nursing theory

When does the caring occasion occurs according to Watson's framework?

A caring occasion occurs whenever the nurse and another person come together with their unique subjective realities, seeking to connect to the other in the present

Know the list of attributes of culturally competent organizations.

A list of attributes of culturally competent organizations, organized arbitrarily by governance and administration, education and orientation, and language, follows (Purnell, 2009a; Purnell, Giger, Davidhizar, Strickland, Harden, et al., 2009; Purnell & Paulanka, 2008): Governance and Administration 1. The organization has mission statement and policies that address diversity. 2. The board of governance includes members of the ethnicity of the community that the organization serves. 3. A committee for cultural competence exists and includes staff, managers, administrators, chaplains, and members who are representative of the community. 4. The organization engages in community diversity fairs. 5. The organization seeks resources from federal, state, and private agencies to continually upgrade and integrate cultural competence into its care. 6. The organization partners with diverse community agencies. 7. The organization networks with diverse community leaders. 8. Administrators, managers, and staff are encouraged to be active in developing public policy for the client base to whom they deliver care. 9. Policy statements include efforts to eliminate bias and prejudice on the part of both clients and staff. 10. Programs reflect the needs of the diverse community. 11. The organization's programs are advertised in community newspapers and on the radio and television in the languages of the community. 12. There is a willingness to support a mentoring program to entice recruitment into the health professions. 13. Data collected include race, ethnicity, culture, and language preferences of the staff and client base. 14. Patient rights documents are available in the major languages of the community. 15. Cultural and linguistic standards are adhered to by all members of the organization. 16. Fiscal resources are available for interpretation. 17. Strategic planning reflects the needs of the community. 18. Input on research priorities is sought from consumers. 19. Researchers are reflective of the staff, clients, and community. 20. Human resources recruitment and hiring activities reflect the diversity of the community. 21. The job analysis procedure includes scoring for ethnocultural and language ability. 22. Position descriptions and evaluation practices reflect cultural competence. 23. Conflict and grievance procedures reflect the language of the staff. 24. The organization actively recruits bilingual staff. 25. Staff members are compensated for bilingual ability and certification. 26. The ethics committee includes members who are reflective of the staff and clients. 27. The hours of operation of clinics are adjusted to meet the needs of the community. 28. Pictures and posters are reflective of the client base. 29. Food choices are reflective of the client and staff preferences. 30. The holiday calendar represents the holidays recognized by the client population base. 31. Intake forms reflect cultural assessment. 32. Pain scales are available in the diverse languages used by the population served. 33. Culturally appropriate toys are available (e.g., Hispanic Santa, African American dolls). 34. If staff members are used as interpreters or if professional interpretation is available, a plan is in effect to address their job duties while interpreting for patients and staff (also a requirement established by The Joint Commission). 35. Education and orientation diversity are addressed as part of new employees' orientation, in-service, and continuing education programs. 36. Nursing care delivery systems, the U.S. system of insurance reimbursement, and issues related to culture and autonomy are discussed. 37. Mentoring programs exist for diverse student and staff populations. 38. Diversity of the health professions is included in orientation. 39. All employees are offered education on both general cultural topics and the culture-specific needs of populations for whom they provide care. 40. Cultural celebrations are reflective of the staff and clients. 41. Resources are available to staff both the clinical unit and the library. 42. Staff members are trained in language interpretation. 43. Health classes are offered to clients whom the community serves. 44. Certification in culture for staff is offered at various levels. 45. Pharmacists, nurses, and physicians are educated in ethnopharmacology. 46. Lunch-and-learn series support the ongoing development of cultural competence. Language 1. There are mechanisms in place for translation of written materials in the preferred language of the client. 2. Policies address interpretation services. 3. Resources are available for translation of educational materials and discharge instructions in the languages of the client population. 4. The organization engages in activities that address health literacy of the population whom it serves. 5. Written documents undergo a cultural sensitivity review. 6. Consent and procedure forms are translated into the languages of the population served. 7. "English as a second language" classes exist for staff. 8. Language classes are offered to clients and family (in English and the language of the population served). 9. Waiting areas have literature in the language of the population served. 10. Directions to referral facilities are in the languages of the client base. 11. Videos are in the language of the client base and have pictures reflective of the client base. 12. Diverse language includes sign language. 13. The need for an interpreter is determined ahead of time. 14. The telephone system prompts are in the languages of the community. 15. Television programs are available in the languages of the community. 16. Satisfaction surveys are available in the languages of the community. 17. Staff surveys are available in the languages of the employees. 18. Audiovisual materials for staff and clients are available in their preferred languages. 19. Wellness and health promotion classes are offered in the languages of the client base. APNs—whether they work in clinical practice, education, research, policy,

