Week 4 - Nursing History & Foundations PDF

NUSC 1P12: WEEK 4 HISTORY OF NURSING, THEORETICAL FOUNDATIONS, & WAYS OF KNOWING (A NEW CONTEXT) (Potter et al., 2024) Ch. 3 & 6 (Chinn & Kramer, 2022) Ch. 1 WHAT DO WE KNOW? WHAT DO WE WONDER ABOUT? What ”context” have we established in our first 2 weeks of classes and readings? What have we not...

NUSC 1P12: WEEK 4 HISTORY OF NURSING, THEORETICAL FOUNDATIONS, & WAYS OF KNOWING (A NEW CONTEXT) (Potter et al., 2024) Ch. 3 & 6 (Chinn & Kramer, 2022) Ch. 1 WHAT DO WE KNOW? WHAT DO WE WONDER ABOUT? What ”context” have we established in our first 2 weeks of classes and readings? What have we not yet explored? What do you know about history (in general?) Why is history important? ­History of nursing vs. your history, your life story for example? Why is your life story/ past relevant to you? How are these things the same or different? What do you imagine or wonder about the history of nursing? CONTEXT Your nursing education should prepare you not for only what is, but also what might be… We do this by: 1. Tracking changing social and political trends and related health care policies 2. Staying abreast of cutting-edge research 3. Studying nursing’s past o By exploring key persons, issues, and events in nursing and how these have changed over time, you can help to envision nursing’s future and your role in shaping it So, let’s look at where we’ve been to better understand where we might be going… CANADA’S HISTORY & NURSING Indigenous Peoples as Healers & Early Settlers •When early settlers came over from Europe, an estimated 500,000 Indigenous people lived in North America •These Indigenous people had knowledge of health, healing, and herbal remedies •As hospitals and health care grew after 1890, cost and distance made accessing this new type of care difficult so Indigenous women played essential roles as midwives, nurses, and caregivers, also caring for many White settlers in Western Canada ­ Outbreaks of disease among settler and Indigenous populations (especially at trade centers), sometimes decimated Indigenous populations with little/ no immunity to these new diseases Early History of Nursing Care (French and Christian Influence) ­ Religious orders provided care (originally male Jesuit priests who were missionary immigrants), then female religious orders (nuns) came over from France to help, responding to their call for assistance CANADA’S HISTORY & NURSING Colonialism ­Caring for the sick being performed by those with a strong religious affiliation aided their mission to spread Christianity as a dominant religion/ belief system, including trying to convert Indigenous peoples to Christianity ­Controlling people (have you heard of oppression and assimilation?) and exploiting geographic areas resulting in a loss of culture, knowledge, traditions, ways of life, role of family and community, spirituality and health, and so on… The Leonard Nurses Home, a residence for nurses, was built to the east of the original St Catharines General Hospital. FLORENCE NIGHTINGALE (1820-1910) Founder of modern nursing. Upbringing was upper class, wealthy and educated. Becoming a nurse (working outside the home) brought shame to her family. Her challenging of social norms helped trigger a shift in public attitudes toward the acceptability of women doing nursing outside the home. Educated as a nurse in Germany in 1850. Worked in England and France with nuns; worked in London at a street hospital. Appointed superintendent of English nurses in Turkey during the Crimean war (1853-56) ­ Arrived to find unsanitary conditions (filth, disease and mortality) and decreased the mortality rate from 42% to 2.2% in 6 months by improving sanitation, hygiene and nutrition. Tracked and evaluated outcomes becoming the first nursing statistician. ­ Saved thousands of lives by promoting comfort, cleanliness, ventilation, sanitary conditions (while also collecting data to support her ideas were right!) Elevated status of nursing and lobbied for standards and education. Started the first School of Nursing in London (1860), and nursing education was born. This was a hospitalbased model with a trained superintendent, staff as instructors, and nursing students who provided the bulk of the care. Nightingale did believe, as was very much accepted at the time, that nursing was women’s work, best practiced under the supervision and guidance of (male) physicians. GENDER & DIVERSITY IN NURSING How did gender and race play a role in defining nurses work during this period? What was a woman’s role in society? What was “women’s work”? •Nursing was initially considered suitable for unmarried, white, Christian women •Discrimination in admission of nursing students that originally would