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CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING THEORY HISTORY OF NURSING THEORY -“THEORIA” speculate. Florence Nightingale CHARACTERISTICS OF THEORIES...

CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING THEORY HISTORY OF NURSING THEORY -“THEORIA” speculate. Florence Nightingale CHARACTERISTICS OF THEORIES -envisioned nurses as a BODY OF 1.Theories can INTERRELATE EDUCATED WOMEN at a time CONCEPTS in such a way as to create a when women were neither educated nor different way of looking at a particular employed in public service. phenomenon. 2. Theories must be LOGICAL in nature. Mid 1800’s – “Nursing Knowledge” is distinct from 3. Theories should be relatively SIMPLE MEDICAL KNOWLEDGE (NIGHTINGALE) YET GENERALIZABLE. “Nursing practices” based on “PRINCIPLES 4. Theories can be the bases for AND TRADITIONS PASSED ON” HYPOTHESES THAT CAN BE TESTED. through apprenticeship education and 5. Theories contribute to and assist in common sense wisdom. increasing the GENERAL BODY OF KNOWLEDGE within the discipline through Nursing as a “VOCATIONAL HERITAGE” the RESEARCH implemented to validate more than professional vision. them. 1960’s 6. Theories can be used by the practitioners – debates of proper direction and to GUIDE and IMPROVE their practice. appropriate disciple for nursing knowledge development. 7. Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING MID 1970’S HISTORICAL ERAS Evaluation of 25 years of nursing research CURRICULUM ERA revealed that “nursing lacked conceptual connections and theoretical Moving nursing education from frameworks.” hospital-based diploma programs into COLLEGE AND UNIVERSITIES. Transition from VOCATION TO PROFESSION. RESEARCH ERA Nursing practice (based on Nursing Science) RESEARCH is the path to new knowledge. Part of the curricula of developing graduate programs. 1980’S GRAD.EDU ERA -“Pre- paradigm period-Paradigm period” MASTERS PROGRAM IN NURSING -Introduced ORGANIZATIONAL emerged to meet the need for nurses with STRUCTURE specialized education in nursing. (nursing knowledge development to the Nursing Theory and Nursing nursing literature) Conceptual models were included ascourses in the study of nursing. Utilization phase of the Theory Era THEORY ERA –emphasis shifts from the development to the use and application of what is “Outgrowth of the research era.” known. Research Without theory produced isolated information; however RESEARCH AND THEORY PRODUCED NURSING SCIENCE. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING 2. Importance of nursing conceptualizations SIGNIFICANCE OF NURSING THEORY for the research process Nursing Theoretical Works represents the The role of a conceptual framework in most COMPREHENSIVE ideas and the purpose and design of research SYSTEMATIC knowledge about nursing; production of science and nursing theoretical works also began to be Theory is vital to both the discipline and the published. profession. 3. Nursing scholars such as Henderson, (Alligood, 2014). Nightingale, Orlando, Peplau, and Wiedenbach were recognized for the THE MEANING OF A DISCIPLINE AND A theoretical nature of their earlier writings. PROFESSION THE DISCIPLINE IS DEPENDENT UPON DISCIPLINE: department of learning THEORY or a domain of knowledge. NURSING THEORY: PROFESSION : specialized field of practice - Explains - Describes - theoretical structure of the SCIENCE OR - Predicts KNOWLEDGE - Prescribes =NURSING CARE SIGNIFICANCE FOR THE DISCIPLINE SIGNIFICANCE OF NURSING THEORY 1. University baccalaureate programs FOR THE PROFESSION proliferated, master’s programs in nursing were developed, and the curricula began They PROVIDE A FOUNDATIONAL to be standardized through the KNOWLEDGE OF CARE CONCEPTS that accreditation process. enable those in the profession to explain what they do for patients and the REASONS FOR THEIR ACTIONS. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING This is particularly important because it 6. Attracts individuals with intellectual and helps nurses articulate evidence that personal qualities of exalting service above justifies the methodologies behind their personal gain who recognize their chosen practice. OCCUPATION AS A LIFE WORK. 7. Strives to COMPENSATE its practitioners CRITERIA FOR DEVELOPMENT OF THE by providing freedom of action, opportunity PROFESSIONAL STATUS OF NURSING for continuous professional growth, and economic security. 1.Utilizes in its practice a well-defined and well organized body of SPECIALIZED These criteria have historical value for KNOWLEDGE [that] is on the intellectual enhancing our understanding of the level of the higher learning. developmental path that nurses followed. 2.Constantly enlarges the body of knowledge it uses and improves its techniques of education and service through THE STRUCTURE OF SPECIALIZE use of the SCIENTIFIC METHOD. NURSING KNOWLEDGE 3. Entrusts the education of its practitioners The criterion that called for specialized to institutions of HIGHER EDUCATION. nursing knowledge and knowledge structure was a particularly important driving force in 4. Applies its body of knowledge in practical recognition of nursing as a profession services vital to HUMAN AND SOCIAL (Bixler& Bixler, 1959). WELFARE. The criterion reads: 5. Functions autonomously in the Utilizes in its practice a well-defined and formulation of PROFESSIONAL POLICY well organized body of specialized and thereby in the control of professional knowledge [that] is on the intellectual level activity of the higher learning. