Theory 3110 exam 2 ch. 4

Paradigm

-A pattern of beliefs used to describe the domain of a discipline -It links concepts, theories, beliefs, values, and assumptions accepted and applied by the discipline -Often used synonymously with the terms conceptual framework Conceptual framework provides a way to organize major concepts and visualize the relationship among phenomena. Different frameworks provide alternative ways to view the subject matter of a discipline and represent the perspective of the author

Theory era

-Contributed to knowledge development, and the nursing metaparadigm was proposed by Fawcett -Resulted in the publication of several nursing journals, the development of nursing conferences, and the offering of more doctoral programs in nursing

Shared theories

-Explain a phenomenon specific to the discipline that developed the theory -Also known as a borrowed or interdisciplinary theory -To practice in today's health care systems, nurses need a strong scientific knowledge base from nursing and other disciplines such as the biomedical, sociological, and behavioral sciences -The nursing process has the following components: 1. input -date or info that comes from a patient's assessment -patient interaction with the environment 2. output -the end product of a system; whether the patient's health status improves, declines or remains stable -patient's health status for returning to the environment 3.. feedback -serves to inform a system about how it functions -outcomes are part of the feedback system to refine the plan of care -other forms of feedback include responses from family members and consultation from other health care professionals -patient successfully or unsuccessfully functions in the environment 4. content -the product and info obtained from the system -includes the nursing process

Practice theories

-Least abstract -also known as situation-specific theories -bring theory to the bedside -narrow in scope and focus -guide the nursing care of a specific patient population at a specific time -often easier to understand and apply -benifit of trial and error through clinical practice

Midle range theories

-More limited instep and less abstract -address a SPECIFIC phenomenon and reflect practice (administration, clinical, or teaching -tends to focus on a concept found in a specific field of nursing such as uncertainty, incontinence, social support, etc rather than reflect on a wide variety of nursing care situations as grand theories do

Research era

-Nurses became increasingly involved in conducting studies and sharing their findings -Nurses studied their own attitudes, their relationships with other disciplines, and their functions in work and political settings

Domain

-The perspective or territory of a profession or discipline -Provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline -Provides both a practical and theoretical aspect of the discipline -It is the knowledge of nursing practice and nursing history, nursing theory, education, and research -Gives nurses a comprehensive perspective that allows you to identify and treat patients' health care needs in all health care setting**

Descriptive theories

=first level if theory development -describe phenomenon and identify circumstances in which phenomenon occur -do not direct specific nursing activities or attempt to produce change but rather help to explain patient assessments

Neuman

Based on stress and the patient's reaction to the stressor Role of nursing is to stabilize the patient or situation. Focus in systems

Graduate education era

Began when research did not explore clinical questions based on medical model of research bc the discipline was attempting to show its uniqueness from medicine -Early versions of nursing theories were developed that offered more structure to nursing research

Benner and Wrubel

Caring is central. middle range theory focus on skill acquisition

Nursing theory

Is a conceptualization of some aspect of nursing Describes, explains, predicts, and/or prescribes nursing care Helps to identify the focus, means, and goals of practice Enhance communication and accountabilty for patient care

Grand theories

Most abstract Abstract, broad, complex -Require further classification through research so they can be applied to nursing practice -does NOT provide guidance for SPECIFIC nursing interventions -but it provides the structural framework for general, global ideas about nursing -adress the nursing metaparadigm components of person,nursing, health, and environment

Theory

Helps explain an event by Defining ideas or concepts Explaining relationships among the concepts Predicting outcomes

Definitions

-Theorists use definitions to communicate the general meaning of the concepts of a theory -Definitions may be theoretical/conceptual/ or operational -Theoretical/conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on theorist's perspective -Operational definitions state how concepts are measured. Ex. a nursing concepts conceptually defines pain as a physical discomfort and operationally as a patient reporting a score of three or above on a pain scale

Theory-based nursing practice

-Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice (EBP). Nursing knowledge -Is derived from basic and nursing sciences, experience, aesthetics, nurses' attitudes, and standards of practice -Goal of nursing knowledge: To explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines -The integration of theory into practice leads to coordinated care delivery and therefore serves as the basis for nursing -the nursing process is used in clinical setting to determine visual patient needs -although the nursing process is central to nursing, it is NOT A THEORY -it provides systematic process for the delivery of nursing care, not the knowledge component of the discipline -However, nurses use theory to provide direction in how to USE the nursing process, how to determine the patient's needs, how to plan cream how to select individualized nursing interventions, and how to evaluate patient outcomes

Prescriptive theories

-addresses nursing interventions for a phenomenon, guide practice change, and predict the consequences -nursing use prescriptive theories to anticipate the outcomes of nursing interventions

Concepts

-concepts are the words or phrases that identify, define, and establish structure and boundaries for ideas generated about particular phenomenon -ideas and mental images -can be abstract or concrete -Theories use concepts to communicate meaning

Phenomenon

-term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations -may be temporary or permanent -examples include caring, self-care, and patient responses to stress

