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Foundation of Nursing (Midterms Reviewer)
Foundation of Nursing (Midterms Reviewer)
Concept
Often called the building blocks of theories
Abstract & concrete concepts
Mental formulation of an object or event that come from individual perceptual experience.
Is a generalized idea of some group of objects; or an abstract idea generalized from several
specific instances
It is an image or mental picture of some phenomenon
Major components of a theory
ABSTRACT
- Indirectly observable and are independent of time or place
- Not easily understood
CONCRETE
- are specific to time, place and are observable.
- Real, perceptible by the senses, experience
Theory
A group of related concepts that propose actions that guide practice
A set of concepts, definitions, relationships, assumptions that project a systematic view of
a phenomena
An organized system of accepted knowledge that is composed of concepts, proposition,
assumption and definition intended to explain a set of fact, event or phenomena
Definition - is composed of various descriptions which convey a general meaning and reduces the
vagueness in understanding a set of concepts
Assumption –
- is a proposition that is taken for granted, as if it were true based upon presupposition
without preponderance of the facts
- A statement that specifies the relationship or connection of factual concepts or phenomena
- Statement that the theorist hold as factual
Conceptual Framework
- Group of related ideas, statements, or concepts
- Often used interchangeably with the terms “conceptual model” and “grand theories”
Examples: Freud’s structure of the mind (id, ego, and superego)
Paradigm
Metaparadigm
- Specifies the main concepts that encompass the subject matter and the scope of a
discipline.
- the metaparadigm concepts provide the boundaries and limitations of a discipline
PERSON – refers to the individual, family, or group who are the interest of nursing
- the recipient of care central to the care being provided
individual clients
families
communities
HEALTH - the goal of nursing care; state of well-being; defined in different ways by the client, the
clinical setting and health care profession; it is a state that is dynamic and continuously changing.
ENVIRONMENT - the internal and external surrounding that affect the client; includes all possible
conditions affecting the client and the setting in which health care needs occur (community, home,
school or workplace).
- Is the place or community where care is provided
- It also describes the world a person lives in and interacts with
NURSING - the discipline from which client care interventions are provided; the diagnosis and
treatment of human responses to actual or potential health problems; attributes, characteristics
and actions of the nurse providing care on behalf of, or in conjunction with the client.
- Are the actions and interactions of the nurse with the person.
Components of a theory
1. Purpose
2. Concepts
3. Models
4. Theoretical statements
5. Structure
6. Assumptions
PURPOSE
- the purpose of a theory explains why the theory was formulated and specifies the context
and situation in which it should be applied
Describe
Explain
Predict
Prescribe
Education
Research
Clinical Practice
- concepts are linguistic labels that are assigned to objects or events and are considered to
be the building blocks of theories
- the theoretical definition defines the concept in relation to other concepts and permits
description and classification of phenomena
- Operationally defined concepts link concept to the real world and identify empirical
referents (indicators) of the concept that will permit observation and measurement.
THEORETICAL STATEMENTS
Theoretical statements, or propositions, are statements about the relationship between two or
more concepts and are used to connect concepts to devise the theory
- Theoretical linkages offer a reasoned explanation of why the variables in the theory maybe
connected in some manner, which brings plausibility to the theory.
- theory structuring includes determination of the order of appearance of relationships,
identification of central relationships and delineation of direction, strength, and quality of
relationships
MODEL
- Are schematic representations of some aspect of reality
- Help illustrates the processes through which outcomes occur by specifying the relationships
among the variables in graphic form where they can be examined for inconsistency,
incompleteness or errors.
- a group of related concepts that derive from the nursing models/other discipline
- A conceptualization of some aspect of nursing communicated for the purpose of describing,
explaining, predicting and or prescribing nursing care.
