Intro to professional nursing theory (Week 1)

What are assumptions in relation to nursing theory?

-"Taken for granted" statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory. -Accepted as truths and are based on values and beliefs

Orem's Self-Care Theory

-Grand theory -focuses on patient's self-care needs so that patient can mange their own health because this is correlated with better outcomes -Nurses continually assess patient's ability to perform self-care and intervenes as needed to meet patient's needs

The nurse is caring for a patient who is actively bleeding. The health care provider prescribes blood transfusions. The patient is a Jehovah's Witness and does not want blood products. The nurse contacts the health care provider to request alternative treatment. Which theory is the nurse using?

-Leininger's theory -goal is to provide the patient with culturally specific nursing care that integrates the patient's cultural traditions, values, and beliefs into the plan of care. The goal of Roy's model is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependence domains. Watson's theory believes that the purpose of nursing action is to understand the interrelationship between health, illness, and human behavior. The goal of Orem's theory is to help the patient perform self-care.

Peplau's Interpersonal Theory

-Middle range theory -Focus on interpersonal relations between nurse, patient, and patient's family -Phases: preorientation, orientation, working, resolution

Leininger's Culture Care Theory

-Middle-range theory -Theory of cultural care diversity and universality -Integrates patients' cultural traditions, values and beliefs into care plans

4 concepts of Nursing Metaparadigm

-Person: recipient of nursing care -Health: has different meanings for each patient, clinical setting, and health care profession -Environment/ situation: all possible conditions affecting patients and health care settings -Nursing: care of individuals of all ages, families, groups & communities, sick or well

Domain of Nursing

-Perspective or territory of a profession/ discipline -provides both a practical and theoretical aspect of the discipline -gives nurses a comprehensive perspective that allows you to identify and treat patients' health care needs in all health care settings

Nursing is both a _________ and ____________.

-Science: based on data obtained from current research -Art: stems from nurse's experience and unique caring relationship that a nurse develops w/ a patient

practice theories

-Situation-specific theories, bring theory to the bedside -narrow in scope and focus -guide nursing care of a specific patient population at a specific time

Theory is essential to nursing practice because it: (Select all that apply.) 1. Guides nursing practice 2. Formulates health care legislation 3. Provides a means of assessing patient vital signs. 4. Explains relationships between concepts 5. Predicts patient behaviors in situations. 6. Contributes to nursing knowledge.

1, 4, 5, 6

Nursing process is central to nursing practice. Nursing practice: 1. is not adaptable to all patients. 2. is derived from a theory. 3. generates knowledge for use in practice. 4. is a theory.

2. is derived from a theory.

Theory Utilization Era

2000s-today nurses provide evidence based practice stemming from theory, research, experiences; middle-range theories provide evidence for EBP and promoted translation into practice

Which behavior from a nurse indicates the nurse is using Nightingale's theory to plan nursing care? a. Knows all about the disease processes affecting patients b. Focuses on medication administration and treatments c. Thinks about the patients and patients' environments d. Considers nursing knowledge and medicine the same

C. Nightingale's theory provides nurses with a way to think about patients and their environment. Nightingale's concept of the environment was the focus of nursing care, and her firm conviction was that nursing knowledge is distinct from medical knowledge. Nightingale did not view nursing as limited to the administration of medications and treatments.

Nursing theories enhance _______ & ______ for patient care

Communication and accountability

Why integrate theory into practice?

Leads to coordinated care delivery & therefore serves as the basis for nursing

_____theories continue to advance nursing knowledge through nursing research

Middle-range

middle-range theories

more limited in scope and less abstract; address a specific phenomenon

A _____ is a pattern of beliefs used to describe the domain of a discipline

paradigm -links the concepts, theories, beliefs, values, assumptions accepted and applied by the discipline -synonymous w/ "conceptual framework"

Nursing theories focus on the __________________________________of nursing and nursing care

phenomenon

How is theoretical knowledge acquired?

reading, observing, or discussing concepts

What is a phenomenon?

term, description, or label given to describe an idea or responses about an event, situation, process, group of events, or a group of situations ex: caring, self-care, patient response to stress

Theory, Research and practice

-Theory, research, and practice are bound together in a continuous interactive relationship -Nurses develop theories to explain the relationship among variables by testing the theory through research & applying it in practice -Throughout this process new info often comes to light that indicates the need to revise a theory, and the cycle repeats

What is a definition in relation to theory formation?