Assumptions

-the 'taken-for-granted" statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory -assumptions are accepted as trusts and are based on values and beliefs

Henderson

14 basic needs of the whole person Framing nursing care are the needs of the individual. Focus on principle and practice of nursing

Nursing metaparadigm

Allows nurses to understand and explain what nursing is, what nursing does, and why nurses do what they do -includes four concepts of person, health, environment/situation, and nursing PERSON -the recipient of nursing care -The person is central to the nursing care you provide -Bc each person's needs are often complex, it is important to provide individualized patient-v=centered care HEALTH -has different meanings for each patient, the clinical setting, and the health care profession. -It is a state of being that people define in relation to their own values, personality, and lifestyle -it is dynamic and continuously changing ENVIRONMENT/SITUATION -includes all possible conditions affecting patients and the settings where they go for their health care -continuous interaction btwn a patient and the environment -this interaction has positive and negative effects on a person's level of health and health care needs NURSING -the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations -the scope of nursing is broad

Watson

Defines the outcome of nursing activity with regard to the humanistic aspects of life Purpose is to understand the interrelationships among health, illness, and human behavior. Focus on caring

Domain of nursing

Domain Paradigm -Conceptual framework Nursing metaparadigm -Person -Health -Environment/Situation -Nursing

Theory utilization era

Evidence based practice, which stems from theory, research, and experience The focus of EBP is safe, comprehensive, individualized, quality health care Theory use is congruent with current national goals for quality health care

Evolution if nursing theory

First nursing theorist: Florence Nightengale Curriculum era: 1900-1940s Research era: 1950-1970s Graduate education era: 1950-1970s Theory era: 1980-1990s Theory utilization era: 2000s-today -Theories are dynamic and responsive to the changing environment in which we live. -Theories often build on works of prior theories -theories have changed over time in response to changes in society and the world

Peplau

Focus on interpersonal relations between nurse, patient, and patient's family Development of nurse-patient relationship

Orem

Focuses on patient's self-care needs Goal is for patient to manage his or her health problems. When applying this grand theory, a nurse continually assesses a patient's ability to perform self care and intervenes as needed to ensure that the patients meet physical, psychological, sociological, and developmental needs. According to Orem, people who participate in self care activities are more likely to improve their health outcomes Nurses continually assess and determine why patients are unable to meet these needs, identify goals to help them perform self-care, and evaluate how much they are able to perform

Florence Nightengale

Generally regarded as the first nursing theorist -Her theory was founded on her belief that nursing could improve a patient's environment to facilitate recovery and prevent complications -in this era, nurses were trained to observe each patient's condition and report changes to the doctor, thus beginning the status of nursing as subservient to the physician -The environment of war was a primary factory in developing Nightengale's theory -Environment as the focus of nursing care -Descriptive theory -Grand theory -the focus of -through observation and date collection, she linked the patient's health status with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War. -Taught and used the nursing process -Vital observation is not for the sake of piling up miscellaneous info or curious facts, but for the sake of saving life and increasing health and comfort

Link between theory and knowledge development in nursing

Nursing knowledge is theoretical and experiential. -The goals of theoretical knowledge are to stimulate thinking and create a broad understanding of nursing science and practice. -Experiential knowledge, or the "art" of nursing, is based on nurses' experiences in providing care to patients. -both types of knowledge are needed to provide safe, comprehensive nursing care -Nursing theories guide nursing practice -Grand theories help shape and define your practice -middle range theories continue to advance nursing knowledge through nursing research and EBP -Practice theories help you provide specific care for individuals and groups of diverse populations and situationsTheories provide direction for nursing research. -Nursing theory and nursing research build the knowledge base for nursing, which is then applied to practice. Theory-generating or theory-testing research -refines the knowledge base of nursing. -uses logic to explore relationships among phenomenon -as a result, Nurses incorporate research-based interventions into theory-based practice. The "expert nurse" translates both the art and science into the realm of creative caring, which takes the extra step of individualizing care to the specific needs of each patient -**no one study tests ALL components of a theory

Components of a theory

Phenomenon Concepts Definitions -Theoretical/conceptual -Operational Assumptions -All these components provide a foundation of knowledge for nurses to direct and deliver caring nursing practices

Curriculum era

Spanned the 1900s to the 1940s -nursing education expanded beyond basic anatomy and physiology courses to include courses in the social sciences, pharmacology, and "nursing arts" that addressed nursing actions, skills, and procedures

Nursing foundation

Theory is the foundation for the art and science of nursing. The science is based on data obtained from current research. The art of nursing stems from a nurse's experience and the unique caring relationship with the patient. Theory, research, and practice are bound together in a continuous interactive relationship.

Leininger

Theory of cultural care diversity and universality Considers social structure factors(values and beliefs) What does their culture believe? Middle range theory of cultural diversity and universality Human caring varies among cultures in its expressions, processes, and patterns. Social structure factors such as a patient's politics, culture, and traditions are significant forces affecting care and influencing that patient's health and illness pattern

Roy

Views the patient as an adaptive system When patient cannot adapt to stressors, nursing is needed. Focus on adaption