Provides

a perspective from which:

to define the what of nursing to describe the who of nursing (the client) to describe when nursing is needed to identify the boundaries and goals of nursings therapeutic activities

the

basic elements of a nursing theory are:

1. Concept 2. Proposition

basic building block of a theory complex mental formulations of ones perceptions of the world labels/names a phenomenon an observable fact that can be perceived through the senses & explained helps us to name things and occurrences in the world around us assist us in communicating with each other about the world Complex mental formulations of ones perceptions of the world A conceptual framework is a structure that links global concepts together.

Set of concepts and propositions that provide an orderly way to view phenomena Purpose: to describe, explain, and predict phenomena traditional definition: an organized, coherent set of concepts & their relationship to each other that offer descriptions, explanations & predictions about a phenomena

provide a framework for thought within the discipline of nursing provide a structure for communication among nurses and other health team members assist nursing in clarifying beliefs, values, and goals help to define the unique contribution of nursing to the care of clients

nursing theory, research, and practice are interdependent.

Grand theory

Orems self-care deficit theory of nursing

Middle-range theory

Micro-range theory

Concepts representing global & complex phenomena Broadest scope Most abstract level of development Addresses the broad phenomena of concern w/in the discipline Provides overall framework for structuring broad, abstract ideas

Addresses more concrete & more narrowly defined phenomena than a grand theory Intended to answer questions about nursing phenomena but doesnt cover the full range of phenomena of concern to the discipline Provides a perspective from which to view complex situations and a direction for interventions

The most concrete & narrow in scope Explains a specific phenomenon

work of early nursing theorists in the 1950s focused on the tasks of nursing practice from a mechanistic point of view in the 1960s nursing theorists made nursing practice, theory & research fit into the prevailing view of science global awareness of health care needs provided a new perspective that unified the notion of nursing as both an art & science

several theories that share a common view of the world can be grouped together to form a paradigm What is a paradigm?

A particular viewpoint or perspective

each discipline has a defined metaparadigm

What is a metaparadigm?

The distinguishing concepts that provide the boundaries and limitations of a discipline The major concepts that provide structure to the domain of nursing are:
1.
2. 3. 4.

person environment health nursing

 Florence

Nightingale is recognized as founder of modernday nursing. Her environmental model is based on the idea that the impetus for healing lies within the individual human being and the focus of care is to place the individual in an environment that is supportive to that healing process. Her 13 canons speak to areas that require the attention of the nurse, such as cleanliness, ventilation, warming, light, noise, variety, nutrition, chattering hopes and advices, and observation of the sick.

OBJECTIVES Describe the historical background of the development of Nightingales environmental model Name at least three of Nightingales major writings Explain each of Nightingales 13 canons Present the relationship between the environmental model and concepts in nursings metaparadigm Provide an example of use of the environmental model in clinical practice Identify strengths and weaknesses of the environmental model for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the environmental model Relate the environmental model to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the environmental model

CRITICAL THINKING Give two examples of therapeutic nursing interventions that could arise from using Nightingales environmental model. Describe at least three current nursing or healthcare activities that are congruent with and three that are in conflict with Nightingales work.

 Hildegard

E. Peplau, in addition to her other accomplishments, presented the first published theoretical development in nursing in the twentieth century. Her focus is on the interpersonal process between a nurse and a client and the roles played by the nurse in this process. The interpersonal process occurs in three phases: orientation, working, and termination.

OBJECTIVES Describe the historical background of the development of Peplaus Interpersonal Relations in Nursing Explain each of the phases in Peplaus Interpersonal Relations in Nursing Identify the roles that nurses may play Present the relationship between Peplaus work and concepts in nursings metaparadigm Provide an example of use of Peplaus Interpersonal Relations in Nursing in clinical practice Identify strengths and weaknesses of Peplaus Interpersonal Relations for Nursing for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing Peplaus work Relate Peplaus work to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of Peplaus work

Critical thinking In your own words, describe how use of Peplaus work can influence the outcomes of nursing care.
What

evidence can you find to support that Peplaus theory is contagious?