Why does theory-practice gap in nursing exists?

A theory-practice gap exists because theories are typically thought of as formulations that are not relevant to practice.

Which of the theory of caring and healing by Swanson's middle-range theory assure clients that reality is appreciated

Being with incorporates emotional presence. It conveys to clients that they matter and assures them that their reality is appreciated

Susceptibility to actual or potential stressors that may adversely affect patient outcomes

Caritas comes from the Greek word meaning "to cherish"; it connotes something that is very precious. Watson's wending path to this way of think- ing highlights the connections between caring, spirituality, and human love.

What is the definition of Cultural imposition

Cultural imposition intrusively applies the majority cultural view to individuals and families. Prescribing a special diet without regard to a person's culture and limiting visitors to immediate family border on cultural imposition

Describe comforting intervention?

Comforting is not a "one-shot" intervention; it is a process that occurs in many iterative steps within the interaction and the developing relationship. During the comforting interaction loop in which a comforting action occurs, the patient is reevaluated and another comforting action is provided, and so forth. Examples of the comforting interaction loop follow: Observing that the patient appears to be in pain (noting the signal of suffering or cues of distress), verifying the pain with the patient (action), administering an analgesic action (comforting action), and observing signs that the pain was subsequently alleviated Observing that the patient appears cold and is shivering (noting the behavioral cue), fetching a warm blanket (comforting action), and observ- ing the patient appears more relaxed and warmer As nursing tasks increase in complexity, so do the comforting actions: During childbirth, the nurse observes that the patient is becoming dis- tressed (signal of suffering) and uses his or her voice (comforting interac- tion, "talking through") to assist in synchronizing the second-stage labor until the woman regains control In the trauma room during resuscitation, a patient is scared but lying still (caring observation). The nurse provides a "running commentary" by talking constantly, describing everything that she and the trauma team are doing. Later the patient reports that "she just listened to that nurse's voice and held on. During trauma resuscitation, the nurse observes that the patient is ter- rified (signal of suffering). He or she uses the comfort talk register to enable the patient to hold on, and hold still (comforting action) until the analgesics take effect Comforting continues until it is no longer needed or demanded by the patient. Thus comfort is defined as a relative and optimal state of well-being that may occur during any stage of the illness-health continuum. Responding to signals of suffering by making the patient comfortable is the goal of nursing (Morse, 1992). The Comforting Interaction The comforting interaction comprises the patient cue, or a signal of distress from the patient; the cue or signal observed by the nurse; and the nurse's assessment of the patient and provision of a comfort strategy (Morse, Havens, DeLuca, & Wilson, 1997). The nurse then assesses for the effectiveness of the strategy and, if the need has not been resolved, provides another strategy. This cycle may be slow and deliberate, or as quick and almost subconscious as an interaction. As the comforting interactions accrue, so does the trust in the nurse-patient relationship build. The relationship itself changes from a clini- cal relationship; to a therapeutic relationship; then, to a connected relationship (Morse, 1991); the patient feels safe and relinquishes himself or herself to the nurse's care The comforting interaction is patient led. In our observations of postoperative infants, for example, comforting always occurred in response to the infant's cues. If the infant did not, or could not, "demand" a comforting strat- egy, it was usually not provided. For instance, because the infants were intu- bated, they cried silently, unable to vocalize their distress. As a result, nurses rarely used their voices to comfort the infants The nurse needs to provide care that is appropriate to the patient's state, and each state is associated with a different compendium of comforting strategies. If the nurse provides the wrong strategy, then the patient's state esca- lates. Ideally, the nurse will immediately correct the error and change the comforting intervention

What is descriptive theories translated into?