not admit nonwhite, non-English speaking student, nor would they admit men •In the early-mid 1900s, nursing students were segregated based on race (segregated facilities and residences, trained to work in ”their own” communities) ­ Note - patients were also often segregated during these times •Since the 1960s and 70s, the profession has become increasingly aware of the need for gender balance and social diversity in nursing How does gender continue to play a role in the professional identity and public image of nursing in society? THE ROLE AND CHARACTER OF A NURSE Consider the following as “admission criteria” to apply to become a nurse back in 1873. You can see the value of Christianity, obedience, and conformity for nursing students/ nurses (also common societal views at the time, so not unique to nursing). St. Catharines General Hospital in 1873: o Every woman entering the service must give satisfactory evidence of good character and Christian conduct, and of having received the elements of a plain English education…An implicit submission to the discipline of the Home and Hospital and obedience to those in authority there, as well as a strict conformity to rules and regulations, will be exacted. EVOLUTION OF NURSING EDUCATION •St. Catharines Training School (Mack Training School for Nurses) est. in 1874 was the first official training school for nurses in Canada. Started a shift away from apprenticeship under a nun, toward a more formal and medical education. Also used Florence’s system theory on hygiene and medicine. Nurses trained by nurses not nuns. •Based in service and practical skills (2-years) •The end of an era: St. Catharines Hospital was on Queenston St. and closed in 2013 when the new Niagara Health St. Catharines site opened. It was demolished in 2018. ­ This was only 6 km away from Brock University! And here we are… almost 150 years later, right where it all began at the very first nursing school in Canada! ­ What did they learn about then? ­ Chemistry, sanitary science, physiology, anatomy and hygenie. They were taught to observe patients for changes in temperature, skin condition, pulse, respirations, and functions of organs and to report “faithfully” to the attending physician. PAST, PRESENT, FUTURE… Your History & Life Story Look back… where have you been? Who/what influenced you in your life? What has shaped your perspective, what you value, how you see yourself and others? In what ways can you challenge yourself to grow and develop? The History & Origins of Nursing Look back… where have we been as a profession? Who/what influenced nursing over time? What has shaped nursing’s values and how we see ourselves/ the profession, how we see others? In what ways can nursing challenge itself to grow and develop professionally? NURSING THEORY “I HAVE A THEORY…” How do we use and understand this word? What does it mean to us? To science? To nursing? Chapter 6 SETTING THE STAGE CONCEPT o An idea or notion that represents some aspect of personal/human experience o Can be about concrete things we experience through our senses (pain, hunger) o Can be about things that are abstract or not experienced through our senses (spirit, love, grief) THEORY o Comprises a purposeful set of assumptions or propositions that identify relationships between concepts (conceptualization) o Used to describe, explain, or make predictions about a phenomenon (something in the physical and/or social world) o Theory suggests relationships within, between, or among concepts o Provide nurses with perspective from which to view client situations, a way to organize data, and a method of analyzing and interpreting information to bring about coherent and informed nursing practice THE EMERGENCE OF THEORY o Florence Nightingale’s systems for nursing education and practice lay the foundation for the knowledge and practice of nursing to be formalized into a professional context o This early theoretical and conceptual model for nursing provided a frame of reference focused on patients and environment o After WWII, developments in science and technology had a powerful influence on health care and nursing practice, and nursing science began to develop it’s own unique body of knowledge about the practice of nursing (the art + the science) NURSING’S METAPARADIGM Nursing theories are specific to nursing and address relationships among the major key concepts that make up the metaparadigm in nursing. Think about the lines between the components of nursing’s metaparadigm… This is where theories help us to understand (describe, explain, predict) what is happening within and between these concepts… over time.. in various cultural contexts… for an individual patient… etc. Research on professional identity formation