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING TYPES OF CONCEPTS: 1. ABSTRACT CONCEPTS: indirectly observed or intangible and is independent of time and place. EX: love, care, freedom. 2. CONCRETE CONCEPTS: are directly observed or tangible. EX: nurse, mother, pain Types of Definition of Concepts : TERMINOLOGY 1. CONCEPTUAL (textbooks) –the meaning of a word based on THEORY- organized system of accepted knowledge how a certain theory perceives it to be. Composed of: 2. OPERATIONAL (methods) a. concept –meaning of a word based on the b. propositions c. definitions method of how it was measured or d. assumptions intended to explain a set of person’s perception. fact, event or phenomena PROPOSITIONS- statements of relationships between and among concepts. CONCEPT - idea formulated by the mind or an DEFINITION- descriptions general meaning experience perceived and observed. and reduces the vagueness. (justice, love, war and disease.) CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING ASSUMPTIONS- specifies the relationship The Metaparadigm of Nursing or connection of factual concepts or 1. PERSON phenomena. The recipient of nursing care, like individuals, families and communities Ex. All patients who are not able to take good care of themselves need nurses 2. ENVIRONMENT all the external and internal aspects of life that influences the person The following diagram explains the relationships of concepts, propositions, 3. HEALTH assumptions and definitions with theory and the holistic level of wellness that the phenomena. person experiences. 4. NURSING the interventions of the nurse rendering care in support of, or in cooperation with the client. Concepts NURSING THEORY Propositions Systemically THEORY Interrelated concepts that are developed from Assumptions Organized various studies of disciplines and related Definition experiences. view PHENOMENA This aims to view the essence of nursing care. Barnum (1994): a complete nursing theory is: CONTEXT : resembles environment to NURSING PARADIGM which nursing act takes place -patterns or models clear relationship among existing theoretical works in nursing. CONTENT : subject of the theory metaparadigm: Greek word, PROCESS : nurse acts in using nursing theory. “meta” - with “paradeigma” - pattern) CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING PREDICTIVE THEORIES OR FOUR CLASSIFICATIONS OF NURSING SITUATION- RELATING THEORIES THEORIES -are achieved when able to describe future according to Function (Dickoff and James, 1968) outcomes consistently. -this kind of theory is generated and tested DESCRIPTIVE THEORIES using experimental research. (“Factor-Isolating Theories”) -deal with nursing actions, and test the -primary level of theory development. validity and certainty of a specific nursing intervention. They identify and describe major concepts of phenomena. This kind of theory is commonly used in testing new nursing interventions Their main purpose is to present a phenomenon based on the five senses CHARACTERISTICS OF A THEORY: together with the corresponding meaning. theories can correlate concepts in such a way as to generate a different way of EXPLANATORY THEORIES or looking at a certain fact or phenomenon. FACTOR-RELATING THEORIES -must be logical in nature. -present relationship among concepts and propositions. -should be simple but generally broad in nature. - provide information how or why concepts are related. -can be the source of hypotheses that can be tested for it to be elaborated. “Cause and effect relationship” are well explained using this theory -contribute in enriching the general body of knowledge through the studies implemented to validate them. -can be used by practitioners to direct and enhance their practice CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING CONCEPTUAL VS THEORETICAL 2. RESEARCH FRAMEWORK there is the development of clear understanding about the quality of life as CONCEPTUAL (own study) well as the management of symptoms structure of concepts or theories (indication that conceptual perspectives which are pulled together as a map are constantly improving) for the study. GRAND THEORIES : (BROAD THEORY) THEORETICAL (existing study) -broad in scope and complex in nature, they a structure of concepts which exist or tested in only assist nursing research in the the literature, a ready-made map for the study. occasional manner. ROLE OF NURSING THEORY MIDDLE-RANGE THEORIES : focuses on the discovery of concepts such as 1. EDUCATION pain, self esteem and learning. -used to develop and guide education in universities and institutions Theoretical concepts from social sciences - foundations of qualitative nursing -were once known to be more strongly research. established in the field of academics than in clinical practice CRITICAL THEORY: is used in the academe to describe theories that In the 1970s and 1980s, many nursing clarify how