Descriptive theories that are generated or tested by descriptive research can be translated into tools used to assess patients. An example is the assessment tool that DeSanto-Madeya (2006) included in her report of the generation of a descriptive theory of the experience of living with spinal cord injury.

What is your conclusion of a theory if the evaluation of research has flaws?

Discovery of any flaws indicates that revisions in the content of the conceptual model are required or that the conceptual model should be discarded.

Which of the Models focuses on areas of communication

Giger and Davidhizar Model

Know the characteristics of expert nurses according to Benner's model

Has an intuitive grasp of the situation and zeros in on the accurate region of the problem (model) No reliance on rules, guidelines, or maxims Extensive and varied experiences Highly developed intuitive sense Understands total situation in depth Prioritizes, acts quickly and fluidly Uses keen analytical skills and problem solving when situations do not go as anticipated

What describes the relationship between theory and evidence in advanced practice nursing?

In advanced practice nursing, theory and evidence are equivalent

which of the Koloroutis elements for transforming the care delivery environment refers to various practices of increasing time nurses spend to patient

Infrastructure refers to the practices, systems, and processes through which vision is achieved. It is the foundation that allows change to occur

Know the definition of Health according to King

King's view of health is "a process of human growth and development and relates to the way individuals deal with stress of growth and development while functioning within the cultural pattern in which they were born and to which they attempt to conform"

Level 3 under Clinical Judgement characteristic of nurses in the AACN Synergy Model for Patient Care

LEVEL 3 COMPETENT Collects and interprets complex patient data; makes clinical judgments based on an immediate grasp of the whole picture for common or routine patient populations; recognizes patterns and trends that may predict the direction of illness; recognizes limits and seeks appropriate help; focuses on key elements of case, while sorting out extraneous details

Why are empirical indicators used to test theory concepts and propositions

Most theory concepts are not directly observable and must be connected to a real-world proxy known as an "empirical indicator.

Know the postulates of Rogers Theory, most especially the concept of openness

Openness is a key postulate because the openness of human and environmental fields is what unifies them as one essential unity

What is the purpose of outcome identification and planning according to Neuman's model

Outcome identification and planning involves negotiation between the caregiver and the client or recipient of care

Know the levels of prevention based on Neuman's model

Primary prevention is health promotion and maintenance of wellness (vaccines) Secondary prevention as intervention is related to the treatment of symptoms Tertiary prevention follows after the system has been treated through secondary prevention

Know the three principles of Parse's Theory. What humans do to avoid confronting external reality

Rather than confronting an independent, external reality, humans construct reality through the significance they give situations throughout the "was,""is," and "will be," all of which are experienced simultaneously

When searching for the published literature for information about a theoretical problem, which approach is the best place to draw search terms?

Searching published literature is done through scoping review in order to determine the amount of literature available on the subject. Review focuses on the theory component of the C-T-E structure. Search terms can be drawn from the conceptual model, PICOT format, type of article being searched, practice guidelines, review summaries, and best practices.

Know the criteria in evaluating a theory.