 Virginia

Henderson presented her definition of nursing as part of her effort to regulate nursing practice through licensure. Although all states now have licensure regulations for the practice of nursing, her definition has had far greater impact. Her 14 components of basic nursing care augment the definition to provide an overall guide to the practice of nursing.

OBJECTIVES Describe the historical background of the development of Hendersons definition and 14 components Identify the impetus for the development of Hendersons definition of nursing Discuss each of Hendersons 14 components Present the relationship between the definition and components and concepts in nursings metaparadigm Provide an example of use of Hendersons work in clinical practice Identify strengths and weaknesses of Hendersons work for clinical practice, including her views of the nursing process Discuss the appropriateness of qualitative and quantitative research methods for testing Hendersons work Relate Hendersons work to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of Hendersons work

14 Components of Basic Nursing Care

CRITICAL THINKING Choose 4 of Hendersons 14 components and give an example, in your own words, of how each might be used in clinical practice. Hendersons work may be used to guide nursing care. Discuss how the selection of therapeutic nursing interventions would be affected by using Hendersons work. Are there interventions that are more or less likely to be chosen? Support your response.

Lydia E. Hall believed that patients over the age of 16, who were past the acute stage of illness, required a different focus of care than did the acutely ill. She demonstrated the effectiveness of her theory in practice at the Loeb Center. The three components of her theory are care, core, and cure. Care is based in the natural and biological sciences, includes the intimate aspects of bodily care, and is exclusive to nursing. Core is based in the social sciences, involves the therapeutic use of self, and is shared with other members of the health care team. Cure is based in the pathological and therapeutic sciences, involves working with the patient and family in relation to the medical care, and is shared with other members of the health care team.

OBJECTIVES Describe the historical background of the development of Halls care, core, and cure Identify what is unique about Halls theory Explain the meaning of, and who is involved in, care, core, and cure Present the relationship between Halls work and concepts in nursings metaparadigm Provide an example of use of care, core, and cure in clinical practice Identify strengths and weaknesses of care, core, and cure for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing Halls work Relate care, core, and cure to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of Halls work

CRITICAL THINKING

Give

examples of outcome statements that would be congruent with Halls theory. Discuss, in writing, the strengths and weaknesses of this particular theory for use in clinical practice in this particular situation.

Dorothea E. Orems general theory of nursing is made up of the three interrelated theories of self-care, selfcare deficit, and nursing systems. A peripheral concept, basic conditioning factors, applies to all of the theories.

The major concepts of self-care are self-care, self-care agency, self-care requisites (universal, developmental, and health deviation), and therapeutic self-care demand. A self-care deficit exists when the therapeutic self-care demand exceeds self-care agency. Nursing systems involve nursing agency and the design of nursing systems for care (wholly compensatory, partly compensatory, and supportive-educative). Orems nursing process is a three-step process (diagnosis and prescription, nursing system design, production and management of nursing systems).

OBJECTIVES Describe the historical background of the development of Orems Self Care Deficit Nursing Theory Name the three interrelated theories in Orems general theory of nursing Define the concepts related to each of the three interrelated theories Present the relationship between Orems general theory of nursing and concepts in nursings metaparadigm Provide an example of use of Orems general theory of nursing in clinical practice, including the guidelines to be used Identify strengths and weaknesses of Orems general theory of nursing for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing Orems general theory of nursing Relate Orems general theory of nursing to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of Orems general theory of nursing

3 systems exist within this professional practice model

nursing

Compensatory system -nurse provides total care Partially compensatory system -nurse & patient share responsibility for care Educative-development system -client has primary responsibility for personal health, with nurse acting as a consultant

CRITICAL THINKING Give three examples of the contagiousness of Orems work and, in your own words, describe how they relate to her work. Discuss how using Orems work in clinical practice can demonstrate the use of critical thinking.

