1st year-1st Exam

Question 1

Period of Intuitive Nursing/Medieval Period

Answer 1

 “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.

Question 2

Period of Apprentice Nursing/Middle Ages

Answer 2

 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.

Question 3

Period of Educated Nursing/ Nightingale Era 19th-20th century

Answer 3

 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.

Question 4

Period of Contemporary Nursing/20th century

Answer 4

 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

Question 5

Why Theory?

Answer 5

 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

Question 6

Evolution of Nursing Theory

Answer 6

 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.

Question 7

Curriculum Era

Answer 7

Addressed the question of what prospective nurses must study and learn to become a nurse.

Question 8

Research Era

Answer 8

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.

Question 9

Graduate Nursing Education Era

Answer 9

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.

Question 10

Theory Era

Answer 10

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.

Question 11

Silent Knowledge Stage

Answer 11

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

Question 12

Received Knowledge Stage

Answer 12

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.

Question 13

Subjective Knowledge Stage

Answer 13

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.

Question 14

Procedural Knowledge Stage

Answer 14

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.

Question 15

Constructed Knowledge

Answer 15

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

Question 16

Conceptual models and philosophies of practice

Answer 16

 The nature of nursing
 The purposes for which nursing exist

Question 17

Nursing process as a framework for viewing nursing practice

Answer 17

 Deliberate, reflective, critical, and self-correcting
 Encouraged nurses to cultivate basic inquiry skills

Question 18

Development of philosophies with emphasis on knowledge associated with:

Answer 18

 Esthetic
 Ethical
 Personal

Question 19

Application of theories borrowed from other disciplines

Answer 19

 Means to resolve problems
 Use with caution

Question 20

Nursing theories in the 1960’s and 1970s functional view of nursing

Answer 20

 What nursing is describes how nursing functions; variables influencing health and illness

Question 21

Development of midrange practice-linked theory

Answer 21

 Needed to provide specific guidance for nursing practice
 Tend to cluster around a concept of interest

Question 22

Metaparadigm

Answer 22

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”.

Question 23

Philosophy

Answer 23

It is the next knowledge level; it specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing.

Question 24

Conceptual Models

Answer 24

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.

Question 25

Theory

Answer 25

It is a group of related concepts that propose actions that guide practice

Question 26

Nursing Theory

Answer 26

Is a group of related concepts that derive from the nursing models.

Question 27

Middle Range Theories

Answer 27

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.

Question 28

Grand Theories

Answer 28

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.

Question 29

Knowledge

Answer 29

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.

Question 30

Phenomena

Answer 30

They are subject matter of a discipline

Question 31

Concept

Answer 31

Is an idea or complex mental image of a phenomenon (object property or event). They are the major components of a theory.

Question 32

Abstract Concepts

Answer 32

Are independent of time or place and they are indirectly observable.

Question 33

Concrete concepts

Answer 33

Are specific to time and place and are observable.

Question 34

Model

Answer 34

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

Question 35

Paradigm

Answer 35

Is another term for conceptual framework or conceptual model

Question 36

Propositions

Answer 36

They are theoretical statements that specify the proposed relationships of the concepts of theory.

Question 37

Induction

Answer 37

Is a form of reasoning that is loosely described as moving from specific to general

Question 38

Deduction

Answer 38

Logical reasoning from general to specific

Question 39

Overview of Theory

Answer 39

 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

Question 40

Deductive Reasoning

Answer 40

 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.

Question 41

Induction

Answer 41

 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.

Question 42

Definition and Meaning of Nursing Theory

Answer 42

 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.

Question 43

Importance of Nursing Theories

Answer 43

1. Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs 1978)
2. 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)
3. Theory is important because it help us to decide what we know and what we need to know (Parson 1994)
4. It helps to distinguish what should form the basis of practice by explicitly describing nursing.
5. 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.
6. 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

Question 44

Characteristics of Theories

Answer 44

1. Interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.
2. Are logical in nature
3. Are generalizable
4. Are the bases for hypotheses that can be tested
5. Increase the general body of knowledge within the discipline through the research implemented to validate them
6. Are used by the practitioners to guide and improve their practice
7. Are consistent with either validated theories, laws, and principles but will leave open unanswered questions that need to be investigated

Question 45

Meta Theory

Answer 45

 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.

Question 46

Grand Theory

Answer 46

 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.

Question 47

Categorization of Grand Nursing Theories

Answer 47

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

Question 48

Middle Range Theory

Answer 48

 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.

Question 49

Practice Theory

Answer 49

 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.

Question 50

Interaction theories

Answer 50

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.

Question 51

Needs theories

Answer 51

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.

Question 52

Outcome theories

Answer 52

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).

Question 53

Humanistic theories

Answer 53

Humanistic theories emphasize a person’s capacity for self-actualization.

Question 54

Descriptive

Answer 54

describe, observe, and name concepts, properties, and dimensions, but they do not indicate how changes in how concept affect other concepts.

Question 55

Explanatory

Answer 55

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)

Question 56

Predictive

Answer 56

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)

Question 57

Prescriptive

Answer 57

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)