CH 9: Nursing Theory: The basis of Professional Nursing

Watson's Philosophy

-10 Caritas Processes -Focused on the relationship b/w the nurse and the patient -an approach that emphasized how the nurse and patient change together through transpersonal caring (spiritual emphasis, holistic approach) -health promotion, health restoration, illness prevention

Henderson's Philosophy

-14 Basic Needs of the Patient -The unique function of the nurse is to assist the patient in the performance of those activities contributing to health or its recovery that they would perform unaided if they had the necessary strength, will or knowledge.

King's Interacting Systems Framework and Theory of Goal Attainment

-Focus on people with 3 interacting systems: personal (pt's perception), interpersonal relationships (pt's role within relationships & stresses in each role), and social contexts (consider influences on pt's decision making) -Emphasis on the importance of goal setting by the nurse and pt (mutually) in gaining/regaining health

Orem's Self-Care Model

-Focuses on the patient's self-care capacities and the process of designing nursing actions to meet the patient's self-care needs -nurse prescribes and regulates the nursing system on the basis of the patient's self-care deficit (the extent to which a pt is incapable of providing effective self-care) -Orem formalized 3 interrelated theories: -Theory of self-care -Theory of self-care deficit -Theory of nursing system -Appropriate care for the pt is developed through a series of 3 operations: -Diagnostic: nurse-pt relationship; Assessment of pts baseline ability to provide self-care -Prescriptive: therapeutic self-care requisites (based on deficits) are determined -Regulatory: nurse designs, plans and produces a system for care

Orlando's Nursing Process Theory

-How the nurse processes their observations of pt behavior and about how the nurse reacts to pt based on inferences from pt's behavior -Specific to nurse-pt interactions -Goal of RN: determine and meet pt's immediate needs and to improve their situation by relieving distress or discomfort -Emphasizes deliberate action (rather than automatic) -Individualize care for each patient: attend to behavior, confirm with pt ideas & inferences the RN draws from interactions, identify pressing needs "BOTTOM LINE"

Nightingale's Philosophy

-Notes on Nursing: What it is and What it is not (1859, 1969) -made important distinctions b/w nurses & physicians -identified preventative health as a major concern (vs illness) -Focused on the relationship b/w a patient and their environment -clean air, water, adequate ventilation, sunlight, etc.

Roy's Adaption Model

-Provides comprehensive understanding from the perspective of adaption -environmental demands high + pt's adaptive mechanisms low = behavioral responses are ineffective for coping -Focus on adaption of the pt and the environment

Peplau's Theory of Interpersonal Relations in Nursing

-Relationship b/w pt and nurse is the focus of attention, rather than pt only as the unit of attention -Goals: -Survival of pt -Pt's understanding of health problems and learning from these problems as they develop new behavior patterns -Nurse assumes roles of: counselor, resource, teacher, technical expert, surrogate, and leader (spending more/less time in these roles depending on setting/situation)

Leininger's Theory of Culture Care Diversity and Universality

-Transcultural Nursing: planning care based on knowledge that is culturally defined, classified, and tested and then used to provide culturally congruent care -Considers the impact of culture on all aspects of human life, with particular attention to health and caring practices

Theory

A group of related concepts, definitions & statements that describe a certain way of viewing phenomena from which to describe, explain or predict outcomes.

Conceptual Model or Framework

A more specific organization of nursing phenomena than philosophies -Provides an organizational structure that makes clearer connections between concepts

Philosophy

A set of beliefs about the nature of how the world works. -Nursing philosophy puts together some or all concepts of the metaparadigm

Grand Theory

A theory designed to describe and explain all aspects of a given phenomenon

Metaparadigm of Nursing

Consists of the major concepts of the discipline: Person, Environment, Health & Nursing -Caring was recently added as another major concept

List of terms from most abstract to least abstract

Metaparadigm - Philosophy - Conceptual Model/Framework - Theory - Propositions

Middle Range Theory

Narrower in focus and makes connections between grand theories and nursing practice -Incorporate a limited number of concepts and focus on a speciic aspect of nursing -Typically merge practice and research

Metaparadigm

Refers to the primary or central phenomena that are of interest to a particular discipline.

Propositions

Statements that describe linkages between concepts and are more prescriptive (they propose an outcome that is testable in practice and research)

The nurse professor is giving a lecture on Dorothy Orem. Which statement by one of the nursing students indicates that teaching has been effective? a. an underlying assumption of orem's model is that patients want to be in control of their lives b. orems work focuses on goal attainment, for and by the patient c. orem focused on the patient as a biopsychosocial adaptive system d. orem believed that unless attention was paid to the patient's concerns, mutual goal setting was unlikely

a. an underlying assumption of orem's model ist hat patients want to be in control of their lives Over the years, Orem formalized three interrelated theories: theory of self-care, theory of self-care deficit, and theory of nursing system. Her model focuses on the patient's self-care capacities and the process of designing nursing actions to meet the patient's self-care needs. An underlying assumption of Orem's model is that patients want to be in control of their lives. Imogene King's work focused on goal attainment for and by the patient. King believed that unless attention was paid to the patient's concerns, mutual goal setting was unlikely. Sister Calista Roy focused on the patient as a biopsychosocial adaptive process.