Significance of the Theory - extent to which the theory is socially and theoretically important Internal consistency of the Theory - extent to which the concepts of the theory are comprehensible (i.e. explicitly identified and clearly defined) Parsimony of the Theory - extent to which content of the theory is stated as concisely as possible - made up of as few concepts and propositions as necessary to clearly convey its meaning. Testability of the Theory - extent to which the theory can be empirically tested. Must be empirically measurable which is accomplished when each concept is explicitly linked to an empirical indicator.

know the components of the Praxis Theory of Suffering

The Components of the Praxis Theory of Suffering The praxis theory of suffering is a state theory: Suffering is an emotional experience; emotion is reflected in, and evidenced in, the suffering person's behaviors. However, while these emotions are observable in distinctive behav- iors, they may also be "covered" or concealed. Suffering is a patient-centered, patient-led, dynamic model, and the responses to suffering are individualized and may vary according to the person's way of responding to the loss, the con- text, cultural and social norms, and the amount to privacy afforded. Suffering is defined as a basic human response to a threat to one's physical or psychosocial integrity (such as occurs in illness or disability, pain, or the death of a loved one), or in untenable life situations (such as abuse or accident). The suffering response may vary in intensity from slight to severe, according to the significance of the loss to the person. It is an emotional response that is manifested behaviorally, that occurs in response to a perceived, threatened (anticipated), or actual loss. The goal of the suffering response is to "shut down" the body or mind to protect the self. Suffering consists of two major states: enduring and emotional suffering. Enduring is a state in which the person's emotions are suppressed and the person focuses on the present. In this situation, the past, which has resulted in the loss, is too painful to recall, and the altered future is too painful contemplate. Suffering persons are aware that if they respond emotionally to the loss, they might "break down"—that is, they would be unable to function in daily activi- ties and to do whatever needs to be done. The emotional suppression is visible and is evident in the person's posture, facial expression, interaction with others, and speech. The person who is enduring stands erect, has a mask-like expres- sion, and moves "like a robot" with a lumbering gait that is devoid of spontane- ous movement. These people stand apart from one another, tend to be silent, and respond to any attempt at conversations with a single word, nod, or gesture. When the person is "ready to take it"—that is, to accept whatever is being suffered—he or she transitions into emotional suffering. This shift in state occurs when the individual acknowledges the actuality of the loss. The emo- tional resources can no longer be controlled and are manifested as states of despair, grief, and sorrow. Emotional suffering is a state in which the emotions of distress are released and the person acknowledges the incomprehensible past, the altered present, and the anticipated future. Persons who are in a state of emotional suffering may cry or weep and have a sorrowful expression. They often want to talk incessantly about the loss to whoever will listen; they have a hunched posture that invites others to hold and to comfort them. These states—enduring and emotional suffering—do not occur simultane- ously, nor is the praxis theory of suffering a stage model. Instead, the person may flip back and forth between enduring and emotional suffering. Eventually, when the person has "suffered enough," hope seeps in and the emotions change. He or she gains a new perspective about the experience of suffering—that is, reformu- lates (see self-reformulation in Figure 23-1) (Carter, 1994; Morse & Carter, 1996). Individuals who have suffered reevaluate the experience and their altered lives. They are able to consider whatever has made them suffer in a new light, even valuing the experience. Suffering has given them a new appreciation for living, and they leave the states of suffering with a new perspective.

What is the criteria for a theory to be an empirically adequate?

The criteria is operational adequacy which refers to the appropriateness of the empirical indicators as measures of the theory concepts. When the empirical indicator used to measure a theory concept yields qualitative data, it should be dependable and credible.

Know the application of Rogerian science in Advanced Practice nursing

The idea is that the nurse goes above in beyond in her practice, tries to distract the patient from the pain that they are in

What is the lived experience between a patient and a nurse that affects a person's personhood according to Boykin and Schoenhoefer's theory?

The nursing situation is the lived experience between a patient and a nurse that affects one's personhood.

What is the reason for an increased interest in translational research in recent years?

Translational research helps transform research findings into practical actions.

Know the trait of competency of a leader according to the RBC Model

competency—know expectations and have support to acquire the skills needed to meet those expectations;

management goals of nursing problems for APN by Dorothy Johnson

to restore, maintain, or attain the patient's behavioral system balance and stability and to help the patient achieve an optimal level of balance and functioning.

Know the assumptions of care within Leininger's Cultural Care Diversity and Universality Theory and Model.