Faye Glenn Abdellah conducted research to identify ways to promote patient-centered comprehensive nursing care. As a result of the first three of these studies, 21 basic nursing problems were identified. The problems may be overt or covert, and problem solving is to used by the nurse. The nursing process as a problemsolving process is compatible with this approach.

OBJECTIVES Describe the historical background of the development of Abdellahs patient-centered approaches Discuss the 21 nursing problems, overt and covert problems, and problem solving Present the relationship between Abdellahs patientcentered approaches and concepts in nursings metaparadigm Provide an example of use of Abdellahs patient-centered approaches in clinical practice, including effectiveness criteria Identify strengths and weaknesses of Abdellahs patientcentered approaches for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing Abdellahs patient-centered approaches Relate Abdellahs patient-centered approaches to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of Abdellahs patientcentered approaches

CRITICAL THINKING
What guidelines or support do the 21 nursing problems provide for therapeutic nursing interventions? How nursing care delivery would be influenced by using the indicated theoryfor example, does the theory provide a specific guide to practice or to areas of practice? would certain assessment data be collected or missed? Are there certain kinds of actions that would or would not be taken? Would evaluation be included?

Dorothy E. Johnson presents the Behavioral System Model in which the patients behaviors are the nurses objects of analysis. As a behavioral system, the human being has seven subsystems attachment or affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement.

The behavior of each subsystem arises from a drive related to a desired goal, a set of likely responses specific to the individual, a group of choices as to effective responses, and the observable outcomes identified as behavior. Others have indicated nursing diagnoses in the Behavioral System Model may deal with insufficiency, discrepancy, incompatibility, or dominance.

OBJECTIVES Describe the historical background of the development of Johnsons Behavioral System Model Discuss the relationship between Johnsons definition of nursing and the assumptions of the Behavioral System Model Define each of the seven subsystems in the Behavioral System Model Present the relationship between the Behavioral System Model and concepts in nursings metaparadigm Provide an example of use of the Behavioral System Model in clinical practice Identify strengths and weaknesses of the Behavioral System Model for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the Behavioral System Model Relate the Behavioral System Model to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the Behavioral System Model

CRITICAL THINKING
In

what ways is communication influenced by use of the Behavioral System Model? you describe the Behavioral System Model as contagious? Provide rationale for your response.

Would

Ida Jean Orlando developed the nursing process discipline through the study of numerous nurse-patient interactions. She identified that the difference between a good outcome and a bad outcome was the sharing of the nurses reaction to the patients behavior with the patient. She describes nursing as unique and independent with a focus on the patients immediate need for help.

The patients expressed need for help leads to a reaction in the nurse. This automatic reaction consists of a perception, thought, or feeling, which is shared with the patient and owned as the nurses. After validating or correcting the accuracy of the reaction with the patient, the need for help is identified and a deliberative action is taken. A deliberative action occurs in an effort to meet the patients need; an automatic action occurs for some other reason.

OBJECTIVES Describe the historical background of the development of Orlandos Nursing Process Discipline Define each of Orlandos key concepts and relate them to the Nursing Process Discipline Present the relationship between the Nursing Process Discipline and concepts in nursings metaparadigm Provide an example of use of the Nursing Process Discipline in clinical practice Identify strengths and weaknesses of the Nursing Process Discipline for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the Nursing Process Discipline Relate the Nursing Process Discipline to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the Nursing Process Discipline

 Give

an example of the use of critical thinking in carrying out the disciplined nursing process. Describe the role of communication in the disciplined nursing process.

 Imogene

M. King developed a general systems framework and a theory of goal attainment. The framework speaks to three levels of systemsindividual or personal, group or interpersonal, and society or social. The theory of goal attainment speaks to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space.

 King

emphasizes that both the nurse and the client bring important knowledge and information to the relationship and that they work together to achieve goals. Research has supported that when the nurse and client communicate and work together toward mutually selected goals, the goals are more likely to be attained.

