NSG 6604 Final
Discuss the history of nursing through the years, from Nightingale to modern day (to include the patterns of knowing) a. Define the 5 patterns of knowing (Carper)?
1. Emancipatory Knowing: praxis of nursing - Human capacity to be aware of and critically reflect on the social, cultural, and political status quo and to determine how and why it came to be that way. Calls forth action in ways that reduce or eliminate inequality and injustice. Awareness and critical reflection are essential to identify the inequalities that are embedded in social and political institutions, as well as to identify the cultural values and beliefs that need to change to create fair and just conditions for all 2. Ethics: moral component of nursing - Focused on matters of obligation: what ought to be done. Moral component of knowing in nursing goes beyond knowledge of the norms or ethical codes of conduct: it involves making moment to moment judgements about what ought to be done, what is good and right, and what is responsible. Guides and directs how nurses morally behave in their practices, what the select as being important, where their loyalties are placed, and what priorities demand advocacy - Attitudes and knowledge derived from an ethical framework, including an awareness of moral questions and choices. Determining whether moment to moment nursing decisions are morally responsible and deliberately positive 3. Personal Knowing: the self and other in nursing - Concerns the inner experience of becoming a whole, aware genuine Self. Encompasses knowing one's own self and self in relation to others. Full awareness if self in the moment and in the context of interaction makes possible meaningful, shared human experience. - Knowledge and attitudes derived from personal self-understanding and empathy, including imagining one's self in the patient's position. Being able to recognize one's own bias and understandings of the world and placing the patients' needs above those, recognizing that the individual may need something outside the norms of care, not always in agreement with our own beliefs 4. Aesthetics: art of nursing - Involves an appreciation of the meaning of a situation and calls forth inner resources that transform experience into what is not real, thus manifesting something that would not otherwise be possible. Allows one to move beyond the surface to sense the meaning of the moment and to connect with human experiences that are unique for each person: suffering sickness, etc. Expressed by the individual nurse through her creativity and style in designing and providing nursing that is effective and satisfying. Empathy is important part. 5. Empirics: science of nursing - What is known is accessible through the physical senses (esp. seeing, touching and hearing). Can be traced to Nightingale's precepts regarding the importance of accurate observation and record keeping. Grounded in science and other empirically based methodologies - Developing abstract and theoretical explanations. Publicly verifiable information. Principles of explanation
Theory Development Process
Is a process that primarily involves induction, deduction and retroduction
Why is theory development necessary in nursing?
It helps provide knowledge to improve practice by describing, explaining, predicting and controlling phenomena. Nurse power is increased through theoretical knowledge: systemic methods are more successful. Provides professional autonomy by guiding the practice, education and research functions of professions. The study of theory helps develop analytical skills, challenge thinking, clarify values and assumption and determine purposes for nursing practice, education, and research.
3. Define and distinguish between concepts and theories Concept -
complex mental formulation of experience: major component of theory and convey the abstract ideas within the theory
theory model -
logical grouping if related concepts that is usually created to draw together several different aspects that are relevant to a complex situation, such as a practice setting or an educational program; this term is used synonymously with conceptual framework; a knowledge form within the empirics patterns
conceptual model -
logical grouping of related concepts or theories that is usually created to draw together several different aspects that are relevant to a complex situation, such as a practice setting or an educational program ; term used synonymously with theoretic framework; knowledge form within the empiric pattern
Metaparadigm -
most abstract level of knowledge. In nursing this is main concepts that encompasses the subject matter and the scope of the discipline. Central concepts of person, environment, health, and nursing
Deduction
• A form of logical reasoning that progresses down from general to specific. • Start with a medical diagnosis and identify specific signs & symptoms
Conceptual Model
• Are made up of abstract and general ideas (concepts) and propositions that specify their relationships • And integrate those concepts into a meaningful configuration (Fawcett)
Phenomena
• Comprise the subject matter of a discipline (grief, caring, etc) • A thing, fact, situation, or event of scientific interest susceptible to scientific description and explanation.
How Does Theory Contribute To the Scientific Base of A Discipline?
