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3103 Flashcards

1
Q

What is a theory

A

Aquired through philosophy + science

(Both informs truth)

Esse tual to examine knowledge and truth before theories

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2
Q

Is nursing a occupation or profession

A

Profession

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3
Q

What is an occupation

A

Job/career

Means of income

Values generally bot in training

Guided decision making

Employer holds accountability

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4
Q

What is a profession

A

Specialized knowledge base

Decisions guided by evidence/theoretical constructs

Formal training (school)

Ensures competency

Service to society

Ethics

Autonomy over practice

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5
Q

Nursing is both..

A

A profession and discipline

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6
Q

A profession must have

Determines who we are

A

A group of scholars that continually advance knowledge

  • establish requirements
  • promote practice standards
  • quality assurance
  • enforce standards and conduct
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7
Q

What is a discipline? What does it determine?

Describes out body of knowledge

A

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
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8
Q

What phenomena defines nursing

Donaldson and Crowley

A
  1. Concern with principles and laws that govern life processes
  2. Concern with human behavior in interaction with environment in critical situations
  3. Concern with processes by which health is effected
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9
Q

A professional discipline needs

A

A focus statement

(Area of study + social relevance)

Caring for person, environment, health, nursing
+
Commitment to caring as moral imperative

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10
Q

What is philosophy

A

Abstract concept

Difficult to understand without context

A lens to look at world to derive meaning

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11
Q

Science

Ex. Sir Issac Newton

A

Concerned with causality (cause and effect)

Approach understanding reality (observation, verification, experience)

Hypothesis testing/experiment

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12
Q

Philosophy is concerned with?

Ex. Karl Marx (socialism, communism)

A

Purpose of life

Nature of reality

Nature of knowledge

Understanding by
- intuition, introspection, reasoning

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13
Q

Science process and product

A

Process

  • research
  • observe
  • advance knowledge

Product

  • knowledge
  • explain phenomena and knowledge
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14
Q

Science branches

A

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)

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14
Q

Science branches

A

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)

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15
Q

Science branches

A

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)

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16
Q

Philosophy aim

A

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

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17
Q

Philosophy is concerned with

A

Nature of existence (metaphysics)

Nature of being (ontology)

Nature of knowledge (epistemology)

Morality (ethics)
Reasoning (logic)
Philosophy of science
Human purpose

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18
Q

Ontology

A

What is/ what exsists

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19
Q

Epistemology

A

Nature of knowledge

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20
Q

Philosophy is divided into which 2 groups

A

Rationalist (received view)

  • empiricism
  • positivism
  • post-positiveism)

Relativism (precived view)

  • phenomenology
  • constructivist
  • post-modern (feminist, post colonialism)
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21
Q

Received view

A

Universal truths exist and can be proven

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22
Q

Empiricism

A

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

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23
Q

Positivism (close to empiricism)

A

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

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24
Q

Postpositivism

A

1960s scrutinized (too idealistic)

Research is value laden (research based on interest and values)

Focus on rigor, objective inquiry (recognizes contextual variables)

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25
Q

Perceived view

A

Knowledge from descriptions

No single truth

Belief in interpretation

(Ex. Study of human science)

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26
Q

Phenomenology

A

Seek to understand meaning of human experience

Seek to understand essence/experience and meaning

Core of experience similarities (ESSENCE)

(Ex. Human suffering, mental health)

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27
Q

Constructivist

A

Knowledge is subjective

Multiple interpretations of reality

Goal to understand how reality is constructed

Multiple truths

(Understanding pt. Unique reality)

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28
Q

Postmodernism

A

Dominate in nursing

Rejects single truth

Knowledge uncertain, contextual and relative

Post colonialism and feminist

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29
Q

Nursing philosophy

A

Multi paradigms

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30
Q

Nursing science vs nursing philosophy

A

Science

  • inform nursing practice
  • understanding

Philosophy

  • establish meaning of science in nursing
  • concepts, theories, laws
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31
Q

Nursing epistemology

A

Nurse knowledge of

  • structure
  • methods, pattern
  • criteria for knowledge claims

Relied on multiple disciplines

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32
Q

Ways of knowing

(Schultz, Meleis)

