Ch 4

Question 1

Nursing Theory

Answer 1

-Nursing theories are organized, knowledge-based concepts that essentially define the scope of nursing practice.
-offer a framework for assessing your patients’ situations.
-help you recognize and analyze cues that emerge from data.
-helps to identify the focus, means, and goals of practice.
-enhance communication and accountability for patient care
-Serves as the foundation of nursing care
-Theories may be tested through critical reasoning, description of personal experiences, and used in practice.

Question 2

Theory

Answer 2

• A theory helps explain an event by defining ideas or concepts, explaining relationships among the concepts, and predicting outcomes
• In the case of nursing, theories are designed to explain a phenomenon such as self-care or caring.

Question 3

Meta theory

Answer 3

• Metatheory examines relationships within a discipline.
• It encompasses philosophical, theoretical, and empirical aspects.
• Offers a broad perspective of the discipline.
• Used to develop theories and theoretical concepts.

Question 4

Phenomenon
Figure 4.2

Answer 4

• describes ideas or responses about an event, situation, or process
  -Phenomena may be temporary or permanent.
  -Examples of phenomena of nursing include caring, self-care, and patient responses to stress.

Question 5

Concepts

Answer 5

• A concept is a thought or idea of reality that is put into words or phrases to help describe or explain a specific phe- nomenon
• Concepts can be abstract such as emotions or concrete such as physical objects
  -For example, in Meleis and colleagues’ theory of transitions, abstract concepts include coping and adapting, while Nightingale described con- crete concepts such as physical conditions and health care environments

Question 6

Definitions

Answer 6

-Definitions may be theoretical/ conceptual or operational. Theoretical or conceptual definitions simply define a concept, much like what can be found in a dictionary, based on the theorist’s perspective
-Operational definitions state how concepts are measured
-For example, a nursing concept conceptually defines pain as physical discomfort and operationally as a patient reporting a score of 3 or above on a pain scale of 0 to 10.

Question 7

Assumptions

Answer 7

-Assumptions are accepted as truths and are based on values and beliefs
- For example, Watson’s transpersonal caring theory has the assumption that a conscious intention to care promotes healing and wholeness

Question 8

Domain

Answer 8

-The domain is the perspective or territory of a profession or discipline
-It provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline.
-The domain of nursing provides both a practical and a theoretical aspect of the discipline.
-It is the knowledge of nursing practice and nursing history, nursing theory, education, and research.

Question 9

Paradigm
Conceptual framework

Answer 9

• Paradigm: Belief pattern describing a discipline, connecting concepts, theories, beliefs, values, and assumptions.
• Conceptual Framework: Organizes major concepts, visualizes relationships among phenomena; akin to a paradigm.
• Grand theorists address similar concepts but define them uniquely based on their ideas and experiences.

Question 10

Nursing metaparadigm

Answer 10

-The nursing metaparadigm allows nurses to understand and ex- plain what nursing is, what nursing does, and why nurses do what they do
-includes the four concepts of person (or human beings), health, environment/ situation, and nursing

Question 11

Person

Answer 11

• Person is the recipient of nursing care and in- cludes individual patients, groups, families, and communities.
  -The person is central to the nursing care you provide. Because each person’s needs are often complex, it is important to provide individualized patient-centered care

Question 12

Health

Answer 12

-Health has different meanings for each patient, the clinical setting, and the health care profession
-It is a state of being that people define in relation to their own values, personality, and lifestyle.
- Your challenge as a nurse is to provide the best possible care based on a patient’s level of health and health care needs at the time of care delivery.

Question 13

Environment/situation

Answer 13

-includes all possible conditions affecting patients and the settings where they go for their health care.

Question 14

Nursing

Answer 14

-“care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people”
-The scope of nursing is broad. For example, a nurse does not medically diagnose a patient’s health condition as heart failure. However, a nurse assesses a patient’s response to the decrease in activity tolerance because of the disease and develops nursing diagnoses of fatigue, activity intolerance, and difficulty coping

Question 15

Goals of Theoretical Nursing Models

Answer 15

1. Define nursing’s domain and goals, enhancing administration, practice, education, and research.
2. Direct research to advance nursing knowledge.
3. Validate nursing interventions with research techniques and tools.
4. Design nursing education curriculum plans.
5. Set quality criteria for nursing care, education, and research.
6. Create a nursing care delivery system with structure and rationale.

Question 16

Grand theories

Answer 16

-Grand theories are abstract, broad in scope, and complex; there- fore, they require further clarification through research so that they can be applied to nursing practice.
-A grand theory does not provide guidance for specific nursing interventions. Instead, it provides the structural framework for general, global ideas about nursing. Grand theories intend to answer the question “What is nursing?” and focus on the whole of nursing rather than on a specific type of nursing.

