Chapter 4 - Theory Foundations of Nursing

Environment/Situation

- directly affects the patient - healthcare settings (clinics, hospitals) Ex. a teen with diabetes --> their environment may affect them in the sense that their diet may be impacted and how/when they administer insulin injections

Shared Theory: Leadership/Management

- how to lead people - how to change people

Curriculum Era (1900-1940s)

- liberal arts curriculum = includes social sciences (sociology, psych) - Makes students well rounded - Pharmacology

Peplau's phase: Pre-orientation

- listening to report - looking at chart *Gather data*

Shared Theory: Eduational

- provide patient education - adult learning theories

Nightingales Environmental Theory

- theory focuses on environment (light, noise, cleanliness, etc.) - believed she could manipulate the environment to improve patients health - looked to improve sanitary conditions - improved survival rates of patients by manipulating the environment * GRAND THEORY FOCUSED ON ENVIRONMENT *

Nursing process

1. Assessment --> gather data 2. Diagnosis --> care plan 3. Planning --> Make Goals 4. Implementation --> put interventions into action 5. Evaluation --> looking back at the progress of patient; Evaluate progress towards goal

according to Peplau, a nurse is what 3 things?

1. Counselor 2. Resource 3. Surrogate

Theory Utilization Era

21th century, provide EBP

Metaparadigm of Nursing

4 concepts of nursing: 1. person 2. health 3. environment/situation 4. Nursing definition

Susan is a new nurse who tutors a nursing student, Bill, who has difficulty mastering good study habits and prioritizing school assignments. Susan is helping Bill learn the theoretical foundations of nursing practice. After Susan and Bill review interdisciplinary theories, such as Maslow's hierarchy of needs and the developmental theories, they move on to the topic of nursing theories. Q. Bill reads about the concept of culturally specific nursing care. The theory that integrates patients' cultural traditions, values and beliefs into care plans is ______________.

= Leininger

Definitions: Operational

= We have to be able to measure it Ex. measuring patients pain on a scale of 0-10

Henderson's theory

= assisting patient with 14 activities that they may not be able to do on their own and assisting patient with peaceful death - a few activities include hygiene and positioning

Relationship Between Nursing Theory and Nursing Research: Theory testing research

= describes Ex. research study where patients describe the pain with heart disease

Relationship Between Nursing Theory and Nursing Research: Theory Generating Research

= explains relationships ex. a patient experiences sadness with a child with a mental/intellectual disability (relationship between the mental illness and sadness)

Shared Theory: developmental Theory

= growth and development - changing care based on the age/level of development

Roy's Theory

= helps patients adapt to major changes ex. new amputee * they must adapt physically, emotionally, and mentally to their new life*

Neuman's Theory

= how to help patients cope with stress focuses = stress coping mechanisms + disease prevention

Feedback

= how well a system is functioning - patient satisfactory surveys - family feedback

Content

= product information and interventions - interventions --> teaching about BP meds; Teaching diet control

Assumptions

= statements we take for granted Ex. Watson's theory on caring --> Assumption that caring promotes healing

Shared Theory: stress/adaptation theory

= teaching patients how to cope with illness = teaching how to cope with stress of Nursing Discipline

Shared Theory: Biomedical Theory

= theories that cause diseases

Theory is essential to nursing practice because it: (Select all that apply.) A. Contributes to nursing knowledge. B. Predicts patient behaviors in situations. C. Provides a means of assessing patient vital signs. (asses vital signs through nursing process) D. Guides nursing practice. E. Formulates health care legislation. F. Explains relationships between concepts.

A. Contributes to nursing knowledge. B. Predicts patient behaviors in situations. D. Guides nursing practice. F. Explains relationships between concepts.

Systems Theory

A. Input/Output B. Feedback C. Content **Nursing process is systematic (NOT A THEORY)

Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.) A. Nursing theory differentiates nursing from other disciplines. B. Nursing theories are standardized and do not change over time. C. Integrating theory into practice promotes coordinated care delivery. D. Nursing knowledge is generated by theory. E. The theory of nursing process is used in planning patient care. F. Evidence-based practice results from theory-testing research.

