3103 Flashcards
What is a theory
Aquired through philosophy + science
(Both informs truth)
Esse tual to examine knowledge and truth before theories
Is nursing a occupation or profession
Profession
What is an occupation
Job/career
Means of income
Values generally bot in training
Guided decision making
Employer holds accountability
What is a profession
Specialized knowledge base
Decisions guided by evidence/theoretical constructs
Formal training (school)
Ensures competency
Service to society
Ethics
Autonomy over practice
Nursing is both..
A profession and discipline
A profession must have
Determines who we are
A group of scholars that continually advance knowledge
- establish requirements
- promote practice standards
- quality assurance
- enforce standards and conduct
What is a discipline? What does it determine?
Describes out body of knowledge
Unique body of knowledge
(Person, environment, health, nursing)
- distinct prospective
- determine phenomena of interest
- determine context of phenomenon
- questions to ask
- what methods of study are used
- what evidence is proof
What phenomena defines nursing
Donaldson and Crowley
- Concern with principles and laws that govern life processes
- Concern with human behavior in interaction with environment in critical situations
- Concern with processes by which health is effected
A professional discipline needs
A focus statement
(Area of study + social relevance)
Caring for person, environment, health, nursing
+
Commitment to caring as moral imperative
What is philosophy
Abstract concept
Difficult to understand without context
A lens to look at world to derive meaning
Science
Ex. Sir Issac Newton
Concerned with causality (cause and effect)
Approach understanding reality (observation, verification, experience)
Hypothesis testing/experiment
Philosophy is concerned with?
Ex. Karl Marx (socialism, communism)
Purpose of life
Nature of reality
Nature of knowledge
Understanding by
- intuition, introspection, reasoning
Science process and product
Process
- research
- observe
- advance knowledge
Product
- knowledge
- explain phenomena and knowledge
Science branches
Natural (Chem, physics, bio)
Basic/pure (math, logic, chemistry)
Human/social science (psychology, anthropology, sociology, political, nursing)
Practice/applied science (architecture, engineering, med, pharmacology, nursing)
Science branches
Natural (Chem, physics, bio)
Basic/pure (math, logic, chemistry)
Human/social science (psychology, anthropology, sociology, political, nursing)
Practice/applied science (architecture, engineering, med, pharmacology, nursing)
Science branches
Natural (Chem, physics, bio)
Basic/pure (math, logic, chemistry)
Human/social science (psychology, anthropology, sociology, political, nursing)
Practice/applied science (architecture, engineering, med, pharmacology, nursing)
Philosophy aim
Compass to direct how theories are developed about phenomena and knowledge
Studies concepts that structure thought processes to reveal foundations of presuppositions
Does not aim to solve problems
Philosophy is concerned with
Nature of existence (metaphysics)
Nature of being (ontology)
Nature of knowledge (epistemology)
Morality (ethics)
Reasoning (logic)
Philosophy of science
Human purpose
Ontology
What is/ what exsists
Epistemology
Nature of knowledge
Philosophy is divided into which 2 groups
Rationalist (received view)
- empiricism
- positivism
- post-positiveism)
Relativism (precived view)
- phenomenology
- constructivist
- post-modern (feminist, post colonialism)
Received view
Universal truths exist and can be proven
Empiricism
Value observation by sence and verifiable experience
Truth observable
Reduction, control, bias-free science
Understanding parts to understand whole
Math equations and simple dichotomy
Relies heavily on instrumentation
Positivism (close to empiricism)
Complex into basic
Science is logical and empirical, value free, independent from scientist, objective measures
Goal of science to predict, control, explain
Facts can be measured with senses
Postpositivism
1960s scrutinized (too idealistic)
Research is value laden (research based on interest and values)
Focus on rigor, objective inquiry (recognizes contextual variables)
Perceived view
Knowledge from descriptions
No single truth
Belief in interpretation
(Ex. Study of human science)
Phenomenology
Seek to understand meaning of human experience
Seek to understand essence/experience and meaning
Core of experience similarities (ESSENCE)
(Ex. Human suffering, mental health)