• Care (caring) is essential to curing and healing, for there can be no curing without caring. • Every human culture has generic, folk, or indigenous care knowledge and practices and usually some professional care knowledge and practices that vary transculturally. • Culture care values, beliefs, and practices are influenced by and tend to be embedded in the worldview, language, philosophy, religion and spirituality, kinship, social, political, legal, educational, economic, technological, ethnohistorical, and environmental contexts of cultures. • A client who experiences nursing care that fails to be reasonably congruent with his or her beliefs, values, and caring lifeways will show signs of cultural conflict, noncompliance, stress, and ethical or moral concern. • Within a cultural care diversity and universality framework, nurses may take any or all of three culturally congruent action modes: (1) cultural preservation/maintenance, (2) cultural care accommodation/negotiation, and (3) cultural care repatterning/restructuring

What inspired Joanne Duffy to create the quality-caring model

Developed in 2003 to fill a perceived practice and research void, the Quality-Caring Model

Know the three approaches in selecting conceptual model linking an existing nursing theory?

The first approach is the selection of the conceptual model of nursing and the direct derivation of a theory from that conceptual model - this approach ensures a logical linkage between the conceptual model and the theory. The logic is ensured because the philosophical assumptions undergirding the conceptual model and the theory are the same. The second approach is to select a conceptual model of nursing and then link an existing nursing theory to that conceptual model. If the philosophical assumptions undergirding both conceptual models are the same, logical congruence is evident. The third approach is to select a conceptual model of nursing and then link an existing theory borrowed from another discipline to that conceptual model. For example, the theory of planned behavior, taken from the discipline of social psychology, has been linked to Neuman's Systems Model.

Know the assumptions of Purnell Model.

1. All healthcare professions need similar information about cultural diversity. 2. All healthcare professions share the metaparadigm concepts of global society, family, person, and health. 3. One culture is not better than another culture; they are just different. 4. There are core similarities shared by all cultures. 5. There are differences within, between, and among cultures. 6. Cultures change slowly over time. 7. The primary and secondary characteristics of culture determine the degree to which one varies from the dominant culture. 8. If clients are coparticipants in their care and have a choice in healthrelated goals, plans, and interventions, their compliance and health outcomes will be improved. 9. Culture has a powerful influence on an individual's interpretation of and responses to health care. 10. Individuals and families belong to several subcultures. 11. Each individual has the right to be respected for his or her uniqueness and cultural heritage. 12. APNs need both cultural-general and cultural-specific information to provide culturally sensitive and culturally competent care. 13. Caregivers who can assess, plan, intervene, and evaluate in a culturally competent manner will improve the care of clients for whom they care. 14. Learning culture is an ongoing process that develops in a variety of ways, but primarily through cultural encounters (Campinha-Bacote, 2008). 15. Prejudices and biases can be minimized with cultural understanding. 16. To be effective, health care must reflect the unique understanding of the values, beliefs, attitudes, lifeways, and worldview of diverse populations and individual acculturation patterns. 17. Differences in race and culture often require adaptations to standard interventions. 18. Cultural awareness improves the caregiver's self-awareness. 19. Professions, organizations, and associations have their own culture, which can be analyzed using a grand theory of culture. 20. Every client encounter is a cultural encounter.

health metaparadigm according to Florence Nightingale

1. Person 2 environment, 3 health, 4 nursing.

7 Assumptions of Nola Pender

1. Persons seek to create conditions of living through which they can express their unique human potential. 2. Persons have the capacity for reflective self-awareness, including assessment of their own competencies. 3. Persons value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability. 4. Persons seek to actively regulate their own behavior. 5. Persons in all their biopsychosocial complexity interact with the environment, both progressively transforming the environment and being transformed over time. 6. Health professionals constitute a part of the interpersonal environment, which influences persons throughout their life span. 7. Self-initiated reconfiguration of person-environment interactive patterns is essential for behavior change

5 components of basic nursing care by Virginia Henderson

1. To breathe normally 2. To eat and drink adequately 3. To eliminate bodily wastes 4. To move and maintain desirable postures 5. To sleep and rest