for example focuses on the relationship between “person” and “nursing”. METAPARADIGM FRAMEWORK Metaparadigm describes a global way a professional discipline looks at the world (most general statement of a discipline, includes primary and fundamental concepts of interest and importance to nursing). Nursing’s Metaparadigm (Fig. 6-1) CONCEPT OF PERSON CONCEPT OF HEALTH recipient of holistic nursing care; personal characteristics and human needs; unique context of individuals: body, feelings, situation; how actions/ interventions benefit the client intended outcome of nursing care (improve health of individual and society); across the lifespan; remember our definitions of health and wellness (and disease and illness) from Week 1? CONCEPT OF ENVIRONMENT/SITUATION all that affects a person (internal/external context); immediate surroundings; family, social ties, community, health care system and policies impacting health; SDOH CONCEPT OF NURSING variation in interpretations of what nursing should be achieving and how; common ground and underpinnings e.g. caring and relational practice; (CNA) Code of Ethics and nursing values NURSING THEORISTS & NURSING THEORIES Nursing theory represents the body of knowledge that is used to describe or explain various aspects or phenomena found in nursing practice. • Types/Levels of Theory (Table 6-2) o Grand Nursing Theories (broad, abstract, cannot be directly tested) o Midrange/Middle-Range Theories o Narrower in scope o Bridges between grand nursing theories and practice level theories o Focused enough to guide practice and research; general enough to be used across different client populations and concepts; can be “tested” through research and used to support nursing interventions o Descriptive Theory (describes phenomena; cause + effect; why things are as they are) o Prescriptive Theory (practice theories guiding nursing interventions; interventions/actions=consequences) o For use within specific nursing care situations (practical application) o Provide a framework for nursing interventions or activities (how to) o Suggest outcomes or impact of nursing practice, specifically actions and interventions (x=y) CONCEPTUAL FRAMEWORKS ALSO REFERRED TO AS NURSING THEORIES o Goal is to understand how effective nurses systematically organize knowledge about nursing to understand an individual patient’s situation. o Frameworks and models sought to depict theoretical structures that would enable a nurse to grasp a clinical situation within the larger context of available options. o E.g. Nursing process: assessment, planning, intervention, evaluation (more on this in Week 8!) Practice-Based Theories Needs Theories Interactions Theories Systems Theories Simultaneity Theories Reflect issues shaping the role and context of nursing Patient representing a collection of needs based on competing demands (e.g. Maslow’s hierarchy) Nurse-client relationship (self + other) Complexity of human health comprised of interactions between parts (subsystems) and the whole; all in constant interaction with environment o Florence Nightingale (environment crucial to healing) o The McGill Model (health vs. illness; family as context) o Virginia Henderson (14 basic human needs) o Dorothea Orem (selfcare theory, health maintenance) o Hildegard Peplau (interactive/ therapeutic relationship between nsct) o Joyce Travelbee (meaning in illness) o Evelyn Adam (helping process characterized by empathy, caring, mutual respect) o Dorothy Johnson o Martha Rogers (client (behavioural system, 7 not just a person but an subsystems) energy field in constant o University of British interaction with the Columbia Model (9 environment) basic human needs o Rosemarie Parse (nurses shaped by psychological in their patterns of sociocultural relating support environment) individuals in the human o Betty Neuman “becoming” process) (prevention and holistic o Jean Watson (individual care) as embodied spirit of o Sister Callista Roy (ct as evolving consciousness; adaptive vs behavioural caring for healing and system in constant growth) interaction with changing environment) The big picture of the whole client (holistic) as well as nursing’s role in relation to the client AN EXAMPLE THEORY: PEPLAU (A THEORY OF INTERPERSONAL RELATIONS, 1952) o Peplau (1952) looked at interpersonal experiences between nurses and patients o Describes nursing as “an experience lived between human beings” – inspire us to move beyond technical “doing” to ”being” o Understands nursing “happens between people” (emphasizes presence, and awareness to a “with-ness” between nurse and patient) o Nurses needing to be attentively present with people o Begin by asking about the experience of the client/ other (how events/ illness