social structures influence a wide programs identified the major concepts of variety of human experiences from art to in one or two nursing models, organized social practices. these concepts into conceptual framework, and built the entire curriculum around the 3. CLINICAL PRACTICE framework. (Kozier, 2016) - guide critical thinking and decision making in clinical nursing practice. with these models, they come up with unique terms such as: nurses will have a better understanding on the basis and the nature of their work PROGRAM OBJECTIVES and be able to express it clearly in COURSE OBJECTIVES collaboration with other health COURSE DESCRIPTION professionals. PERFORMANCE CRITERIA CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING HISTORICAL DEVELOPMENT OF NURSING Nursing theories strengthen professional THEORY 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. Ex: Leininger’s Transcultural Nursing Theory The more research is conducted, the more learning is gained as to what extent a given theory can be useful in providing knowledge that will enhance client’s care THEORETICAL KNOWLEDGE aims to broaden understanding of science and practice of the Nursing discipline. PRACTICAL KNOWLEDGE referred to as the art of nursing. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING drunken, untrained and inexpert nurse FLORENCE NIGHTINGALE'S causes a stigma and bad impressions about ENVIRONMENTAL THEORY nurses. The novel greatly affects her beliefs about being a nurse and pursue the battle to change the negative stigma about nurses. Florence Nightingale (1820–1910) Intellectuals: -founder of modern nursing, Political leaders greatly affected and influenced -May 12, 1820, (Florence, Italy) her beliefs of changing things as she viewed as -named after her birthplace. unacceptable to society. -“ with the Lamp”, providing care to wounded and ill soldiers Religious Beliefs: For Nightingale, an during the Crimean War action for the benefit of others is called "God's Calling". DUM VIVIMUS, First nursing notes (1860) by florence SERVIMUS. “Notes on Nursing: What it is, What is not” Use of Empirical Evidence: She uses the -basis of nursing practice and research. polar diagram (statistical diagram) in her reports, books and letters. Theories: Environmental Theory, restoration of the usual health status of the She highlighted the use of observation and nurse's clients into the delivery of health the performance of tasks in the nursing care which is still practiced today. education Theoretical Sources Of The theory Environmental Theory: Major Concepts and Definitions Education: Her tutelage by her well educated, intellectual father in subjects such as mathematics and Environment - concepts of ventilation, philosophy provided her with knowledge and warmth, light, diet, cleanliness and noise. conceptual thinking abilities that were unique for She focused on the physical aspects of women of her time the environment. Literature: She believed that "Healthy surroundings Dicken's novel "The Adventures of Martin were necessary for proper nursing Chuzzlewit", a novel that portrays a victorian care." CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING very important.“ “Nursing is an act of utilizing the environment of the patient to assist 6. Any deficiency in one or more of these him in his recovery”. factors could lead to “impaired functioning” (Nightingale 1860/1969) of life processes or “diminished health status.” 5 Essential Components of The, factors posed great significance during A Healthy Environment: Nightingale's time, when health institutions had poor sanitation, and health workers had little 1. pure air education and training and were frequently 2. pure water incompetent and unreliable in attending to the 3. efficient drainage needs of the patients. 4. cleanliness 5. light Also emphasized in her environmental theory is the provision of a quiet or noise- free and warm environment, attending to 1. Pure fresh air - "to keep the air he breathes patient's dietary needs by assessment, as pure as the external air without chilling documentation of time of food intake, and him.“ evaluating its effects on the patient. 2. Pure water - "well water of a very impure kind Nursing Metaparadigm is used for domestic purposes. And when epidemic disease shows itself, persons using Nursing such water are almost sure to suffer.“ -is very essential for everybody's well-being. Notes on nursing focus on the implementation 3. Effective drainage - "all the while the sewer and rendering efficient and effective nursing maybe nothing but a laboratory from which care. epidemic disease and ill health is being installed into the house." Person -The patient is the focus of the environmental 4. Cleanliness - "the greater part of nursing theory. The nurse should perform the task for the consists in preserving cleanliness.