• Conceptual models and theories present different views of a phenomenon. • Linking the results of research together, leading to cumulative scientific knowledge • Providing frameworks by which to study concepts and variables • Provide a framework that allows interpretation of research findings beyond the specific data
Concept
• Is a complex metal formulation of an object, property or event that is derived from individual perceptual experience (Chinn & Jacob, 1987) • It is an idea, a mental image or a generalization formed and developed in the mind • Concepts label phenomena • Abstract Concept: completely independent of time or place. Temperature for example, is an abstract concept • Concrete Concept: specific to time and place, such as the body temperature of a specific person, at a specific time, on a specific day
Induction
• Is a form of reasoning that moves up from the specific to the general • Example..start with a list of signs and symptoms and end up with a medical diagnosis
Theory
• Is a set of two or more concepts, definitions, and propositions that project a systematic view of phenomena by designing specific interrelationships among concepts for purposes of describing, explaining, and predicting (Chinn & Jacob, 1987; Fawcett, 2000) • Generally, applicable in clinical practice. • The facts need to be ordered in a cohesive body that will result in an organized body of knowledge. • Provide a description, prediction, understanding and explanation of phenomena (Kim) • Theories allow one to explain past events, provide a sense of understanding about current events, predict future events and provide the potential for controlling them • Nursing intervention is served through the ability to predict and ultimately to control phenomena associated with health and health care. • A degree of uncertainty is inherent in theories; The concepts may be tentative and the propositions may be predictions of what reality is believed to be like, rather than a set of known, undeniable facts (Hoover, 1988) • The functions of theory include summarization of knowledge, explanation of phenomena of interest to the discipline employing the theory and provision of to guide, predict and ultimately to control phenomena (Mehlberg, 1962). • Theories are composed of statements that state specific relationships between two or more concepts.
Watson - Philosophy and Theory of Transpersonal Caring.
"Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health." It focuses on health promotion, as well as the treatment of diseases. According to Watson, caring is central to nursing practice, and promotes health better than a simple medical cure. The nursing model also states that caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring environment accepts a person as he or she is, and looks to what he or she may become. Assumptions: (1) Caring can be effectively demonstrated and practiced only interpersonally. (2) Caring consists of carative factors that result in the satisfaction of certain human needs. (3) Effective caring promotes health and individual or family growth. (4) Caring responses accept the patient as he or she is now, as well as what he or she may become. (5) A caring environment is one that offers the development of potential while allowing the patient to choose the best action for him or herself at a given point in time. (6) A science of caring is complementary to the science of curing. (7) The practice of caring is central to nursing. The Philosophy and Science of Caring has four major concepts: human being, health, environment or society, and nursing. • Society provides the values that determine how one should behave and what goals one should strive toward. Watson states: +"Caring (and nursing) has existed in every society. Every society has had some people who have cared for others. A caring attitude is not transmitted from generation to generation by genes. It is transmitted by the culture of the profession as a unique way of coping with its environment." • Human being is a valued person to be cared for, respected, nurtured, understood, and assisted; in general a philosophical view of a person as a fully functional integrated self. Human is viewed as greater than and different from the sum of his or her parts. • Health is the unity and harmony within the mind, body, and soul; health is associated with the degree of congruence between the self as perceived and the self as experienced. It is defined as a high level of overall physical, mental, and social functioning; a general adaptive-maintenance level of daily functioning; and the absence of illness, or the presence of efforts leading to the absence of illness. • Nursing is a human science of persons and human health - illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions. • Actual caring occasion involves actions and choices by the nurse and the individual. The moment of coming together in a caring occasion presents the two persons with the opportunity to decide how to be in the relationship - what to do with the moment. • The transpersonal concept is an intersubjective human-to-human relationship in which the nurse affects and is affected by the person of the other. Both are fully present in the moment and feel a union with the other; they share a phenomenal field that becomes part of the life story of both.
Johnson - Behavioral Systems Model.
