1st year-1st Exam Flashcards
Period of Intuitive Nursing/Medieval Period
“Untaught” and instinctive
Natural job nurturing for women
Expected to take good care of children, sick and the aged
No caregiving training
Based on experience and observation
Trephining-drilling a hole in the skull with a rock or stone without anesthesia was a last resort to drive evil spirits from the body of the afflicted.
Period of Apprentice Nursing/Middle Ages
Care was done by Crusader, Prisoners, and religious orders
Developed by religious orders of the Christian Church
Nursing went down to the lowest level
-Wrath/anger of Protestantism removed properties of hospitals and schools connected with Roman Catholicism
Became the work of the least desirable of women -Prostitutes, Alcoholics, Prisoners
Pastor Theodore Fliedner and his wife, Fredericka established the Kaisers Werth Institute for the training of Deaconesses (the 1st formal training school for nurses) in Germany.
Period of Educated Nursing/ Nightingale Era 19th-20th century
The development of nursing during this period was strongly influenced by
a) Trends resulting from wars – Crimean, Civil war
b) Arousal of social consciousness
c) Increased educational opportunities offered to women
In 1860, The Nightingale Training School of Nurses opened at St. Thomas Hospital in London.
The school served as a model for other training schools.
Its graduates traveled to other countries to manage hospitals and institutes nurse-training programs.
Period of Contemporary Nursing/20th century
Licensure of nurses started
Specialization of Hospital and diagnosis
Training of Nurses in diploma program
Development of Baccalaureate and advance degree programs
Scientific and technological development as well as social changes mark this period.
Health is perceived as a fundamental human right
Nursing involvement in community health
Technological advances – disposable supplies and equipment
Expanded roles of nurses was developed
Why Theory?
Theory enables understanding of what, how and why we do the practice of nursing
It facilitates questions about the relevance & application of nursing practice & research
It stimulates thinking, identifying what is mindless and what needs to be changed
It facilitates the development of nursing knowledge and evidence-based practice
Evolution of Nursing Theory
The history of professional nursing began with Florence Nightingale who envisioned nurses as a bod of educated women.
In last century, nursing began with a strong emphasis on practice
Nursing theory has been a prevalent theme in the nursing literature for the past 30years and has stimulated phenomenal growth in the nursing profession.
It is interesting to note that 90% of all Nursing theories have been generated in the last 20 years.
Curriculum Era
Addressed the question of what prospective nurses must study and learn to become a nurse.
Research Era
As more and more nurses sought degrees in higher education, research era emerged. Nurses began to participate in research and research course began to be included in nursing curricula.
Graduate Nursing Education Era
Masters program in nursing emerged to meet the need for nurse with specialized education in nursing. The Masters education had an embedded course in nursing research nearing the end of this era a course in nursing theory or nursing conceptual models that introduced students to the early nursing theorists and development of nursing theories was introduced.
Theory Era
Was the natural outgrowth of research era. With an increased understanding of research and knowledge development. It became obvious that research without theory produced isolated information, however research and theory produced nursing science.
Silent Knowledge Stage
Source of Knowledge:
Blind obedience to medical authority
Impact on Theory and research:
Little attempt to develop theory
Research was limited to collection of epidemiological data
Received Knowledge Stage
Source of Knowledge:
Learning through listening to others
Impact on theory and research:
Theories were borrowed from other disciplines. As nurses acquired non-nursing doctorial degrees, they relied on the authority of educators, sociologists, psychologists to provide answers to nursing problems.
Subjective Knowledge Stage
Source of Knowledge:
Authority was internalized and a new sense of self emerged
Impact on theory and research:
A negative attitude toward borrowed theories and science emerged. Nurse scholars focused on defining nursing and on developing theories about and for nursing.
Nursing research focused on the nurse rather than on clients and clinical situations.
Procedural Knowledge Stage
Source of Knowldge:
Includes both separate and connected knowledge
Impact on theory and research:
Proliferation of approaches to theory development.
Application of theory in practice was frequently underemphasized.
Emphasis was replaced on the procedures used to acquire knowledge, with over attention to the appropriateness of methodology, the criteria for evolution, and statistical procedure for data analysis.
