TFN Evolution of Nursing Reviewer

EVOLUTION OF NURSING |TFN NCM1008 LESSON 1-3 (A-C) “I attribute my success to this – I never gave or took any excuse.” FLORENCE NIGHTINGALE NURSES DEAL WITH CLINICAL MANIFESTATION; PHYSICIANS TREAT THE DISEASE HISTORY OF NURSING THEORY NURSING AND ITS BEGINNING • • • Nursing is unique because it addresses the many responses of individuals and families Expertise in nursing is the result of knowledge and clinical experience NURSING • According to American Nursing Association (ANA), Nursing is the “diagnosis and treatment of human responses to actual or potential health problems.” • As defined by the International Council of Nurses (ICN), Nursing encompasses “autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings.” • In ancient civilization, providing care revolves around the use of magical thinking, superstitious and religious beliefs. However, non-magical forms of service still emerged. Female slaves are usually the ones who provide physical maintenance and comfort for the sick. Nursing roles were mentioned in the Old Testament of the Bible as women provide and assist in the care of children and infants in the delivery. Henderson’s definition of nursing is “to assist clients in the performance of activities contributing to health, its recovery or peaceful death that clients would perform unaided, if they had necessary will, strength or knowledge.” • According to Association of Deans of Philippine Colleges of Nursing (ADPCN), Nursing is “a dynamic discipline. It is an art and a science of caring for individuals, families, groups and communities geared toward promotion and restoration of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. • It is focused on assisting the client as he or she responds to health-illness situations, utilizing the nursing process and guided by ethico-legal moral principles.” Nursing started in the intuitive way of caring for the sick members of the family. Traditionally, the roles of women are limited as wives, mothers, daughters and sisters. They are the one who stayed at home and took care of the family member. • HISTORY OF NIGHTINGALE ERA The history of professional nursing begins with Florence Nightingale who envisioned nurses as a body of educational women were neither educated nor employed in public service. Following her years of service organizing and caring for the wounded in the Crimean War, her vision and her establishment of a school of nursing at St. Thomas Hospital in London marked the birth of modern nursing. ALTHEA REAÑO| 1 NCM1008 HISTORICAL ERA OF NURSING’S SEARCH FOR SPECIALIZED KNOWLEDGE HISTORICAL ERA MAJOR QUESTIONS Curriculum Era What curriculum content should student nurses' study to be nurses? Research Era 1950-1960 What is the focus for nursing research? Graduate Education EMPHASIS OUTCOMES EMERGING GOAL Standardized curricula for diploma program. Develop standardized knowledge and higher education. Role of nurses and what to research Problem studies and studies of nurses Isolated studies do not yield unified knowledge What knowledge is needed for the practice of nursing? Carving out an advanced role and basis for nursing practice Nurses have an important role in health care. Focus graduate education on knowledge development Theory era: 19801990s How do these frameworks guide research and practice? There are many ways to think about nursing Nursing theoretical works shift the focus to the patient Theories guide nursing research and practice Theory utilization is: 21st century What new theories are needed to produce evidence for quality care? Nursing theory guides research, practice education, and administration Middle-range theory may be from quantitative or qualitative approaches Nursing frameworks produce knowledge (evidence) for quality care. Courses included in nursing program ALTHEA REAÑO| 2 NCM1008 SIGNIFICANCE OF NURSING THEORY • DISCIPLINE • It is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge • Empiricism makes use of objective and tangible data or those that are perceived by the senses (smell, sight, taste and feeling) to observe and collect data. • These data are then used to formulate general knowledge, which is the use of inductive type of reasoning. PROFESSION • Refers to specialized field of practice, a founded on the theoretical structure of the science or knowledge of the discipline and accompanying practice abilities EARLY 20TH CENTURY HISTORY OF NIGHTINGALE ERA ➢ ➢ ➢ ➢ Rationalism Empiricism Early 20th century Late 20th Century • During the early 20th century, philosophers and scientists argued the use of empiricism and rationalism. • The philosopher’s point of view is that knowledge should be based on the understanding of existing theories while scientists believe that knowledge should not only focus on theoretical existence but also on understanding what there is still