"an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found." It also states that "each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual." Goals of nursing are fourfold, according to the Behavior System Model: (1) To assist the patient whose behavior is proportional to social demands. (2) To assist the patient who is able to modify his behavior in ways that it supports biological imperatives. (3) To assist the patient who is able to benefit to the fullest extent during illness from the physician's knowledge and skill. And (4) To assist the patient whose behavior does not give evidence of unnecessary trauma as a consequence of illness. The assumptions made by Johnson's theory are in three categories: assumptions about system, assumptions about structure, and assumptions about functions. Johnson identified several assumptions that are critical to understanding the nature and operation of the person as a behavioral system: (1) There is "organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the system." (2) A system "tends to achieve a balance among the various forces operating within and upon it, and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces occurring on him." (3) A behavioral system, which requires and results in some degree of regularity and constancy in behavior, is essential to man. It is functionally significant because it serves a useful purpose in social life as well as for the individual. And (4) "System balance reflects adjustments and adaptations that are successful in some way and to some degree." The four assumptions about structure and function are that: (1) "From the form the behavior takes and the consequences it achieves can be inferred what 'drive' has been stimulated or what 'goal' is being sought." (2) Each individual person has a "predisposition to act with reference to the goal, in certain ways rather than the other ways." This predisposition is called a "set." (3) Each subsystem has a repertoire of choices called a "scope of action." And (4) The individual patient's behavior produces an outcome that can be observed. And lastly, there are three functional requirements for the subsystems.: (1) The system must be protected from toxic influences with which the system cannot cope. (2) Each system has to be nurtured through the input of appropriate supplies from the environment. And (3) The system must be stimulated for use to enhance growth and prevent stagnation. Major Concepts • Human beings: having two major systems: the biological system and the behavioral system. It is the role of medicine to focus on the biological system, whereas nursing's focus is the behavioral system. The concept of human being was defined as a behavioral system that strives to make continual adjustments to achieve, maintain, or regain balance to the steady-state that is adaptation. • Environment: not directly defined, but it is implied to include all elements of the surroundings of the human system and includes interior stressors. • Health: seen as the opposite of illness, and Johnson defines it as "some degree of regularity and constancy in behavior, the behavioral system reflects adjustments and adaptations that are successful in some way and to some degree... adaptation is functionally efficient and effective." • Nursing: seen as "an external regulatory force which acts to preserve the organization and integration of the patient's behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health, or in which illness is found." • Behavioral system: Man is a system that indicates the state of the system through behaviors. • System: That which functions as a whole by virtue of organized independent interaction of its parts. • Subsystem: A mini system maintained in relationship to the entire system when it or the environment is not disturbed.
Research
Application of systematic methods to obtain reliable and valid knowledge about empirical reality
Neuman - Systems Model.
Based on the individual's relationship to stress, the reaction to it, and reconstitution factors that are dynamic in nature. The central core of the model consists of energy resources (normal temperature range, genetic structure, response pattern, organ strength or weakness, ego structure, and knowns or commonalities) that are surrounded by several lines of resistance, the normal line of defense, and the flexible line of defense. The lines of resistance represent the internal factors that help the patient defend against a stressor, the normal line of defense represents the person's state of equilibrium, and the flexible line of defense depicts the dynamic nature that can rapidly alter over a short period of time. The purpose of the nurse is to retain this system's stability through the three levels of prevention: 1. Primary prevention to protect the normal line and strengthen the flexible line of defense. 2. Secondary prevention to strengthen internal lines of resistance, reducing the reaction, and increasing resistance factors. 3. Tertiary prevention to readapt and stabilize and protect reconstitution or return to wellness following treatment.
Retroduction
Combines induction and deduction
Theoretical Definitions
Convey the general meaning of the concept in a manner that fits the theory
Pender - Health Promotion Model.
Defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client's level of wellbeing. The health promotion model describes the multidimensional nature of persons as they interact within their environment to pursue health. Focuses on following three areas: individual characteristics and experiences, behavior-specific cognitions and affect, behavioral outcomes Assumptions: (1). Individuals seek to actively regulate their own behavior. (2) Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. (3) Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span. (4) Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change Major Concepts • Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness. On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. • Individual characteristics and experiences (prior related behavior and personal factors). • Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences). • Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior).