OBJECTIVES Describe the historical background of the development of Kings framework and theory Differentiate between Kings framework and theory Define the concepts in Kings theory Present the relationship between Kings theory and concepts in nursings metaparadigm Provide an example of use of the theory of goal attainment in clinical practice Identify strengths and weaknesses of the theory of goal attainment for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the theory of goal attainment Relate the theory of goal attainment to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the theory of goal attainment

CRITICAL THINKING How does Kings Theory of Goal Attainment influence communication in clinical practice? Are there any therapeutic nursing interventions that would be either eliminated or mandated when using Kings Theory of Goal Attainment? Support your response.

 Martha

E. Rogers developed the Science of Unitary Human Beings as nursings unique body of knowledge. Human beings and their environments are infinite energy fields in continuous motion. They produce patterns and are unitary. Rogers three principles are the principles of resonancy (continuous change from lower to higher frequency), helicy (increasing diversity), and integrality (continuous process of the human and environmental fields).

OBJECTIVES Describe the historical background of the development the Science of Unitary Human Beings Explain paradigm shift Define the five building blocks and three principles of Rogers conceptual system Present the relationship between the Science of Unitary Human Beings and concepts in nursings metaparadigm Provide an example of use of the Science of Unitary Human Beings in clinical practice Identify strengths and weaknesses of the Science of Unitary Human Beings for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the Science of Unitary Human Beings Relate the Science of Unitary Human Beings to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the Science of Unitary Human Beings

Critical Thinking Provide examples of the contagiousness of Rogers work. What are the implications of Rogers theory for identifying and achieving outcomes?

 Sister

Callista Roy developed the Roy Adaptation Model, which is based on the belief that the human being is an open system. The system responds to environmental stimuli through the cognator and regulator coping mechanisms for individuals and the stabilizer and innovator control mechanisms for groups. The responses occur through at least one of four modes physiological-physical, selfconcept-group identity, role function, and interdependence.

 The

responses in these modes are usually visible to others and can be identified as adaptive or ineffective. Adaptive behaviors that need support and ineffective behaviors are then analyzed to identify the associated stimuli. The major stimulus leading to one of these behaviors is the focal stimulus; other stimuli that are verified as being involved are contextual, and stimuli that might be involved but have not been verified are residual. Nursing care focuses on altering stimuli or strengthening adaptive processes to result in adaptive behaviors.

OBJECTIVES Describe the historical background of the development of the Roy Adaptation Model (RAM) Name at least three of Roys major writings Identify the assumptions basic to the RAM Define the major concepts of the RAM Present the relationship between the RAM and concepts in nursings metaparadigm Provide an example of use of the RAM in clinical practice for an individual and for a group Identify strengths and weaknesses of the RAM for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the RAM Relate the RAM to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the RAM

Critical Thinking Discuss the strengths and weaknesses of this particular theory for use in clinical practice in a particular situation. How nursing care delivery would be influenced by using the indicated theoryfor example, does the theory provide a specific guide to practice or to areas of practice? would certain assessment data be collected or missed? Are there certain kinds of actions that would or would not be taken? Would evaluation be included?

Betty Neuman developed the Neuman Systems Model to provide a structure for integrating information about humans in a wholistic manner. The model consists of a core or basic structure and energy resources that provide for basic survival. Surrounding the core are the lines of resistance that are activated when a stressor invades the system. Outside of the lines of resistance is the normal line of defense, the systems usual level of wellness that protects from the negative impact of stressors. Finally, the flexible line of defense is the outer boundary and provides the initial response to stressors.

 Each

of these levels also incorporates the five client variablesphysiological, psychological, sociocultural, developmental, and spiritual. There are three environmentsinternal, external, and createdand three levels of preventionprimary, secondary, and tertiary. Less clearly defined are reaction and reconstitution. Neuman presents her own process, which is compatible with the nursing process.