transpired, what was meaningful), vs. jumping into telling them what to do next, and what to do next time o Has evolved to ”Humanistic Nursing” Try to practice these principles in your next conversation with a friend or family member THEORY IN PRACTICE How does looking through a theoretical lens inform your view of “theory”, “nursing”, your own “worldview”? How have we been looking through the lens of relational inquiry in our previous classes? How does doing this extend your capacity and effectiveness as a nurse? What can a theory lead you to question about yourself and your own future nursing practice? WAYS OF KNOWING Chinn & Kramer (2022) Ch. 1 (Brightspace) REFLECT What do you value? What do you know? What is the relationship between the two? Do we gravitate to knowledge when it is related to what we feel is valuable? (ex. of qual/quant research; stats vs. stories) Do nurses do this? Do our clients do this? What does nursing value? What do you believe nurses need to know? Do you find your answer to be grounded in what you value or what the profession values? Or both? If you believe that nurses need to know more than what they learn from classes, textbooks, and articles, where does that knowledge come from? THEORY: WAYS OF KNOWING (CARPER, 1978) Chinn & Kramer’s (2022) “Knowledge Development in Nursing” is based on Carper’s (1978) original theory “Ways of Knowing” (see Chapter 1 posted under Week 3 on Brightspace) Carper’s “Ways of Knowing” (1978): o Empirics: science of nursing o Aesthetics: art of nursing o Personal knowledge: self-awareness and self-reflection o Ethics: moral knowledge in nursing Chinn & Kramer (2008) added a 5th pattern of knowing to the original four of Carper’s o Emancipatory Knowing: being aware of social problems and taking action to create social change Which of these patterns of knowing has been and continues to be a major focus for all health care disciplines, including nursing? Why is a broader understanding critical for a practice discipline? WHAT DO NEW GRADUATES THINK OF THIS? “I think I definitely have a better appreciation for the art of nursing now, like I think I finally get it, or I think I’m getting it now, whereas before I looked at it more superficially, I didn’t really dive in that how much the art side of nursing and the science side of nursing are intertwined, and how without one you wouldn’t get the other.” (Participant “Kelly”) “KNOWING” Chinn & Kramer (2022) suggest “knowing” refers to ways of perceiving and understanding the Self and the world When/how have we already looked at this idea of “perceiving and understanding the Self and the world?” Knowing is fluid and internal to the knower (constantly changing, evolving, situational, subjective, internal). Could this relate to reflection and reflexivity? How then might “knowing” be related to critical thinking? Knowing is a concept linked to ontology (a way of being) that is grounded in and unique to our individual and personal reality (different for everyone) PERSONAL KNOWING o Process of self-knowing (authenticity, wholeness, questioning, biases/assumptions, strengths, values) o Who you are as a person affects your behavior, attitudes, and values both positively and negatively. o Develops from interactions and relationships o Process of reflection in order to understand how your feelings may affect your nursing care o Why it’s important in nursing? o Assists in building therapeutic relationships. o Assists in minimizing biases that interfere with caring for patients. PERSONAL KNOWING EXAMPLE Personal knowing is operating when Luella, an older nursemidwife, recognizes that she has strong negative feelings about young, single mothers that she must contain. Raised in a religious family with conservative political values, Luella is in touch with the source of her negativity and tries to channel it into accepting and understanding the perspective and situation of her young female clients. ETHICAL KNOWING o Ethics in nursing is focused on matters of obligation (duty): what ought to be done. o The moral component of knowing in nursing goes beyond knowledge of the norms or ethical codes of conduct: it involves making moment-to-moment judgments about what ought to be done, what is good and right, and what is responsible. o Ethical knowing guides and directs how nurses morally behave, what they value as being important, what is good and right, and how they navigate ethical dilemmas. ETHICAL KNOWING o Involves clarifying conflicting values and exploring alternatives o May be no satisfactory answer to ethical dilemma o May experience moral distress o Requires experiential knowledge of social values o Ethical principles/codes provide insight (e.g. CNA Code of Ethics, CNO Code of