Theoretical Statements
Describe a relationship between two or more concepts
Who is the founder of modern nursing?
Florence Nightingale
Leinenger - Transcultural Nursing Theory.
Involves knowing and understanding different cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context. It focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors. Major Concepts • Transcultural nursing: learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs, and values with the goal to provide me aningful and efficacious nursing care services to people according to their cultural values and health-illness context. • Ethnonursing: This is the study of nursing care beliefs, values, and practices as cognitively perceived and known by a designated culture through their direct experience, beliefs, and value system (Leininger, 1979). • Nursing: a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well-being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death. • Professional nursing care (caring): formal and cognitively learned professional care knowledge and practice skills obtained through educational institutions that are used to provide assistive, supportive, enabling, or facilitative acts to or for another individual or group in order to improve a human health condition (or well-being), disability, lifeway, or to work with dying clients. • Cultural congruent (nursing) care: defined as those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor-made to fit with individual, group, or institutional cultural values, beliefs, and lifeways in order to provide or support meaningful, beneficial, and satisfying health care, or well-being services. • Health: It is a state of well-being that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways. • Human Beings: believed to be caring and to be capable of being concerned about the needs, well-being, and survival of others. Leininger also indicates that nursing as a caring science should focus beyond traditional nurse-patient interactions and dyads to include families, groups, communities, total cultures, and institutions. • Society and Environment: These terms are not defined by Leininger; she speaks instead of worldview, social structure, and environmental context. • Worldview: way in which people look at the world, or at the universe, and form a "picture or value stance" about the world and their lives. • Cultural and social structure dimensions: defined as involving the dynamic patterns and features of interrelated structural and organizational factors of a particular culture (subculture or society) which includes religious, kinship (social), political (and legal), economic, educational, technological and cultural values, ethnohistorical factors, and how these factors may be interrelated and function to influence human behavior in different environmental contexts. • Environmental context: the totality of an event, situation, or particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical and/or cultural settings. • Culture: the learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways. • Culture care: defined as the subjectively and objectively learned and transmitted values, beliefs, and patterned lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, improve their human condition and lifeway, or to deal with illness, handicaps or death. • Culture care diversity: indicates the variabilities and/or differences in meanings, patterns, values, lifeways, or symbols of care within or between collectives that are related to assistive, supportive, or enabling human care expressions. • Culture care universality: indicates the common, similar, or dominant uniform care meanings, pattern, values, lifeways or symbols that are manifest among many cultures and reflect assistive, supportive, facilitative, or enabling ways to help people.
King - Theory of Goal Attainment.
Nursing is a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation" and "a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals." In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse "includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying." The function of a professional nurse is "to interpret information in the nursing process to plan, implement, and evaluate nursing care." Assumptions are: (1) The focus of nursing is the care of the human being (patient). (2) The goal of nursing is the health care of both individuals and groups. (3) Human beings are open systems interacting with their environments constantly. (4) The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process. (5) Patients perceive the world as a complete person making transactions with individuals and things in the environment. (6) Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences. • Nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation. The nurse and client share specific goals, problems, and concerns and explore means to achieve a goal. • Health is a dynamic life experience of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one's resources to achieve maximum potential for daily living. • Individuals are social beings who are rational and sentient. Humans communicate their thoughts, actions, customs, and beliefs through language. Persons exhibit common characteristics such as the ability to perceive, to think, to feel, to choose between alternative courses of action, to set goals, to select the means to achieve goals, and to make decisions. • Environment is the background for human interactions. It is both external to, and internal to, the individual. According to King, there are three interacting systems in the Theory of Goal Attainment. These are the personal system, the interpersonal system, and the social system. Each system is given different concepts. The concepts for the personal system are: perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are: interaction, communication, transaction, role, and stress. The concepts for the social system are: organization, authority, power, status, and decision making
Levine - The Conservation Model.