Constructivist
Knowledge is subjective
Multiple interpretations of reality
Goal to understand how reality is constructed
Multiple truths
(Understanding pt. Unique reality)
Postmodernism
Dominate in nursing
Rejects single truth
Knowledge uncertain, contextual and relative
Post colonialism and feminist
Nursing philosophy
Multi paradigms
Nursing science vs nursing philosophy
Science
- inform nursing practice
- understanding
Philosophy
- establish meaning of science in nursing
- concepts, theories, laws
Nursing epistemology
Nurse knowledge of
- structure
- methods, pattern
- criteria for knowledge claims
Relied on multiple disciplines
Ways of knowing
(Schultz, Meleis)
1988
Clinical
Conceptual
Empirical
Clinical knowledge
Ways of knowing
(Schultz, Meleis)
Unblocking no tubes with fizzy drink
Warm water to take blood
Medical play
Conceptual knowledge
Ways of knowing
(Schultz, Meleis)
Beyond personal experience
Patterns from multiple situations
Concepts drafted and related to eachother
Relies on experience, curiosity, persistent
Impirical
Ways of knowing
(Schultz, Meleis)
Research
Justify actions
Credited by Judge
(Studies, systematic review, publishings)
Fundamental ways of knowing
Carpers 1978
Epirics, esthetic, personal, ethics
Shape nursing knowledge
Carper 1978
Empirics
Person, health, environment, nursing
Factual, objective, descriptive, classification
Carper 1978
Esthetics
Creative process of discovery
Direct feeling from experience
Relies on perception
EMPATHY
Carper 1978
Personal knowledge
Shapes values
Helps chose specialty that alignes with values
Most problematic
Hard to teach
Authentic relationship with pt
Carper 1978
Ethics
Questions what is abd isn’t important
Carper 1978 addition
Emancipatory knowledge (2011)
Uncovering injustice
Explore how some are less privileged
Propose ways to decrease oppression
Social Justice
Nursing was originally (1900s) modeled after?
Then in 1980s
Empiricism
Methodological battle spurring philosophical debate about nature of profession
(Beginning of importance of qualitative study)
Historical eras of nursing
Pg 8
window view theory
View you have depends on the lens you apply
what do you need to make a theory
meaningful
relevant
understandable
systematic explanation of an event where concepts are identified, relationships are proposed and predictions are made
creative and rigorous structuring of ideas that project a tentative purposeful and systematic view of a phenomena
set of interpretive assumptions principles or propositions that help explain a guide of action
theory definition
what do conceptual models and frameworks detail
a network of concepts and their relationships
ex: Peplau’s theory of interpersonal relationships
theories accompany the narrative by
providing an outlined description of all the components and the relationships
define concepts, relationships between concepts and assumptions of framework
Peplau’s Framework assumptions
nurse and pt can interact
both mature as apart of process
communication is a fundamental skill
nurses can understand themselves
significance of a theory
distinguish disciplines (nature, outcome and purpose of practice)
nursing theory helps
- distinguish
- assist in knowing pt needs
- provide templates to help nurses
Birth of nursing theory
nursing was largely under medicine
prescribed by others (relied on tradition)
idea behind nursing theory
articulate out ontology
provide moral/ethical structures
foster systematic thinking
nightingale
graduated 1851, served in Crimean war returned to London and made school for nurses first for nursing goals and practice defined nursing process - observe sick in environ - record observations - ways to promote healing nurses should control
in 1870s hospitals led my physicians and admin ( hadn’t changed much)
theory development in nursing
silent knowledge, received, subjective
silent knowledge (1860-1930)
- nurses trained in hospital by doctors
- focus on technical skills
- university believed to be over trained
Received knowledge (1940-1950s)
- listen to others
- shift to university
- nova scotia 1910 nurse licensing
subjective knowledge (1950s-1970s)
- sense of self
- research nurse focused
- iconic writing (Peplau)
Rebuttal of silence knowledge era
seen as radical thought for woman in 1904
1900 - teaching only
1901 - woman 13% of workforce, resign with marriage
1904 - attempt to fire woman from working
Theory development in nursing
procedural, constructed, integrated
procedural knowledge (1970-1980s)
