Nursing Theories Chapter 3-9
Who was considered the first nurse theorist?
Florence Nightingale
What is "The caring moment" by Jean Watson?
"Maybe this one moment, with this one person, is the very reason we're here on earth at this time..."
What was the first book of its kind to theoretically describe the nature of nursing and who was the author of this book?
"Notes of Nursing: What it is and What it is Not By Florence Nightingale **Her theory development and research was not carried forth. It would not become considered for another 100 years.
Weidenbach's Four Elements to Clinical Nursing
1. Philosophy: An attitude toward life and reality that evolves from each nurse's beliefs and code of conduct; includes: Reverence for the gift of life. Respect for the dignity, worth, autonomy, and individuality of each human being. A resolution to act on personally and professionally held beliefs 2. Purpose: That which the nurse wants to accomplish through what he or she does The overall goals for professional practice, including activities directed toward the overall good of the patient 3. Practice: Observable nursing actions that are influenced by disciplined thoughts and feelings toward meeting the patient's need for help. Goal-directed and patient-centered 4. Art: Consists of the nurse's: Understanding of the patient's condition, situation, and need. Internal goals and external actions that are meant to enhance patient capability through appropriate nursing care. Activities directed toward improvement of the patient's condition through artful utilization of the medical plan of care. Interventions aimed at prevention of recurrence of the current concern or development of a new concern.
A Closer Look at 10 Major Elements of Clinical Caritas Processes
1. Practice of loving-kindness and equanimity within the context of an intentional caring consciousness 2. Being authentically present 3. Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self 4. Developing and sustaining a helping-trusting, authentic caring relationship 5. Being present to, and supportive of, expression of positive and negative feelings as connection with deeper spirit of self and one being cared for 6. Creative use of self and all ways of knowing as part of caring process Engaging in artistry of caring-healing practices 7. Engaging in genuine teaching-learning experience that attends to unity of being and meaning, while attempting to stay within other's frame of reference 8. Creating healing environment at all levels, whereby wholeness, beauty, comfort, dignity, and peace are potentiated 9. Assisting with basic needs, with intentional caring consciousness, administering human care essentials, which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care Tending to both embodied spirit and evolving spiritual emergence of both other and self 10. Opening and attending to spiritual-mysterious and existential dimensions of one's own life-death Soul care for self and one being cared for
The first step when trying to understand and evaluate a theory is to identify the presence or absence of the following six components:
1. What concepts are presented that list and classify nursing components of interest? 2. How does the theory define person, health, environment, and nursing? 3. What are the specific statements that clarify exactly what the theory is trying to describe? 4. What types of definitions are used in the theory? a. Theoretical definitions explain the nature of something in a broad sense and may not be immediately applicable to everyday activities. b. Operational definitions are meant to explain exactly how something works (e.g., exactly what is meant by "wellness"? What are the observable or measurable signs that a person is experiencing a high degree of wellness?). 5. What are the links or relationships between terms, concepts, and theoretical assertions? 6. How are the concepts and statements organized? (Simple to complex? Linear? Highly structured? Unstructured?)
The six components(simplified)
1. What concepts are presented that list and classify the nursing components of interest? 2. How does the theory define person, health, environment, and nursing? 3. What are the specific statements that clarify exactly what the theory is trying to describe? 4. types of definitions are used in the theory? Theoretical definitions explain the nature of something in a broad sense and may not be immediately applicable to everyday activities. Operational definitions are meant to explain exactly how something works 5. What are the links or relationships between terms, concepts, and theoretical assertions? 6. How are the concepts and statements organized? Simple to complex? Linear? Highly structured? Unstructured?
These six components help to evaluate the theory in terms of personal and professional relevance.
1. What is your gut response to the basic tenets put forth in this theory? Does it make sense in relation to your own professional experience? 2. How clear is this theory? Can you "buy into it"? What factors made this theory either clear or unclear to you (e.g., a feeling or belief that you have held or specificity to a clinical area that you are either familiar or unfamiliar with)? 3. How simple is it? Could you easily describe the overall ideas presented in the theory to a colleague? 4. How general is this theory? Could it be used in many types of nursing settings or is it limited to a selected type of nursing-client situation? 5. How much research exists in current literature that uses this theory as its framework or theoretical base? Choose a time frame (e.g., the years between 1999 and 2003) and conduct a literature search. Is the amount of research using this theory increasing, decreasing, or staying the same? 6. Evaluate the potential impact this theory would most likely have on your current nursing practice. If you used this theory, how significantly would it impact your practice?
It was not until the _______ that nurse scholars started to develop nursing theories
1950s
What is the process of theory creation?