“ patient and control environment for easy recovery. She practice nurse-patient passive 5. Light (especially direct sunlight) - "the relationship. usefulness of light in treating disease is CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Health She gives a little focus on the interpersonal -is the being well and using every power that the relationship and nurse caring behavior. person has to the fullest extent. A healthy body can recuperate and undergo reparative process. She believed that the nurse should be moral Environmental control uplifts maintenance of agents. "Think and act like a nurse." health. Professional relationships, principles of Environment confidentiality and care for the poor to improve health and social condition were the focus of her Poor or difficult environments led to nursing care. poor health and disease. Environment could be altered to improve Logical Form conditions so that the natural laws would She used inductive reasoning from her allow healing to occur. experiences and observation which is addressed with logical thinking and Theoretical Assertions philosophy. Prevention of interruption is very vital in the reparative process of the patient. PATRICIA BENNER'S STAGES OF NURSING EXPERTISE Nursing Practice is the application of common sense, observation, perseverance Patricia Benner and ingenuity. “Novice to Expert” theory in 1982. "If the person wants to recuperate, he needs to cooperate with the nurse. Many publications refer to her nursing practice model. Disease came from the organic materials from the patient and environment not on the Current Professor Emerita at the University germ theory. of California, San Francisco Sanitation means the manipulation of the Has taught and been involved in environment to prevent diseases. research since 1979. Nursing is the commitment to the nursing Well published in journals and works. books. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Named one of the American Academy of Using theory in nursing helps us to: Nursing’s. “Living Legends” in August, 2011. Think critically Analyze information and make clinical Purpose judgments Basic overview of nursing theory Explanation of Patricia Benner’s work “From Assist in decision making Novice to Expert” model Relation of Benner’s work to current practices Support excellence in practice Assist novices in becoming experts What is nursing theory? therefore improving patient care A set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or From Novice to Expert Nursing Model from other disciplines and project a purposive, systematic view of phenomena by “Patricia Benner developed a concept known designing specific inter-relationships among as “From Novice to Expert”. concepts for the purposes of describing, explaining, predicting, and/or -nurses develop skills and an understanding prescribing.” of patient care over time from a combination of a strong educational foundation and Many nursing theories incorporate the personal experiences.” four paradigms: nursing, person, health and environment. Benner’s theory identifies five levels of nursing experience: Why is theory important? 1. novice 2. advanced beginner When nursing practice is built on sound 3. competent theories, the profession is strengthened. 4. proficient 5. expert CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Benner’s influences Benner’s Motivation for Novice to Expert Virginia Henderson Nursing practice has been studied primarily Benner has acknowledged that her from a sociological perspective as opposed “thinking has been influenced greatly by to the study of nursing practice itself Virginia Henderson.” Nursing knowledge is accrued over time; it Dreyfus model of Skill acquisition (1980) is embedded in expertise. Thoughts are based on the Dreyfus model. Describes five levels of skill acquisition and development Knowledge has gone uncharted and unstudied because differences between Model showed advancement through the practical and theoretical knowledge have stages by changes in performance been misunderstood Developed by studying chess players and Well charted nursing practice and pilots observation are essential for theory development Benner adapted the Dreyfus model for clinical nursing practice, basis for her work: Novice to Expert. Benner’s Philosophy Benner “proposed that a nurse could gain knowledge and skills without actually learning a theory” Described as “knowing how” without “knowing that” Development of knowledge in nursing is “a combination of knowledge through research and understanding through clinical experience” CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Novice to Expert Benner’s stages of Nursing Proficiency Novice Advanced Beginner Competent Proficient Expert The Novice Begins with no prior experience Taught rules to perform tasks Rule governed behavior is limited and inflexible Being a novice is not exclusive to students- any nurse entering a setting without prior experience with that particular patient population may be limited to the novice level. The Advanced Beginner Can demonstrate marginally acceptable performance Has gained prior experience in actual nursing situations Formulation of guidelines or principles from prior experiences provide guidance in future experiences. