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