1988

A

Clinical
Conceptual
Empirical

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33
Q

Clinical knowledge

Ways of knowing

(Schultz, Meleis)

A

Unblocking no tubes with fizzy drink
Warm water to take blood
Medical play

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34
Q

Conceptual knowledge

Ways of knowing

(Schultz, Meleis)

A

Beyond personal experience

Patterns from multiple situations

Concepts drafted and related to eachother

Relies on experience, curiosity, persistent

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35
Q

Impirical

Ways of knowing

(Schultz, Meleis)

A

Research

Justify actions

Credited by Judge

(Studies, systematic review, publishings)

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36
Q

Fundamental ways of knowing

Carpers 1978

A

Epirics, esthetic, personal, ethics

Shape nursing knowledge

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37
Q

Carper 1978

Empirics

A

Person, health, environment, nursing

Factual, objective, descriptive, classification

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38
Q

Carper 1978

Esthetics

A

Creative process of discovery

Direct feeling from experience

Relies on perception

EMPATHY

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39
Q

Carper 1978

Personal knowledge

A

Shapes values

Helps chose specialty that alignes with values

Most problematic

Hard to teach

Authentic relationship with pt

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40
Q

Carper 1978

Ethics

A

Questions what is abd isn’t important

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41
Q

Carper 1978 addition

Emancipatory knowledge (2011)

A

Uncovering injustice

Explore how some are less privileged

Propose ways to decrease oppression

Social Justice

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42
Q

Nursing was originally (1900s) modeled after?

Then in 1980s

A

Empiricism

Methodological battle spurring philosophical debate about nature of profession
(Beginning of importance of qualitative study)

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44
Q

Historical eras of nursing

A

Pg 8

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45
Q

window view theory

A

View you have depends on the lens you apply

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46
Q

what do you need to make a theory

A

meaningful
relevant
understandable

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47
Q

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

A

theory definition

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48
Q

what do conceptual models and frameworks detail

A

a network of concepts and their relationships

ex: Peplau’s theory of interpersonal relationships

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49
Q

theories accompany the narrative by

A

providing an outlined description of all the components and the relationships

define concepts, relationships between concepts and assumptions of framework

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50
Q

Peplau’s Framework assumptions

A

nurse and pt can interact
both mature as apart of process
communication is a fundamental skill
nurses can understand themselves

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51
Q

significance of a theory

A

distinguish disciplines (nature, outcome and purpose of practice)

nursing theory helps

  • distinguish
  • assist in knowing pt needs
  • provide templates to help nurses
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52
Q

Birth of nursing theory

A

nursing was largely under medicine

prescribed by others (relied on tradition)

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53
Q

idea behind nursing theory

A

articulate out ontology

provide moral/ethical structures

foster systematic thinking

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54
Q

nightingale

A 
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)

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55
Q

theory development in nursing

silent knowledge, received, subjective

A

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)
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56
Q

Rebuttal of silence knowledge era

seen as radical thought for woman in 1904

A

1900 - teaching only
1901 - woman 13% of workforce, resign with marriage
1904 - attempt to fire woman from working

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57
Q

Theory development in nursing

procedural, constructed, integrated

A

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
58
Q

silent knowledge link to philosophy

A

not a lot of philosophical inquiry

59
Q

received knowledge

A

empiricism and positivism

60
Q

subjective knowledge

A

ontology (who we are)

61
Q

procedural knowledge

A

epistemology (nature of knowledge development)

62
Q

constructed knowledge

A

constructivism, phenomenology

63
Q

integrated knowledge

A

constructivism, phenomenology, postmodern

64
Q

scope

A

level of specificity of concepts

meta-grand-mid-practice

65
Q

metatheory

A

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)

66
Q

Grand theory

A

most complex and broad in scope
non-specific
abstract concepts (caring, existence)
originate from thought not science

conceptual frameworks (Orem, Roy, Rogers)

67
Q

Middle range theory

A

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)

68
Q

practice theories

A 
prescriptive in nature 
least complex
narrow scope
tangible concepts 
specific direction for practice
69
Q

descriptive theory

A

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

70
Q

predictive theory

A

state specific conditions and situations
less common in nursing lit.
(Braden scale)

71
Q

prescriptive theory

A

prescription to reach desired goals
nursing intervention vs outcome
complex, not many in nursing

