1.

Perspective on nursing theory

Nursing theory is used to develop a nursing concept model so that the nursing model can be
interpreted as the application of nursing it self allowing nurses to be able to apply their strategies to
work within the limits of authority as a nurse. Nursing concept models are used to determine the
nursing practice model, because in the nursing practice model the basic components such as the
value of beliefs and values that underlie a model, the existence of practical goals that want to
achieve in providing health care and information needed by nurses to develop. This conceptual and
theoretical model view is a picture of the form of nursing services that will be provided in meeting
basic human needs in accordance with agreements and work assignments with a clear direction in
nursing services

2. Evolution of nursing theory

NURSING THEORY

The evolution of professional nursing began with Florence Nightingale. It was Nightingale who
envisioned nurses as a body of educated women at a time when women were neither educated nor
employed in public service. Following her service of organizing and caring for the wounded in
Scutari, during the Crimean War, her vision and establishment of a School of Nursing at St. Thomas’
Hospital in London marked the birth of modern nursing. Nightingale’s pioneering activities in nursing
practice and subsequent writings describing nursing education became a guide for establishing
nursing schools in the United States at the beginning of the twentieth century (Kalisch & Kalisch,
2003; Nightingale, 1859/1969). Nursing began with a strong emphasis on practice, but throughout
the century, nurses worked toward the development of nursing as a profession through successive
periods recognized as historical eras (Alligood, 2006a).

The curriculum era addressed the question of what prospective nurses should study to learn how to
be a nurse. In this era, the emphasis was on what courses nursing students should take, with the
goal of arriving at a standardized curriculum (Alligood, 2006a). By the mid-1930s, a standardized
curriculum had been published. However, it was also in this era that the idea of moving nursing
education from hospital-based diploma programs into colleges and universities emerged. Even so, it
was the middle of the century before this goal began to be acted upon in many states (Kalisch &
Kalisch, 2003).

As nurses increasingly sought degrees in higher education, a research emphasis era, as it is deemed,
began to emerge. This era came about as more and more nurses embraced higher education and
arrived at a common understanding of the scientific age, that is, that research is the path to new
nursing knowledge. Nurses began to participate in research, and research courses began to be
included in the nursing curricula of many developing graduate programs (Alligood, 2006a).

The research era and the graduate education era developed in tandem. Master’s degree programs in
nursing emerged to meet the public need for nurses with specialized clinical nursing education.
Many of these programs included a nursing research course. It was also in this era that most nursing
master’s programs began to include courses in concept development or nursing models that
introduced students to early nursing theorists and the knowledge development process (Alligood,
2006a).

The theory era was a natural outgrowth of the research and graduate education eras. As our
understanding of research and knowledge development increased, it soon became obvious that
research without theory produced isolated information, and that it was research and theory
together that produced nursing science (Batey, 1977; Fawcett, 1978; Hardy, 1978). In the early years
of the theory era, doctoral education in nursing flourished with an emphasis on theory development.

In the theory utilization era, emphasis was placed on middle range theory for theory-based
nursing practice, as well as on theory development (Alligood & Tomey, 1997, 2002, 2006; Batey,
1977; Chinn & Kramer, 2008; Fawcett, 2005; Tomey & Alligood, 2006).

Each era addressed nursing knowledge in a unique way that contributed to and is observable in the
history of nursing. Within each era, the pervading question “What is the nature of the knowledge
that is needed for the practice of nursing?” seems to have been addressed at the level of
understanding that prevailed at that time (Alligood, 2006a).

