Theoretical-Foundations-in-Nursing-intro PDF.pdf

THEORETICAL FOUNDATIONS IN NCM100 NURSING INTRODUCTION Course Description Theoretical Foundations in Nursing deals with the meta concepts of a person, health, environment and nursing as viewed by the different theorists. Likewise, it includes non-nursing theories such as systems, developmen...

THEORETICAL FOUNDATIONS IN NCM100 NURSING INTRODUCTION Course Description Theoretical Foundations in Nursing deals with the meta concepts of a person, health, environment and nursing as viewed by the different theorists. Likewise, it includes non-nursing theories such as systems, developmental and change theories. It presents how these concepts and theories serve as guide to nursing practice. It further deals with health as a multifactorial phenomenon and the necessary core competencies that the nurse need to develop. THEORY Formal statements that are constructed in order to organize ideas and explain events. A set of interrelated constructs(concepts), definitions, and propositions that present a systematic view of phenomena by specifying relationships between variables, with the purpose of explaining and predicting the phenomena.(Kerlinger)  THEORY Systematic explanation of an event in which construct and concepts are identified and relationships are proposed and predictions made (Streubert-Speziale & Carpebter, 2003) Creative and rigorous structuring of ideas that project a tentative , purposeful and systematic view of phenomena (Chinn & Kramer, 2004) A set of interpretative assumptions, principles or propositions that help explain or guide action (Young, Taylor & Repenning, 2001). TYPES OF THEORY 1. Descriptive/Factor-isolating Those that describe, observe, and name concepts, properties, and dimensions. Identifies and describes the major concepts of phenomena but does not explain how or why the concepts are related. Purpose is to provide observation and meaning regarding the phenomena. TYPES OF THEORY Example of descriptive theory: Kidner and Flanders –Stepans (2004) developed a theory model which described the experience of mothers whose pregnancies were complicated with HELLP syndrome ( hemolysis, elevated liver enzymes, and low platelets). A model for the HELLP syndrome: the maternal experience. Kidner MC1, Flanders-Stepans MB. Author information Abstract OBJECTIVE: To describe the experience of mothers whose pregnancies were complicated with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) and to determine if such experiences could be clustered by common themes from which a model could emerge. DESIGN: Retrospective, descriptive, qualitative study utilizing grounded theory analysis. SETTING: Participants were interviewed in their homes via telephone. Participants were from Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, South Carolina, Utah, and Wyoming, representing both urban and rural settings. PARTICIPANTS: Nine self-selected survivors of HELLP syndrome. RESULTS: The essential structure of the experience of HELLP syndrome can be expressed as a circle of no control and not knowing, which included the five themes of premonition, symptoms, betrayal, whirlwind, and loss. The pervading emotions expressed were fear (of death), frustration, anger, and guilt. HELLP syndrome represents a unique maternal experience that can be expressed in a model. TYPES OF THEORY 2. Explanatory/Factor-relating Those that relate concepts to one another, describe the interrelationships among concepts and propositions, and specify the associations or relationships among some concepts. TYPES OF THEORY Example of explanatory theory: Model of chronic dyspnea (Mc Carley, 1999). In this model, dyspnea is defined and described along with physiologic antecedents of chronic dyspnea and consequences of chronic dyspnea.  TYPES OF THEORY 3. Predictive/Situation-relating Achieved when the conditions under which concepts are related are stated and the relational statements are able to describe future outcomes consistently. Example: Experimental research Predict well being among breast cancer survivors TYPES OF THEORY 4. Prescriptive/Situation-producing Should describe the prescription, the consequences, the type of client, and conditions (Meleis, 2005). Those that prescribe activities necessary to reach defined goals. Address nursing therapeutics and consequences of interventions Includes propositions that call for change and predict consequences of nursing interventions. TYPES OF THEORY Example of prescriptive theory: Work by Auvil-Novak (1997) which presented the development of a middle range theory of chronotherapeutic intervention for postsurgical pain based on three experimental studies of pain relief among postsurgical clients. The theory