The nurse is interested in improving nursing practice by providing culturally competent care. What action by the nurse indicates a need for further education? a. be aware of other cultures b. show respect for the culture of each patient c. recognize and incorporate health beliefs and folk practices of the patient's culture into care d. question the patient regarding cultural practices

a. be aware of other cultures Leininger specified caring as the essence of nursing, and nurses who use Leininger's theory of cultural care in their practices view patients in the context of their cultures. In order to provide culturally competent care, it is important that the nurse first question the patient to determine if there are any cultural practices that can be incorporated into care. The nurse should show respect for the culture of each patient, and incorporate health beliefs and folk practices into care whenever possible. The nurse should spend time becoming educated, and feeling comfortable to provide culturally competent care.

The nurse has decided to incorporate Imogene King's model into practice. Which action by the nurse indicates that further teaching is needed? a. create a plan of care for the patient after receiving report b. determine what factors influence the patient's decision-making c. develop and maintain a rapport with the patient d. determine what the patient's goals are

a. create a plan of care for the patient after receiving report When using King's work, nurses focus on goal attainment for and by the patient. It is important that the nurse include the patient in decision making regarding care. The nurse should sit down with the patient and determine what factors influence the patient's decision-making, and what the patient's goals are. Developing and maintaining rapport with the patient allows the nurse to understand the patient on a deeper level and gain trust.

Which statement by the nursing student on theory-based nursing practice indicates a need for further teaching? a. theory-based nursing practice inhibits autonomy b. nursing theory develops analytical skills c. theory provides the language to explain what nurses do d. theory provides a nursing-based guide for practice

a. theory-based nursing practice inhibits autonomy Nursing theory provides a language for the nurse to explain what nurses do, as well as provide a nursing-based guide for practice. Use of nursing theory develops analytical skills, as well as contributes to professional autonomy.

The nurse is listening to a lecture on Virginia Henderson. Which statement by the nurse indicates that further teaching is necessary? a. Henderson identified 14 basic needs as a general focus for patient care b. henderson believed that exposure to sunlight was necessary for good health c. henderson described the role of the nurse as a substitute or helper for the patient d. henderson believed that the nurse's role changed day-t-day

b. henderson believed that exposure to sunlight was necessary for good health Virginia Henderson identified 14 basic needs as a general focus for patient care. She described the role of the nurse as a substitute or helper for the patient, and believed that the nurse's role changed day-to-day. Florence Nightingale believed that exposure to sunlight was necessary for good health.

The nurse is listening to a lecture on Jean Watson. Which statement indicates that further teaching is necessary? a. watson emphasized the caring aspects of nursing b. watson identified 14 basic needs as a general focus for patient care c. watson equated health with harmony d. watson encourages nurses to share their genuine selves with patients

b. watson identified 14 basic needs as a general focus for patient care Jean Watson's caring theory focuses on the nurse-patient relationship, and draws upon philosophical sources for a new approach that emphasized how the nurse and patient change together through transpersonal caring. Watson equated health with harmony, and encouraged nurses to share their genuine selves with patients, in order to reach a deeper level of caring. Watson introduced the 10 caritas processes. Virginia Henderson identified 14 basic needs of patient care.

Which action by the nurse shows the incorporation of Nightingale's philosophy of nursing into practice? a. allow visitors to bring fast food to the patient b. arrange the patient's bed to avoid sun exposure c. arrange for periods of rest throughout the day d. schedule housekeeping to clean once a week

c. arrange for periods of rest throughout the day Florence Nightingale believed that the health of the patient was related to their environment. Clean air, water, adequate ventilation, rest, sunlight and proper diet were all recognized in her philosophy of nursing. The nurse incorporating Nightingale's philosophy of nursing would incorporate periods of rest throughout the day for the patient, as well as: healthy food choices, sun exposure and housekeeping once per day, or as needed.

Which action by the nurse incorporates Watson's Caritas Processes into practice? a. rounding on the patient every 3-4 hours b. avoiding personal conversation with the patient c. arranging for the patient to have a private church service with family d. providing an overview of cancer treatment for the newly diagnosed patient

c. arranging for the patient to have a private church service with family Watson's Caritas Processes focus on the nurse-patient relationship and acts by the nurse that promote caring and understanding on a deeper level. In order for the nurse to establish this relationship, the nurse must be present. Rounding frequently, engaging in conversation with the patient, and personalizing nursing care and education allow this connection to happen. Taking the time to get to know the patient, understanding the needs of the patient and acting on them—such as arranging a private church service—put the caritas processes into action.

The nurse is caring for a terminally ill patient who is near the end of life. The patient has expressed her desire to not be alone when she dies. Which action by the nurse shows an incorporation of Watson's caring theory into practice? a. strictly following visiting hours b. impose a time limit for each visitor c. coordinate routine medication passes with visits d. help the patient create a schedule of visitors for each day

d. help the patient create a schedule of visitors for each day Jean Watson's caring theory focuses on the nurse-patient relationship, and creating a deeper level of caring. The patient has expressed a desire to be with others at the end of life. It is important that the nurse help the patient create a schedule of visitors each day, to fulfill the request.

After listening to a lecture on Hildegard Peplau, which statement by the nurse indicates that further education is necessary? a. the nurse hold many roles including: leader, educator and counselor b. peplau recognized the importance of the work of nursing rather than continuing to define nursing c. peplau drew from developmental interactionist and human needs theories in developing her work d. peplau focused on goal attainment

d. peplau focused on goal attainment Hildegard Peplau was one of the earliest nurse theorists to recognize the importance of the work of nursing, rather than continuing to define and delineate nursing. Peplau created her nursing theory by drawing from developmental, interactionist and humanistic needs theories. Peplau believed that the nurse holds many roles including: counselor, resource, teacher, technical expert, surrogate, and leader. Imogene King's model focuses on goal attainment.