Claywell ch 10-14

Theory of Goal Attainment states

- 3 human systems: personal, interpersonal, social - Goal is health for the WHOLE WORLD

Theory of Self-Care Deficit

- 3 theories: nursing systems, self-care, SC deficit - Nsg goals should promote SC - SC activities: purposeful, ordered, learned - Agency/deficit: in/ability to participate in SC - Develop care via diagnostic, prescriptive, regulatory operations

clinical question types

- Dx - Tx - Px - harm or etiology - prevention - qualitative

Nursing philosophies

- Express beliefs about nursing/nursing values - Provide explanations that contribute to nursing knowledge - Guides for professional practice/behavior

gaps in utilizing research

- don't know there's information out there - don't have the education to understand information - don't have time, busy c pt care - can't actually change anything anyway - where would I even take a proposal - not sure how to perform a trial

limitations of EBP

- evidence: hard to access, lots to sift through - individual: resistant to change - HC system: bureaucracy; "physician idiosyncrasy" - nsg: too busy, not enough support, deficient ability to find/read/analyze evidence

Behavioral Systems Model states

- focus on human behavior - nsg role is assess int/ext environments, help pt select goals and develop interventions Interrelated subsystems: attachment, dependency ingestive, eliminative sexual aggressive achievement restorative

nursing process theory states

- goals are to meet immediate pt needs, relieve distress/discomfort - pt's thoughts/feelings/perceptions, assess verbal and nonverbal communication - use nursing process

Health Promotion model states

- pt assumes active role in own health 10 determinants of pt's health-promoting behavior -prior related behavior -personal factors -perceived benefits -perceived barriers -perceived self-efficacy -activity-related effect -interpersonal influences -situational influences -commitment to plan -competing demands/preferences

Aim of EBP

- standardize practice - integrate data and expertise - problem-solving approach

Healthcare Systems Model states

- three levels of prevention: primary, secondary, tertiary - nurses should treat whole pt - interventions to maintain stability in dynamic environment

Conservation Model states

- wholeness, adaptation, conservation - conservation has 4 areas: energy, structural integrity, personal integrity, social integrity - wholeness is sustained by adaptation - the outcome of adaptation is conservation

communication blockers:

-'why' questions -task-oriented approach to pt -not listening attentively -unsolicited advice, false reassurance -cliches -gossip

Effects of EBP on health care system

1. Dec hospitalization costs, LOS, re-admits 2. Dec complications 3. Nursing retention/satisfaction

8 elements of critical thought

1. PURPOSE to be accomplished 2. QUESTION at issue 3. POINT OF VIEW - take other 4. AVAILABLE INFO 5. CONCEPTS shape thinking 6. ASSUMPTIONS challenged/verified 7. IMPLICATIONS, CONSEQUENCES considered 8. INFERENCES - conclusion, summary of process

Maslow's hierarchy

1. Physiological (air, water, food) 2. Safety (personal, financial, injury, health) 3. Social belonging (friendship, intimacy, family) 4. Esteem (respect from others, self-respect) 5. Self-actualization (realizing full potential)

Without EBP, effects on health care system

1. Pt care compromised 2. Costs increase dramatically

3 basic questions in evaluating study data

1. are these results valid 2. what are the results 3. do they apply to my pt

2 things the cultivated thinker does NOT do

1. assume they have all the information 2. be arrogant - this interferes with gaining knowledge

5 steps to EBP

1. from clinical concern, construct relevant, answerable question 2. search for evidence in literature that addresses 3. critical analysis of evidence's validity/relevance 4. apply evidence to concern 5. evaluate performance

3 key features of EBP

1. problem solving approach, in context of nurse's clinical experience 2. evidence + knowledge + theory 3. allows expression and inclusion of pt values

it has been estimated that about ________ of communication is verbal

10%

Per IOM, how many iatrogenic events annually?

100,000/year

what percentage of what nurses do is EBP

15%

basic timeline of nursing process

1955 Lydia Hall - observation, administration, validation 1958-61 Orlando - assess, plan, evaluate 1967 Yura/Walsh - APIE 1973 ANA - diagnosis 1991 ANA - outcome

background vs foreground questions

B: general knowledge seeking F: specific to pt/situation

Attributes of critical thinker

Curiosity Information-seeking Rational thought Reflective Creative Intuitive

3 keys to critical thinking

Have you RED Pearson's Critical Thinking? R - recognize symptoms E - evaluate arguments D - draw conclusions

What tool helps prioritize nsg dx'es

Maslow's hierarchy

PICO

P: pt/problem I: intervention C: comparison (may not always use this) O: outcome In rotten stupid dogs, does eating poop, compared with not eating poop, result in getting yelled at more?

Roy Adaptation Model

Promoting adaptive responses to change in environment by: - assess behaviors - assess stimuli - nursing dx - set goals to promote adaptation - implement interventions - evaluation

simplest research for RN to engage in

QAPI - track pt outcomes, charting completion, protocol adherence: helps staff deliver consistently excellent care

Nursing theory provides... Nursing theory serves as...