uses time-dependent approach to pain assessment and provides directed nursing interventions to address postoperative pain. NURSING THEORY Creative products of nurses who seek (sought) to thoughtfully describe the many aspects of nursing in many ways that could be studied, evaluated, and used by other nurses. An attempt to explain patterns and relationships found in nursing phenomena. NURSE THEORISTS People who are or have been nurses, have thought deeply about how one might describe the phenomenon of nursing, and then tried in their own way, from their own perspective, to record their thoughts and observations based on professional and personal experiences. Each theory is as uniques as the individual who created it. NURSING PARADIGM Metaparadigm The global perspective of a discipline that identifies the primary phenomena that are of interest to that discipline and explains how the discipline deals with those phenomena in a unique manner (Fawcett, 2000). METAPARADIGM Purpose/Function: To summarize the intellectual and social missions of the discipline and place boundaries on the subject matter of that discipline.  NURSING METAPARADIGM PERSON Refers to a being composed of physical, intellectual, biochemical, and psychosocial needs; A human energy field; A holistic being in the world; An open system; An integrated whole; An adaptive system; and A being who is greater than the sum of his parts. NURSING METAPARADIGM HEALTH Ability to function independently; Successful adaptation to life’s stressors; Achievement of one’s full life potentials; and Unity of mind, body and soul. NURSING METAPARADIGM ENVIRONMENT Typically refers to the external elements that affect the person; Internal and external conditions that influence the organism; Significant others with whom the person interacts; and An open system with boundaries that permit the exchange with human beings of matter, energy and information  NURSING METAPARADIGM NURSING A science, an art and a practice discipline, and involves caring. Goals include:  care of the well;  care of the sick;  assisting with self-care activities;  helping individuals attain their human potential ; and  discovering and using nature’s laws of health NURSING METAPARADIGM NURSING Purposes of nursing care: placing the client in the best condition for nature to restore health promoting the adaptation of the individual facilitating the development of an interaction between the nurse and the client in which jointly set goals are met promoting harmony between the individual and the environment. facilitates, supports, and assists individuals, families, communities, and societies to enhance, maintain, and recover health to reduce and ameliorate the effects of illness. RELATIONSHIPS AMONG METAPARADIGM CONCEPTS 1. Person and Health Nursing is concerned with the principles and laws that govern the life-process, well being, and optimal functioning of human beings, sick or well. RELATIONSHIPS AMONG METAPARADIGM CONCEPTS 2. Person and Environment Nursing is concerned with the patterning of human behavior in interaction with the environment in normal life events and critical life situations. RELATIONSHIPS AMONG METAPARADIGM CONCEPTS 3. Health and Nursing Nursing is concerned with the nursing action or processes by which positive changes in health status are effected. RELATIONSHIPS AMONG METAPARADIGM CONCEPTS 4. Person, Environment and Health  Nursing is concerned with the wholeness or health of human beings, recognizing that they are in continuous interaction with their environment. PHILOSOPHY Study of problems that are ultimate, abstract, and general These problems are concerned with : Nature of existence Knowledge Morality Reason Human purpose PHILOSOPHY Tries to discover knowledge and truth and attempts to identify what is valuable and important. PHILOSOPHY IN NURSING Basis for developing theory and advancing knowledge. Studies the concepts that structure the thought processes of a certain discipline with the intent of recognizing and revealing foundations and presumptions CONCEPTUAL MODELS CONCEPTS Building blocks of theories Can come from an empirical phenomena or any abstraction of how a person perceived an object that is not physically present or observed like charity, caring, patience. CONCEPTUAL MODELS CONCEPTS Can be used in making or formulating a conceptual or an operational definition. CONCEPTUAL MODELS Conceptual definition- meaning of a word based on how a certain theory or relevant literature perceives it to be. Eg., roles,/concepts of a nurse, patient care, and environment. CONCEPTUAL DEFINITION Comparable to a definition from a literature such as dictionary, encyclopedia, and journals E.g., Hospital stay defined as the time during which a