Conduct) ETHICAL EXAMPLE Ethical knowing comes into play when Juan, a nurse working in rehabilitation, learns that a young man in his care has had a family member bring him marijuana, which he uses at home for pain control. Juan must decide whether to “turn a blind eye” or to share this knowledge with the physician knowing it is possible the marijuana could interfere with his other medications, but also wanting his pain to be adequately controlled. AESTHETIC KNOWING o Aesthetic knowing in nursing involves an appreciation of the meaning of a situation. o Allows us to connect with human experiences that are unique for each person: sickness, suffering, recovery, birth, and death. o Expressed through actions, conduct, attitudes, interventions, in relation to others. o “Being with” “with-ness” “in relation”. o Entails drawing on experiences in health/illness; nursing; drawing from different ways of knowing (personal, ethical). AESTHETIC KNOWING o Aesthetic knowledge means o Grasping the meaning of an encounter o Establishing connection- knowing “self” and “other” is fundamental to knowing how to connect, different for everyone, every time o Not what you do, but how do it o Establishing therapeutic relationships o It is often spontaneous, in the moment, intuitive o Helps us know how to deal with circumstances that are unique and unpredictable o Helps us to grow through reflection AESTHETIC KNOWING EXAMPLE Presley works in an orthopedic clinic and uses aesthetic knowing with each young child who comes for cast removal. It is aesthetic knowing that helps him remove the cast in the least distressing way for the child. Presley understands that this child likely sees a large person approaching her leg with an electric cutter and other tools that resemble those in her father’s woodworking shop. Presley might use a combination of distraction and humor as well as careful timing to move through the required interaction and procedure in an artful way. EMPIRICAL WAYS OF KNOWING o Empirics is based on the assumption that what is known is accessible through the physical senses, particularly seeing, touching, and hearing (objective). o Grounded in science and other empirically based methodologies (logical reasoning/systematic methods including testing hypothesis, generating theory, describing phenomena) o Assumes that an objective reality exists and that truths about it can be understood through inferences based on observations and understandings that are verifiable or confirmable by other observers. EMPIRICAL WAYS OF KNOWING Chelsea is a new graduate nurse working in an acute care facility. She uses empirical knowing by reviewing the procedure, important considerations and hospital policy on catheter insertion prior to completing the skill. EMANCIPATORY KNOWING Emancipatory knowing is the human capacity to be aware of and critically reflect on the social, cultural, and political status quo and to determine how and why it came to be that way. o Structural vulnerability o Intersectionality o Racialization o SDOH o Inequalities and justice EMANCIPATORY KNOWING Emancipatory knowing calls forth action in ways that reduce or eliminate inequality and injustice. Examining relations of power-dominance, oppression, marginalization, racialization Why is this important in nursing? o Identifies barriers that prevent health and well-being for all people. o Determines factors (e.g. economic, social, political) causing and sustaining injustices. o Helps nurses to see and “know” in a variety of complimentary ways “PRAXIS” o Nursing involves processes, dynamics and interactions that are most effective when the five knowing patterns come together (empirics, ethics, aesthetics, personal knowing, and emancipatory knowing). o When all are integrated in a way that supports social justice praxis is possible. o “Praxis” requires a nurse to move beyond just practicing (irrigating a wound for ex.) and to engage in processes that undo any social inequities that he or she finds to be present in the health care environment. o The expectation is not for praxis to come out of each and every nursing encounter, but in the context of practice and the profession, we must be aware of situations of injustice, raise awareness of injustices, reflect on situations, and act to improve them whenever possible (in other words, keep an eye on the big picture vs. one task at a time). See (Chinn & Kramer, 2015, p. 2) PRACTICE QUESTION QUESTION Why are theories in nursing important? A. B. C. D. They solve specific and serious patient health problems. They provide a precise method of providing nursing care. They demonstrate how nursing is different from medicine. They provide a systematic view of explaining, predicting, and describing phenomena. D