- is an organized framework of concepts and purposes designed to guide the practice of
nursing
Systematic set of interrelated concepts, definitions and deductions that describe, explore, explain
or predict interrelationships. – According to Pinnel and Menesis
Internally consistent group of relational statements (concepts, definitions and propositions) that
presents a systematic view about phenomenon and which is useful for description, explanation,
exploration and prediction. – according. To Walker and Avant
Creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view
of phenomena. – according. To Chinn and Krammer
Characteristics of a Theory
Creative in structure
Articulate, systematic and logical
Tentative in nature
Uses of a Theory
Guides research
Improves nursing practice
Facilitates communication
To develop body of knowledge
Grand Theories
Middle Range Nursing Theories
Practice Theories
Florence Nightingale
Nightingale became a heroine in Great Britain as a result of her work in the Crimean War. Her
depiction of the very poor sanitary conditions in the hospital wards at Scutari is overwhelming. She
fought the bureaucracy for food, bandages, fresh bedding, and cleaning supplies for the soldiers.
At times she bought supplies with her finances.
She showed concern for the comfort of the English soldier - well, injured, or sick, including
supporting the establishment of a laundry, library, assistance with letter writing, a banking system
so the soldiers could save their pay, and a hospital for the families who go with the soldiers to war.
Also, she provided comfort and security to the seriously sick and dying. Her skills in decision-making
were often better than those of many officers in the army. She spent the years after the Crimea
establishing schools of nursing and influencing public policy by lobbying her acquaintances about
several of her concerns.
Nightingale’s Canons
- Check the patient’s body temperature, room temperature, ventilation and foul odors.
- Create a plan to keep the room well-ventilated and free of odor while maintaining the
patient’s body temperature.
Light
Cleanliness
- Check surrounding environment for fresh air, pure water, drainage, cleanliness and light.
- Remove garbage, stagnant water and ensure clean water and fresh air.
Noise
Personal cleanliness
Variety
Taking food
- Check the diet of the patient. Note the amount of food and fluid ingested by the patient at
every meal.
Petty management
Metaparadigm
Person - referred to the person as a patient; a person with vital reparative powers to deals with the
disease and is responsive to the environment
Health - being well and using every power that the person has to the fullest extent; focus is on the
reparative process of getting well
Environment - those elements external to and which affect the health of the sick and healthy
person; all external conditions that affect the life and development of the individual
Nursing - every woman, at one time in her life, would be a nurse; goal is to place the individual in the
best condition for nature to act by basically affecting the environment; nurse performs the task to
and for the patient
Virginia Henderson
The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to a peaceful death) that he would perform
unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help
him gain independence as rapidly as possible.
14 Basic Needs
Physiologic
1. Breathe normally
2. Eat & drink adequately
3. Eliminate body waste
4. Move and maintain desirable posture
5. Sleep & rest
6. Select suitable clothing, dress and undress
7. Maintain body temperature
8. Keep the body clean & well groomed & protect the integument
9. Avoid dangers in the environment & avoid injuring others
10. Communicate with others in expressing emotions, needs, fears, or opinions
11.
Spiritual
Sociological
Metaparadigm
Person - The individual who requires assistance to achieve health and independence or peaceful
death
Health - The patient’s ability to perform the 14 components of nursing care unaided or
independently
Environment - The aggregate of all the external conditions and influences affecting the life and
development of an organism.
Nursing - “The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to a peaceful death) that
he would perform unaided if he had the necessary strength, will or knowledge and to do this in such
a way as to help him gain independence as rapidly as possible.”
Major Assumptions
Person
Environment
- Healthy individuals may be able to control their environment, but illness may interfere with
that ability.
- Nurses should have safety education.
- Nurses should protect patients from mechanical injury.
- Nurses should minimize chances of injury through recommendation regarding construction
of buildings, purchase of equipment, and maintenance.
- Doctors use nurse’s observations and judgments as the base of their prescriptions for
protection devices.
- Nurses must know about social customs and religious practices to assess dangers.
Nursing
GOAL OF NURSING: Assisting individuals to achieve health and independence or peaceful death
Nurse assumes the following role:
As a substitute for the patient (substitutive)
As a helper for the patient (supplementary)
As a partner with the patient (complimentary)
The nurse formulates an individualized view of the client’s needs, which may occur in the following
four areas:
Comfort, hygiene and safety.