to be observed. RATIONALISM • Emphasizes the importance of priority reasoning as the appropriate method for advancing knowledge. • Approaches the task of scientific inquiry by developing a systematic explanation (theory) of a given phenomenon. generalization of observed facts in the natural world. The approach is called inductive method, based on the idea that the collection of facts precedes attempts to formulate generalizations, called research-thentheory MAJOR DEVELOPMENTS • Rationalism makes use or reason gained through expert study, tested theory and established facts to evidently prove something • The use of experimentation to gain new knowledge emerged during this period as nurses strive to base their actions on evidence and scientific data. • DEDUCTIVE REASONING – Used to • Positivism, which encloses the use of both logical reasoning and empiricism, became prevalent during this era in the discovery of truth for the development of science. • Empirical and objective data co-exist as the focus of interest of study as one of each need to be tested in order to determine as to what is true or what is not. • As a result of the different point of views during this period, the growth of new scientific knowledge commenced. generate rationalist view which starts from the general to specific knowledge. EXAMPLE: The use of Evidence-Based Nursing and Nursing Research that make use of a general or broad concept that needs to be studied and understand thru different supplemental materials. EMPIRICISM • Based on the central idea that scientific knowledge can only be derived from sensory experience. • Francis Bacon believed that scientific truth was discovered through the ALTHEA REAÑO| 3 NCM1008 PATTERNS OF KNOWING BARBARA Carper identifies four “patterns of knowing” that make up the basic core of nursing knowledge. 1. Empirics/Science 2. Aesthetics or Esthetics 3. Ethics 4. Personal EMPIRICAL KNOWING Example is knowledge obtained from textbooks, lectures, journals and online resources. AESTHETIC KNOWING “Aesthetics or Esthetics Knowing” • It is related to understanding what is of significance to patients such as feelings, attitudes, points of view. It is also a manifestation of the creative and expressive styles of the nurse. • Aesthetic knowing focuses on empathy – the ability for sharing or vividly understanding another’s feeling. This is the primary form of aesthetic knowing. • The principal form relating factual and descriptive knowing aimed at the expansion of abstract and theoretical explanations • Empirical knowing is the first primary model of knowing. It is information source or base of knowing. It emphasizes scientific research is important to nursing knowledge. • It also includes the nurse’s ability in changing ways and manner of rendering nursing care based on the client’s individual needs and perceptions. • As a part of empirics, clinical and conceptual knowledge are the keys to nursing practice. • It is done by knowing the distinctive individual instead as a typical, stereotype whole. • Empirical knowing focuses on evidencebased research for effective and accurate nursing practice. • • It is where most theory and research development is concentrated, and some conceptual forms have better capacity to explain nursing phenomena than others. Aesthetic knowing is used in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasizing use of creative and practical styles of care. EXAMPLES: ______, a nursing student answers a question posed by the clinical instructor based on what he learned from the school. _______, a nurseresearcher, uses scientific method to produce desired study results. Nurse ________ practices nursing interventions based from the accepted clinical practices. EMPIRICS / SCIENCE • “cognitive, brain” of nursing • Includes knowledge obtained through nursing research and research in other disciplines NURSE’S NOTES • Any scientific, research-based, theoretical and information that the nurse makes use of is under Empirical Knowing! • NURSING ESTHETICS “art or heart” of nursing • Way in which nursing knowledge is expressed; includes attitudes, beliefs and values EXAMPLES: Nurse ________ places himself in the “patient’s shoes” when communicating, giving judgment and providing care. Nurse _______ shows compassion, mercy and understanding towards patients, co -workers and supervisors. Nurse ______ uses layman terms in explaining the needs of the patient with the Right -sided heart failure. NURSE’S NOTES Aesthetic knowing is used in the process of giving appropriate nursing care through understanding the uniqueness of every patient, thus emphasizing use of creative and practical styles of care. ALTHEA REAÑO | 4 NCM1008 ETHICAL KNOWING • Requires knowledge of different philosophical positions regarding what is good and right in making moral actions and decisions, particularly in the