Nursing's role in conservation is to help the person with the process of "keeping together" the total person through the least expense of effort. Levine (1989) proposed the following four principles of conservation: The conservation of energy of the individual (1) The conservation of the structural integrity of the individual. (2) The conservation of the personal integrity of the individual. (3)The conservation of the social integrity of the individual. "The conservation principles do not, of course, operate singly and in isolation from each other. They are joined within the individual as a cascade of life events, churning and changing as the environmental challenge is confronted and resolved in each individual's unique way. The nurse as caregiver becomes part of that environment, bringing to every nursing opportunity his or her own cascading repertoire of skill, knowledge, and compassion. It is shared enterprise and each participant is rewarded. Assumptions about Individuals: Each individual "is an active participant in interactions with the environment... constantly seeking information from it." (Levine, 1969). The individual "is a sentient being and the ability to interact with the environment seems ineluctably tied to his sensory organs." "Change is the essence of life and it is unceasing as long as life goes on. Change is characteristic of life." (Levine, 1973) Assumptions about Nursing: "Ultimately the decisions for nursing intervention must be based on the unique behavior of the individual patient." "Patient centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques and ideas designed specifically for him." (Levine, 1973) Relationships (1.) Conservation of energy is based on nursing interventions to conserve through a deliberate decision as to the balance between activity and the person's available energy. (2.) Conservation of structural integrity is the basis for nursing interventions to limit the amount of tissue involvement. (3). Conservation of personal integrity is based on nursing interventions that permit the individual to make decisions for himself or participate in the decisions. (4.) Conservation of social integrity is based on nursing interventions to preserve the client's interactions with family and the social system to which they belong. (5.) All nursing interventions are based on careful and continued observation over time. Major Concepts • Environment includes both the internal and external environment. • Three Aspects of Environment Drawn upon Bates' (1967) Classification: The operational environment consists of the undetected natural forces and that impinge on the individual. The perceptual environment consists of information that is recorded by the sensory organs. The conceptual environment is influenced by language, culture, ideas, and cognition. • Person is the unique individual in unity and integrity, feeling, believing, thinking, and whole. • Health is the pattern of adaptive change of the whole being. • Nursing is the human interaction relying on communication, rooted in the organic dependency of the individual human being in his relationships with other human beings. • Adaptation is the process of change and integration of the organism in which the individual retains integrity or wholeness. It is possible to have degrees of adaptation. • Conservation includes joining together and is the product of adaptation including nursing intervention and patient participation to maintain a safe balance. • Personal integrity is the person's sense of identity and self-definition. Nursing intervention is based on the conservation of the individual's personal integrity. • Social integrity is life's meaning gained through interactions with others. Nurses intervene to maintain relationships. • Structural integrity: Healing is the process of restoring structural integrity through nursing interventions that promote healing and maintain structural integrity.
Meleis - Transition theory.
Patients, families and health systems encounter and face many changes that prompt processes and strategies for coping with these changes and their aftermath. There are many questions that formal and informal caregivers and health systems should carefully consider, and for which the answers to these questions must include specific processes and systems. Two parts in the Transitions Theory: The first is an intervention made to facilitate transition and promote well-being and mastery of change consequences. This includes conceptually supporting systems through significant others as well as a care team of advanced practice nurses. The goals are to clarify what the person (or groups) is experiencing at the moment as well as what the person (or groups) may experience subsequently by providing knowledge, skills, strategies and tangible and psychosocial competencies to deal with the transition experience and responses. Second and most important part is an understanding of the transition experience itself, for patients and significant others, which is defined as the experience during a passage from one state to another state. But those experiences and responses are defined by whether the transition triggers are developmental (becoming an adolescent, becoming a new parent), health and illness (from healthy to acute, from healthy to chronic), situational (natural disasters, divorce) or organizational (changes in leadership or staffing patterns, new policies or technology). It