1st step Theorist observes phenomenon in practice 2 nd step Theorist reflects on phenomenon over time, comparing it to what is known 3 rd step Theorist determines goodness of fit and usefulness 4th step Theorist names, classifies, and categorizes phenomenon and describes relationships/ interrelationships
What is the definition of philosophy?
A system of beliefs regarding the general nature of all things, particularly morality, ethics, and how the world should be viewed
what is the definition of theory?
AN ABSTRACT GENERALIZATION THAT PRESENTS A SYSTEMATIC EXPLANATION ABOUT THE RELATIONSHIPS AMONG PHENOMENA. A NURSING THEORY IS A THEORY THAT IS MEANT TO ADDRESS PHENOMENA SPECIFIC TO NURSING PRACTICE
Discuss Peplau's process of developing her model of interpersonal relations in nursing.
An example of practice-based theory development can be found in the work of Peplau and her use of participant observation with depressed women (Peplau, 1989). Peplau's work was the earliest published work (1952) after Nightingale. Peplau used several methods of observation, such as interviews, spectator observation, and random observation. She recorded her observations of the nurses and patients, classified and categorized the data, assigned meaning at different levels of abstraction within the phenomenon, and interpreted the observations in the context of the phenomenon. Patterns emerged throughout this process, and Peplau was able to develop interventions from the patterns that helped the patient gain interpersonal competencies during illness (Peden, 1998). It was through this process that Peplau developed her model Interpersonal Relations in Nursing.
What are the basic human needs compared to the basic components of nursing care?
BASIC HUMAN NEEDS ARE: Breathing Eating and drinking Bodily elimination Comfortable body postures Sleeping and resting Selection of proper clothing and maintenance of body temperature and skin integrity Adequate cleanliness Avoiding danger to self and others Communicating meaningfully with others Individually appropriate human developmental tasks Worshipping according to one's faith Work that provides a sense of accomplishment Play and leisure activities Opportunities to learn and satisfy curiosity COMPONENTS OF NURSING CARE ARE: Respiration Eating and drinking Elimination Postures and ambulation Sleep and rest requirements Clothing needs Temperature regulation Hygiene Avoiding danger to self and others Communication, especially associated with needs and feelings Religious and spiritual activities The performance of appropriate work activities Play and recreation Learning and human developmental activities
Watson's Personal Reflections on Being a Nurse Theorist
Began as a process of exploring deep meaning, integrity, distinction, and philosophical underpinning of the nature of nursing. Influenced by background in psychiatric mental health nursing and PhD studying various existential and phenomenological aspects of human existence. Writing her first book was a healing experience from distress that most of the focus and direction for advancing nursing was within the context of medical science, technology, and conventional research related to disease treatment and curing. First book, Nursing: The Philosophy and Science of Caring, began exploration of core values, knowledge, and context for nursing science Focus on humanity and human caring, healing, human experiences, and health Contrasted with but complementary to medical science Caring science unites and seeks converging ideas and models within a unitary worldview and ethic of belonging to an infinite field of universal love, which holds the world and humanity in a global field. Caring theory seeks wisdom, compassion, love, and personal integration of knowledge and all of life's known and unknown experiences.
Ernestine Wiedenbach Overview
Born in Hamburg, Germany ( to an affluent family), in 1900 (died in 1998 at age 98) - immigrated to United States as a girl Received BA degree from Wellesley College (1922) Received nursing degree from Johns Hopkins School of Nursing (1925) Received MA in public health nursing from Teachers College, Columbia University (1934) Received midwifery degree from School for Midwives at the Maternity Center Association of NY (1946) Taught at Teachers College and Yale University Wrote textbooks, including Clinical Nursing: A Helping Art (1946) Best known for theory development and maternal-child nursing
Virgina Henderson Overview
Born in Kansa City, Missouri, in 1897 (died 1996 at age 99 years of age) but grew up in Washington, D.C. Graduated from Army School of Nursing 1921 Worked as home-visiting community health nurse at Henry Street Settlement in NYC Received bachelor's and master's degrees from and taught at Teacher's College at Columbia University Professor Teacher's College 1930-1948 Served as educator, researcher, and author IN 1960 Wrote pamphlet Basic Principles of Nursing Care in response to ICN (International Council on Nurses) request to define nursing "independently of technology or medicine"
Jean Watson Overview
Born in West Virginia in 1940s Graduated from Lewis Gale School of Nursing, Roanoke, West Virginia (1961) Attended University of Colorado Received BS (1964) Received MS in psychiatric and mental health nursing (1966) Received PhD in educational psychology and counseling (1973) Joined nursing faculty of University of Colorado Health Sciences Center and served in many capacities Currently Distinguished Professor Emerita and Dean Emerita of Nursing Created Center for Human Caring at University of Colorado **Founded the Watson Caring Science Institute, an organization dedicated to transforming and leading healthcare systems in the United States and abroad toward a Caring Science model that values authentic caring-healing relationships grounded in love and compassion
What are the major elements of theory?