SYSTEMATIC and knowledgeable pt care APPROACH TOOL for critical THINKING and DECISION making in practice

3 kinds of nsg dx'es

actual potential wellness

systems theory states that

all parts of a system are connected change in one part will affect all parts systems have boundaries systems are affected by what's going on inside and outside of them -> reaction, self-correction

nursing is both an _____ and a _______

art, science

quantitative study

asks who, what, where, when, or why

nursing process steps

assessment diagnosis outcome identification planning implementation evaluation

The definition of nursing (Henderson)

assist individual (sick or well) in performing activities that contribute to wellness/healing (or to peaceful death) 14 needs that fall into physical, psych, emotional, sociological, spiritual, development categories

Difference between concept and construct

concept: -idea -building block -describe/classify phenomenon construct: -similar to above but more abstract -inferred from observable phenomena

2 building blocks of a nursing theory

concepts and constructs

Grand theory is

conceptual framework under which concepts/principles can be defined

sample selection involves

creating a representational model of the population that will be affected by study results

_____ drives the nurse to seek knowledge

curiosity

reasoned thought avoids

decisions skewed by emotions, feelings, or prejudices

applying research to practice

direct: change in practice habit, new intervention indirect: increased knowledge base persuasive: advocate for practice change

experimental vs quasi-experimental research design

experimental: control independent variables, subjects randomly assigned to groups quasi: no randomization, attempt to show relationship between I and D variables

qualitative study

exploratory - gain understanding and insights. may provide basis for quantitative study.

practice theory is

explores one particular situation found in nursing identifies goals, how goals will be achieved.

communication facilitators are

factors that enhance effective communication -project warmth, openness, friendliness -providing privacy, comfort -pace of words/actions -appropriate humor -touch (c consent)

Diagnostic thinking is ________ and embraces ________

flexible, complexity

role theory helps nurses...

function therapeutically; understand behaviors

adaptation theory states...

goal of nsg to promote adaptive responses to changes in environment using the nursing process

statistical significance

how likely is it this could have occurred by chance

Philosophy of science and caring states

humans are not objects, are part of larger universe 10 carative factors -values -faith/hope -compassion -trust -rapport -encouraging/accepting emotional expression -analytical decisions -collaborative teaching -supportive environment -meeting needs

every nsg dx must be supported by

identifying criteria (defining characteristics)

Culture Care Theory states

importance of culturally congruent care pts do not want view of self fragmented, care for whole pt

A theory is an

integrated set of concepts/statements that can explain, describe, predict, or control a phenomenon

EBP definition

integrating best evidence c clinical expertise in context of clinical circumstances & pt values/preferences - process by which nurses make decisions utilizing above

internal validity

integrity of experiment's design

Theory of interpersonal relationships states

interpersonal relationship stages: preorientation, orientation, working, termination

clinical judgment of a situation is based on

knowledge empirical data theory scientific inquiry

reliability:

measuring the device/technique/instrument: how trustworthy is it at collecting the intended data

level 1 evidence

most valid reports analyzing pt outcomes

null hypothesis

no difference after independent variable

Benner theory of nsg knowledge

novice, advanced beginner, competent, proficient, expert

3 characteristics of cultivated thinking

organized, enlightened, educated

Health as Expanding Consciousness

patterns, life processes, wholeness health = evolving pattern of consciousness health/illness both part of person-environment pattern nsg role: listen to pt's pattern

5 realms of assessment

physiological psychological social cultural spiritual

deductive reasoning

proceeds from general to specific

inductive reasoning

proceeds from specific to general

Nightingale - 3 major relationships

pt - environment pt - nurse nurse - environment

Define "critical thinking"

purposeful, goal-driven process use facts, principles, theories, abstractions make inferences, decisions, solve problems

Nightingale felt nsg role is to

put the pt in the best condition for healing to happen

To be comfortable c critical thinking, one must practice

reflection

reproducibility

repeating the experiment will result in same, or very similar, result

level 3 evidence

reports not based on scientific analysis of pt outcomes

external validity

results also applicable to people who aren't study subjects

level 2 evidence

some science in analyzing pt outcomes (implies association more than causality)

what do middle-range nsg theories answer

specific practice questions

transcultural nursing is

study of diverse populations, c respect to individual values/expressions; find predictable patterns of health-illness

Creativity is...

the ability to be INNOVATIVE, RESOURCEFUL, INVENTIVE

validity:

the degree to which an instrument is measuring what it's supposed to measure the degree to which a study's results are true, believable, free of bias

active variable

the variable being manipulated to see what happens in stupid rotten dogs (ATTRIBUTE VARIABLE), does eating poop (ACTIVE VARIABLE) result in being yelled at?

alternative hypothesis

there is a difference (opposite of null hypothesis)

attribute variable

variable over which researcher has no control in stupid rotten dogs (ATTRIBUTE VARIABLE), does eating poop (ACTIVE VARIABLE) result in being yelled at?

dependent variable

variable that is being influenced - what happens after IV applied? rotten dogs are [offered a distracting treat (INDEPENDENT VARIABLE)] to find out [if it will make them stop eating poops (DEPENDENT VARIABLE)]

independent variable

variable that is intended to produce an effect - program, treatment, intervention rotten dogs are [offered a distracting treat (INDEPENDENT VARIABLE)] to find out [if it will make them stop eating poops (DEPENDENT VARIABLE)]

we are more aware of our own (verbal or nonverbal?) messages

verbal