nursing philosophy & theoretical knowledge

Concepts

• abstract ideas or mental images of phenomenom

• can be directly observable or abstract

• building blocks to the formation of theory

Major component to nursing theories

metaparadigm concepts

Theory

a purposeful set of assumptions or prepositions that identify the the relationships between concepts

Conceptual framework

a group of related concepts

The purpose of conceptual framework

• to organize concepts in a meaningful way

• to make sense of information and decision-making processes

The goal of conceptual framework

goal is to understand how effective nurses systematically organize knowledge about nursing to understand and individual patient’s situation

Historical development of nursing theory

• nightingale’s work is considered an early theoretical and conceptual model for nursing

• nightingale - descriptive theory

Who is Florence Nightingale?

she was a visionary leader who provided nurses with a way to think about nursing in a frame of referent that focused on clients and the environment

What did Nightingale find?

she found that unsanitary conditions lead to infections (Crimea)

Assumptions of Nightingale’s practice to approach care

• nurse-patient relationship is important

• environment has a direct effect on the patient

• fresh air, water, cleanliness contribute to good health and recovery

• nurses can act to modify the environment

Ways of knowing

refers to patterns of knowledge application in nursing practice

Totality paradigm person

• made up of biopsychosocial components

• interacts with environment

Totality paradigm health

• defined by norms

• physical, psychological, and social well-being

Totality paradigm nursing

focus is goal orientated care, therapeutic relationships, health promotion, disease prevention

Simultaneity paradigm person

• “person environment” - an irreducible, whole system

• constantly engaged in a dynamic process

Simultaneity paradigm health

• subjective, cannot be measured or quantified

• a value

Simultaneity paradigm nursing

focus is the human lived experience

Components of a theory

• sets of concepts

• definitions

• relationships

• assumptions or prepositions

Type of theories

• grand theory

• middle-range theory

• practice-based theory

Grand theory

theory that is broad in scope

Middle-range theory

theory that is narrower in scope, serving as bridges between grand nursing theories and practice

Practice-based theory

theory designed to guide and shape practice, reflective of what was happening in nursing practice at that time

Nightingale’s environmental theory

• practice-based theory

• emphasized the link between environment and health

• clearly differentiated the role of nursing from medicine

McGill Model

• practice-based theory

• model developed by Dr. Morya Allen

• focuses on promoting health

• focuses on strengths rather than deficits

Needs theories

• conceptualizes the client as a collection of needs

• human behavior can be explained by the competing demands of various basic human needs

• examples: Virginia Henderson & Dorthea Orem

Henderson’s theory

• needs theory

• identified 14 fundamental needs of individuals

• nurses role is to meet these needs

• remains popular in practice today

Orem’s theory

• needs theory

• self-care theory

• the individual is responsible for meeting universal self-care requisites

• focuses on individuals role in maintaining health

• nurses role is to act temporarily for the client

Interactionist theory

• focuses on relationships between nurses and their clients

• defined specific communication techniques and behavioural patterns by which nurses met their clients’ needs

• example: Hildegard Peplau

Peplau’s interpersonal relations model

• focuses on the development of a therapeutic relationship between a nurse and client

• nursing is an interpersonal process; understanding the behaviour of others

The four phases of Peplau’s interpersonal relations model

1. orientation

2. identification

3. exploitation

4. resolution

Systems theories

• accounts for the whole of an entity, its component parts and the interactions between the parts

• allowed nurse theorists to view the individual as an open system in constant interaction with its environment

• examples: sister callista roy

Roy’s adaptation model

• individual seen as a biopsychosocial adaptive system

• responds to needs in four adaptive models

• role of nurse is to manage the stimuli that influence adaptation

The four adaptive models of Roy’s adaptation model

• physiologic

• self-concept

• role-function

• interdependence

Simulanity theories

• characteristic feature of these theories is unitary human being

• viewed individual as an entirely irreductible whole and connected with the universal environment

• examples: Martha Rogers & Jean Watson

Martha Roger’s theory

• individual seen as an energy field

• nursing role is to focus on the life process of a person along a time-space continuum

• object of nursing is to help the client reach maximum health potential

Jean Watson’s theory

• individual is embodied spirit; person-nature-universe as oneness

• nurses must attend to caring

• caring infuses all aspects of a nurse’s role/ draws attention to nursing acts as embodying an aesthetic that facilitated healing and growth

Person-centered care

the individuals’ values and preferences are elicited and once expressed, guide all aspects of their health care, supporting realistic health and life goals

How person-centered care is achieved

achieved through a dynamic relationship among individuals, others who are important to them and all relevant providers

Attributes and criteria of person-centered care

• respect for patient values, preferences, needs

• coordination and integration of care

• information and education

• physical comfort

• involvement of family and friends

• continuity of care

• access to care

• emotional support

What is caring?

• a universal phenomenon

• human capacity or trait

• genuine concern for the good of others despite what one may derive for oneself

• involves honesty, trust, humility, hope and courage

• expresses itself as an emotion or feeling

Why is caring important?

• it qualifies our relationships with others and involves letting the other person grow

• caring reflects what matters to a person

• essential to the health and development of humans

• ensures survival of humanity

Jean Watson - transpersonal caring theory

seven basic assumptions - science of caring model

1. caring can be effectively demonstrated and practiced interpersonally

2. caring consists of factors that result in the satisfaction of certain human needs

3. effecting caring promotes health and individual or family growth

4. caring responses accept a person not only as they are now but what they may become

5. a caring environment is one that offers the development of potential while allowing the person to choose the best action for themselves at a given point in time'

6. caring integrates biophysical knowledge with knowledge of human behavior to generate or promote health

7. the practice of caring is central to nursing

Watson’s ten attributes of caring

1. practice of loving kindness

2. being authentically present

3. cultivation of one’s own spiritual practices

4. helping-trusting relationship

5. being present to and supporting of one’s expression and feelings

6. creative use of self and all ways of knowing

7. engaging in genuine teaching-learning experience

8. creating healing environment at all levels

9. assisting with basic needs, with an intentional caring consciousness

10. opening and attending spiritual dimentions

Strengths-based nursing and healthcare (SBNH)

• a holistic approach to care

• understanding deficits and problems in a broader context

• promotes empowerment, self-efficacy and hope

• primary focus is on health, healing and the alleviation of suffering

Four pillars of SBNH

• person-centered

• empowerment

• relational

• innate capacities

The eight values of SBNH

• health and healing

• uniqueness

• holism and embodiment

• subjective reality and created meaning

• self-determination

• person-environment are integral

• learning, readiness and timing

• collaborative partnership