Clinical caritas processes Transpersonal caring relationships Caring moments/caring occasions Expanded views of self and person "mindbodyspirit" Caring-healing consciousness: Cultivated intention to care and to promote healing Caring consciousness: State of being mindfully within caring exchange, recognizing distinct energy within caring moment Recognition of wholeness and connectedness of all Openness to belief that advanced caring-healing modalities/nursing arts constitute valid future model for advanced practice of nursing
Evaluation of Nursing Philosophy Requires Two Vantage Points
Close-up: Determine the ideas (dots of color) contained in the theory that comprise the whole picture Far away: Determine the central idea (picture) that exemplifies the theory in general KEEP THIS IN MIND AS WE STUDY THE VARIOUS THEORIES AND PHILOSOPHIES THIS SEMESTER
What were Virgina Henderson's accomplishments?
Creating a definition of nursing Numerous awards and honors (Sigma Theta Tau International Library named for her)
Rewards of the Theory
Deeper knowledge, understanding of, and compassion for self and others Self-knowledge The self we learn about is every self, the human self. We learn to recognize ourselves in others.
The three questions of theory
Does a theory resonate with long-held professional insights? Does a theory stimulate new ways of thinking? Does a theory provide fresh viewpoints? A theory warrants further study if you can answer yes to any of the above.
Pointillism as a Framework for Viewing Nursing Philosophy
Each theory consists of distinct points "Close-up" views of points may vary among nurses When mixed by the mind's eye, points create an impression of nursing as a whole "Faraway" view usually a broad concept most nurses can agree on
Global Sense of Nursing
Effective identification of patient's need for help through observation of presenting behaviors and symptoms Exploration of meaning of symptoms with patient Codetermining cause(s) of discomfort Assessment of patient's ability to resolve discomfort Provision of necessary help as needed
What is the nurses role?
Follow and assist with the medical plan of care outlined by a physician. Assume leadership role as independent practitioners of planning and providing basic nursing care. Should not independently diagnose, prescribe medical treatment, or formulate prognoses (does this apply today? Why or why not?) The method by which the nurse facilitates optimal independence for the patient varies from patient to patient and is based on the nurse's professional judgment. Empathy coupled with knowledge and interest on the part of the nurse will enhance the healing process. Follow overall goal of promoting patient independence with regard to 14 points.
Transpersonal Caring Relationship
Foundation of nursing work Second major element of Watson's theory Seeks to connect with and embrace spirit or soul of the other through the processes of caring and healing and being in authentic relation, in the moment Implies that nurse consciously focuses on uniqueness of self, other, and present moment Nurse/client exchange is mutual and reciprocal, each fully embodied in the moment Paradoxically capable of transcending moment and opening to new possibilities Nurse attempts to enter into and stay within other's frame of reference for connecting with the inner-life world of meaning and spirit of the other Exchange potentiates comfort measures, pain control, a sense of well-being, wholeness, and/or even spiritual transcendence of suffering. Person is viewed as whole and complete, regardless of illness or disease.
Georges Seurat
French Post-Impressionist painter (1859-1891) Perfected pointillism, the use of tiny dots of pure color to create two effects: Up close, viewer sees points of color Far away, viewer actively "mixes" the colors to see image Perceptions of his paintings vary widely, depending on individual viewer Paintings create feeling of boundlessness
who perfected the painting technique of pointalism?
Georges Seurat
Nightingale's Crimean War Accomplishments
Helped lower mortality rate from 60% to just over 1% Improved hygiene, nutrition, and the level of care to patients in Scutari Raised public awareness of nurses through accomplishments Nightingale became a celebrity in England Nightingale went on to develop nurse training schools and reform military hospitals
Boundlessness in Seurat's Works and in Studying Nursing Theories
In Seurat's paintings, the light and color in the painting seem to merge with light and color outside the bounds of the canvas. In studying nursing theories in general, one merges personal nursing experiences ( AS ONE GAINS EXPERIENCE) into the structure of the theory to find resonance and meaning, expanding the bounds of the theory into real-life practice.
Florence Nightingale
Inspected and wrote about conditions in English hospitals, reformatories, and charitable institutions Served as superintendent of London's Hospital for Invalid Gentlewomen Along with 38 nurses, arrived in Scutari, Turkey, during Crimean War to care for more than 3,000 injured soldiers
What does nursing theory do?