Constructed Knowledge
Source of Knowledge
Integration of different types of knowledge (intuition reason and self-knowledge)
Impact on theory and research
Nursing theory should be based on prior empirical studies, theoretical literature, client reports of chemical experience and feeling, nurse scholar’s intuition or related knowledge
Conceptual models and philosophies of practice
The nature of nursing
The purposes for which nursing exist
Nursing process as a framework for viewing nursing practice
Deliberate, reflective, critical, and self-correcting
Encouraged nurses to cultivate basic inquiry skills
Development of philosophies with emphasis on knowledge associated with:
Esthetic
Ethical
Personal
Application of theories borrowed from other disciplines
Means to resolve problems
Use with caution
Nursing theories in the 1960’s and 1970s functional view of nursing
What nursing is describes how nursing functions; variables influencing health and illness
Development of midrange practice-linked theory
Needed to provide specific guidance for nursing practice
Tend to cluster around a concept of interest
Metaparadigm
It is the most abstract level of knowledge. It specifies the main concepts that encompass the subject matter and the scope of a discipline. Nursing metaparadigm consists of the central concepts “Person, Environment, Health, and Nursing”.
Philosophy
It is the next knowledge level; it specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing.
Conceptual Models
To the phenomena with which the are frameworks or paradigms that provide “a broad frame of reference for systematic approaches discipline is concerned”. It differs according to the concepts of the models.
Theory
It is a group of related concepts that propose actions that guide practice
Nursing Theory
Is a group of related concepts that derive from the nursing models.
Middle Range Theories
They are lest abstract level of theoretical knowledge because they include details specific to nursing practice. They include information indicating the situation or health conditions, the patient population or age group, the location or area of practice and the action of the nurse or the intervention.
Grand Theories
Grand Theories are defined as the broadest in scope, less abstract than conceptual models but composed of general concepts still relatively abstract, and the relationships cannot be tested empirically.
Knowledge
Understanding acquired through learning or investigation of what is known about a discipline’s subject matter. It may be facts or theoretically beads knowledge that is more tentative.
Phenomena
They are subject matter of a discipline
Concept
Is an idea or complex mental image of a phenomenon (object property or event). They are the major components of a theory.
Abstract Concepts
Are independent of time or place and they are indirectly observable.
Concrete concepts
Are specific to time and place and are observable.
Model
It can be Verbal: Verbal model are worded statements.
Schema: means symbols or physical visualization. Schematic models can be diagrams, graphs, or pictures that facilitate understanding
Paradigm
Is another term for conceptual framework or conceptual model
Propositions
They are theoretical statements that specify the proposed relationships of the concepts of theory.
Induction
Is a form of reasoning that is loosely described as moving from specific to general
Deduction
Logical reasoning from general to specific
Overview of Theory
The uniqueness of theories and perspectives used by a disciple distinguishes it from other disciplines.
The theories used by members of a profession clarify basic assumptions and values shared by its members and define the nature, outcome and purpose of practice.
Kerlinger- views theories as a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory and predictive in nature)
Theories are composed of concepts, definitions, models, propositions, and are based on assumptions. They are derived through two principal methods:
Deductive reasoning
Inductive reasoning
Nursing theorists use both of these methods
Deductive Reasoning
It is form of reasoning from the general to the specific. In deductive logic where two or more premises as relational statements are used to draw a conclusion.
In deductive process, an abstract theoretical relationship is used to thrive specific questions or hypothesis.
Theory that is developed from the applications of deductive logical System is only as sound as premises upon which the argument is based.
Induction
It is a form of logical reasoning in which a generalization is induced from a number of specific observed instances.
The inductive form is based on the assumption that members of any given class share common characteristics. Therefore, what is true for any randomly selected members of the class is accepted as true for all members of the class.
Definition and Meaning of Nursing Theory
Nursing theories are an organized and systematic expression of a set of statements related to questions in the discipline of nursing.
Powers and Knapp (1995), defined theory as “a set of statements that tentatively describe, explain, or predict relationships among concepts that have been systematically selected and organized as an abstract representation of some phenomenon.
Boddie and Chitty (1993) defined theory as “an internally consistent group of relational statements (concepts, definitions and propositions) that represent a systematic view about a phenomenon and which is useful for description, explanation, prediction and control”.
Socialization into a discipline is guided by
Theories use of language
Identification of concepts
Definition of relationships
Structured ideas
And facilitation of disciplined inquiry, practice and communication, as well as predicting outcomes of practice.
Nursing professionals apply theory to describe, explains, predict or prescribe nursing practice.
Importance of Nursing Theories
- Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs 1978)
- It provides the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964)
- Theory is important because it help us to decide what we know and what we need to know (Parson 1994)
- It helps to distinguish what should form the basis of practice by explicitly describing nursing.
- The benefits of having a defined body of theory in nursing include
Better patient care
Enhanced professional stats for nurses
Improved communication between nurses
Guidance for research and education (Nolan 1996)
In addition, because the main exponent of nursing- caring- cannot be measure, it is vital to have the theory to analyze and explain what nurses do. - As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge
Characteristics of Theories
- Interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.