- nursing a scientific discipline
- development of procedures
- develop methodology
- nursing conceptual frameworks
Constructed knowledge (1980-1990)
- nursing identity to foundations
- Evidenced based practice
Integrated knowledge (2000-now)
- knowledge from nursing and other disciplines
- multi-paradigmatic
- knowledge translation
silent knowledge link to philosophy
not a lot of philosophical inquiry
received knowledge
empiricism and positivism
subjective knowledge
ontology (who we are)
procedural knowledge
epistemology (nature of knowledge development)
constructed knowledge
constructivism, phenomenology
integrated knowledge
constructivism, phenomenology, postmodern
scope
level of specificity of concepts
meta-grand-mid-practice
metatheory
theory about theory
focus on generation of discipline knowledge
philosophical debate in academic nurse scholarship
knowledge wars (knowledge to drive discipline and research to support it)
Paradigm shift (to postmodern, feminist/colonial)
Grand theory
most complex and broad in scope
non-specific
abstract concepts (caring, existence)
originate from thought not science
conceptual frameworks (Orem, Roy, Rogers)
Middle range theory
not person specific (described phenomena, relationships between and predicts the effects of phenomena on another)
limited concepts
- concrete (operationalized, empirically testable)
- limited real work use
(Benner, Leininger, Pender)
practice theories
prescriptive in nature least complex narrow scope tangible concepts specific direction for practice
descriptive theory
describe, observe, name concept
researched by case studies (case studies, phenomenology, ethnography, grounded theory)
concept analysis
explanatory
explain how and why concepts relate
correlation studies, extensive lit. reviews
predictive theory
state specific conditions and situations
less common in nursing lit.
(Braden scale)
prescriptive theory
prescription to reach desired goals
nursing intervention vs outcome
complex, not many in nursing
metaparadigm: person, health, environment, nursing
summarize intellectual and social mission of the discipline and place boundaries on the subject matter of discipline
Concepts
words to describe a phenomena
must be operationalized or theorized before using
Concepts
abstract
- hope, love, despair
- independent of space and time
more concrete
- temp, pain, satisfaction
- dependent of time and space, observable in reality
variable
- quality of life, wellness
- classification on continuum
Non-variable
- religion, sex, NOT gender, yes/no
- discrete concepts
enumerative
always present and universal (age, height, weight)
associative concepts
only some conditions in phenomena (suffer, anxiety)
relational concepts
dependent on concepts to explain existence (elderly)
Statistical concepts
related to properties to the greater population
summative concepts
represent entirety of complex phenomena
Concept development
- Purpose (recognize, define, clarify)
- facilitates examination of development stages of concepts
- challenges what concepts mean
- identify gaps
- identify need to refine concepts
- evaluate concepts
- examine congruence of concept and theorization
- determine fit of concept and its application
concept analysis method
rigorous, academic process, follow method
Example Walker and Avant (2004)
-linear process, structures
- best for disciplinary concepts
Example Rodger’s evolutionary model (2000)
- not as structures
- best for new concepts (ecological grief)
Concept delineation (morse)
extensive lit. synthesis (separate linked concepts)
identify commonality/differences (moral agency vs moral repair)
concept comparison (morse)
clarifies competing concepts
identify unique preconditions, process and outcome
(change resistance, change fatigue)
concept clarification (morse)
used for mature concepts taken for granted
ethical practice
Concept exploration (melelis)
new concepts in nursing
may revitalize old concept
concept clarification (meleis)
refine concepts with shared meaning
Conceptual expansion (tsuoka)
expanding concepts beyond current understanding
using alternative philosophical assumptions to examine existing concepts
confirmation bias
tendency to search for information in a way that supports beliefs
4 types of theory
factor isolating (descriptive) factor relating (explanatory) situation relating (predictive) situation predictive (prescriptive)
theory development systemic approach
concept analysis refine concepts explain relationship state proposition test positions