Physiological balance
Psychological & social factors.
Sociological and community factors
Abdellah’s 21 Nursing Problems
Metaparadigm
Person - The recipient of care having physical, emotional, and sociologic needs that may be overt
and covert.
Environment - Suggests that patients interact with and respond to their environment and the nurse
is part of that environment; also refers to the home or community where the patient come from
GOAL OF NURSING
To provide service to individuals, families, and society. To be kind and caring but also intelligent,
competent, and technically well prepared to provide its service.
FRAMEWORK
Assumptions
Metaparadigm
Health - Unity and harmony within the mind, body and soul
Nursing - To assist persons to attain a higher degree of harmony by offering caring relationships
that clients can use for personal growth and development
Dorothea Orem
To understand this theory one must first understand the concepts of:
Self-Care is the performance or practice of activities that individual initiate and perform on their
own behalf to maintain life, health and well being
Self-Care Agency - Is the human’s acquired ability or power to engage in self-care. This ability to
engage self-care is affected by: basic conditioning factors
Therapeutic Self-Care Demand - Is the TOTALITY of “care measures necessary at specific times
or over duration of time meeting an individual’s self-care requisites by appropriate methods and
related sets of operations and actions”.
- Age
- Gender
- Developmental state
- Health state
- Sociocultural factors
- Health care system factors
- Diagnostic & Treatment modalities
- Family system factors
- Patterns of living
- Activities regularly engaged in
- Environmental factors
- Resource adequacy and availability
Self-Care Requisites - The reason for which self-care is undertaken; they express the intended or
desired results.
1. Universal
2. Developmental
3. Health Deviation
Self-Care Requisites: UNIVERSAL
Eight elements:
Associated with human growth and developmental process and with condition and events occurring
during various stages of the life cycle.
Examples:
Result from illness, injury, or disease or its treatment. Includes actions such as: seeking health care
assistance’ Carrying out prescribed therapies, Learning to live with effects of illness or treatment
In the theory of self-care: Orem explains WHAT it means by self-care and lists the various factors
that affect its provision.
Theory of Self-Care Deficit - Results when self-care agency is not adequate to meet the known
self-care demand. Delineates WHEN nursing is needed.
Five methods of helping that nurses may use:
Nursing Agency -Is a complex property or attribute of people educated and trained as nurses that
enables them: to act, to know, and to help others meet their therapeutic self-care demands by
exercising or developing their own self-care agency.
Wholly Compensatory
-When the nurse is expected to accomplish the entire patient’s therapeutic self-care or to
compensate for the patient’s inability to engage self-care or when the patient needs
continuous guidance in self-care
Partly Compensatory
- When both the nurse and patient engage in meeting self-care needs.
Supportive-Educative
- Requires assistance in decision making, behaviour control and acquisition of knowledge and
skills. The patient is doing all of the self-care
Metaparadigm
Health - “A state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity”.
Environment - Requisites for self-care have their origins in human beings and the environment.
Nursing - A creative effort of one human being to help another human being.
Consists of three nursing systems:
- Wholly compensatory,
- Partially compensatory, and
- Supportive/educative.
Martha Rogers
Energy Field - Constitute the fundamental unit of both the living and the non-living.
Universe of Open System - Holds that energy fields are infinite, open, and integral with one
another.
Pattern - The nature of the pattern changes continuously, innovatively, and these changes give
identity to the energy field.
Principles of Homeodynamics
Principle of Resonancy: - Patterning changes with development from lower to higher frequency,
that is, with varying degrees of intensity.
Metaparadigm
Person - An open system in continuous process with the open system that is the environment.
Health - She uses the term passive health to symbolize wellness and the absence of disease and
major illness.
Behaviour - Output of intraorganismic structures and processes as they are coordinated and
articulated by and responsive to changes in sensory stimulation
Equilibrium - Stabilized but more or less transitory resting state in which the individual is in
harmony with himself and his environment.