72
Q

metaparadigm: person, health, environment, nursing

A

summarize intellectual and social mission of the discipline and place boundaries on the subject matter of discipline

73
Q

Concepts

A

words to describe a phenomena

must be operationalized or theorized before using

74
Q

Concepts

A

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
75
Q

enumerative

A

always present and universal (age, height, weight)

76
Q

associative concepts

A

only some conditions in phenomena (suffer, anxiety)

77
Q

relational concepts

A

dependent on concepts to explain existence (elderly)

78
Q

Statistical concepts

A

related to properties to the greater population

79
Q

summative concepts

A

represent entirety of complex phenomena

80
Q

Concept development

A
  • 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
81
Q

concept analysis method

A

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)

82
Q

Concept delineation (morse)

A

extensive lit. synthesis (separate linked concepts)

identify commonality/differences (moral agency vs moral repair)

83
Q

concept comparison (morse)

A

clarifies competing concepts
identify unique preconditions, process and outcome
(change resistance, change fatigue)

84
Q

concept clarification (morse)

A

used for mature concepts taken for granted

ethical practice

85
Q

Concept exploration (melelis)

A

new concepts in nursing

may revitalize old concept

86
Q

concept clarification (meleis)

A

refine concepts with shared meaning

87
Q

Conceptual expansion (tsuoka)

A

expanding concepts beyond current understanding

using alternative philosophical assumptions to examine existing concepts

88
Q

confirmation bias

A

tendency to search for information in a way that supports beliefs

89
Q

4 types of theory

A 
factor isolating (descriptive)
factor relating (explanatory)
situation relating (predictive)
situation predictive  (prescriptive)
90
Q

theory development systemic approach

A 
concept analysis
refine concepts
explain relationship
state proposition
test positions
91
Q

theoretical definition

operational definition

A

descriptive phenomena

how can phenomena be measured/known to exist

92
Q

evaluation of theory

A 
complexity/ simplicity
scope generalizability
conceptual definition clarity
consistency
contribution
utility
testability
93
Q

Middle range theories

A

limited aspects of real world

relatively concrete concepts (can be empirically tested/operationally defined)

good for addressing specific patient populations

94
Q

Purpose of MRT

A

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

95
Q

Characteristics of MRT

A

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

96
Q

Concepts and relationships MRT

A

2+ concepts and relationship between concepts must be hypothesized and tested

97
Q

Development of MRT

A

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

98
Q

Approaches to MRT and production

A

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

99
Q

Orem’s grand theory added concepts

original: self care

A

self care for chronic illness

self care and homeless youth

100
Q
  1. Pender’s health promotion model purpose
A

explain and predict health promotion behaviors

101
Q
  1. Pender’s health promotion model concepts and definitions
A

person, environment, health, illness, nursing

individual characteristics and experiences
behavior specific cognitions and affect
behavior outcomes

102
Q

self efficacy is perception of capabilities by:

A

mastery experience
physiological/affective (stress pain)
vicarious experience (role modeling)
verbal persuasion

103
Q
  1. Pender’s theoretical statements (HPM)
A 
existence statements (3concepts)
relational statements (personal characteristics/non-modifiable, life benefit/modifiable, barriers)
104
Q
  1. Pender structure and links (HPM)
A

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

105
Q
  1. Assumptions of Pender model (HPM)
A

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

106
Q
  1. Model/framework
A

note

107
Q
  1. Impact on HP strategies

2. what’s happening in grade 8

A

females lower in exercise, self esteem, health status, experiences and self schema

5/6th grades increased social support for exercise than grade 8

108
Q
  1. significant finding in theory application

4. importance of nursing interventions

A

gender played a role in exercise behavior HPM useful in explaining physical activity and health promotion

+ influences decrease overtime for activity decrease support

109
Q
  1. gender significant finding

6. pulling concepts from multiple theories

A

Woman decrease > men

used transtheoretical theory and HPM

110
Q
  1. testing theory in practice
  2. important finding to nursing
  3. -
A

quasi-experimental pre/post

not significance in diet fat and exercise. less decrease in activity with interventions