Question 17

Middle-range theories

Answer 17

-Middle-range theories are more limited in scope and less abstract. They address a specific phenomenon and reflect practice (administration, clinical, or teaching).
-While grand theories take a wide-angled lens perspective to nursing, middle-range theories ex- pand on specific concepts or phenomena in a specific field of nursing such as uncertainty, incontinence, social support, quality of life, and caring
-For example, Kolcaba’s theory of comfort encourages nurses to meet patients’ needs for comfort in physical, psychospiritual, environmen-tal, and sociocultural realms

Question 18

Practice theories

Answer 18

-Practice theories, also known as situation-specific theories, bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time

-An example of a practice theory is a pain-management protocol for patients recovering from cardiac surgery. Practice theories are less abstract and are often easier to understand and apply than the grand and middle-range theories

Question 19

Fig. 4.3 demonstrates the level of abstraction for each of the grand, middle-range, and practice theory categories.

Question 20

Descriptive theories

Answer 20

• describe phenomena m
  -explain patient assessments.

Question 21

Prescriptive theories

Answer 21

-Prescriptive theories address nursing interventions for a phenomenon, guide practice change, and predict the consequences.
-Nurses use prescriptive theories to anticipate the outcomes of nursing interventions
-Prescriptive theories direct nursing actions toward an explicit goal.
-Wiedenbach’s prescriptive theory of the helping art of nursing conveys the purpose of nursing through three components: to motivate a patient, to facilitate efforts to overcome obstacles, and to develop nursing action based on the immediate situation

Question 22

EBP

Answer 22

Evidence-based practice

Question 23

Shared theory

Answer 23

-Shared theory, also known as a borrowed or interdisciplinary theory, explains a phenomenon specific to the discipline that developed the theory

-For example, Piaget’s theory of cognitive
development helps to explain how children think, reason, and perceive the world (see Chapter 11). Knowledge and use of this theory help pediatric nurses design appropriate therapeutic play interventions for toddlers or school-age children who are experiencing chronic illness. Knowles’ adult learning theory helps a nurse plan and provide appropriate dis- charge teaching for a patient who is recovering from surgery.

Question 24

Input

Answer 24

Input for the nursing process is the data or infor- mation that comes from a patient’s assessment.

Question 25

Output

Answer 25

Output is the end product of a system; in the case of the nursing process, it is whether the patient’s health status improves, declines, or remains stable as a result of nursing care.

Question 26

Feedback

Answer 26

Feedback serves to inform a system about how it functions.
-For example, in the nursing process the outcomes reflect the patient’s responses to nursing interventions.
-The outcomes are part of the feedback system to refine the plan of care.
-Other forms of feedback in the nursing process include responses from family members and consultation from other health care providers.

Question 27

Content

Answer 27

-The content is the product and information obtained from the system.
-For example, patients with impaired bed mobility have common skin care needs and interventions (e.g., hygiene and scheduled positioning changes) that are successful in reducing the risk for pres- sure injuries.

Question 28

Fig 4.4 Nursing process system

Question 29

The following phases characterize the nurse- patient interpersonal relationship:

Answer 29

-preorientation (data gathering), orientation (defining issue), working phase (therapeutic activity), and resolution (termination of relationship).
- In developing a nurse-patient relationship, the nurse serves as a resource person, counselor, and surrogate.
- For example, when a patient seeks help, the nurse and patient first discuss the nature of any problems, and the nurse explains the services available.

Question 30

[overview of selected shared theories]
Human needs

Answer 30

Focus: Need motivates human behavior. Maslow’s hierarchy of basic human needs includes five levels of priority (e.g., physiological, safety and security, love and belonging, self-esteem, and self-actualization)
Application to nursing: Basic physiological and safety needs are usually a patient’s first priority, especially when the patient is dependent on others to meet these needs. When a patient has no emergent physical or safety needs, the nurse gives high priority to psychological, sociocultural, developmental, or spiritual needs. Patients entering the health care system generally have unmet needs. A patient in pain after surgery (basic need) is not ready for discharge teaching (higher-level need) until the pain is relieved. The hierarchy of needs is a way to plan for individualized patient care

Question 31

[overview of selected shared theories]
Stress/adaptation

Answer 31

Focus: Humans respond to actual or perceived threats by adapting to maintain function and life.
Application to nursing: Patients demonstrate a similar pattern of reacting to stress through physiological and psychological responses. Failure to adapt to stress can lead to exhaustion and decline in health. Nurses need to understand the reaction of body and mind to stress and intervene to help patients develop methods of coping/adapting to prevent or manage illness and disease

Question 32

[overview of selected shared theories]
Developmental

Answer 32

Focus: Humans have a common pattern of growth and development.
Application to nursing: Human growth and development are orderly, predictive processes that begin with conception and continue through death. Varieties of well-tested theories describe and predict behavior and development at various phases of the life continuum