A. Nursing theory differentiates nursing from other disciplines. C. Integrating theory into practice promotes coordinated care delivery. D. Nursing knowledge is generated by theory. F. Evidence-based practice results from theory-testing research.

A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories? A. Roy B. Watson C. Johnson D. Benner

A. Roy

Nursing theories provide nurses with perspectives from which to: A. analyze patient data. B. predict phenomena. (nursing theories predict nursing care, not phenomena) C. formulate legislation. D. link science to nursing. (nursing theories link nursing to science)

A. analyze patient data.

Components of a theory

A. phenomenon B. Concepts C. Definitions D. Assumptions

Nursing process is central to nursing practice. Nursing practice: A. is a theory. B is derived from a theory. C. is not adaptable to all patients. D. generates knowledge for use in practice.

B is derived from a theory.

Using Maslow's hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing. A. Self-actualization B. Air, water, and nutrition C. Safety D. Esteem and self-esteem needs

B. Air, water, and nutrition

Susan is a new nurse who tutors a nursing student, Bill, who has difficulty mastering good study habits and prioritizing school assignments. Susan is helping Bill learn the theoretical foundations of nursing practice. After Susan and Bill review interdisciplinary theories, such as Maslow's hierarchy of needs and the developmental theories, they move on to the topic of nursing theories. Q. Susan quizzes Bill about the core concept of Peplau's theory. Peplau's theory has only three phases, including orientation, working, and resolution. A. True B. False

B. False * phases = pre-orientation, orientation, working, resolution

The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient can begin performing these activities. The nurse in this situation is applying the theory developed by: A. Johnson. B. Orem. C. Roy. D. Peplau.

B. Orem.

Concepts

Both abstract and concrete Ex. abstract --> emotions (can't physically touch emotions) Ex. concrete --> the healthcare environment (decreasing Noise, cleanliness)

Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse? A. Biomedical B. Leadership C. Psychosocial D. Developmental

C. Psychosocial

Input/Output

Input = collect data through assessment skills - subjective data --> what the patient says - objective data --> what you see, hear, smell, feel * see the patient gasping for air * hear lung and heart sounds * smell the foul odor of an infected wound * touch/feel pulse EX. Blood Pressure - elevated BP = input Output = end product of system - evaluate progress of patient Ex. evaluate BP and see if it has improved, worsened, or stayed the same

Nursing Theory Generates...

Knowledge

Theory Era (1980-1990s)

Nurses began providing care with EBP (research)

Research Era (1950-1970s)

Nurses began to conduct research studies

Bullying video: Passive communication skills as a target

passive communicators avoid conflict - easy going - "whatever is easier", "whatever you want to do", "it doesn't matter to me" - speak in an extreme apologetic manner FIX = be assertive; clear and respectful

Domain of nursing

perspective of nursing

Shared Theories

using theories from other disciplines

Prescriptive Theory

- Address nursing interventions for a phenomenon, guide practice change, and predict the consequences - testing a nursing intervention ex. if you believe meditation can relieve headaches, you can test it

Descriptive Theory

- Describe phenomena and identify circumstances in which phenomena occur -Growth + Development - Ex. how a person matures as they age

Shared Theory: Maslows Hierarchy of Human Needs

- Focuses on human needs From base to peak: a. Physiological Needs (food, water) b. Safety (fall risks, socks with grips) c. Social Needs (family, 24 hour visiting) d. Self esteem needs e. Self actualization

Middle-Range Theory

- Less abstract, limited in scope - focuses on concept Ex. Caring = caring promotes healing

Practice Theory

- Narrow in scope and focus - Theories we bring to the bedside Ex. a mom pyschologically adapts to baby after birth

Graduate education era (1950-1970s)

- Nursing began to publish journals - Nursing conferences - Doctoral programs --> encourages higher degree of education

Grand Theory

- abstract, broad in scope, complex - Ex. Florence Nightingales Theory of Environment - focuses on the Metaparadigm (People, Health, Nursing, Environment)

Person

- as a novice, you will be taking care of one patient at a time in clinical - OB and PEDS --> taking care of families - Communities Patient --> families --> communities

Bullying video: Lack of self confidence as a target

- bullys look for those who avoid eye contact; act nervous FIX = do the opposite *act as if you're confident * stand tall, firm handshake --> builds confidence

Peplau's phase: Orientation

- defining the issue/problem ex. a patient is diabetic and doesn't know how to administer their own insulin. this is the problem

Types of Theory

1. Grand Theory 2. Middle-Range Theory 3. Practice Theory 4. Descriptive Theory 5. Prescriptive Theory

Bullying video: How do bully's choose their targets

1. New Nurses 2. Lack of self confidence 3. Passive communication skills

Bullying video: what are the steps to protecting yourself from bullying?