OBJECTIVES Describe the historical background of the development of the Neuman Systems Model Define the major aspects of the Neuman Systems Model Identify the propositions of the Neuman Systems Model Present the relationship between the Neuman Systems Model and concepts in nursings metaparadigm Provide an example of use of the Neuman Systems Model in clinical practice Identify strengths and weaknesses of the Neuman Systems Model for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the Neuman Systems Model Relate the Neuman Systems Model to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the Neuman Systems Model

CRITICAL THINKING Discuss the contagiousness of the Neuman Systems Model. What therapeutic nursing interventions would be most compatible with the Neuman Systems Model?

 Jean

Watson proposed that the ultimate aim of nursing is caring with the purpose of preserving the dignity and wholeness of humans. She emphasizes that caring may occur without curing, but curing cannot occur without caring. Nursing as a discipline is devoted to caring, to health, and to healing in their many meanings and interpretations.

 Nursing

occurs in caring occasions or moment through the use of ten carative factors in a nursepatient relationship known as transpersonal caring. The practice of nursing is both a science and an art and focuses on the goals of growth, meaning, and self-healing rather than the problem solving seen in the use of the nursing process.

OBJECTIVES Describe the beliefs underlying Watsons theory of Transpersonal Caring Name at least three of Watsons major writings Discuss postmodern, transpersonal caring relationship, carative factors, caring occasion/caring moment Present the relationship between the theory of Transpersonal Caring and concepts in nursings metaparadigm Provide an example of use of the theory of Transpersonal Caring in clinical practice Identify strengths and weaknesses of the theory of Transpersonal Caring for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing the theory of Transpersonal Caring Relate the theory of Transpersonal Caring to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of the theory of Transpersonal Caring

10 carative factors: 1. Formation of a humansitic-altruistic system of values 2. Nurturing of faith-hope 3. Cultivation of sensitivity to ones self and to others 4. Developing a helping-trusting, human caring relationship 5. Promotion & acceptance of the expression of positiver and negative feelings 6. Use of creative problem solving method process 7. Promotion of transpersonal teaching & learning 8. Provision for a supportive, protective, or corrective mental, physical, sociocultural, and spiritual environment 9. Assistance with gratification of human needs 10. Allowance for existential-phenomenological

CRITICAL THINKING Discuss the contagiousness of Watsons theory of Transpersonal Caring. Discuss the types of communication to be used with Watsons theory. Are these similar to those of any of the other theorists?

 Madeleine

M. Leininger recognized the importance of an understanding of culture both the nurses and the clientsto effective nursing practice. She believes that all cultures have practices related to caring. Those practices that are common across cultures are culture care universalities, and those that are specific to a given culture are culture care diversities. Research findings indicate there is more diversity than universality. Leiningers Sunrise Model depicts the dimensions of Culture Care Diversity and Universality.

 The

cultural and social structure dimensions include technological, religious, philosophic, kinship, social, value and lifeway, political, legal, economic, and educational factors. These factors influence the patterns and expressions of caring in relation to the health of individuals, families, groups, and communities. The involved health systems include folk systems, nursing, and other professional systems. To achieve culture congruent care, nursing actions are to be planned in one of three modes: culture care preservation/maintenance, culture care accommodation/negotiation, or culture care repatterning/restructuring.

OBJECTIVES Describe the historical background of the development of Leiningers theory of Culture Care Diversity and Universality Discuss the relationship between care, culture, and nursing Present the relationship between Culture Care Diversity and Universality and concepts in nursings metaparadigm Provide an example of use of Culture Care Diversity and Universality in clinical practice Identify strengths and weaknesses of Culture Care Diversity and Universality for clinical practice Discuss the appropriateness of qualitative and quantitative research methods for testing Culture Care Diversity and Universality Relate Culture Care Diversity and Universality to critical thinking, therapeutic nursing interventions, communication, and outcomes Cite examples of the contagiousness of Culture Care Diversity and Universality

CRITICAL THINKING Discuss why a focus on the human being could be problematic in using Leiningers work. Leininger proposes that there are cultural universalities and cultural diversities. Which are more common? Why do you say this?