Nursing History

Florence Nightingale

-Is the founder of modern nursing

• Influenced the development of epidemiology by connecting poor sanitation with cholera and dysentery

• Founded a nursing school and stressed the need for university-based education for nurses

Cholera

• is a serious bacterial infection caused by Vibrio chlerae

• It spreads through contaminated food or water

Symptoms:

• Severe watery diarrhea

• vomiting

• rapid dehydration

• muscle cramps

• weakness

Dysentery

• is an intestinal infection that causes diarrhea containing blood and/or mucus. It can be caused by bacteria (such as Shigella) or parasites (such as Entamoeba histolytica)

Symptoms:

• Bloody diarrhea

• Abdominal pain and cramps

• Fever

• Nausea

• Frequent urge to have a bowel movement

Dorothea Dix

-Led of the U.S Sanitary Commission, which was a forerunner of the Army Nurse Corps.

• Advocated for the mentally ill

• Played an instrumental role in the founding or expansion of more than 30 hospitals for the treatment of the mentally ill

Clara Barton

• practiced nursing during the Civil War and established the American Red Cross

Linda Richards

• was America’s first trained nurse

• Graduated from Boston’s Women’s Hospital in 1873

Lenah Higbee

• Superintendent of the U.S. Navy Nurse Corps

• was awarded the Navy Cross in 1918

Hildegard Peplau (1952)

• focused on the roles played by the nurse and the interpersonal process b/t a nurse and patient

• The interpersonal process occurs in overlapping phases:

1. orientation

2. Working, consisting of two subphases- identification and expoitation

3. resolution

• This theory is used widely in psychiatric nursing and enhances the understanding of changing aspects regarding the goals and roles in the nurse - patient relationship

Nursing Theories

• To enhance nursing as a profession, nursing works to establish itself as a scientific discipline

• demonstrates a theoretical base that reflects its practice

• give substance to the body of knowledge of nursing

Metaparadigm

• concepts of human beings

• health

• nursing

• environment

Philosophy

• A statement about the beliefs and values of nursing in relation to a specific phenomenon such as health

• a philosophy provides guidance in practice

Nursing Theory

• Represents a group of concepts that can be tested in practice and can be derived from a conceptual model

Grand theory - almost as board as the framework

Middle-range theory- directly guide practice

Environmental Theory

• Florence Nightingale’s concept of the environment emphasized illness prevention, clean water, housing

• Nightingale’s theory states that the imbalance b/t the patient and the environment decreases the capacity for health and does not allow for conservation of energy

Humane & Holistic Care Theory

• Virginia Henderson defined nursing as “assisting individuals to gain independence in relation to the performance of activities contributing to health or its recovery

• Her 14 components were based on Maslow’s hierarchy of human needs from the physiologic, psychological, sociocultural, spiritual, and developmental domains

-Described the nurse’s role as (for patient’s independence):

• Subsititutive: doing for the person

• Supplementary: Helping the person

• Complementary: Working with the person

Martha Rogers

• Developed the Science of Unitary Human Beings

• stated that human beings and thier environments are interacting in continuous motion as infinite energy fields.

• Model has 4 dimensions:

1. Energy fields

2. Openness

3. Patterns and organizations

4. Dimensionality

- These are used in developing the three principles:

• Resonancy (continuous change from lower to higher frequency)

• Helicy (increasing diversity)

• Integrality (continuous process of the human and environmental fields)

• The resultant well-being of pattern and organization included a symphonic interaction b/t the patient and the environment

Adaptation Model of Nursing

• Sister Callista Roy’s adaptation model is based on the human being as an adaptive open system

• adapts by meeting physiological needs, developing a positive self-concept-group identity, performing social role functions, and balancing dependence and independence

• The nurse helps patients strengthen their abilities to adapt to their illnesses or helps them adaptive behaviors

Dorothea Orem

Three interrelated theories of self-care, self-care deficit, and nursing systems constitute Forothea Orem’s Self-Care Deficit Therory of Nursing

Self-Care Deficit (Dorothea Orem)

• when patients are unable to meet their self care needs

• nursing systems care for patients who require assistance with:

  • wholly compensatory

  • partly compensatory

  • supportive-education

• Goal of nursing care is to help patients perform self-care by increasing their independence

  • e.g. if patient used to give showers at home independently, they should be allow to give their own showers as well

Imogene M. King

Developed a general system framework that incorporates three levels of systems:

1. Individual or personal

2. Group or interpersonal

3. Society or social

-Discusses the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space

*The nurse and the patient work together to achieve goals in the continuous adjustment to stressors

Holistic Concepts & open System

• Betty Neuman’s Systems Model includes a holistic concept and an open-system approach

• Identifies energy resources that provide for basic survival, with lines of resistance that are activated when a stressor invades the system

• The person has a normal response to stress, known as normal lines of defense, whereas a flexible line defends against unusual stress

-Stressors many be intrapersonal, interpersonal, or extrapersonal

• The nurse’s goal is to assist with attaining and maintaining maximum wellness, focusing on patient’s response to stressors and strengthening their line of defense

Rosemarie Rizzo Parse

• Formulated the Theory of Human Becoming by combining concepts from Martha Rogers’s Science of Unitary Human Beings with existential-phenomenological thought.

