Nursing Final

Philosophies

Definitions of nursing in general; system of beliefs regarding morality, ethics, how world should be viewed

Grand Theories

Discussions of broad nursing practice areas

Why Are Theories Important in Nursing?

Provide structure and order for guiding and improving professional practice, teaching, learning and research

Two major schools

Columbia and Yale

Why Theories Were Developed

hospital-based training schools → universities

How Theorists Created Theories

* Began with Flo and her astute observations of actual nursing practice environments (fresh air, clean bandages).
* Notes on Nursing: What it is and what it is not (1859)

Logical Positivism

scientific method

* proven through rigorous observation + experimentation
* accepting a process rather than a solution or discovery of truth

Postmodern

beginning to accept phenomena, not always being concretely measured or quantified through Logical Positivism

When did theories begin?

1950’s and 1960’s (same time doctoral programs were established)

Columbia University

used biomedical model concentrating on role of nurses

Yale University

focus was on nursing as a process

Qualitative

scientific method; expressed in terms of language (what is the lived experience of..)

Quantitative

counted and measured

Examples of phenomenon in nursing

grieving, happiness, depression

Basic Understanding of Theory

1. Concepts that list/classify nursing components?
2. Does theory define person, health, environment, nursing?
3. What is the theory trying to describe?
4. Types of definitions:

a) theoretical

b) operational


5. Links between terms, concepts, etc. 
6. How are concepts organized

Evaluate the Theory

* Does the theory make sense 


* Is the theory clear
* Is it easily explainable 
* How general is it 
* How much research exists in current literature using theory 
* If you used the theory would it impact your practice 

Nursing philosophies

How does nursing fit into the universe

Nursing philosophers

Nightingale, Henderson, Wiedenbach and Watson

Florence Nightingale

* Preferred to serve humankind vs. traditional Victorian marriage
* 1854 went to Crimean War with 38 nurses
* Mortality rate 60% → 1%
* led to training schools

Flo’s definition of nursing

* Nursing is **independent, yet parallel profession to medicine** 


* All factors in patient’s environment influence healing 
* Recognize negative factors, correct them
* Highly trained/educated
* Dignified, highest moral character 

Virginia Henderson

* International Council of Nurses requested her assistance to define nursing

What is Henderson’s definition of nursing?

nurse is an independent practitioner with expertise in aiding the patient to become as independent as possible

Wiedenbach

* wrote for the American Journal of Nursing
* best known for theory development + maternal child nursing

Wiedenbach’s Four Elements of Clinical Nursing

1. philosophy: relevance for the gift of life, respect for dignity, resolution to act on personally + professionally held beliefs.
2. purpose: overall goals for professional practice
3. practice: observable nursing actions
4. art: nurse’s understanding of patient’s condition, goals are meant to enhance patient capability, improvement of patient’s condition, prevention of recurrence

Five Terms Used to define Nursing Practice

1. Patient: entered healthcare system and is receiving care, teaching or advice
2. Need For Help: anything that helps the patient cope with situations affecting health/wellness
3. Clinical Judgment: likeliness to make sound decisions. Improves with knowledge and experience
4. Nursing Skills: acts carried out to improve health
5. Person:(nurse or patient)endowed with unique potential

Jean Watson’s Theory of Caring 3 Main Elements

* **Clinical caritas**


* **Transpersonal caring**
* **Caring moments/caring occasions** 

10 Clinical Caritas Processes

1\. Practice loving kindness and equanimity

2\. Be authentically present

3\. Cultivate your own spiritual practice

4\. Develop authentic caring relationship

5\. Support expression of feelings to connect

6\. Creative use of self to engage in artistry

7\. Engage in teaching-learning experience

8\. Create healing environment

9\. Assist with basic human needs

10\. Attending to spiritual-mysterious dimensions life-death: soul care

Jean Watson’s def of nursing

* Core of intentional caring intertwined with excellent skills \\
* Nurse/patient equally valued
* Connections between nurse/patient
* The Theory of Human Caring sought to balance the orientation of medicine

What were Levine’s intentions behind her theory of conservation?

* **unintentional**


* wanted to **teach major concepts in medical-surgical nursing**
* wanted to refocus nursing education practices on **active problem-solving and individualized patient care**

Conservation

state in which an individual’s adaptive responses confront change productively and with the least expenditure of effort, while preserving optimal function and identity; achieved through successful activation of adaptive pathways

Three Factors That Influence Conservation

Historicity, Specificity, and Redundancy

Historicity

Adaptive responses are partially based on personal and genetic past history

Specificity

Each system within a human being has unique stimulus-response pathways; responses.

