Theoretical Foundations Of Nursing

THEORY  

 

A group of concepts that describe a pattern of reality. This term is used to signify a conjecture, an opinion, a speculation or a hypothesis. An idea or set of ideas that is intended to explain facts or events. An organized system of accepted knowledge that is composed of concepts, propositions, definitions, and assumptions intended to explain a set of fact, event, or phenomena.

CONCEPT An idea formulated by the mind or an experience perceived and observed such as justice, love, war, disease. Something conceived in the mid; thought; idea.

PROPOSITION Explains the relationships of different concepts. Something that is presented to a person or group to consider A statement to be proved, explained, or discussed.

DEFINITION Composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts.

ASSUMPTION A statement that specifies the relationship or connection of factual concepts or phenomena.

PHILOSOPHY Study of general and fundamental problems The most basic beliefs, concepts, attitudes of an individual or group. A set of ideas about how to do something or how to live.

NURSING THEORY is the body of knowledge that is used to support NURSING PRACTICE. “ Nursing theories are reservoirs in which findings related to nursing concepts, such as comfort, healing, recovering, mobility, rest, caring, enabling, fatigue, and family care, are stored.”

COMPONENTS OF A THEORY CONTEXT – resembles environment to which nursing act takes place CONTENT – subject of the theory PROCESS – method by which nurse acts in using nursing theory

T H E O R Y

Describes Explains Predicts Prescribes

NURSING CARE

NURSING THEORY Differentiates nursing from other disciplines and activities in that it describes, explains, predicts, and controls desired outcomes of nursing care practice

General theories: 

General systems theory



Adaptation theory

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Developmental theory

DIFFERENT TYPES OF THEORIES DESCRIPTIVE Theories – also known as Factor-Isolating theories; primary level of theory development. They identify and describe major concepts of phenomena Their main purpose: to present a phenomenon based on the five sense together with their corresponding meaning

EXPLANATORY THEORIES Also known as Factor-relating theories. They present relationship among concepts and prepositions. Aim to provide information on how or why concepts are related. Cause and effect relationship

PREDICTIVE THEORIES Also known as Situation-relating theories. This kind of theory is generated and tested using experimental research

PRESCRIPTIVE THEORIES Also known as Situation-producing theories Deal with nursing actions, and test the validity and certainty of a specific nursing intervention. Commonly used in testing new nursing interventions.

METATHEORIES Theories whose subject matters some other theories These are theories about theories.

are

GRAND THEORIES Broad in scope and complex and therefore require further specification through research before they can be fully tested. They are intended to provide structural framework for broad, abstract ideas about nursing.

MIDDLE – RANGE THEORIES Have more limited scope, addresses specific phenomena or concepts and reflect practice (administration, clinical or teaching). Quality of life, uncertainty in illness, social support, incontinence, caring.

WHAT IS NURSING? American Nursing Association (ANA) is the “diagnosis and the treatment of human responses to actual or potential health problems.”

International Council of Nurses (ICN) – nursing encompasses “autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disables and dying people...

Association of Deans of Philippine Colleges of Nursing (ADPCN) – Nursing is a dynamic discipline. It is an art and a science of caring for individuals, families, groups and communities ageared toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. It is focused on assisting the client as he or she responds to healthillness situations, utilizing the nursing process.

WHAT ARE NURSING PARADIGMS Patterns or models used to show a clear relationship among the existing theoretical works in nursing. Focus (Metaparadigms): 1. Person/individual 2. Health 3. Environment 4. Nursing

METAPARADIGM Came from the word “meta” a Greek word which means “with” and “paradigm” which means “pattern”. The highest level of knowledge.

Nursing

Person

Health

Environment

PERSON - Refers to all human beings; the recipients of nursing care. - They include individuals, families, communities, and groups.

ENVIRONMENT Factors that affect individuals internally and externally. Also includes setting where nursing care is provided. Ventilation Warmth Noise Light Cleanliness

HEALTH The holistic level of wellness that the person experiences. - It addresses the person’s state of wellbeing.