Nightingale’s (1859/1969) vision of nursing has been practiced for more than a century, and theory
development in nursing has evolved rapidly over the past 5 decades, leading to the recognition of
nursing as an academic discipline with a substantive body of knowledge (Alligood,
2006a, 2006b; Alligood & Tomey, 2006; Chinn & Kramer, 2008; Fawcett, 2005; Tomey & Alligood,
2006; Walker & Avant, 2005). In the mid-1800s, Nightingale wrote that nursing knowledge is distinct
from medical knowledge. She described a nurse’s proper function as putting the patient in the best
condition for nature (God) to act upon him or her. She proposed that care of the sick is based on
knowledge of persons and their surroundings—a different knowledge base than that used by
physicians in their practice. Despite this early edict from Nightingale in the 1850s, it was 100 years
later, during the 1950s, that the nursing profession began to engage in serious discussion about the
need to develop, articulate, and test nursing theory (Alligood, 2006d; Alligood, 2004; Chinn &
Kramer, 2008; Meleis, 2007; Walker & Avant, 2005). Until the emergence of nursing as a science in
the 1950s, nursing practice was based on principles and traditions that had been passed on through
an apprenticeship model of education and hospital-kept procedure manuals (Alligood, 2002a; Kalisch
& Kalisch, 2003).

Although some nursing leaders aspired for nursing to be recognized as a profession and become an
academic discipline, nursing practice continued to reflect its vocational heritage more than a
professional vision. The transition from vocation to profession included successive eras of history as
nurses searched for a body of substantive knowledge on which to base nursing practice. The
curriculum era emphasized course selection and content for nursing programs and gave way to the
research era, which focused on learning the research process and meeting the long-range goal of
acquiring substantive knowledge to guide nursing practice.

In the mid-1970s, an evaluation of the first 25 years of the journal Nursing Research revealed that
nursing studies lacked conceptual connections and theoretical frameworks (Batey, 1977). An
awareness of the need for concept and theory development coincided with two other significant
milestones in the evolution of nursing theory. One was the standardization of curricula for nursing
master’s education provided by the National League for Nursing accreditation criteria for
baccalaureate and higher degree programs, and the second was the decision that doctoral education
for nurses should be in nursing (Alligood, 2006a). The nursing theory era, coupled with an awareness
of nursing as a profession and as an academic discipline in its own right, emerged from debates and
discussions in the 1960s regarding the proper direction and appropriate discipline for nursing
knowledge development. The explosive proliferation of nursing doctoral programs and nursing
theory literature substantiated that nursing doctorates should be in nursing (Nicoll,
1986, 1992, 1997; Reed, Shearer, & Nicoll, 2003; Reed & Shearer, 2008). In the 1970s, nursing
continued to make the transition from vocation to profession as more and more nurses asked, “Will
nursing be other-discipline based or be nursing based?” The history records the answer, “Nursing
practice needs to be based on nursing science” (Alligood, 2006a; Fawcett, 1978; Nicoll, 1986). It is
as Meleis (2007) noted, “theory is not a luxury in the discipline of nursing … but an integral part of
the nursing lexicon in education, administration, and practice” (p. 4).

The 1980s was a period of major developments in nursing theory characterized as a transition from
the pre-paradigm to the paradigm period (Fawcett, 1984; Hardy, 1978). The prevailing nursing
paradigms (models) provided perspectives for nursing practice, administration, education, research
and further theory development. In the 1980s, Fawcett’s seminal proposal of four global nursing
concepts presented a nursing metaparadigm that served as an organizing structure for existing
nursing frameworks, and introduced a way of grouping what previously had been viewed as
individual theoretical works (Fawcett, 1978, 1984, 1993). Classifying the nursing models as
paradigms within a metaparadigm of the concepts person, environment, health,
and nursing systematically united the nursing theoretical works for the discipline. This system
clarified and improved comprehension of a knowledge development process by embedding the
theorists’ works in a larger context, thus facilitating understanding of the growth of nursing science
from a paradigm perspective (Alligood & Tomey, 2006; Fawcett, 2005). The body of nursing science
and research, education, administration, and practice continues to expand through nursing
scholarship. Podium presentations at national and international conferences, newsletters, journals,
and books written by communities of scholars associated with the various nursing models and
theories describe a theoretical basis for practice and research presenting their scholarship on a
selected model or theory from a paradigm perspective (Alligood, 2004; Alligood & Tomey,
2006; Fawcett, 2005; Parker, 2006).