1. Recognize bullying behaviors 2. understanding how Bully's choose their targets

how is nursing both an art and science?

Art --> caring and nursing experience Science -->Evidence based practice (EBP/research)

Definitions: Theoretical/Conceptual

Conceptual = defining the theory or concept by a dictionary definition

A nurse ensures that each patient's room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist's work is the nurse practicing in this example? A. Henderson B. Orem C. King D. Nightingale

D. Nightingale

The components of the nursing metaparadigm include: A. Person, health, environment, and theory. B. Health, theory, concepts, and environment. C. Nurses, physicians, health, and patient needs. D. Person, health, environment, and nursing.

D. Person, health, environment, and nursing.

Resource

Ex. the nurse helps the patient trying to learn how to administer their own insulin where to get supplies at home at a good budget

Who is the First Nursing Theorist?

Florence Nightingale

Peplau's Interpersonal Theory

Focus on interpersonal relations between nurse, patient, and patient's family. developed ways to interact with people Phases: 1. preorientation 2. orientation 3. working 4. resolution *Middle-range theory*

Health

Health is different for each patient

Bullying video: Bullying behaviors

Overt Behavior = you can see it (screaming) Covert behavior = more subtle (gossip, backstabbing, rolling eyes) *More destructive

Nursing Definitions

Person, Health, and environment all interconnected

Peplau's phase: Working

Teaching/ Therapeutic activity ex. the diabetic patient who doesn't know how to administer their own insulin will be taught by the nurse

Peplau's phase: Resolution

Termination of relationship - give final report - must make patient aware of when you're leaving (i have 12 hours left as your nurse) - set the next nurse coming to care for the patient up for success

The Nursing Process is ....

The Nursing Process is a systematic way to provide care (System Theory)

The Nursing Process is NOT ...

The Nursing Process is not a theory

Why is Nursing both Theory and Experiential

Theory = observation in class, learning from reading and interactive studies Experiential = clinical/simulation experience

what is the link between Theory and Knowledge development?

Theory builds knowledge (EBP/Research) this new knowledge (EBP/Research) is implemented into care practices

Theory generates....

Theory generates knowledge for clinical practice - theory supports EBP

What is nursing theory and why is it important?

Theory, research, and clinical practice all function together

What do theories do?

They explain, describe, predict, and prescribe Nursing Care

Surrogate

We do things for the patient until they can independently do it on their own Ex. the insulin patient --> we administer their insulin until they feel comfortable or know how to do it confidently by themselves

Maslow's Hierarchy of Needs example

a patient is in pain (physicological need). You need to satisfy/meet the needs of the pain in order to move up in the hierarchy

paradigm

beliefs used to describe discipline

Orem's Self-Care Deficit Nursing Theory

believes that patients can improve their health by participating in self-care Ex. initially nurses help patients do things they cannot do by themselves. Then, when their health improves we let them do it by themselves

Leininger's Culture Care Theory

culture care theory - providing culturally specific care ex. Irish are stoic when experiencing pain ex. middle easterns are more vocal with pain

Counselor

discuss the problem ex. patient does not know how to administer insulin

Phenomenon

ex. caring ex. self-care ex. how a patient responds/copes to stress

what was Nightingales theory?

focused on environment - believed in using the environment to promote patient recovery and prevent complications

Shared Theory: Psychosocial Theory

focuses on: A. Physical needs B. Psychological needs C. Developmental needs D. Spiritual --> Jehovah witnesses refuse blood transfusions E. Sociocultural --> how culture affects health (ex. Irish people are stoic when it comes to pain) **These things make nursing wholistic

Theory Based Nursing Practice

goal of theory = to show how nursing is different from other disciplines