111
Q
  1. coping and asthma
  2. New insight into theory for pt population
  3. new prepositions of structural linkages
  4. -
A

coping skills affects asthma control

models don’t reflect situational influence, media helpful but doesn’t replace interpersonal

examine nurses role in self efficacy

112
Q

HPM with Dudley criteria

A 
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)
113
Q

Middle range theory usefulness

no comprehensive (narrow focus)
some generalizability'
limited concepts
clear stated propositions
can be tested and generate hypothesis
A

more specific than grand but abstract enough to generalize and operationalize across a range of populations

114
Q

TRAQ

A

transition readiness assessment questionnaire
barrier focus on individual
doesn’t involve systems
ICU transition to other unit

115
Q

Meleis Transition theory

A

began in practice with observations of human experience

began with concept analysis and lit review

116
Q

Meleis TT Purpose

A

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

117
Q

Meleis TT origins

A

education background
early research of role insufficiency of new mothers
theory to practice

118
Q

Transition theory assumptions

A 
nurse concerned with pt experiences
transitions assisted by nurses
impacted by facilitators and inhibitors
nursing therapeutics important 
Process indicators, outcome indicators
119
Q

Transition theory key concepts

A

transitions (developmental, situational, health/illness, organizational

patterns (single, multiple, sequential, simultaneous, related, unrelated)

properties (awareness, time, engagement)

nursing therapeutics

120
Q

Modern assessment from Transition theory

A

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

121
Q

Transition theory critiques

A

all woman disempowering

relationships are reciprocal

does not address complexity (pt populations, workforce constraints, organizational constraints, legislative frameworks)

122
Q

Mishel’s Theory of Uncertainty purpose

A

explain construct of meaning in illness
nursing interventions for coping
support positive coping
3decades revised in 1990s for chronic uncertainty

123
Q

Theory of uncertainty

A

desire to understand stress and hospitalization
started with development of scale

sources (information processing models, psychology, stress and coping model)

124
Q

Mishels UT assumtptions

A 
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
125
Q

Mishels UT key concepts

A 
stimuli frame (symptoms, familiarity, congruency)
cognitive capacity
structure providers
uncertainty
appraisal (inference, illusion)
coping (opportunity vs buffering)
adaption (biophysical, neutral zone)
126
Q

Mishels UT critiques

A

uncertainty is not always negative
is role of others represented
non-modifiable risk factors?
is it linear?

127
Q

Kolcaba theory of comfort origins

A

1994 (influence of practice in dementia)
modified in 2001
comfort universal experience (concrete enough to be tested)
from nursing, med, psych lit

128
Q

Kolcaba theory of comfort purpose

A

explain comfort holistically

for interventions for comfort

129
Q

Kolcaba theory of comfort sources

A

comfort - nightingale
relief - Orlando
ease - Henderson
transcendent - Patterson

130
Q

Kolcaba theory of comfort concepts

A

basic human needs
relive, ease, transcendence
holism (physical, psychospiritual, sociocultural, environmental)

131
Q

Kolcaba theory of comfort assumtions

A

humans have holistic responses
comfort desirable
humans strive to have needs met

132
Q

grand theories

A

widest scope/complexity
explain broad issues
created from ideas
provide philisopical reasoning

133
Q

Grand theory categories

based on paradigms

A

needs
interactions
outcomes
caring/becoming

134
Q

Analyzing grand theories

A 
background and time period 
philosophical underpinnings (must align with theory)
135
Q

Roy adaptation model purpose

A

explain relationships between 4 adaptation systems (physiologic needs, self-concept, role function and interdependence ) and guide nurse to meet needs

136
Q

Roy adaptation model origens

A

importance of nature in nursing
religious calling
pediatric
1976

137
Q

Roy adaptation model sources

A 
johnsons nursing model
stress and adaption
coping models
systems theory
sociology
138
Q

Roy adaptation model assumptions

A

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

139
Q

Roy adaptation model key concepts (metaparadigm)

A

environment
health
person
nursing (goal)

140
Q

Roy adaptation model key concepts (theory specific)

A 
adaptation
stimuli
cognitive subsystem
regulator subsystem
control process
141
Q

Roy adaptation model critique

A

alot in nursing curriculum
not parsimonious (easy to understand)
who defines best adaptation
many elements

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