“goal of all nursing activity should promote client’s health”

NURSING The interventions of the nurse rendering care in support of, or in cooperation with the client. - nurse is responsible in promoting wellbeing of clients by manipulating the environment

WHAT IS PHILOSOPHY IN NURSING? Philosophy is the next knowledge level after metaparadigm. It sets forth the meaning of phenomena through analysis, reasoning, and logical argument.

CONCEPTS The building blocks of theories. Enhances one’s capacity to understand phenomena as it helps define the meaning of a word. ABSTRACT CONCEPTS – indirectly observed or intangible. Eg: love, care, freedom CONCRETE CONCEPTS – directly observed or tangible. Eg: nurse, mother, pain

CONCEPTS CAN BE USED IN MAKING OR FORMULATING: CONCEPTUAL DEFINITIONS = meaning of a word based on how a certain theory or relevant literature perceives it to be. Examples: roles/concepts of a nurse, patient care, environment. OPERATIONAL DEFINITIONS = meaning of a word based on the method of how it was measured or how the person come up with that perception.

CONCEPTUAL MODELS AND THEORETICAL MODELS THEORETICAL MODELS Highly established set of concepts that are testable.

CONCEPTUAL MODELS Representations of an idea or body of knowledge based on the own understanding or perception of a person or researcher on a certain topic, phenomena or theory. Represented thru a diagram or in narrative form which shows how concepts are interrelated.

CONCEPTUAL It is a structure of concepts or theories which are pulled together as a map for the study

THEORETICAL It is a structure of concepts which exist or tested in the literature, a ready-made map for the study

T YPES OF DEFINITION OF CONCEPTS CONCEPTUAL OPERATIONAL Comparable to Specifies exactly definition from a how the concept will literature such as be determined and a dictionary, assess it, also encyclopedia, identifies and journals. procedures and operations significant to determine concepts

SCIENCE  From the Latin “SCIENTIA” meaning “knowledge, refers to any systematic knowledge or practice in a discipline of study. A system of acquiring knowledge based on the scientific method. It is also the organized body of knowledge gained through research.

STEPS Observation Gathering information / data Forming hypothesis Experimental investigation Conclusion or theoretical explanation

KNOWLEDGE  Information, skills and expertise acquired by a person through various life experiences, or through formal/informal learning such as formal education, self-study, vocational

Knowledge is acquired through: Perception, Association, Learning, Reasoning, Communication.

Perception

Achieving understanding of sensory data

Association

Combining two or more concepts/ideas to form a new concept, or for comparison

Learning

Acquiring experience, skills, information and values

Reasoning

Mental process of seeking conclusions through reason

Communication

Transferring data from sender to receiver using different medium or tools of communication

SOURCES

TRADITIONAL KNOWLEDGE – passed down from generation to generation. Example: routine changing of bed linens whether it is soiled or not.

AUTHORITATIVE KNOWLEDGE

An idea by a person of authority which is perceived as true because of his or her expertise. Example: a nurse supervisor teaching a nurse beginner on the proper insertion of a urinary catheter.

SCIENTIFIC KNOWLEDGE Type of knowledge which came from a scientific method through research. These new ideas are tested and measured systemically using objective criteria. Example: A student nurse providing TSB(tepid sponge bath) to a patient with fever – scientific rationale is heat transfer through evaporation.

PHENOMENON Sets of empirical data or experiences that can be physically observed or tangible All natural events that the human senses can perceive can be called PHENOMENON

It is concerned with how an individual person reacts using the human senses concerning their surrounding and assessing the different behavior and factors that affect such behavior.

IN NURSING, PHENOMENA CAN BE: Clinical or environmental setting of nursing – health center Disease process – stomach ulcer Client’s behavior – guarding behavior at the pain site Interventions – care of the client in pain Practices that are utilized in nursing theories and metaparadigms

KEY POINTS

PHENOMENON

An empirical data that can be observed

Concepts

Building blocks of theories which can either be an empirical or abstract data

Conceptual models

Derived from a person’s own point of view

Paradigms

Assumptions

Another term for conceptual framework or model Statements that the theorists hold as factual

Propositions – statements that imply the relationships of concepts Hypothesis – a testable relationship statement Research – use of systematic methods to study a phenomenon and create a general knowledge Induction – a type of reasoning that uses specific details to form a general conclusion

Deduction – a type of reasoning wherein general conclusions are made based from specific concepts.

