Nursing Theory, Nursing Knowledge and Evidence-Based Practice

Question 1

Florence Nightingale

Answer 1

• 1860
• Nursing is more than just applying medicines and managing the environment
• Goal is to put the person in the best possible position to heal

Question 2

Interactionist Theory

Answer 2

Hildegard Peplau (1950’s)

Nursing as an interactive interpersonal process

Who you are as a nurse will influence the care that the patient receives

Question 3

Needs Theory

Answer 3

Virginia Henderson (1955)

Basic human psycho-social needs

Identifying the needs of the patient and helping the person to recover and regain independence

Question 4

Systems Theories

Answer 4

Sister Callista Roy (1970s)

Sees the person as an adaptive system in constant interaction with environment

Roy Adaptation Model: Nursing’sgoalis to promote modes of adaptation that support overall health.

Question 5

Simultaneity

Answer 5

Jean Watson (1979):

Person is an ‘irreducible whole’

Everything interacts with everything all at once

Question 6

Nursing Metaparadigm Concepts

Answer 6

The collective key bodies of knowldge that are needed to understand clinical situations.

4 components: person, nursing, health, environment

Explanation:

Nursing’s focus is on the whole “person;” people being seen as biopsychosocial beings, constantly interacting with and being influenced by their social and physical “environments.”

“Health” is not simply disease and disability, but rather on health maintenance, restoration, and promotion.

“Nursing” actions enable and support patients in the pursuit of their health goals.

These components all interact, moving from “doing for” patients to “working with patients.”

Question 7

Cultural Awareness (4)

Answer 7

• Acknowledgment of difference (“Diversity is reality, inclusion is choice”).
• Focus on the ‘other’ and the ‘other culture.’
• Does not consider political or socio-economic influences on cultural difference
• Individual not required to reflect on own cultural perspective

Question 8

Cultural Sensitivity (3)

Answer 8

• Recognition of the need to respect cultural differences – exhibit respectful behaviours
• Still ‘other’ and the ‘other culture’ focused’
• Does not require the individual to reflect on own cultural perspective

Question 9

Cultural Competence (4)

Answer 9

• Implies that you have the ability to function effectively within the context of the cultural beliefs, behaviors, and needs
• Can build upon self-awareness

Limitations:
-Reduces culture to a set of skills that can be “mastered”

-Over-emphasis on cultural difference as the source of conflict.

Question 10

Cultural Safety (3)

Answer 10

• Provider embraces self-reflection as a means to advance therapeutic encounter with First Nations, Inuit, [and] Métis peoples
• Analyzes “power imbalances, institutional discrimination, colonization and colonial relationships as they apply to health care.”(National Aboriginal Health Association)
• The patient defines what ‘culturally safe care’ means to them

Question 11

Propositional, codified knowledge

Answer 11

-Formal, explicit, derived from research, concerned with generalizability

Question 12

Non-propositional or personal knowledge

Answer 12

• Informal, implicit, derived primarily through practice:

- tacit knowledge

Question 13

Sources of Knowledge (4)

Answer 13

1. Research (Quantitative, Qualitative)
2. Clinical experience
3. Local context and environment
4. Patients, clients and carers

Question 14

Research as a Source of Knowledge (SOK)

Answer 14

• Research evidence is socially and historically constructed; dynamic and eclectic
• Multiple interpretations by different stakeholders, varying within and between professions

Question 15

Clinical Experience as a SOK

Answer 15

• Tacit knowledge (intuition, hunches) sometimes needs to be made explicit – clinical reasoning - in order for it to be disseminated, critiqued and developed
• Student role – the naïve inquirer

Question 16

Local context and environment as SOK

Answer 16

Unit culture, local policy, ‘internal’ evidence

Question 17

Patients, clients and carers as SOK

Answer 17

Where does self knowledge or ‘authoritative knowledge’ fit? Whose voices are heard? Silenced?

Question 18

Critical Thinking

Answer 18

• A process and a set of skills that allow nurses to use knowledge and reasoning to make clinical judgments and decisions
• Requires “reflective reasoning to examine ideas, assumptions and beliefs, principles, conclusions, and actions within the context of a situation (Romyn, 2019, P. 175).”

Question 19

Habits of Critical Thinkers (6)

Answer 19

1. Truth-seeking (current knowledge/evidence)
2. Open-minded: multiple solutions are possible; active listening
3. Analytic ability (what is significant)
4. Systemized approach to problem solving
5. Self-confidence – trusting your reasoning and seeking confirmation
6. Curiosity and inquisitiveness

Question 20

Clinical Critical Thinking Competencies (Clinical Reasoning) (4)

Answer 20

1. Diagnostic reasoning (assessment of health status, patient data gathering)
2. Clinical Inference (analysis of diagnostic informatino to draw conclusions)
3. Clinical Decision making (definition of problem and appropriate intervention)
4. The Nursing Process

Question 21

Nursing Process

Answer 21

5-step cyclical, clinical decision-making approach:

1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

Question 22

General Clinical Thinking Competencies (3)

Answer 22

1. Scientific method
2. Problem solving (including assessment and reevaluation)
3. Decision making (problem resolution, informed conclusions)