person is a registered patient in a certain hospital Ambulation defined as to walk from one place to another or to move about CONCEPTUAL MODELS Operational definition- meaning of a word based on the method of how it was measured or how the person come up with that perception. Example, significance of pain perception and practiced nursing intervention OPERATIONAL DEFINITION Specifies exactly how the concept will be determined and assessed It also identifies procedures and operations significant to determine concepts E.g., Hospital stay defined as the total of days as patient, beginning with admission day and finishing with discharge Ambulation defined as taking 6 steps without assistance CONCEPTUAL MODELS ABSTRACT CONCEPTS Indirectly observed or intangible Independent of time and place Examples: love, care, freedom CONCRETE CONCEPTS Directly observed or tangible Examples: nurse, mother, pain THEORETICAL MODELS/FRAMEWORKS Highly established set of concepts that are testable. A structure of concepts which exist or tested in the literature, a ready-made map for the study E.g. proposed by Lydia Hall, a nurse theorist: CONCEPTUAL MODELS/FRAMEWORKS Representations of an idea or body of knowledge based on the own understanding or perception of a person or researcher on a certain topic, phenomena or theory Can be represented thru a diagram or in a narrative form which shows how concepts are interrelated A structure of concepts or theories which are pulled together as a map for the study SCIENCE From the Latin scientia, meaning “knowledge”, refers to any systematic knowledge or practice in a discipline of study Refers to a system of acquiring knowledge based on the scientific method Organized body of knowledge gained through research  SCIENTIFIC METHOD: STEPS 1. Observation- integration of knowledge and/or phenomenon by a rational/sentient being e.g. Elmer, a nurse-researcher observes a certain nursing phenomena and makes a study about it 2. Gathering information/data- recognition and collecting data for a particular scientific problem or inquiry e.g. His colleague, Dave helps him to gather data thru various methods 3. Forming hypothesis- an attempt to explain or suggest a nature of a phenomenon e.g., They both make a hypothesis, an intelligent guess on the nature of the phenomenon 4. Experimental investigation- a set of examinations done to solve the particular query raised through the hypothesis process e.g., They conduct a survey and interview, and apply statistical treatment on the data 5. Conclusion or theoretical explanation- a statement explaining a set of natural phenomena or a scientific query derived from experimental investigation e.g., Based from the result, they draw a conclusion. As new data emerge, the study is re- examined and verified.  KNOWLEDGE Information, skills, and expertise acquired by a person through various life experiences, or through formal/informal learning such as formal education, self- study, vocational The abstract or workable understanding of a subject or idea What is known in a particular field of discipline or study Facts and information or awareness or familiarity gained by experience of a fact or situation  KNOWLEDGE: COGNITIVE PROCESSES 1. Perception- achieving understanding of sensory data 2. Association- combining two or more concepts/ideas to form a new concept, or for comparison 3. Learning- acquiring experience, skills, information and values 4. Reasoning – mental process of seeking conclusions through reason. 5. Communication- transferring data from sender to receiver using different media or tools of communication  SOURCES OF KNOWLEDGE 1. TRADITIONAL KNOWLEDGE- nursing practice which is passed down from generation to generation; basis of nursing practice- “It’s always been practiced this way.” e.g., the routine practice of changing bed linens whether it is soiled or not (ICU set up) - eventhough no research data to support this, still the practice is adopted in the hospital as important component of providing quality patient care  SOURCES OF KNOWLEDGE 2. AUTHORITATIVE KNOWLEDGE- idea by a person of authority which is perceived as true because of his/her expertise. e.g., a nurse supervisor teaching a nurse beginner (novice) on the proper insertion of a urinary catheter SOURCES OF KNOWLEDGE 3. SCIENTIFIC KNOWLEDGE- came from scientific method through research; new ideas are tested and measured systematically using objective criteria. e.g., nursing student rendering TSB to a patient with fever should know the rationale behind this procedure,i.e., heat transfer through evaporation (basic physics)  PHENOMENON Sets of empirical data or experiences that can be physically observed or tangible such as crying or grimacing when in pain