Question 33

[overview of selected shared theories]
Biomedical

Answer 33

Focus: Theory explains cause of disease; principles related to physiology.
Application to nursing: Nurses must have knowledge of theories from the fields of biology, medicine, public health, physiology, and pharmacology to provide holistic patient care, promote health, and prevent illness

Question 34

[overview of selected shared theories]
Psychosocial

Answer 34

Focus: Theory explains and/or predicts human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains.
Application to nursing: Nursing is a diverse discipline that strives to meet holistic needs of patients. Chapter 9 discusses models for understanding cultural diversity and implementing care to meet the diverse needs of the patient. Chapter 10 describes family theory and how to meet the needs of the family when the family is the patient or the caregiver. Chapter 36 discusses several models of grieving and demonstrates how to help patients through loss, death, and grief.

Question 35

[overview of selected shared theories]
Educational

Answer 35

Focus: Theory explains the teaching-learning process by examining behavioral, cognitive, and adult
learning principles.
Application to nursing: Nurses provide education to patients, families, community groups, and members of the health care team. A basic understanding of various teaching-learning theories is critical for this aspect of the professional nursing role.

Question 36

[overview of selected shared theories]
Leadership/management

Answer 36

Focus: Theory promotes organization, change, power/ empowerment, motivation, conflict management, and decision making.
Application to nursing: Nurses often assume leadership positions in the health care realm and as such are expected to effectively manage individuals and groups to promote change and improve quality care and outcomes .

Question 37

QSEN: Building Competency in Patient-Centered Care:
You are caring for a high school student who was in a motor vehicle accident on the way to spring break. The parents are not present. The patient has not previously been hospitalized and has never been away from home this long. How could you use Peplau’s interpersonal theory when caring for this patient?

Question 38

Peplau’s Interpersonal Theory

Answer 38

Hildegard Peplau is considered the mother of psychiatric nursing; the focus of her middle-range theory includes interpersonal relations among a nurse, a patient, and a patient’s family and developing the nurse- patient relationship
- According to Peplau, nurses help patients reduce anxiety by converting it into constructive actions
- Nurses develop therapeutic relationships with patients that are respectful, empathetic, and nonjudgmental

Question 39

Nightingale’s Environmental Theory

Answer 39

Through observation and data col- lection, she linked the patient’s health status with environmental fac- tors and initiated improved hygiene and sanitary conditions during the Crimean War. Nightingale taught and used the nursing process, noting that “vital observation [assessment] . . . is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort”

Question 40

Orem’s Self-Care Deficit Nursing Theory

Answer 40

When applying this grand theory, a nurse continually assesses a patient’s ability to perform self-care and intervenes as needed to ensure that patients meet physical, psycho- logical, sociological, and developmental needs. According to Orem, people who participate in self-care activities are more likely to improve their health outcomes

Question 41

Leininger’s Culture Care Theory

Answer 41

-As early as the 1950s Madeleine Leininger recognized the need to focus on culture in nursing as she predicted that nursing and health care would become more global. She blended her background in anthro- pology with nursing to form her middle-range theory of cultural care diversity and universality
-The major concept of Leininger’s theory is cultural diversity, and the goal of nursing care is to provide a patient with culturally specific nursing care

Question 42

Table 4.2
Overview of Select Grand and Middle-Range Nursing Theories

Question 43

Summary

Answer 43

• Nurses use theory to describe, explain, predict, or prescribe nursing care.
• The components of a theory provide a foundation for knowledge for nurses to direct and deliver nursing care.
• The nursing metaparadigm includes the four concepts of person, health, environment/situation, and nursing, which allows nurses to understand what nursing is, what nursing does, and why nurses do what they do.
• Theories are dynamic and responsive to the changing environment in which we live.
• The types of nursing theories include grand theories, middle-range theories, practice theories, and descriptive and prescriptive theories.
• The integration of theory into practice leads to coordinated care
delivery.
• Nurses need a strong scientific knowledge base from nursing and
other disciplines, such as the biomedical, sociological, and behav-
ioral sciences.
• Grand and middle-range nursing theories can help you understand
the practice of nursing.
• The National Council of State Boards of Nursing Clinical
Judgment Model (NCSBN-CJM) builds upon other nursing theories and can be used to guide your critical thinking, clinical judgment and decision making while planning and providing patient care.
• The relationship between theory and research builds the scientific knowledge base of nursing, which is then applied to practice.