It explains, describes, predicts and prescribes nursing care
When did nursing theories become essential?
Nursing leaders realized nursing theories were essential if nursing was to develop its own body of knowledge
Florence Nightingale Overview
Lived during Victorian era England from 1820-1910 Daughter of well-educated, aristocratic English family (she was expected to marry a wealthy gentleman.....) Received education from her father (which he highly valued) in mathematics, languages, religion, and philosophy Completed nurse training at a German Protestant hospital (much to the dismay of her family) - 3 month training - and returned to England where her career began
Watson's Theory of Human Caring/Transpersonal Caring
Makes explicit nursing's values, knowledge, and practices of human caring that are geared toward subjective inner healing processes and the life world of the experiencing person Requires framework of "carative factors" Complements conventional medicine Contrasts "curative factors" Balances cure orientation of medicine Gives nursing unique disciplinary, scientific, and professional standing with itself and its public Assumes inherent human need is to both give and receive care Serves as theoretical mainstay for: Individual nurses Entire nursing education programs in United States and globally
Why do most nurses begin constructing theories?
Most began constructing a theory as a way to improve care delivered to clients, whether through direct clinical practice or through education of nurses.
Nightingale's Philosophy
Nursing is a vocation and noble undertaking that requires discipline and training Act of nursing requires educated and meticulous planning by those wishing to provide effective nursing care Ideas are encapsulated in Notes on Nursing: What It Is and What It Is Not, along with prolific writing
Points of Color
Nursing primarily consists of a core of intentional caring, intertwined with excellent nursing skills. Nurse and patient are equally valued in the nurse-patient interaction. Both contribute various attributes to the caring environment. Central to excellent transpersonal caring on part of the nurse is realization that connections between patient and nurse exist on many levels. Overt physical environment Deep levels of energy exchange not readily observable Spirituality, intentionality, and mindful attention to the here and now within the human-to-human exchange enables the nurse to holistically express caring in the physical, emotional, psychological, spiritual, social, and matter/energy realms simultaneously.
Weidenbach's "Points of color"
Nursing primarily consists of identifying patient's need for help. If need requires intervention, nurse facilitates medical plan of care and creates/enacts nursing plan of care based on patient's individual needs and expressed desires. Nurse exercises sound judgment through deliberative, practiced, educated recognition of sentinel symptoms. Patient's perception of the situation is an important consideration to the nurse. Nurses respect individuality, dignity, worth, and autonomy of each patient and understand that patients generally value independence. When assessing need for help/response to care, remember human beings generally do the best they can with what they have, making best judgments possible at any given moment. Includes emotional, physical, intellectual, social resources The need for help and resulting care are more important than attempting to determine and/or judge why patient may have made a particular life decision.
What was Henderson's Nursing Philosophy?
Origin of nursing activities is universal human need. Nurse continuously interprets the way these needs are modified by the particular state of the person he or she serves. Nurse's basic care is the same, regardless of the patient's condition. Nurse's role is to assist individual in performance of those activities contributing to health or its recovery (or to a peaceful death) that the person would perform unaided given the necessary strength, will, or knowledge and to do this in such a way as to help the individual gain independence as rapidly as possible.
Weidenbach's Definitions of Key Terms
Patient: Any person who has entered the healthcare system and is receiving help of some kind Patient need not be ill Need for help: Any measure desired by the patient that has the potential to restore or extend the patient's ability to cope with various life situations that affect health and wellness Judgment: Nurse's likeliness to make sound decisions Based on differentiating fact from assumption and relating to cause and effect Result of disciplined functioning of mind and emotions Improves with expanded knowledge and increased clarity of professional purpose Nursing skills: Carried out to achieve a specific patient-centered purpose, rather than completion of the skill itself being the end goal Consist of various actions characterized by harmony of movement, precision, and effective use of self Each person: Endowed with unique potential to develop self-sustaining resources Includes both nurse and patient People generally tend toward independence and fulfillment of responsibilities Self-awareness and self-acceptance essential to personal integrity and self-worth Whatever an individual does at any given moment represents best available judgment for that person at the time
Who was the earliest published nursing theorist after Nightingale?
