Nursing Theories Flashcards
Purpose of Theory
Theory informs nursing practice by:
- Furnishing a distinct body of nursing knowledge governing the scope of practice.
- Providing professional values to guide nurses in the decision-making process.
- Portraying the role of nurses in a multidisciplinary health care environment.
How does theory influence practice
- Theory and research are generated from the practical world
- These questions lead to scientific testing and theory building - e.g. infant bonding studies in obstetrics or the mother-child separation in pediatrics or theories about the grieving process and death and dying as seen in palliative care.
Nursing Theory Development
Notes on Nursing
- Considered the founder of modern nursing.
- First nursing theorist - “Notes on Nursing: What it is and what it is not”.
- She described nursing as “the care that puts the patient in the best condition for nature to act”.
- She defined health as “not only to be well, but to use well every power that we have”.
Nursing Leaders
- 1950’s - nursing leaders found themselves coping unsuccessfully with confusion and ambiguity about the role of nurses particularity those with high degrees.
- Leaders - Henderson, Rogers, King, Roy, Orem, Neuman, Allen, Parse, Watson, Leininger
Nursing Education
- Nursing education is part of the career ladder that is used to enhance practice.
- Nursing theory practice and development continues to be relevant at all levels of education.
Broadest Level of Nursing Knowledge
- Nursing’s Metaparadigm
- Hierarchy of Nursing Knowledge
- Concept of person
- Concept of environment
- Concept of health
- Concept of nursing
Nursing and Patterns of Knowing
- Empirical: grounded in the scientific principles that a nurse incorporates in all phases of the nursing process.
- Personal: incorporates the lived experience that each nurse brings to the situation. The nurse is able to intuitively understand and tailor nursing responses to each person as unique.
- Aesthetic: incorporates creative application in the relationship through the use of literature, poetry, art and music so as to connect to the client.
- Ethical: encompass knowledge of what is right and wrong. Involves standards and codes in making moral choices and taking responsibility for one’s actions as well as professional values in providing health care.
Second level of Nursing Knowledge
- Concepts are broad, comprehensive ideas that serve as the building blocks of conceptual models.
- To retain ones identity, developing our own concepts separates us from medicine, physiotherapy, and/or social work.
- Examples of nursing concepts are adaptation, health, anxiety, nurse-client interaction, social support, etc.
- Assumptions are belief statements that form the basis for development of a concept model.
Third level of Nursing Knowledge that nurses bring to practice
- Nursing theories can be tested empirically. Regular reading of professional journals provide nurses with explanations of nursing theory in nursing practice, its use, and related clinical research.
- Most nurses take elements from different theories to develop a relevant theory of nursing to guide their clinical practice.
Major Theoretical Models of Nursing
Needs theory - arose from Maslow’s hierarchy of needs whereas the idea that human behavior can be explained by the competing demands of various basic human needs features prominently in many nursing models.
Interactionist theory - requires that the nurse attend to the interpersonal processes that occur between the nurse and client. Processes include the nurse-client relationship, communication, pattern integration & the role of the nurse. Stresses the importance of nurses’ ability to understand their own behavior to help others identify perceived difficulties.
Simultaneity theory sets itself apart from all other theories and is spear headed by Rogers.
- The individual as an energy field in constant interaction with the environment, which itself is also an irreducible energy field, coextensive with the universe.
- The object of nursing is to help the client reach maximum health potential in the context of change and development from a lower to a higher level of diversity.
Roger, Parse
Systems theory - accounts for the whole of an entity (the system) and its components (subsystems) as well as the interactions between the parts and the whole.
- Being outside the system the nurse could be one of the forces that impacts on the system and its components of the system. To intervene on one part of the system would produce reactions and consequences in other parts of the system and in the system as a whole.
- It views the individual as an open system in constant interaction with the environment.
The McGill Model of Nursing
Global assumptions of the Model:
- The health of the nation is it’s most valuable resource.
- Clients are motivated towards better health and have the potential to do it.
- Health is achieved through active involvement and personal discovery.
User of the Model
- Broad yet specific knowledge base in science and humanities.
- The nurse needs skills of analysis & synthesis.
- Nursing complements the work of other professionals, not replacing it.
The salient features of the model:
- Health - focus on overall health rather than illness and treatment.
- Family - all family members rather than the patient alone, on family goals rather than on the nurse’s, and on family strengths rather than deficits.
- Collaboration - nursing takes place within a collaborative relationship wherein both the nurse and family jointly assume responsibility.
- Learning - the nurse’s role is to structure learning experiences that empower families and enable them to define their issue of concern and arrive at approaches to meet their goals.
Coping and Development
- Coping refers to the efforts made to deal with some problematic situation.
- Coping is mastery or problem solving rather than just reduction of tension or amelioration of the problem.
- Coping can be divided into various problem-solving activities such as identifying the problem, finding alternative actions, and evaluating these alternatives.
- Conscious and deliberate or unconscious and intrapsychic, that a person adopts when facing stress.
Process of cognitive appraisal
- Primary appraisal - involves consideration of the situation to positive, a challenge, neutral, or a threat.
- Secondary appraisal - occurs simultaneously with the primary appraisal. Involves consideration of coping resources and options.
- Development is goal directed as the family develops healthier ways of living as they go through life.
- Development involves acts of recognizing, mobilizing, maintaining, and regulating the potentials and resources that reside within the individual or family and the larger social context.
McGill Model Vs Roy
Learning in the McGill Model is achieved when the nurse structures the environment so as to promote learning, problem-solving, and decision making by actively engaging the client in the learning process, whereas Roy describes the nurse as acting as an external regulatory force to modify stimuli affecting adaptation. By this act, the person is assisted to an improved state
Factors Affecting Learning
Motivation - the desire to learn. Generally greatest when a person recognizes a need and believes the need will be met through learning i.e. clients with heart disease may need to know the effects of smoking before they recognize the need to stop smoking.
Readiness to learn is the behavior that reflects motivation at a specific time. It’s a willingness and ability to learn. For example, a client joins a smoking cessation program.
Active involvement makes learning more meaningful. If the learner actively participates in planning and discussion, learning is faster and retention is better.
Feedback - support or desired behaviour through praise, positive words, and/or suggestions of alternative methods are ways of providing positive feedback. Negative feedback such as ridicule, anger, or sarcasm leads people to withdraw from learning.
Simple to complex - learning is facilitated by material that is logically organized and proceeds from simple to the complex.
Repetition of key concepts and facts facilitate retention of newly learned material. Practice make perfect.
Timing - people retain information and psychomotor skills best when the time between learning and use is short. The longer the time interval, the more is forgotten.
Environment - an optimal learning environment facilitates learning i.e. reducing distractions, adequate lighting, comfortable room temperature, and good ventilation. Noise can also be a distraction and interfere with listening and thinking. Also, having a support person present is helpful for some clients.
Physiological factors - learning can be inhibited by physiologic events such as critical illness, pain, or impaired hearing, etc.
Psychological factors - emotions i.e. elevated anxiety level can impede learning. Extreme anxiety might be reduced by medications or by information that relieves uncertainty
Cultural factors - obviously the client who does not understand the nurse’s language will learn little. Also, Western medicine may conflict with cultural healing beliefs.