is also mediated by whether the person is going through single or multiple transitions, the meaning they impute on the transition and what else may be going on in the life of the person. There are many conditions (personal, community, society, global) that exacerbate or ameliorate responses to transitions. Assumptions: There are universal features in supporting people undergoing transitions and also in the nature of outcomes of transition experiences. Identifying "transitions" as a central concern for nursing and developing coherent frameworks to describe transition experiences and predict responses, provides the impetus for uncovering the mechanisms used by diverse populations to experience different changes in their lives that lead to health - illness consequences (some are healthy and some are not), and to advance knowledge about nursing therapeutics that facilitate the transition experience and enhance healthy coping and healing. Parse - Human becoming. Focus on quality of life as it is described and lived. The theory is structured around three abiding themes: meaning, rhythmicity, and transcendence. ASSUMPTIONS About man: The human is coexisting while coconstituting rhythmical patterns with the universe. The human is open, freely choosing meaning in situation, bearing responsibility for decisions. The human is unitary, continuously coconstituting patterns of relating. The human is transcending multidimensionally with the possibles. About Becoming: Becoming is unitary human-living-health. Becoming is a rhythmically coconstituting human-universe process. Becoming is the human's patterns of relating value priorities. Becoming is an intersubjective process of transcending with the possibles. Becoming is unitary human's emerging Three Major Assumptions of Human Becoming Meaning: Human Becoming is freely choosing personal meaning in situations in the intersubjective process of living value priorities. Man's reality is given meaning through lived experiences. Man and environment cocreate Rhythmicity: Human Becoming is cocreating rhythmical patterns of relating in mutual process with the universe. Man and environment cocreate (imaging, valuing, languaging) in rhythmical patterns Transcendence: Human Becoming is cotranscending multidimensionally with emerging possibles. Refers to reaching out and beyond the limits that a person sets. One constantly transforms Major Concepts Person: Open being who is more than and different from the sum of the parts Environment: Everything in the person and his experiences. Inseparable, complimentary to and evolving with. Health: Open process of being and becoming. Involves synthesis of values Nursing : A human science and art that uses an abstract body of knowledge to serve people
Recognize and define the four concepts in nursing's metaparadigm
Person/Human being -recipient of care Environment - internal/external conditions/influences Health - degree of wellness or illness of the recipient Nursing - actions/attributes of nurses
Roy - Adaptation Model of Nursing.
Sees the individual as a set of interrelated systems who strives to maintain balance between various stimuli. Scientific Assumptions: Systems of matter and energy progress to higher levels of complex self-organization. Consciousness and meaning are constructive of person and environment integration. Awareness of self and environment is rooted in thinking and feeling. Humans by their decisions are accountable for the integration of creative processes. Thinking and feeling mediate human action. System relationships include acceptance, protection, and fostering of interdependence. Persons and the earth have common patterns and integral relationships. Persons and environment transformations are created in human consciousness. Integration of human and environment meanings results in adaptation. Philosophical Assumptions: Persons have mutual relationships with the world and God. Human meaning is rooted in the omega point convergence of the universe. God is intimately revealed in the diversity of creation and is the common destiny of creation. Persons use human creative abilities of awareness, enlightenment, and faith. Persons are accountable for the processes of deriving, sustaining, and transforming the universe. Major Concepts Person: "Human systems have thinking and feeling capacities, rooted in consciousness and meaning, by which they adjust effectively to changes in the environment and, in turn, affect the environment." Based on Roy, humans are holistic beings that are in constant interaction with their environment. Humans use a system of adaptation, both innate and acquired, to respond to the environmental stimuli they experience. Human systems can be individuals or groups, such as families, organizations, and the whole global community. Environment : "The conditions, circumstances and influences surrounding and affecting the development and behavior of persons or groups, with particular consideration of the mutuality of person and health resources that includes focal, contextual and residual stimuli." The environment is defined as conditions, circumstances, and influences that affect the development and behavior of humans as adaptive system. The environment is a stimulus or input that requires a person to adapt. This stimuli can be positive or negative. Roy categorized this stimuli as focal, contextual, and residual. Focal stimuli are that which confronts the human system, and