Redundancy

If one system is unable to ensure adaptation, another pathway may take over and complete the job.

Four Principles of Conservation

* conservation of energy
* conservation of the structural integrity
* conservation of the personal integrity
* conservation of the social integrity

Betty Neuman’s General Systems Theory

* World comprised of connected systems that exert influence on one another


* Disruption in one system will affect all associated systems
* Larger systems may be comprised of layers of smaller systems

What were Neuman’s intentions behind her model of general systems?

* To assist in teaching nurses in the 1970s


* To provide a “**unifying focus for a wide range of nursing concerns**”

Human’s Response System (

* Alarm


* Resistance or adaption 
* Exhaustion
* Adjustment or healing

Philosophic Base of Neuman Systems Model

* Nursing paradigm: Person, Environment , Health, Nursing


* Wholism
* Wellness orientation
* Client perception and motivation
* Dynamic systems perspective to mitigate possible harm from internal/external stressors
* Partnership between caregiver and client

Sister Callista Roy

worked as an educator

Sister Callista’s RAM two concepts

system and adaptation

System

Grouping of units that are related and connected, forming a unified whole. May be individual, family, group, community, or society

Adaptation

Effective coping mechanisms that promote integrity for a person, or groups, for survival, growth, reproduction, mastery

Four Modes of Adaptation (RAM)

* 1. Physiologic–physical adaptation
* 2. Self-concept-group identity adaptation 
* 3. Role Function adaptation
* 4. Interdependence adaptation

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Four Major Concepts of RAM

1. Humans are wholistic, adaptive systems as both individuals and groups.
2. 2. The environment is made up of internal and external stimuli from around the individual or group system.
3. Health: “A state and process of being and becoming an integrated whole as a human being.”
4. Goal of Nursing: Promote the 4 modes of adaption

Dorothea Orem's Theory of Nursing

* **1. Theory of Self-Care**


* **2. Theory of Self-Care Deficit** 
* **3. Theory of Nursing System**

4 aspects of self-care

* self-care
* self-care agency
* basic conditioning factors
* therapeutic self-care demand

Self-care

What people plan and do on their own behalf to maintain life, health, well-being

Self-care agency

Person’s acquired ability to engage in self-care

Basic conditioning factors:

Affect self-care agency; include age, gender, developmental/ health state, sociocultural factors, healthcare system factors, family system factors, patterns of living, environmental factors, adequacy/ availability of resources

Therapeutic self-care demand

What is needed at various times when health care is required to meet self-care needs through use of appropriate actions and interventions

Self-Care Deficit

Occurs when adults or parents with dependent children are incapable of providing continuously effective self-care

Nursing Systems

Designed by nurses based on an assessment of the individual’s self-care needs

Madeleine Leininger’s Culture Care: Diversity and Universality Theory

* Addresses the cultural dynamics that Influence the nurse–client relationship


* Uses a wholistic and comprehensive approach
* Provides care measures that are in harmony with an individual’s or group’s cultural beliefs, practices, and values
* Requires the coparticipation of the nurse and client in the identification, planning, implementation, and evaluation of each caring mode for culturally congruent nursing care

Transcultural Nursing (Madeleine Leininger)

area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health

Culturally Competent Nurses

Consciously address the fact that culture affects their interactions with clients.

Origins of Orlando Pelletier's Theory

* Collected data while observing nursing students and patients (project grant entitled “Integration of Mental Health Concepts in a Basic Curriculum”)
* Reported findings in book The Dynamic Nurse–Patient Relationship
* Nurse–patient relationship is reciprocal, or the actions of one affect the other
* Patient is the participant

Three Concepts of Theory middle range theory

1. Nursing process is set in motion by patient behavior. 
2. Patient behavior stimulates a nurse reaction
3. Professional nursing actions are nursing-care activities that result from deliberative activity.

Automatic nurse action

Does not meet the criteria for professional nursing behavior.

Deliberative nursing action

Professional nursing actions

Orlando-Pelletier’s Origami

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* Patient behavior


* Nurse reaction
* Nurse action

Kolcaba’s Definition of Nursing’s Function

middle range theory (comfort)

Three Types of Comfort

Relief

* State of a patient who has had a specific need met 

Ease

* State of overall calm and contentment 

Transcendence

* State in which a person rises above problems and pain

Four Contexts of Comfort

Physical: Pertains to bodily sensations and homeostatic mechanisms

Psychospiritual: Pertains to internal awareness of self (esteem, sexuality, life’s meaning, relationship to higher being)

Environmental: Pertains to external surroundings, conditions, and influences

Sociocultural: Interpersonal, family, societal relationships

Intervening Variables

Factors that influence a patient’s perception of total comfort

Four Assumptions of Theory

1. Humans have holistic responses to complex stimuli.

2\. Comfort is a holistic outcome of effective nursing care.