theoretical and clinical components of nursing. • The code of morals or code of ethics that leads to the conduct of nurses is the main basis for Ethical Knowing. • It is deeply rooted in the concepts of human dignity, service and respect for life. • Lessening suffering, upholding and preserving health is one of the key elements why nursing is a core service in society. NURSING ETHICS • Knowledge of accepted professional • Information about basic moral principles and processes for determining “right” standards of conduct actions EXAMPLES: Nurse ______ presents himself as a patient advocate and defends his client’s right to choose care. Sir _______, a clinical instructor, reprimands a student who cheated on a quiz and explains the consequences. PERSONAL KNOWING • Encompasses knowledge of the self in relation to others and to self. It involves the entirely of the Nurse-Patient Relationship. • It is the most difficult to master and to teach. • It is the key to comprehending health in terms of personal wellbeing • It involves therapeutic use of self. • It takes a lot of time to fully know the nature of oneself in relation to the world around. EXAMPLES: _____, a nursing student, strives to promote a meaningful personal relationship with his elderly patient. _____, a nursing student undergoes Psychological Counseling and Self-awareness sessions before his Psychiatric Nursing rotation. PERSONAL KNOWLEDGE • • Concerned with knowing oneself Conscious awareness of one’s values, beliefs, attitudes and abilities NURSE’S NOTES • Personal Knowledge is focused on realizing, meeting and defining the real, true self. One nursing term defines this as self-awareness. Nurse _______ explains the concepts behind organ donation to a terminally-ill patient. NURSE’S NOTES • Ethical Knowing involves the judgment of right and wrong in relation to intentions, reasons and attributes of individuals and situations. ALTHEA REAÑO | 5 NCM1008 STRUCTURE OF NURSING KNOWLEDGE NURSING PARADIGM - C. CONCEPTS • • Are the building blocks of theories. An idea or complex mental image of a phenomenon (object, property, or event). Patterns or models used to show a clear TYPES OF CONCEPTS relationship among the existing theoretical works in nursing 1. observed or intangible. A. THE METAPARADIGM OF NURSING 2. Comes from Greek word “meta” – with and “paradeigma” – pattern FOUR MAJOR CONCEPTS 1. 2. 3. 4. Person Environment Health Nursing PERSON ➢ The recipient of nursing care like individuals, families and communities. ENVIRONMENT ➢ The external and internal aspects of life that influence the person. HEALTH ➢ The holistic level of wellness that the person experiences. NURSING ➢ The interventions of the nurse rendering care in support of or in cooperation with the client. B. PHILOSOPHY • • CONCRETE CONCEPTS are directly observed or tangible. METAPARADIGM - ABSTRACT CONCEPTS are indirectly • Concepts can be used in making or formulating a conceptual or operational definition. • Are the meaning of a word based on how a certain theory or relevant literature perceives it to be. • Are meaning of a word based on the method of how it was measured or how the person come up with that perception. CONCEPTUAL DEFINITIONS OPERATIONAL DEFINITIONS CONCEPTUAL OPERATIONAL Comparable to definition from a literature such as dictionary, encyclopedia and journals Specifies exactly how the concept will be determined and assess it also identifies procedures and operations significant to determine concepts. EXAMPLE 1: Hospital Stay The time during which a person is a registered patient in a certain hospital. The total of days as patient, beginning with admission day and finishing with discharge. EXAMPLE 2: Ambulation To walk from one place to another or to move about. Taking 6 steps without assistance. The next knowledge level after metaparadigm. It specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing. ALTHEA REAÑO | 6 NCM1008 CONCEPTUAL MODELS AND THEORETICAL MODELS D. THEORY • THEORETICAL MODELS OR FRAMEWORKS - Are highly established set of concepts that are testable. CONCEPTUAL MODELS OR FRAMEWORK - Are representations of an idea or body of knowledge based on the understanding or perception of a person or researcher on a certain topic, phenomena or theory. THEORETICAL It is a structure of concepts which exist or tested in the literature, a readymade map for the study. CONCEPTUAL It is a structure of concepts or theories which are pulled together as a map for the study. THEORETICAL FRAMEWORK (LYDIA HALL) CONCEPTUAL MODEL A theory is an organized system of accepted knowledge composed ➢ concepts ➢ propositions ➢ definitions ➢ assumptions CONCEPT An idea formulated by the mind or an experience perceived and observed. PROPOSITION Explains the relationships of different concepts. DEFINITION Composed of various descriptions which convey a general meaning and