theoretical definition
operational definition
descriptive phenomena
how can phenomena be measured/known to exist
evaluation of theory
complexity/ simplicity scope generalizability conceptual definition clarity consistency contribution utility testability
Middle range theories
limited aspects of real world
relatively concrete concepts (can be empirically tested/operationally defined)
good for addressing specific patient populations
Purpose of MRT
advance research
to describe and predict phenomena (must be socially relevant/ relevant to current nursing concerns)
generalizable to some extent (most sig difference from practice theory)
define/refine nursing science and practice
Characteristics of MRT
must be testable
principles (simple, straightforward and general)
limited number of variables and concepts
focus on patient problems and outcomes and abstract enough to be generalizable
Concepts and relationships MRT
2+ concepts and relationship between concepts must be hypothesized and tested
Development of MRT
research, practice, building on others work
by: lit review, qualitative, quantitative (stat analysis/empirical), conceptual models, nursing diagnosis and interventions, clinical practice guidelines, borrowed theories from other disciplines
Approaches to MRT and production
derived from research or practice (most common)
derived from a grand theory (Orem’s theory)
derived from nursing/non theories
from non nursing disciplines (Kolcaba, Michel, Benner)
From practice guidelines/standards
Orem’s grand theory added concepts
original: self care
self care for chronic illness
self care and homeless youth
- Pender’s health promotion model purpose
explain and predict health promotion behaviors
- Pender’s health promotion model concepts and definitions
person, environment, health, illness, nursing
individual characteristics and experiences
behavior specific cognitions and affect
behavior outcomes
self efficacy is perception of capabilities by:
mastery experience
physiological/affective (stress pain)
vicarious experience (role modeling)
verbal persuasion
- Pender’s theoretical statements (HPM)
existence statements (3concepts) relational statements (personal characteristics/non-modifiable, life benefit/modifiable, barriers)
- Pender structure and links (HPM)
logical arrangement and links
order of appearance of relationships
identify central relationship (with 3 concepts)
identify direction, strength, and quality of relationship (linear, 1-2, strong)
explain why concepts have links
- Assumptions of Pender model (HPM)
prior behavior and characteristic influence concept
persons commit if perceived benefit
barriers can constrain commitment
increased self efficacy influences commitment
positive affect - self efficacy (and vice versa)
affect associated with behavior increases commitment
more likely when sig other models
others are important sources
situational influences can increase/decrease
greater commitment to plan increases
commitment less likely with less control
person can modify their conditions
- Model/framework
note
- Impact on HP strategies
2. what’s happening in grade 8
females lower in exercise, self esteem, health status, experiences and self schema
5/6th grades increased social support for exercise than grade 8
- significant finding in theory application
4. importance of nursing interventions
gender played a role in exercise behavior HPM useful in explaining physical activity and health promotion
+ influences decrease overtime for activity decrease support
- gender significant finding
6. pulling concepts from multiple theories
Woman decrease > men
used transtheoretical theory and HPM
- testing theory in practice
- important finding to nursing
- -
quasi-experimental pre/post
not significance in diet fat and exercise. less decrease in activity with interventions
- coping and asthma
- New insight into theory for pt population
- new prepositions of structural linkages
- -
coping skills affects asthma control
models don’t reflect situational influence, media helpful but doesn’t replace interpersonal
examine nurses role in self efficacy
HPM with Dudley criteria
accurate (to todays reality) consistent (internal consistency) fruitful (build on knowledge) simple and complex (both needed) scope (broad and limited) acceptability sociocultural utility (measured against culture it will be used for)
Middle range theory usefulness
no comprehensive (narrow focus) some generalizability' limited concepts clear stated propositions can be tested and generate hypothesis