requires the most attention. Contextual stimuli are characterized as the rest of the stimuli that present with the focal stimuli, and contribute to its effect. Residual stimuli are the additional environmental factors present within the situation, but whose effect is unclear. This can include previous experience with certain stimuli. Health: "Health is not freedom from the inevitability of death, disease, unhappiness, and stress, but the ability to cope with them in a competent way." Defined as the state where humans can continually adapt to stimuli. Because illness is a part of life, health is the result of a process where health and illness can coexist. If human can continue to adapt holistically, they will be able to maintain health to reach completeness and unity within themselves. If they cannot adapt accordingly, the integrity of the person can be affected negatively. Nursing: "[The goal of nursing is] the promotion of adaptation for individuals and groups in each of the four adaptive modes, thus contributing to health, quality of life, and dying with dignity." In Adaptation Model, nurses are facilitators of adaptation. They assess the patient's behaviors for adaptation, promote positive adaptation by enhancing environment interactions and helping patients react positively to stimuli. Nurses eliminate ineffective coping mechanisms and eventually lead to better outcomes. Adaptation: "process and outcome whereby thinking and feeling persons as individuals or in groups use conscious awareness and choice to create human and environmental integration." Levels of Adaptation Integrated Process: The various modes and subsystems meet the needs of the environment. These are usually stable processes (e.g., breathing, spiritual realization, successful relationship). Compensatory Process: The cognator and regulator are challenged by the needs of the environment, but are working to meet the needs (e.g., grief, starting with a new job, compensatory breathing). Compromised Process: The modes and subsystems are not adequately meeting the environmental challenge (e.g., hypoxia, unresolved loss, abusive relationships).
Operational Definitions
Specify "the activities of operations necessary to measure a construct or a variable, define the specifics of a study in measurable terms
Assumptions
Statements supposed to be true without proof or demonstration
Newman - Health as Expanding Consciousness.
Stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness - a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world ASSUMPTIONS (1) Health encompasses conditions heretofore described as illness, or, in medical terms, pathology. (2) These pathological conditions can be considered a manifestation of the total pattern of the individual. (3) The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes. (4). Removal of the pathology in itself will not change the pattern of the individual. (5) If becoming ill is the only way an individual's pattern can manifest itself, then that is health for that person. (6) Health is an expansion of consciousness. Major Concepts • Health : "Health and illness are synthesized as health - the fusion on one state of being (disease) with its opposite (non-disease) results in what can be regarded as health". • Nursing: "caring in the human health experience". Nursing is seen as a partnership between the nurse and client, with both grow in the "sense of higher levels of consciousness" • Human: "The human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary field" "Persons as individuals, and human beings as a species are identified by their patterns of consciousness"..."The person does not possess consciousness-the person is consciousness". Persons are "centers of consciousness" within an overall pattern of expanding consciousness" • Environment: described as a "universe of open systems"
Orem - Self-Care Deficit Theory of Nursing.
The act of assisting others in the provision and management of self-care to maintain or improve human functioning at home level of effectiveness." It focuses on each individual's ability to perform self-care, defined as "the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being." assumptions of Dorothea Orem's Self-Care Theory are: (1) In order to stay alive and remain functional, humans engage in constant communication and connect among themselves and their environment. (2) The power to act deliberately is exercised to identify needs and to make needed judgments. (3) Mature human beings experience privations in the form of action in care of self and others involving making life-sustaining and function-regulating actions. (4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for, and make inputs into, self and others. (5) Groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members. • Nursing is as art through which the practitioner of nursing gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the medical care the individual receives from the physician. • Humans are defined as "men, women, and children cared for either singly or as social units," and are the "material object" of nurses and others who provide direct care. • Environment has physical, chemical and biological features. It includes the family, culture and community. • Health is "being structurally and functionally whole or sound." Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one's self, to symbolize experience, and to communicate with others.