What is the purpose of a scoping review of the nursing literature

A scoping review of literature is recommended to determine the amount of literature available on the subject. A scoping review, in contrast to a classic systematic review, formally documents the research that has been undertaken to date without providing detailed critical appraisal and synthesis of the individual studies. These authors concluded that the purpose of a scoping review is reconnaissance, which they explain "is generally synonymous with a [preliminary] investigation in which information is systematically gathered and examined in order to establish strengths and weaknesses

When do we say theories are judged to be pragmatically adequate

Pragmatic adequacy refers to the extent to which a theory serves as the evidence for practical actions, including assessment tools and interventional protocols. Theories that are judged to be pragmatically adequate are socially meaningful, compatible with a particular practice setting, feasible in the real world of practice, and con- sistent with patients' preferences for and expectations about care. In addition, for the purposes of this chapter, pragmatically adequate theories lead to actions that are within the legal scope of advanced nursing practice

Adaptive Mode of Roy's Model that describe behaviors related to relationships

The interdependence mode is the category of behavior related to relationships that individuals and groups establish with others.

What is the Praxis Theory of Suffering

The praxis theory of suffering provides a way to conceptualize the individu- al's and family's emotional response to the losses that occur due to acciden- tal injury or illness, or during dying and bereavement. What the patient and the family feel is evident in their behavior. Nurses, in turn, can "read"—or interpret—these cues or signals of distress—whether they be signs of pain or discomfort, or emotions such as feeling scared, frightened, or terrified—and quickly respond with comforting strategies. These nursing responses may take the form of either an appropriate behavioral or verbal interaction or a nurs- ing intervention intended to reduce the physical or emotional distress. The nurse then immediately reevaluates the patient's signals of distress and either continues with the comforting strategy or changes to a different intervention. Thus the praxis part of the praxis theory of suffering refers to pragmatic interventions—that is, the nursing strategies that ease and relieve the suffer- ing (i.e., comfort the patient and family). This theory is clinically useful: Nurs- ing assessments and interventions often take place within an interaction. As such, nurses, by recognizing behavioral cues and instantly responding, serve as the "front line" of intervention

Define conceptual model.

The term conceptual model refers to the very abstract and general work from which theories are derived.

According to Newman's theory, how does illness help patients expand their consciousness

The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness - a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world

Understand Parse's three principles of ontology

The three principles are structuring meaning, configuring rhythmical patterns of relating, and cotranscending with possibles. Underlying these three principles are the postulates of illimitability, "indivisible unbounded knowing extended to infinity"; paradox, "lived rhythms"; freedom, "contextually construed liberation"; and mystery, "the unexplainable"

What are the primary ways in which theory generation and theory testing differ from one another?

Theory generation begins with the identification of the conceptual model concept that guides the selection of the empirical indicator used to collect data. Theory testing involves deductive reasoning from one or more general concepts and propositions to a specific set of concepts and propositions.

Know the types of theory and the equivalent types of research design.

Three types of theories and research designs were listed: descriptive theories generated and tested by descriptive research, explanatory theories tested by correlational research, and predictive theories tested by experimental research.

Know the steps of the process for translating nursing theories into evidenced-based tools.

Type of Theory Type of Research Design Type of Practice Tool Descriptive theories Descriptive research Assessment tools Explanatory theories Correlational research Comprehensive assessment tools Predictive theories Experimental research Intervention protocols

Know the Levels of Vulnerability according to AACN Synergy Model for Patient Care

Vulnerability Definition: Susceptibility to actual or potential stressors that may adversely affect patient outcomes Levels: 1. High: susceptible; unprotected, fragile 3. Moderate: somewhat susceptible; somewhat protected 5. Minimal: safe; out of the woods; protect fragile others

According to King's hypothesis, why is the Theory of goal attainment important for nurses

nursing as a process that is interactional in nature Nurses have long been interacting with clients and making goal setting transactions with patients

4 components of a person by Virginia Henderson

person is composed of biological, psychological, sociological, and spiritual components