-Used to communicate the general meaning of the concepts of the theory -Theoretical (define a concept) -Conceptual (define a concept) -Operational (states how concepts are measured) Ex: nursing concept conceptually defines pain as physical discomfort & operationally as a patient reporting a score of 3 or above on pain scale

Broad Theory

-abstract, broad in scope, complex -require further clarification through research so they can be applied to nursing practice -does not provide guidance for specific nursing interventions -provides framework for general global ideas about nursing

Descriptive theories

-define goals of a theory -address nursing interventions for a phenomenon, guide practice change, and predict consequence

Prescriptive theories

-define goals of a theory -address nursing interventions for a phenomenon, guide practice change, and predict the consequences

Theory-testing research

-determines how accurate a theory describes a phenomenon -develops the evidence for describing or predicting patient outcomes

Nightingale's Environmental Theory

-grand theory -linked patient's health status w/ environmental factors -believed nurses should manipulate environment (ventilation, light, decreased noise, hygiene, nutrition) so that nature is able to restore a patient's health

What is a concept?

-help to describe or label phenomena -words or phrases that identify, define, and establish structure and boundaries for ideas generated about a phenomena

Types of theories are classified by _______ or ______

-levels of abstraction -goals of theory

Nursing Theory

-offers well-grounded rationales for how & why nurses perform specific interventions, and for predicting patient behaviors & outcomes -also help you organize, analyze, and interpret data

A nurse is testing meditation for migraine headaches and the expected outcome of care when performing this intervention. Which type of theory is the nurse using?

-prescriptive theory: details nursing interventions (meditation) for a specific phenomenon (migraine headaches) and the expected outcome of the care. Grand theories are broad in scope and complex and require further specification through research; it does not provide guidance for specific nursing interventions. Descriptive theories do not direct specific nursing activities but help to explain patient assessment. A middle-range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations.

What is the relationship between nursing theory and nursing research?

-research validates, refutes, supports and/or modifies theory -theory stimulates nurse scientists to explore significant issues in nursing practice -both build knowledge base for nursing which is then applied to practice

Theory-generating research

-uses logic to explore relationships among phenomena -investigator makes observations to view a phenomenon in a new way

Nursing theories provide nurses with perspectives from which to: 1. analyze patient data 2. link science to nursing 3. formulate legislation 4. predict phenomena

1. analyze patient data

Curriculum Era

1900-1940's nursing transforms from vocation to profession, standardizing nursing education in diploma programs and encouraged nurses to seek degrees; included social sciences, pharm, nursing "arts"

Graduate Education Era

1950-1970's early versions of nursing theories offering more structure to nursing research

Research Era

1950-1970's nurses become more involved in conducting studies and sharing findings

Theory Era

1980-1990s contributed to knowledge development, nursing metaparadigm proposed by Fawcett, creation of nursing journals, conferences, DNO programs

Nightingale

1st nursing theorist

_______theories are the first level of theory development that describe phenomena, speculate on why they occur, and describe their consequences.

Descriptive

T/F: Nursing theories are standardized and do not change over time

False

T/F: Theory of nursing process is used in planning patient care

False

_____ theories help shape and define your practice

Grand

The _____ _______ allows nurses to understand and explain what nursing is, what nursing does, and why nurses do what they do.

Nursing metaparadigm

The patient is newly diagnosed with diabetes and will be discharged in the next day or so. The nurse is teaching the patient how to draw up and self-administer insulin. Which nursing theory is the nurse utilizing?

Orem's theory -goal is to help the patient perform self-care. In Watson's theory, the nurse is concerned with promoting and restoring health and preventing illness. Roger's theory considers caring as a fundamental component of professional nursing practice and is based upon 10 curative factors. Henderson defines nursing as assisting patients with 14 activities until patients can meet these needs for themselves.

Upon assessment, the nurse notices that the patient's respirations have increased, and the tip of the nose and earlobes are becoming cyanotic. The nurse finds that the patient's pulse rate is over 100 beats per minute. According to Maslow's hierarchy of needs, which patient need should the nurse address first?

Physiological

_____ theories help you provide specific care for individuals and groups of diverse populations/ situations

Practice

Theory-based nursing practice

Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice (EBP).

T/F: Evidence based practice results from theory testing research

True

T/F: Integrating theory into practice promotes coordinated care delivery

True

T/F: Nursing knowledge is generated by theory

True

T/F: Nursing theory differentiates nursing from other disciplines

True

What are the components of a theory?

concepts, definitions, assumptions -all explain a phenomenon

Shared Theory

explains a phenomenon specific to the discipline that developed the theory

A nursing theory help to identify the ______, ______, and ______ of practice

focus, means, goals

How is experiential/ clinical knowledge formed?

from clinical experience