more specific than grand but abstract enough to generalize and operationalize across a range of populations
TRAQ
transition readiness assessment questionnaire
barrier focus on individual
doesn’t involve systems
ICU transition to other unit
Meleis Transition theory
began in practice with observations of human experience
began with concept analysis and lit review
Meleis TT Purpose
nurses concerned with experiences of people as they undergo transitions and they relate to health and well being
develop interventions to support patients during transition
Meleis TT origins
education background
early research of role insufficiency of new mothers
theory to practice
Transition theory assumptions
nurse concerned with pt experiences transitions assisted by nurses impacted by facilitators and inhibitors nursing therapeutics important Process indicators, outcome indicators
Transition theory key concepts
transitions (developmental, situational, health/illness, organizational
patterns (single, multiple, sequential, simultaneous, related, unrelated)
properties (awareness, time, engagement)
nursing therapeutics
Modern assessment from Transition theory
STARx questionnaire (readiness and chronic disease)
strong correlation (health lit and self efficacy)
strong correlation with medication adherence and readiness transition to self management
higher on scale higher medication adherence
Transition theory critiques
all woman disempowering
relationships are reciprocal
does not address complexity (pt populations, workforce constraints, organizational constraints, legislative frameworks)
Mishel’s Theory of Uncertainty purpose
explain construct of meaning in illness
nursing interventions for coping
support positive coping
3decades revised in 1990s for chronic uncertainty
Theory of uncertainty
desire to understand stress and hospitalization
started with development of scale
sources (information processing models, psychology, stress and coping model)
Mishels UT assumtptions
uncertainty is apart of illness uncertainty inability to find meaning when no cognitive schema formed for illness people can adapt adapt desired outcome linear relationships
Mishels UT key concepts
stimuli frame (symptoms, familiarity, congruency) cognitive capacity structure providers uncertainty appraisal (inference, illusion) coping (opportunity vs buffering) adaption (biophysical, neutral zone)
Mishels UT critiques
uncertainty is not always negative
is role of others represented
non-modifiable risk factors?
is it linear?
Kolcaba theory of comfort origins
1994 (influence of practice in dementia)
modified in 2001
comfort universal experience (concrete enough to be tested)
from nursing, med, psych lit
Kolcaba theory of comfort purpose
explain comfort holistically
for interventions for comfort
Kolcaba theory of comfort sources
comfort - nightingale
relief - Orlando
ease - Henderson
transcendent - Patterson
Kolcaba theory of comfort concepts
basic human needs
relive, ease, transcendence
holism (physical, psychospiritual, sociocultural, environmental)
Kolcaba theory of comfort assumtions
humans have holistic responses
comfort desirable
humans strive to have needs met
grand theories
widest scope/complexity
explain broad issues
created from ideas
provide philisopical reasoning
Grand theory categories
based on paradigms
needs
interactions
outcomes
caring/becoming
Analyzing grand theories
background and time period philosophical underpinnings (must align with theory)
Roy adaptation model purpose
explain relationships between 4 adaptation systems (physiologic needs, self-concept, role function and interdependence ) and guide nurse to meet needs
Roy adaptation model origens
importance of nature in nursing
religious calling
pediatric
1976
Roy adaptation model sources
johnsons nursing model stress and adaption coping models systems theory sociology
Roy adaptation model assumptions
consciousness and meaning constitute person and environment integration
self/environ awareness rooted in thinking and feeling
human decision based on creative process
thinking/feeling mediate action
ability to integrate person and environ results in adaption
Roy adaptation model key concepts (metaparadigm)
environment
health
person
nursing (goal)
Roy adaptation model key concepts (theory specific)
adaptation stimuli cognitive subsystem regulator subsystem control process
Roy adaptation model critique
alot in nursing curriculum
not parsimonious (easy to understand)
who defines best adaptation
many elements