• This theory looks at the person as a constantly changing being and at nursing as a human science.

• Today, Parse’s theory is called the Human Becoming School of Thought.

Jean Watson

• Theory is based on caring, with nurses dedicated to health and healing.

• The nurse functions to preserve the dignity and wholeness of humans in health or while peacefully dying. The caring process in a nurse–patient relationship is known as transpersonal caring and includes caratative factors that satisfy human needs.

• Additional concepts include the caring moment or occasion, caring or healing consciousness, and clinical caring processes, such as sensitivity and mindfulness. The practice of nursing focuses on the goals of growth, meaning, and self-healing.

Erikson’s Psychosocial Theory of Development and Socialization

• Based on individuals interacting & learning about their world

• Addressing patient’s developmental stage in r/t meeting holistic needs

Lewin’s Change Theory

A three-step process:

1. Unfreeze: ensures that employees are ready for change

2. Change/Moving: execute the intended change

-Usually the time of translation and confusion

3. Refreeze: Ensures that the change becomes permanent

The nurse Role:

1. Recognize when change is needed

2. Analyzes the situation and look at what is working

3. Identifies methods to use in the change process and analyzes the influence of those involved in the change

Paul’s Critical Thinking Theory

• “intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action”

• Nurses analyze data; develop a patient care plan, implement a plan of action for the patient, and evaluate a care plan

• Involves critical thinking

Rosenstock’s Health Belief Model

-Designed to predict responses of patients to treatment

-Also use to predict more general health behaviors

• Addresses possible reasons for why patient may not comply w/ recommended health promotion behavior

• based on 4 core beliefs of people’s perceptions by thier own assessment:

  • Perceived susceptibility of the risk of getting the condition

  • Perceived severity of the seriousness of the condition and its potential consequences

  • Perceived barriers of the influences that facilitate or discourage adoption of the promoted behavior

  • Perceived benefits of the positive consequences of adopting the behavior

Altruism

the care you show for your patients without expecting anything in return

Body of Knowledge and Research

• There is a well-defined, specific, and unique body of theoretical knowledge in nursing, leading to defined skills, abilities, and norms, that is enlarged by research.

• A profession is distinguished by a specific culture with norms and values common to its members.

• To advance knowledge in their field, professionals publish and communicate their knowledge.

• A profession develops, evaluates, and uses theory as a basis for practice. Nursing has been based on theory since the days of Nightingale. Nursing’s reliance on research for practice is considered EBP.

Accountability

• involves accepting responsibility for actions and omissions.

• has legal, ethical, and professional implications.

• It is essential for developing trusting relationships with patients and co-workers.

• necessary for safe patient care.

• Assessing for and attending to adverse reactions to treatment requires a nurse to be accountable for actions taken.

Higher education

-pursue additional education

Autonomy

the ability to make your own decisions and act independently

• make independent decisions within their scope of practice and are responsible for the results and consequences of those decisions

Code of Ethics

• to guide decisions for practice and conduct

• Ethics is the standards of right and wrong behavior, or moral principles that guide a person’s behavior.

• The ICN and the ANA each have developed a code of ethics for nurses. Public opinion polls show that nurses are admired for their nursing ethics and honesty by rating them the highest of all professionals.

Professional Organization

• support and encourage high standards in nursing.

• Members participate in these organizations, which aim to support and advance nursing.

e.g: ANA

Licensure

is the granting of a license that provides legal permission to practice.

Diversity

“Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity, and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race, or social status”

ANA standards

• the standards of practice, includes six responsibilities for the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation

• focuses on standards of professional performance, which includes ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health

Health literacy

-Is defined in Healthy people 2030 as:

• “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

• Low health literacy is associated with increased hospitalization, greater emergency care use, lower use of mammography, and lower receipt of influenza vaccine

• A goal of patient education by the nurse is to inform patients and deliver information that is understandable by assessing their level of health literacy. The more understandable health information is for patients, the closer the care is coordinated with need.

Evidence-based practice

is integration of the best available research evidence and the nurse’s clinical judgment expertise to make patient care decisions.

• EBP allows a nurse to address questions and problems by reviewing the research, clinical guidelines, and other resources to determine practice.

• EBP results in better patient outcomes, keeps nursing practice current, and increases the nurse’s confidence in professional decision-making

EBP examples

• Identifying research problems when working with patients

• Conducting clinical research to test theories about interventions

• Collecting data in the clinical setting

• Participating on a research committee

• Reviewing research findings to guide EBP

• Sharing research findings

• Using research findings to develop policies, procedures, and standards for patient care at health care facilities

• Incorporating research as part of ongoing learning as nurses