on the disease and the medical care. 8. **Faye G. Abdellah** - Sought to change the focus of care from the disease to the patient, thus proposed patient-centered approaches to care. - Miss Abdellah identified 21 nursing problems, or areas vital to the growth and functioning of humans that require support from nurses when persons are for some reason limited in carrying out the activities needed to provide such growth. 9. **Ernestine Wiedenbach** - Proposed a prescriptive theory that involves the nurse's central purpose, prescription to fulfill that purpose, and the realities that influence the ability to fulfill the central purpose (the nurse, the patient, the goal, the means, and the framework or environment). - Nursing involves the identification of the patient's need for help, the ministration of help, and validation that the efforts made were indeed helpful. 10. **Joyce Travelbee** - concerned with the interpersonal process between the professional nurse and that nurse's client, whether an individual, family, or community. - The functions of the nurse--client, or human-to-human, relationship are to prevent or cope with illness or suffering and to find meaning in illness or suffering. 11. **Myra Estrin** - described adaptation as the process by which conservation is achieved, with the purpose of conservation being integrity, or preservation of the whole of the person. 12. **Imogene M. King** - presented both a systems-based conceptual framework of personal, interpersonal, and social systems and a theory of goal attainment. - The concepts of the theory of goal attainment are interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space. - She emphasizes that both the nurse and the patient bring important knowledge and information to this goal-attainment process. 13. **Martha E. Rogers** - identified the basic science of nursing as the Science of Unitary Human Beings. - The human being is a whole, not a collection of parts. She presented the human being and the environment as energy fields that are integral with each other. The human being does not have an energy field but is an energy field. 14. **Sister Callista Roy** - **Roy Adaptation Model.** - The person or group responds to stimuli from the internal or external environment through control processes or coping mechanisms identified as the regulator and cognator (stabilizer and innovator for the group) subsystems. - The ***Regulator Processes*** are essentially automatic - The ***Cognator Processes*** involve perception, learning, judgment, and emotion. - Results are: physiological--physical mode, self-concept--group identity mode, role function mode, and interdependence mode. 15. **Betty Neuman** - **Neuman Systems Model**. - Systems have three environments---the ***internal***, the ***external***, and the ***created environment***. - The system seeks a state of equilibrium that may be disrupted by stressors. - In the Neuman Systems Model, there are three levels of prevention: - ***Primary Prevention*** - occurs before a stressor enters the system and causes a reaction. - ***Secondary Prevention*** - occurs in response to the symptoms. - ***Tertiary Prevention*** - seeks to support maintenance of stability and to prevent future occurrences. 16. **Kathryn E. Bernard** - focus is on the circumstances that - enhance the development of the young child. - **Child Health Assessment Interaction Model** - The key components are the Child, the Caregiver, the Environment, and the Interactions between Child and Caregiver. 17. **Josephine E. Paterson** and **Loretta T. Zderad** - Humanistic nursing. - Humans are seen as becoming through - choices, and health is a personal value of more-being and well-being. - Humanistic nursing involves dialogue, community, and phenomenological neurology. 18. **Madeleine M. Leininger** - provided a guide to the inclusion of culture as a vital aspect of nursing practice. - Sunrise Model posits that important dimensions of culture and social structure are technology, religion, philosophy, kinship and other related social factors, cultural values and lifeways, politics, law, economics, and education within the context of language and environment. 19. **Margaret Newman** - described health as expanding consciousness. - Important concepts are consciousness (the information capacity of the system), pattern (movement, diversity, and rhythm of the whole), pattern recognition (identification within the observer of the whole of another), and transformation (change). - Proposed (with Sime and Corcoran-Perry) the unitary--transformative paradigm in which human beings are viewed as unitary phenomenon. These phenomena are identified by pattern, and change is unpredictable, toward diversity, and transformative. 20. **Jean Watson** - described nursing as human science and human care. - Her clinical caritas processes include practicing loving- - kindness and equanimity within a context of caring consciousness; being authentically present and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared-for; cultivating one's own spiritual practice and transpersonal self, developing and sustaining helping-trusting in an authentic caring relationship. - The Transpersonal Caring Relationship seeks to provide mental and spiritual growth for both participants while seeking to restore or improve the harmony and unity within the personhood of the other. 21. **Rosemarie Rizzo Parse** - developed the theory of - Human becoming within the simultaneity paradigm that views human beings as developing meaning through freedom to choose and as more than and different from a sum of parts. 22. **Helen C. Erickson, Evelyn M. Tomlin,** and **Mary Ann P. Swain** - presented the theory of Modeling and Role-Modeling. - Modeling requires the nurse to seek an understanding of the client's view of the world. - The art of modeling involves the use of empathy in developing this understanding. - The science of modeling involves the use of the nurse's knowledge in analyzing the information collected to create the model 23. **Nola J. Pender** - developed the ***Health Promotion*** - Model (revised) with the goal of achieving outcomes of health-promoting behavior. 24. **Patricia Benner** - described expert nursing practice and identified five stages of skill acquisition as novice, advanced beginner, competent, proficient, and expert. 25. **Juliet Corbin** and **Anselm L. Strauss** - developed the ***Chronic Illness Trajectory Framework*** - in which they describe the course of illness and the actions taken to shape that course. The phases of the framework are pre- trajectory, trajectory onset, stable, unstable, acute, crisis, comeback, downward, and dying. 26. **Anne Boykin** and **Savina Schoenhofer** - present nursing as caring in a **grand theory** that may be used in combination with other theories. - Persons are caring by virtue of being human; are caring, moment to moment; are whole and complete in the moment; and are already complete while growing in completeness. - Nursing as a discipline is a being, knowing, living, and valuing response to a social call. - As a profession, nursing is based on a social call and uses a body of knowledge to respond to that call. The focus of nursing is nurturing persons living in caring and growing in caring. 27. **Katharine Kolcaba** - Developed a **comfort theory** in which she describes comfort, comfort care, comfort measures, and comfort needs as well as health-seeking behavior, institutional integrity, and intervening variables. 28. **Ramona Mercer** - Describes the process of becoming a mother in the four stages of: - 1\. commitment, attachment, and preparation; - 2\. acquaintance, learning, and physical restoration; - 3\. moving toward a new normal; - 4\. and achievement of the maternal identity. 29. **Afaf Meleis** - In her theory of transitions, identifies four types of transitions: developmental, situational, health--illness, and organizational. - Properties of the transition experience include awareness, engagement, change and difference, time span, critical points, and events. 30. **Merle H. Mishel** - describes uncertainty in illness with the three major themes of antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. - Antecedents of uncertainty are the stimuli frame, including symptom pattern, event familiarity, and event congruence. - Cognitive Capacity or Informational Processing Ability; and structure providers, such as education, social support, and credible authorities.