Question 44

Reflective learning

Answer 44

• Reflect on a patient you recently were assigned to care for during a clinical or simulation experience. Describe how you did or could have applied Nightingale’s environmental theory while you were caring for this patient.
• Reflect on a patient with a chronic health condition you were recently assigned to care for during a clinical or simulation experi- ence. Explain how you would apply the National Council of State Boards of Nursing Clinical Judgment Model (NCSBN-CJM) to plan patient care, help this patient prevent complications, and promote disease management.
• Reflect on a patient you were assigned to care for in a recent clinical or simulation experience who required total patient care. Describe how you would apply Orem’s self-care deficit theory for this patient.

Question 45

TABLE 4.3 Theories Used in Nursing Practice and Research

Question 46

PICOT Question: In patients experiencing their first pregnancy, how does application of Meleis’ theory of transitions compared to no specific theory application influence a healthy transition to parenthood?

Answer 46

Evidence Summary
The transition to parenthood is a life-changing and often challenging time. Successful transitioning to the role of a parent can be accomplished by gaining confidence, planning for the birth, and developing a strong support system
-According to Meleis et al.’s theory of transitions, a transition is required when one’s reality is interrupted, causing the need for a change and a new reality to be formed
-Transitions theory can be applied to various types of transitions: developmental, health-illness, situational, and organizational.
-Nurses can assist expectant parents by providing professional support during the prenatal period. -Expectant parents will require information regarding birth plans, feeding routines, maternal and child appointments, and routine testing before birth
-It is important for parents to be engaged in all decisions and for the nurse to understand and meet the parents’ psychosocial needs, especially if they are experiencing a miscarriage or if their child is born with a serious health condition such as congenital heart disease
-Nursing actions based on Meleis et al.’s theory can assist patients in managing life’s transitions
-Application to Nursing Practice
•Ensure that expectant parents are knowledgeable about health care access in the prenatal period.
• Help patients identify support groups in the community, allowing expectant parents to share knowledge and emotions with others
• Provide new-parent education that covers expectations, coping behaviors, and changes in relationships to facilitate successful transitions.
• Recognize that a first-time parent’s level of self-confidence may change during the pregnancy.

Question 47

1. The components of the nursing metaparadigm include:
2. Person, health, environment, and theory.
3. Health,theory, concepts,and environment.
4. Nurses, physicians, health, and patient needs.
5. Person, health, environment, and nursing.

Answer 47

4

Question 48

Theory is essential to nursing practice because it: (Select all that
apply.)
1. Contributes to nursing knowledge.
2. Predicts patient behaviors in situations
3.Provides a means of assessing patients vital signs
4. Guides nursing practice.
5. Formulates healthcare legislation.
6. Explains relationships between concepts.

Answer 48

1,2,4,6

Question 49

3. A nurse ensures that each patient’s room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist’s work is the nurse practicing in this example?
4. Henderson
5. Orem
6. King
7. Nightingale

Answer 49

4

Question 50

4. A nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient can begin performing these activities. The nurse in this situation is applying the theory developed by:
5. Johnson.
6. Orem.
7. Roy.
8. Peplau.

Answer 50

2.

Question 51

Match the following types of theory with the appropriate descriptions
1. Middle–range theory
2. Shared theory
3. Grand theory
4. Practice theory
a. Very abstract; attempt to describe nursing in a global context
b. Specific to a particular situation; brings theory to the bedside
c. Applies theory from other disciplines to nursing practice
d. Addresses a specific phenomenon and reflects practice

Answer 51

1d, 2c, 3a, 4b

Question 52

Match the following descriptions with appropriate grand theorist
1. King
2. Henderson
3. Oleum
4. Neuman
a. Based on the theory that focuses on wellness and prevention of disease
b. Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes
c. Based on 14 activities, the belief that the nurse should assist patient with meeting needs until they are able to do so independently
d. Based on the belief that nurses should work with patients to develop goals for care

Answer 52

1d ,2c, 3b, 4a

Question 53

Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.)
1. Nursing theory differentiates nursing from other disciplines.
2. Nursing theories are standardized and do not change over time.
3. Integrating theory into practice promotes coordinated care delivery.
4. Nursing knowledge is generated by theory.
5. The theory of nursing process is used in planning patient care.
6. Evidence-based practice results from theory-testing research.

Answer 53

1, 3, 4, 6

Question 54

8. A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories?
9. Roy
10. Watson
11. Johnson
12. Benner

Answer 54

1

Question 55

Using Maslow’s hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing.
1. Self-actualization
2. Air, water, and nutrition.
3. Safety
4. Esteem and self-esteem needs

Answer 55

2

Question 56

10. A nurse is analyzing data generated during a patient assessment to determine the best plan of care. Which layer of the NCSBN-CJM best describes the cognitive process used by the nurse at this time?
11. Layer 0
12. Layer 1
13. Layer 2
14. Layer 3
15. Layer 4

Answer 56

4

Question 57

Figure 4.5 layers of the NCSBN-CJM