3\. Humans need comfort; will seek it wherever possible.

4\. Nurses are able to identify comfort needs and design comfort Measures

What were Nola Pender’s intentions Behind Health Promotion Model?

noticed that health professionals only intervened after a person was ill

Factors That Influence Behaviors

Prior related behavior, personal factors, perceived benefits of action, perceived self-efficacy result in lowered, activity-related effect, interpersonal influences, situational influences, commitment to a plan of action, immediate competing demands, competing preferences

Pender’s Model

Assessment, planning, implementation, evaluation

Assessment (Pender’s Model)

The nurse gathers data related to prior behavior, personal factors, patient perceptions, and competing demands

Planning

the nurse and the patient work together to develop a health promotion plan

Implementation

incorporation of the health-promoting behavior into the patient’s routine

Evaluation

based on actual incorporation of the health-promoting behavior into the patient’s life

Hildegard Peplau

* Taught at Rutgers University
* Contributed greatly to development of psychiatric nursing and advancement of nursing as profession
* Published Interpersonal Relations in Nursing describing the relationship between nurse and client caused paradigm shift

Peplau’s def of nursing

significant, therapeutic, interpersonal process that functions cooperatively with other human processes that make health possible for individuals. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality

Three Areas of Nurse’s Focus

* Observation of own behavior
* Observation of behaviors demonstrated by patient
* Type and quality of relations between nurse and patient

Phases of Nurse–Patient Relationship

Orientation Phase, Working Phase, Termination Phase

Orientation Phase

* Nurse and patient get acquainted


* Nurse clarifies expectations and patient’s expectations
* Nurse uses active listening skills

Working Phase

* Period Of Intense Interaction


* Nurse Assume Multiple Roles As Needed
* Nurse may mature professionally via self-appraisal

Termination Phase

* Nurse and patient summarize work accomplished and move toward closure
* Conclusion Of Discharge planning

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Imogene King’s Conceptual System

Goal of nursing is to assist individuals to attain, maintain, or restore their health.

* Relationships between the personal,interpersonal, and social systems (dynamic systems) make up King’s Theory of Goal Attainment

society

social systems

groups

interpersonal systems

individuals

personal systems

Theory of Goal Attainment (Imogene King)

nurse and patient communicate information, set goals together, and then take actions to achieve those goals

Patricia Benner

* Published Educating Nurses: A Call for Radical Transformation
* Influenced by Virginia Henderson

Benner’s Model of Skill Acquisition in Nursing

* Describes the process by which nurses learn to practice nursing

7 Domains of nursing practice from Benner’s Model

1. Helping role
2. Teaching-coaching function
3. Diagnostic–patient monitoring function
4. Effective management of rapidly changing situations
5. Administration and monitoring of therapeutic interventions and regimens
6. Monitoring and ensuring the quality of healthcare practices
7. Organizational and work role competencies

Caring is primary to nursing because…

Sets up what matters, creates an enabling condition of care, sets up possibility of giving help

Afaf Ibrahim Meleis Origins of Transitions Theory

interviewed women around the globe regarding transitions in their lives and how they related to their health.

Transitions

A passage from one life phase, condition, or status to another; a multiple concept embracing the elements of process, time span, and perception.

Five different types of transitions

* Developmental 


* Situational
* Health
* Illness
* Organizational

Interventions

Include clarifying roles, goal setting, providing expertise, role modeling, providing resources, accessing reference groups, debriefing, and rehearsing

Martha Rogers Science of Unitary Human Beings

* Humans are energy fields identified by patterns.
* Physiological information and social context do not impart an understanding of unitary human beings.

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Nine assertions of Science

* Wholeness
* Openness
* Unidirectionality
* Pattern and Organization
* Sentience Thought
* One Energy Field
* Universe of Open Systems
* Patterns,
* Pandimension

Person

More than a sum of parts; impossible to divide into parts and understand whole person

Environment

Each human field pattern is unique and intertwined with its distinctive environmental field pattern.

Nursing

Organized body of abstract knowledge, used for purpose of assisting human beings to move in direction of maximum well- being

Function of nursing

Recognizing patterns of energy in client and self, then mutually acting to guide and redirect those patterns to support optimum functioning

Margaret Newman’s Health as Expanding Consciousness

Is first that of person, surrounded by family, then community, world, and endless other patterns, making an infinite whole