NURSING as an ART relies on knowledge gained from practice and reflection of past experiences. As a SCIENCE, it is based on scientifically tested knowledge that is applied in the practice setting.

IMPORTANCE OF NURSING THEORIES Aim to describe, predict, and explain the phenomenon of nursing Provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future Help to distinguish what should form the basis of practice by explicitly describing nursing.

Help to provide better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education. Maintains professional boundaries in nursing

PURPOSES OF THEORIES IN PRACTICE Assist nurses to describe, explain, and predict everyday experiences Serve to guide assessment, intervention, and evaluation of nursing care Provide rationale for collecting reliable and valid data about the health status of clients

Help to establish criteria to measure the quality of nursing care Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined. Enhance autonomy of nursing by defining its own independent functions.

IN EDUCATION Provide a general focus for curriculum design. Guide curricular decision making. IN RESEARCH Offer a framework for generating knowledge and new ideas. Assist in discovering knowledge gaps in specific field of study. Offer a systematic approach to identify questions for study.

INTERDEPENDENCE OF THEORY AND RESEARCH NURSING PRACTICE

NURSING THEORY

NURSING RESEARCH

The relationship between nursing theory and nursing research helps in building nursing knowledge.

ACCORDING TO MELEIS 1997

Nursing knowledge is composed of both: 1.Theoretical Knowledge 2.Practical Knowledge

THEORETICAL KNOWLEDGE

Aims to stimulate thinking and broaden understanding of the science and practice of the nursing discipline.

PRACTICAL KNOWLEDGE

Referred to as the art of nursing.

FLORENCE NIGHTINGALE (ENVIRONMENTAL THEORY) PRACTICE = environmental aspects as integral part of nursing care EDUCATION = development of training system in St. Thomas Hospital and King’s College Hospital in London; scientific principles and practical experience in mastery of skills. RESEARCH = invented the “polar diagrams” to analyze and gather data

HILDEGARD PEPLAU (PSYCHODYNAMIC NURSING) PRACTICE = provides clear design for the practice of psychiatric nursing; emphasized the development of interpersonal relationship between the patient and nurse. EDUCATION = formulated effective psychotherapeutic methods RESEARCH = formulated concepts of anxiety as a means to constructively resolve angry feelings

VIRGINIA HENDERSON (14 COMPONENTS OF BASIC NURSING CARE)

PRACTICE = nurses as direct caregiver help patients to become independent. EDUCATION = designed the three phases of curriculum development RESEARCH = recommended library research; advocated research as a way to improve practice

JOYCE TRAVELBEE (HUMAN TO HUMAN RELATIONSHIP MODEL) PRACTICE = hospice is one of her essential contributions; asserted that finding meaning in illness and suffering enables the patient not only to accept illness but it will also served as a self-actualizing experience. EDUCATION = from disease-oriented approach to holistic care approach; nursing programs need to offer much broader background in communication techniques, values clarifications, and care of the dying.

RESEARCH = utilized by various authors in their study of recently diagnosed cancer patients and their personal search for meaning.

BETT Y NEUMAN (SYSTEMS MODEL) PRACTICE = goal-directed, integrated and holistic approach to client care; formulated Neuman nursing process format: Nsg. Diagnosis, Nsg. Goals, Nsg. Outcomes EDUCATION = holistic curriculum; provides an effective framework in conceptual evolution among levels of education of nursing students from diploma to associate to baccalaureate programs.

RESEARCH = guide model to enhance the nursing care of clients with specific physiological stressors.

DOROTHY JOHNSON (BEHAVIORAL SYSTEM MODEL) PRACTICE = used assessement, disorders, treatment, and evaluation instead of nursing process EDUCATION = focuses on the patient as a behavioral system and its dysfunction. RESEARCH = stated that nursing research would “identify and explain the behavioral system disorders which arise in connection with illness, and develop the rationale for the means of management.