- Are logical in nature
- Are generalizable
- Are the bases for hypotheses that can be tested
- Increase the general body of knowledge within the discipline through the research implemented to validate them
- Are used by the practitioners to guide and improve their practice
- Are consistent with either validated theories, laws, and principles but will leave open unanswered questions that need to be investigated
Meta Theory
The fourth level of theory or Meta theory is the highest level of theory, and is defined by the prefix META, meaning “changed in position”, “beyond”, “on a higher level”, or “transcending”, and refers to the body of knowledge or about a field of study.
Presents the most global perspective of the nursing discipline by identifying and evaluating critical phenomena in unique ways.
Even though nursing meta theory is very abstract and may not be easily tested, nursing meta theory provides the meanings, sentences, and structures interconnecting situations and events observed by nurses on a global scale.
Meta theory is criticized as being limited, without boundaries, abstract and very difficult for practical applications.
A true meta theory in nursing will emerge as a superstructure with multiple practical applications and extensive opportunities for researchers to discover grand paradigms, and models, as well as explore how nursing reconstructs and is reconstructed.
Grand Theory
The third level of nursing theory
Emphasizes a global viewpoint with a board perspective of nursing practice, and a distinct nursing perspective of nursing phenomenon.
Fawcett (1995) defined Grand Theories as the broadest in scope, less abstract that conceptual models but composed of general concepts still relatively abstract, and the relationships cannot be tested empirically.
Categorization of Grand Nursing Theories
Human Needs Model and Theories
-Abdellah
-Henderson
-Johnson
-Nightingale
-Neuman
-Orem
Interactive Process Models and Theories
-Artinian and Conger-Intersystem Model
-Erikson, Tomlin and Swain-Modeling and Role Modeling (MRM), a paradigm and theory for nursing
-King
-Levine
-Roy
-Watson
Unitary Models and Theories
-Margaret Newman-health as an expanding consciousness
-Parse
-Rogers
Middle Range Theory
The second level of nursing theories
Moderately abstract, inclusive, organized within a limited scope; have a limited number of variables, which are testable in a direct manner
The mid-range theories have a stronger relationship with research and practice
Mid-range theories provide nurses with the “best of both worlds” -easy applicability in practice and abstract though to be scientifically interesting.
Mid-range theories focus on concepts of interest to nurses, and include: pain, empathy, grief, self-esteem, hope, comfort, dignity, and quality of life
They are categorized as
1. High Middle Range Theories- Benner’s skill acquisition in nursing model, Leininger and Pender
2. Middle-Middle Range Theories- Mishel’s uncertainty of illness theory, Schumacher and Meleis work on transitions and Reed’s self-transcendence theory
3. Low Middle Range Theory- Eakes, Burke and Hainsworth theory of chronic sorrow. Becks postpartum depression theory and Mercers conceptualization of maternal role attainment.
Practice Theory
The first level of nursing theory, describe prescriptions or modalities for practice
Four steps are involved to determine practice theories, which include:
1. Fator Isolating- to identify and describe a phenomenon
2. Factor Relating- to identify and describe possible explanations or causes of the phenomenon
3. Situation Relating- to predict occurrence of a phenomenon when the cause is present.
4. Situation Producing Control- to prevent occurrence of the phenomenon by controlling or eliminating possible causes.
Interaction theories
As described by Peplau (1988), these theories revolve around the relationship’s nurses form with patients. Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs.
Needs theories
These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for replying too much on the medical model of health and placing the patient in an overtly dependent position.
Outcome theories
These portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health (Roy 1980). Outcome theories have been criticized as too abstract and difficult to implement in practice (Aggleton and Chalmers 1988).
Humanistic theories
Humanistic theories emphasize a person’s capacity for self-actualization.
Descriptive
describe, observe, and name concepts, properties, and dimensions, but they do not indicate how changes in how concept affect other concepts.
Explanatory
relate concepts to one another and describe and specify some of the association or interrelations between and among the concepts. Explanatory theories attempt to tell how or why the concepts are related and may deal with causality, correlations, and rules that regulate interactions (Barnum, 1998; Dickoff et al.,1968)
Predictive
describe precise relationships between concepts and are the third level of theory development. Predictive theories presuppose the prior existence of the more elementary types of theory. They result after concepts are defined and rational statements are generated and are able to describe future outcomes consistently. Predictive theories include statements of causal or consequential relatedness (Dickoff et al.,1968)
Prescriptive
are perceived to be the highest level of theory development (Dickoff et al.,1968). Prescriptive theories prescribe activities necessary to reach defined goals. In nursing, prescriptive theories address nursing therapeutics and predict the consequence of interventions (Meleis, 2005)