Peplau
Describe the Nurse Theorists tool of Reflection
Reflection is an intentional undertaking that requires time and commitment. The purpose of reflection is to allow practitioners to examine clinical anecdotes and resolve contradictions between what the nurse desires to achieve and what is experienced in actual practice, with the goal to achieve more effective outcomes
Discuss the key points of the debate over methodology
Scientific method (Logical Positivism) Method used since 1920s Assumes objective truth can be discovered through rigorous observation, experimentation Assumes theory is meaningful; objective verification: Measuring, observing, and quantifying for the purpose of generalizing Basis of most twentieth-century nursing theory Postmodern methods New approaches/late twentieth-century debates Qualitative methods and alternative approaches Views science, theory building, and generation of knowledge as a process, not a way to create a "solution" or "discover the truth" Encompasses phenomenon that cannot be concretely measured and quantified Opinions vary regarding which method of theory development and inquiry is better In general, kind or type of research one chooses should be dependent on the questions, rather than on the method of inquiry deemed "acceptable" All methods contribute to the development of nursing knowledge
What do nursing philosophies do?
Seek to define and document what nursing is Example: How does nursing fit into the universe? Include multiple components that try to categorize and clarify the scope and depth of professional activities on a personal and global level Encompass both science and art
Nightingale's Philosophy in action
She was the first documented nurse to become an expert statistician to better serve her patients. She set the stage for future nurses to envision themselves as researchers. Through extensive research and writings, both private and published, she significantly influenced healthcare policy in Great Britain.
Use a stepwise process to identify a theory's components:
Step 1: Determine the presence or absence of six components Step 2: Evaluate in terms of personal and professional relevance
How do you determine what type of theory to use?
The kind or type of research one chooses should depend on the questions to be answered rather than on the method of inquiry deemed "acceptable" in most academic circles.
Testing of Theory
Theory, practice, and research are interrelated and interdependent. Theory, once conceptualized, must be tested. While theories were being developed in the 1950s and 1960s, doctoral programs in nursing were being established and master's programs were becoming entrenched. Research programs were established, and nurses began to conduct nursing research. Columbia University's Teachers College primarily used a biomedical model for its research focus in the 1950s and concentrated on the roles of nurses. In the 1960s, Yale School of Nursing's research focus was on nursing as a process
Why did nurses create nursing theories?
They Created nursing theories as a process of improving client care
Caring moments/ caring occasions
Third major element of Watson's theory Occur whenever nurse and patient come together in human-to-human transaction Coming together in a given moment becomes focal point in space and time Becomes transcendent: Experience and perception occur Actual caring occasion has greater field of its own in a given moment Consist of actions and choices made by both nurse and patient Present each with opportunity to decide how to participate in the relationship Enable, if transpersonal, patient and nurse to feel connected at spiritual level Transcend time and space Open new possibilities for healing and human connection at a deeper level
Why did the theorists create theories?
To further nursing as a scholarly profession To organize and improve the delivery of nursing care To address concerns over lack of nursing knowledge To develop nursing as a science To create tools that provided structure for the improvement of nursing practice and education
What are the reasons for evaluating a theory?
To gain a basic understanding of each nursing theory of interest To systematically identify meaningful components, evaluate personal relevance, and then apply new knowledge or understandings where applicable To form meaningful insights and opinions that will ultimately deepen professional practice
Who was described as "The first lady of nursing" "The modern day mother of nursing" and "The nightingale of modern nursing"
Virginia Henderson
Step 2: Evaluate for Personal and Professional Relevance
What is your gut response to the basic tenets put forth in this theory? Does it make sense in relation to your own professional experience? How clear is this theory? Can you "buy into it"? What factors made this theory either clear or unclear to you? How simple is it? Could you easily describe the overall ideas presented in the theory to a colleague? How general is this theory? Could it be used in many types of nursing settings or is it limited to a selected type of nursing-client situation How much research exists in current literature that uses this theory as its framework or theoretical base? Evaluate the potential impact this theory would most likely have on your current nursing practice If you used this theory, how significantly would it impact your practice?
Ernestine Wiedenbach's 4 main elements in clinical nursing
a philosophy a purpose a practice the art
Early nurses viewed nursing as a _______________ not an alternative to ______________
career marriage
Theorists may also be motivated by
frustration, confusion, desire for organization, or need for a way to communicate outcomes to others
theorists must be _____________ in practice
immersed
When were the first doctoral programs in nursing established?
in the 1960s
Nightingale demonstrated that research was integral to
modern nursing
Theorists reflect upon..
personal and professional experiences to make sense of worldviews, then assembles the puzzle pieces
Florence Nightingale created the first publication to ..
theoretically describe the nature of nursing
In the 1950s nursing education was in transition ..
with the educaiton and training of nurses moving into college-level educational institutions and out of hospital-based training schools
The most important questions to ask when evaluating theories are:
• Does it resonate with long-held professional insights? • Does it stimulate new ways of thinking? • Does it provide fresh viewpoints?