reduces the vagueness in understanding a set of concepts. ASSUMPTION A statement that specifies the relationship or connection of factual concepts or phenomena. CHINN AND KRAMER (1991) A theory is “a creative and rigorous structuring of ideas that projects a tentative, purposeful and systemic view of phenomena” CHARACTERISTICS OF A THEORY • Theories can correlate concepts in such a way as to generate a different way of looking at a certain fact or phenomenon • Theories must be logical in nature • Theories should be simple but generally broad in nature. ALTHEA REAÑO | 7 NCM1008 • Theories can be the source of hypotheses that can be tested for it to be elaborated. • Theories contribute in enriching the general body of knowledge through the studies implemented to validate them. • Theories can be used by practitioners to direct and enhance their practice. • Theories must be consistent with other validated theories, laws and principles but will leave open unanswered issues that need to be tested. PURPOSES OF NURSING THEORY Provide directions and guidance for: a. b. IN PRACTICE: 1. Assist nurses to describe, explain, predict everyday experiences 2. Serve to guide assessment, intervention and evaluation of care 3. Provide rationale for collecting reliable and valid data about the health status of the client, which is essential for effective decision making and implementation 4. Help to establish criteria to measure the quality of nursing care 5. Help build a common nursing terminology to use in communicating with other health professionals. Ideas are developed and words defined 6. Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. NURSING THEORY - - A group of interrelated concepts that are developed from various studies of disciplines and related experiences . This aims to view the essence of nursing care. NURSING THEORY (MELEIS, 1991) An articulated and communicated conceptualization of invented or discovered reality in or pertaining to nursing for the purpose of describing, explaining, predicting or prescribing nursing care. BARNUM (1994) stated that a complete nursing theory is one that has context, content and process. IN EDUCATION: 1. Provide a general focus for curriculum design 2. Guide curricular decision making IN RESEARCH: 1. Offer a framework for knowledge and new ideas PHENOMENA • • • • Subject matter of a discipline. An aspect of reality that can be consciously sensed or experienced. It reflects the domain of nursing practice. Nursing Theories are developed to improve the quality of care rendered by nurses to their clients. Theory development is inherent in the different nursing fields – education, research and practice. Structuring professional nursing practice, education, and research Differentiate the focus of nursing from other professions • generating 2. Assist in discovering knowledge gaps in the specific field of study 3. Offer a systematic approach to identify questions for study. Select variable, interpret findings and validate nursing interventions. Empirical and objective data co-exist as the focus of interest of study as one of each need to be tested in order to determine as to what is true or what is not. As a result of the different points of view during this period, the growth of new scientific knowledge commenced. ALTHEA REAÑO | 8 NCM1008 CATEGORIES OF THEORIES ➢ ➢ ➢ Micro-Range Theories Grand Theories Middle-Range Theories MICRO-RANGE THEORIES • • • Known to be the most concrete and narrow in scope. Situation-specific and limited to populations or fields of practice. A linking of concrete concepts into a statement that can be observed in practice and research GRAND THEORIES • • • • • Simply known to speak about a broad range of important relationships among concepts of discipline. They are made up of concepts representing common and extremely complex phenomena. They are viewed to be the broadest in scope, represents the summary of development and concentrate on the broad phenomena of concern within the discipline. They arise at a time when Nursing was addressing its nature, mission and goals. Grand Theory’s purpose is not expected to provide a perfect guidance for the formation of specific nursing knowledge, but rather provides a general framework for creating and structuring broad and abstract ideas. Example: Orem’s Selfcare Theory of Nursing; Neuman Systems Model Theory NURSE’S NOTES Grand theories are the broadest in scope, representing universal and broad nursing phenomena! MIDDLE RANGE THEORIES • • They are the least abstract level of the theoretical knowledge because they include details specific to nursing practice. Descriptions, explanations and predictions are made with the purpose of answering questions about different phenomena. NURSE’S NOTES Middle-range theories are known to have a narrower and detailed focus compared to grand theories. ALTHEA REAÑO | 9