Propositions
Used interchangeably with hypotheses to mean "any idea or hunch that is presented in the form of a scientific statement"
Theory -
expression of knowledge within the empirics pattern; the creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena 'Concept' is a term that is widely used in everyday English to mean an idea. It has the same general meaning in a scientific context and is often used to refer to an abstract idea. A concept can be exceptionally broad or very specific. For example, 'plants' and 'animals' are both concepts that help scientists, and everyone else, distinguish objects meaningfully in the natural world. 'Mammal' is a conceptual term that refers to a particular type of animal. A concept can be based in experience or may be entirely imaginary; 'music' is an experience-based concept, whereas a 'dragon' is a concept that exists only in the mind. A theory is a well-established scientific principle that is supported by convincing experimental and observational evidence. A theory has strong explanatory power that helps scientists understand and describe the universe and make predictions about future events. The theory of natural selection, advanced by Charles Darwin in the 19th century, is one of the central organizing principles of evolutionary biology. Einstein's special theory of relativity revolutionized physics in the early 20th century. Other well-known theories in modern science include the geological theory of plate tectonics and the germ theory of disease in medicine.
Theoretical relationship statement -
statement of meaning that conveys essential features of a concept in a manner that fits meaningfully within a theory; a theoretic definition specifies conceptual meaning and implies empiric indicators for concepts; this term may be used synonymously with conceptual definition
Operational relationship statement -
statement of meaning that indicates how a term or concept can be assessed empirically: inferred from theoretic definitions and specify as exactly as possible the empiric indicators used to observe, assess, or measure the concept empirically; the standards or criteria to be used when making observations
phenomenon -
things perceived by our senses, designed to describe or interpret the subjective, lived experiences of people and to comprehend the meaning that people give to these experiences; experiences cannot be observed, directly accessible only to the person who has the experience.
Model
• Is an idea that explains by using symbolic and physical visualization • Symbolic models may be verbal, schematic, or quantitative • Verbal models are worded statements • Schematic models may be diagrams, drawings, graphs or pictures • Quantitative models are mathematical symbols • Physical models may look like what they are supposed to represent; For example, body organs may become more abstract while still keeping some of the physical properties, like ECG tracings • Models can be used "to facilitate thinking about concepts and relationships between them (Bush, 1979) or to map out the research process (Chinn & Jacob, 1989)
Fact
• Is something known with certainty.
Philosophy
• Is the science comprising logic, ethics, esthetics, metaphysics and epistemology • Is concerned with judgments about components of science. • A statement of beliefs and values, what people assume to be true in what they believe (also called worldview) • Statements that reflect values, goals or opinions contribute to the philosophy • Philosophical concerns are not empirically based • The "this we believe" statements associated with nursing practice contribute to the philosophy of the discipline • Philosophical statements are based on opinion • They are accepted in a discipline through public affirmation. • The prevailing philosophy of a discipline is the one shared by the greatest number of members in terms of accepting the beliefs, values, goals and opinions of the philosophy.
Paradigm
• Science, philosophy and theory are all components of the domain of any scientific discipline; Paradigm is used to denote the prevailing network of science, philosophy and theory accepted by a discipline • What members of the community have in common; Includes: knowledge, philosophy, theory, educational experience, practice orientation, research methodology and literature identified with the discipline (shared framework and a shared view held by a discipline (Melesis) • The prevailing paradigm directs the activities of the discipline • It is accepted by the majority of individuals within the discipline and suggest the areas of study of interest to the discipline and the means to study them
Definitions
• Statements of the meaning of a word, phrase, or term • Theoretical Definitions • Operational Definitions
Science
• To know (King) • Is the observation, identification, description, experimental investigation and theoretical explanation of natural phenomena • It is a body of knowledge • Nursing science is the knowledge connected to the discipline of nursing, plus the processes and methodologies used to gain that knowledge • A goal of science is the identification of truths or facts about the subject matter of a discipline-- ascertaining the what, where, when, who and how of phenomena of interest to the discipline.
Knowledge
• What can be structured and represented to others out of the processes of knowing (Kramer) • Is based on factual information • Is an awareness or perception of reality acquired through learning or investigation • The term suggests that science is composed of what one knows about the subject matter of a discipline---A distinction is made between what is "known" to be (fact) and what is "believed" to be • Feigl (1953) suggested a characteristic of science is that it is replicable by using the appropriate scientific methodologies within a discipline; Replication requires the components of phenomena studied to provide knowledge that is observable and measurable • An empirical entity is that which can be experienced through the human senses.