Tension - State of being stretched or strained and can be viewed as an end product of a
disturbance in equilibrium
Stressor - Internal or external stimuli that produce tension and result in a degree of
instability
7 Subsystems
Ingestive- Has to do with when, how, what, how much, and under what conditions we eat.
Sexual - Has a dual function of procreation and gratification. Including but not limited to
courting and mating.
Metaparadigm
Person - A behaviour system with patterned, repetitive, and purposeful ways of behaving that link
the person to the environment.
Health - An elusive dynamic state influenced by biological, psychological and social factors.
Environment - Consists of all factors that are not part of the individual’s behavioural system, but
influence the system.
Nursing - An external force acting to preserve the organization of the patient’s behaviour.
Adaptation Model
Roy based her work on Henderson’s Adaptation Theory
Is an excellent example of how borrowed knowledge becomes unique to nursing
Roy synthesizes different (borrowed) theories, such as systems, stress, and adaptation, into a
collective view for explication of a person interacting with the environment.
Major Concepts
System - This is a set of parts connected to function as a whole for some purpose and that does so
by virtue of the interdependence of its parts.
Systems also have inputs, outputs and control and feedback processes
Adaptation Level - This represents the condition of the life processes described on the three
levels as in integrated, compensatory and compromised.
This is a constantly changing point, made up of focal, contextual and residual stimuli which
represent the person’s own standard of the range of stimuli to which one can respond with the
ordinary adaptive responses.
This is made up of the pooled effect of three classes of stimuli.
Stimulus - is any factor that provokes a response. Stimuli may arise from either the internal or
external environment.
Focal Stimuli - The internal and external stimulus which confront the individual
Contextual Stimuli - Other stimuli present that contribute to the effect of the focal
stimulus
Residual Stimuli - Environmental factors whose effects are unclear in a given situation.
Adaptation Problems - These are broad areas of concern related to adaptation. These describe the
difficulties related to the indicators of positive adaptation. These are seen not as nursing
diagnoses, but as areas of concern for the nurse related to adapting person or group.
Coping Processes - These are innate or acquired ways of interacting with the changing environment
Innate Coping Mechanism - These are genetically determined to the species and are generally
viewed as automatic processes; human do not have to think about them.
Acquired Coping Mechanism - These are developed through strategies such as learning.
Adaptive Responses - These promote integrity in terms of the goals of the human system.
Ineffective Responses - These do not contribute to integrity in terms of the goals of the human
system.
Integrated Life Processes - This refers to the adaptation level at which the structures and
functions of a life process are working as a whole to meet human needs.
Perception - The interpretation of a stimulus and the conscious appreciation of it. Links the
regulator with the cognator and connects the adaptive modes.
Physiological-Physical Mode
Self-Concept-Group Identity Mode
Role Function Mode
Interdependence Mode
Metaparadigm
Environment - stimuli
Betty Neuman
SYSTEM MODEL
Major Concepts
Lines of Resistance - Series of broken rings surrounding the basic core structure.
Represent the resource factors that help the client defend against a stressor such as the
body’s immune system
Normal Line of Defense - The model’s outer solid circle. Represents a stability state for
the individual or system
Flexible Line of Defense - Model’s outer broken ring; Dynamic and can be rapidly altered
over a short time
Wellness - Exists when the parts of the client system interact in harmony with the whole
system. System needs are met.
Illness - Occurs when needs are not satisfied, resulting in a state of instability and energy
depletion.
Stressors - Tension-producing stimuli that have the potential to disrupt system stability.
Prevention as Intervention
Interventions are purposeful actions to help the client retain, attain, and maintain system stability
Negentropy - A process of energy conservation that increases organization and complexity, moving
the system toward stability or a higher degree of wellness
Metaparadigm
Person - A client as a system that may be an individual, family, group, community, or social issue
Health - A continuum of wellness to illness that is dynamic in nature and constantly subject to
change
Environment - Internal and external factors that surround or interact with the person/client