Concerned with how an individual person reacts using the human senses concerning their surrounding and assessing the different behaviors and factors that affect such behaviors All natural events that the human senses can perceive IMPORTANCE OF NURSING THEORY DEVELOPMENT 1. EDUCATION primarily used to develop and guide nursing education in universities and institutions A number of nursing programs recognized the major concepts of some nursing models, structured these concepts into a conceptual framework, and built the complete curriculum around that framework. IMPORTANCE OF NURSING THEORY DEVELOPMENT EDUCATION With these models unique terms came up such as: program objectives, course objectives, course description, and clinical performance criteria which assist and direct the entire education system to create a more comprehensive curriculum Theoretical concepts prepare students for practice as members of the professional community IMPORTANCE OF NURSING THEORY DEVELOPMENT 2. RESEARCH Research in nursing was inspired from different theoretical assumptions or conceptual frameworks in the past Evolution of technology, ideas and emerging nursing issues, interpretations and perspectives were generated to provide answers to questions encountered in practice Critical theory research helps elaborate more on how structures such as race, gender, sexual orientation, and economic class affect experiences and health outcomes of the patients IMPORTANCE OF NURSING THEORY DEVELOPMENT 3. CLINICAL PRACTICE Nurse’s ability is enriched through the help of different nursing theories Theories guide critical thinking and decision-making in clinical nursing practice Nurses will have better understanding on the basis and nature of their work and be able to express it clearly in collaboration with other professionals IMPORTANCE OF NURSING THEORY DEVELOPMENT CLINICAL PRACTICE Nursing theories strengthen professional independence by guiding the deepest and most important part of their practice Nursing theories are always critical in assisting nurses to facilitate questions, reflections and critical thinking in every aspect of care IMPORTANCE OF NURSING THEORY DEVELOPMENT CLINICAL PRACTICE E.g., Leininger’s Transcultural Nursing Theory for developing culturally similar strategies is useful to nurses working with suspected child maltreatment cases  “Practice without theory, like map without route, is blind; theory without practice, like route without map, is empty.” IMPORTANCE OF NURSING THEORY DEVELOPMENT “ Nursing knowledge is composed of both theoretical and practical knowledge.” Theoretical knowledge aims to stimulate thinking and broaden understanding of the science and practice of the nursing discipline. Practical knowledge is referred to as the art of nursing. IMPORTANCE OF NURSING THEORY DEVELOPMENT Knowledge + Skills = Nursing Knowledge + Skills + Attitude + Values = Nursing Science + Art = Nursing FOUR WAYS OF KNOWING 1. EMPIRICAL KNOWING The principal form relating factual and descriptive knowing aimed at the expansion of abstract and theoretical explanations Focuses on evidence-based research for effective and accurate nursing practice E.g., knowledge obtained from textbooks, lectures, journals and online resources FOUR WAYS OF KNOWING 2. AESTHETICS or ESTHETICS KNOWING Related to understanding what is of significance to particular patients such as feelings, attitudes, points of view The manifestation of the creative and expressive styles of the nurse FOUR WAYS OF KNOWING AESTHETICS or ESTHETICS KNOWING Used in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasizing use of creative and practical styles of care Focuses on empathy,i.e., the ability for sharing or vividly understanding another’s feelings FOUR WAYS OF KNOWING AESTHETICS or ESTHETICS KNOWING Includes nurse ‘s ability in changing ways and manner of rendering nursing care based on the client’s individual needs and perceptions Done by knowing the distinctive individual instead as a typical stereotype whole  FOUR WAYS OF KNOWING 3. ETHICAL KNOWING Requires knowledge of different philosophical positions regarding what is good and right in making moral actions and decisions, particularly in the theoretical and clinical components of nursing Deeply rooted in the concepts of human dignity, service and respect for life Lessening suffering, upholding and preserving health FOUR WAYS OF KNOWING 4. PERSONAL KNOWING Encompasses knowledge of the self in relation to others and to self Involves entirety of the nurse-patient relationship Self-awareness Therapeutic use of self ASSIGNMENT: SEPT 19 Bring the following: 1. magazines with varied photos 2. paste /glue 3. short bond paper ( 2-3 pieces) 4. other art materials ( scissors, etc...)