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING The Competent Nurse Benner’s Explanation of the Metaparadigm Has been on the job in similar situations for 2-3 Nursing years Person Health Aware of long term goals-- gain perspective Environment from planning their own actions Nursing Become more efficient and organized Benner viewed nursing as the care and study of the lived experience and the The Proficient Nurse relationship of these three elements: Perceives and understands situations as Health whole parts Illness Disease Views patients holistically Has learned what to expect in certain Person situations and how to modify plans as needed “…the person does not come into the world predefined but gets defined in the course of The Expert Nurse living a life” No longer relies on principles, rules or Benner believed that there are significant guidelines to connect situations and determine aspects that make the being. She actions conceptualized these as the roles of: Performances are fluid, flexible, and highly the situation proficient the body personal concerns Expertise comes naturally temporality CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Interdepartmental job changes (e.g. Health medical-surgical nurse transitioning to an Benner focused “on the lived experience of intensive care unit) being healthy and being ill” Health can be assessed Benner in Action Well-being is the human experience of health or wholeness American Association of Critical-Care Nurses Illness is the human experience of loss or (AACN) dysfunction. Synergy Model Environment Developed as a basis for nursing practice Benner uses the term situation rather than environment. Development utilized use of Benner’s “Personal interpretation of the situation is Novice to Expert stages of development bounded by the way the individual is in it.” Combines nursing competencies with A person’s past, present, and future influences characteristics of patients to “enhance their current situation. optimal patient outcomes” (Kaplow, 2002) Relationship of Paradigms to Benner’s Model Patient outcomes will be different at the different levels of the nurse’s The culmination of the four paradigms of nursing expertise. create experiences that nurses utilize to advance through the stages of Benner’s model From Novice to Expert. Clinical Ladder Programs Most are based on stages of clinical Using Benner’s Model in Practice competence of Benner’s (Murphy, 2012) Examples of use in practice: Intention of the ladder Preceptorship is to retain experienced nurses Orientation processes Nursing educational programs Greater rewards at Professional advancement ladders the expert levels than the novice level CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING KATIE ERIKSON’S CARITATIVE CARING THEORY KATIE ERIKSSON developed the Theory of Caritative Caring A Finnish –Swedish nurse Born in November 18, 1943 (Jakobstad, Finland) She graduated at Helsinki, Swedish School of nursing on 1965 On 1967 she completed her Public Health Nursing specialty Master’s Degree Program in Health Sciences at Abo Akademi University Founded the Department of Caring Sciences at Abo Akademi University WHAT IS CARITATIVE? It is the manifestation of the love that “just Conclusion exist”. (Eriksson 1992) This model can be applied to all areas of Caring communication + Caritative Caring nursing. It looks at the education and = TRUE CARING development of a nurse and how they become an expert. It was also using “caritas” when caring for the human being in health and suffering Patricia Benner examined how nurses learn to nurse. CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Caring Culture MAJOR CONCEPTS AND DEFINITION - The concept that Eriksson uses instead of environment Caritas Suffering - Love and charity - An ontological concept described as a human beings struggle between good and evil in a state Caring Communion of becoming - Structure that determines caring reality - Characterized by: intensity and validity and Suffering related to illness by warmth, closeness, rest, respect, honesty, - experienced in connection with illness and and tolerance treatment The act of caring Suffering related to care - the act of making something very special out - a violation of the patients dignity of something less special - it is when the patient is exposed to suffering caused by care or absence of caring Caritative Caring - comprises the ethics of caring the core of Suffering related to life ethics which is determined by the caritas motive - it is in a situation of being a patient, and the entire life of a human being maybe experiencing Invitation - the act that occurs when the career welcomes The Suffering Human Being the patient to the caring communion - The concept that Eriksson uses to describe the patient Reconciliation - The drama of suffering MAJOR CONCEPTS & RELATIONSHIP Dignity - State or quality of being worthy of honor or The Nursing Metaparadigm respect “In the Mind of Katie Eriksson” Human dignity Absolute Dignity Human Being/ Person an entity of body, soul, and spirit CHAVEZ, GRAHZIELLA, G. BSN-101N | THEORETICAL FOUNDATIONS IN NURSING Nursing A career beams forth what Eriksson calls caritas, or the strength and light of beauty Environment -It symbolizes a human being’s innermost space, where he appears in his nakedness (Lévinas, 1989) Health soundness, freshness, and well-being a pure concept wholeness and holiness, it also implies being whole in body, soul, and spirit HOW THE THEORY WAS ACCEPTED BY THE NURSING COMMUNITY -PRACTICE -EDUCATION -RESEARCH