These observations of nursing theory development bring Kuhn’s (1970) description of normal
science to life. His philosophy of science clarifies our understanding of the evolution of nursing
theory through paradigm science. It is important historically that it was individual efforts that led to
the first theory as nurse leaders in various areas of the country published their works, which later
came to be viewed collectively within a systematic structure of knowledge (Fawcett,
1984, 2000, 2005). Theory development emerged as a product of professional scholarship and
growth among nurse leaders, administrators, educators, and practitioners who sought higher
education. These leaders recognized limitations of theory from other disciplines to describe, explain,
or predict nursing outcomes, and they labored to establish a scientific basis for nursing
management, curricula, practice, and research. The use of theory to convey an organizing structure
and meaning for these processes led to the convergence of ideas that resulted in what is recognized
today as the nursing theory era (Alligood, 2006b; Alligood & Tomey, 2006; Nicoll,
1986, 1992, 1997; Reed, Shearer & Nicoll, 2003; Reed & Shearer, 2008).

The accomplishments of normal science opened the theory utilization era as emphasis shifted to
theory application in nursing practice, education, administration, and research (Alligood,
2006c; Wood & Alligood, 2006). The theory utilization era restored balance between research and
practice for knowledge development in the discipline of nursing. The reader is referred to the fourth
edition Nursing Theory: Utilization & Application (Alligood, 2010, in press) for case applications and
discussion of utilization of nursing theoretical works in practice.

This brief history provides a context for your study of the nursing theorists and their work. The
theory era continues with emphasis on development and use of nursing theory to produce evidence
for professional practice. Particular utility of middle range theories to guide the thought and action
of nursing practice is noted (Alligood, 2006c; Alligood & Tomey, 2006; Fawcett, 2005; Peterson,
2008; Smith & Leihr, 2008). Therefore, preparation for practice in the profession of nursing requires
knowledge of the theoretical works of the discipline. TheThe theoretical works presented in this text
are frameworks that have been organized into four types. Box 1-1 lists the theorists included in each
type. The four types, although somewhat arbitrary, reflect a certain level of abstraction or the
preference of the theorist..

3. Explain about patient assesment

Nursing assessment is the gathering of information about

a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered
Nurse. Nursing assessment is the first step in the nursing process. A section of the nursing
assessment may be delegated to certified nurses aides. Vitals and EKG's may be delegated to
certified nurses aides or nursing techs. (Nurse Journal, 2017) It differs from a medical diagnosis. In
some instances, the nursing assessment is very broad in scope and in other cases it may focus on
one body system or mental health. Nursing assessment is used to identify current and future patient
care needs. It incorporates the recognition of normal versus abnormal body physiology. Prompt
recognition of pertinent changes along with the skill of critical thinking allows the nurse to identify
and prioritize appropriate interventions.] An assessment format may already be in place to be used
at specific facilities and in specific circumstances

Use expressions for assessing the head, face and neck

Inspection, palpation, percussion and auscultation are examination techniques that enable the nurse
to collect a broad range of physical data about patients :

1.Inspection

The process of observation, a visual examination of the patient's body parts to detect normal
characteristic or significant physical signs

2. Palpation

Involves the use of the sense of touch. Giving gentle pressure or deep presure using your hand is the
main activity of palpation

3.PercussionInvolves tapping the body with fingertips to evaluate the size, borden, and consistency
of body organs and discover fluids in body cavities

4. Auscultation

Learning to sounds produced bt the body

4. To give instructions and commitments during implementation, we must use good and
correct language so patients can respond well, for example:

would you lie on the bed ?

would you like to lie down to the left?

Would you lie down on the coach ?

Would you like to eat your food ?

Would you mind , please raise your right/left leg

Would you mind, please roll your sleeve up

Would you mind, please give me you right/left hand

Would you mind , please raise your arm

Now , i want you to take medicine

Now ,i want you to take a deep breath

Now , i want you breathe in and breathe out

Now , i want roll yourself into side lying posisition