IMOGENE KING (GOAL ATTAINMENT THEORY) PRACTICE = developed the Goal Oriented Nursing Record which is used to record goals and outcomes in patient settings. EDUCATION = nursing curriculum development and practice application in Ohio state and other universities. RESEARCH = her work served as a theoretical basis for various studies

DOROTHEA OREM (SELF CARE DEFICIT THEORY IN NURSING) PRACTICE = described nursing management of pertussis; teaching selfcare to diabetic patients and End-stage Renal Failure; pain assessment and control. EDUCATION = came up with the idea of a need for a nursing=specific knowledge structure. RESEARCH = the first instrument developed, named Exercise Self-care Agency which is used to determine the capacity of patients to care for their selves.

FAYE ABDELLAH (T YPOLOGY OF 21 NURSING PROBLEMS) PRACTICE = typology helps in efficient assessment, nursing diagnosis, and planning interventions EDUCATION = provided scientific body of knowledge and filled-in the gaps of weaknesses in nursing education. RESEARCH = believed that evidencedbased practice on scientific data has a great impact in nursing research

SR. CALLISTA ROY (ADAPTATION MODEL) PRACTICE = manipulating the stimuli and not the patient; nurses enhance the interaction person of and their environment thus improving health. EDUCATION = Three vertical strands in the curriculum: the adapting person, health-illness, nursing management; two horizontal strands in the curriculum: nursing process, student adaptation and leadership

MADELEINE LEININGER (TRANSCULTURAL NURSING) PRACTICE: provides human care and health behaviors as background knowledge to understand nursing phenomena; prepares nurses to prevent culture shock and conflicts as they practice in different places with different cultures. EDUCATION = education in transcultural nursing leads to culturally competent nursing care. RESEARCH = focused on cultural care

JEAN WATSON (PHILOSOPHY SCIENCE OF NURSING) PRACTICE = caring as an essential field in nursing; eg: ICU, NICU EDUCATION = described the core of nursing as aspects of the nurse-patient relationship resulting in a therapeutic result RESEARCH = research must focus on both subjective and objective patient outcomes in knowing that caring is important in nursing.

PATRICIA BENNER (FROM NOVICE TO EXPERT: EXCELLENCE AND POWER IN CLINICAL NURSING PRACTICE PRACTICE = formulated the levels of competency in nursing practice EDUCATION = learning needs at an early stage of clinical knowledge are different from those needed in later stage. RESEARCH = extended the study of formal models which direct care and substitute knowledge used in nursing practice

FOUR WAYS OF KNOWING Empirics / empirical = scientific discipline of nursing Ethics / ethical = the moral directions of nursing Personal = method by which nurses approach their patients Aesthetics / esthetics = deals with the emphatic aspect of nursing

EMPIRICAL KNOWING

1. It is a knowing that is base on: a. fact or experience b. it should be objective 2. Empirical evidence is not just facts but RELEVANT facts. 3. Empirical knowing focuses on EVIDENCE-BASED RESEARCH for effective and accurate nursing practice

Any scientific, research-based, theoretical and factual information that the nurse makes use of is under empirical knowing. Example: knowledge obtained from textbooks, lectures, journals, and online resources

EVIDENCE-BASED PRACTICE (EBP)

 Involves accurate and thoughtful decision making about health care delivery for clients. It can bridge the gap of nursing practice and research to provide basis for nurses to transform research into quality care. Promotes quality care

AESTHETIC KNOWING Used in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasizing use of creative and practical styles of care  It is the manifestation of the creative and expressive styles of the nurse.

Used in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasizing use of creative and physical styles of care. Focuses on EMPATHY = the ability for sharing or vividly understanding another’s feelings.

ETHICAL KNOWING  Involves the judgment of right and wrong in relation to intentions, reasons and attributes of individuals and situations.  Requires knowledge of different philosophical positions: “ what is good and right”. The code of morals or code of ethics that leads the conduct of nurses is the main basis for ethical knowing.

PERSONAL KNOWING

Encompasses knowledge of the self in relation to others and to self. Is focused on realizing, meeting and defining the real, true self. One nursing term defines this as “SELFAWARENESS” Involves the therapeutic use of self.