THeories, metaparadigm and others Flashcards
What is Epistemology?
The study of knowledge
Nursing Epistemology can be described as
The study of knowledge in the nursing profession, the patterns of knowing and knowing that develops from them, and the criteria for accepting these knowledge claims
What are the 4 patterns of knowing?
Aesthetic, Personal, Empirical & Ethical Knowing
What is Aesthetic knowing?
(5) principles (what is the acronym?)
We stand on an _______ standpoint and?
Expressive, Subjective, Unique, Creative & Experiential
Compared to Empirical knowing
It is based on sensing, not analysis
We stand on an evaluative standpoint and envision the outcome of our actions chosen for the situation
Empirical knowing is about (2)
and how you use ______
Knowledge (evidence based) test → examining + analysing → legitimise aspects of nursing care
and how we use these knowledge to help patients recover
Personal knowing is about
How do you gain personal knowing?
Your experiences as a nurse (with practice), you understand what can happen in certain situations
This is gained by engagement & active empathetic participation
Ethical knowing is about (3) components
Right/wrong
good/bad
fair/unfair
The morals in nursing
How do you actually justify your actions?
Definition: meta-paradigm?
general concept that defines/identifies the discipline (the uniqueness of the discipline)
Fawcett’s meta-paradigm of nursing contains
Keep in mind these are general concepts
Person, Environment, Health and Nursing
How did Fawcett view persons?
(2)
- refers to the sick individual
- unique and autonomous
- considered in terms of their physiological, psychological, social, spiritual and cultural selves
- responsible for their health - involved in care planning
How did Fawcett view Health?
- a perceived state of well-being
- harmonious connection of the physical, psychological, social and spiritual parts of an
individual with the environment - viewed both in normative state and/or process of
living as well as the process of dying
How did Fawcett view the environment? (2)
- comprises internal and
external factors that act
on human beings and
affect their behavior and
development - home life, mental state,
addictions, physical pain,
chances of relapse,
rewarding work
Fawcett Definition of nursing?
What are the roles of nurses?
What type of care do we cater to our patients?
Ethical and Emotional paradigm!
- process of caring for the health of human beings
- assisting individuals in meeting their needs
- teaching them the basics of caring for themselves
- extends beyond the health care facility to the community and society
- ethical and emotional paradigm
What are the 2 types of Nursing theories?
Grand: global emphasis on nursing practice
Middle-range: tested directly
Florence Nightingale’s Focus
What does the ________ contribute to? (Think meta-paradigm)
Environment is very important for everyone’s well being
Environmental control can prevent disease and uplift the maintenance of health
- this benefits everyone, especially the sick and poor
Virginia Henderson’s Focus
________ focuses on the?
The nurse’s unique function here is to?
Henderson’s needs theory focuses on improving the patient’s independence
According to Henderson, the unique function of the nurse is to
assist the individual (sick/well) in the 14 activities that improves/(or leads to peaceful death)
To help him gain independence as rapidly as possible
Dorothy Orem’s Focus
When is the nurse necessary according to Orem?
Orem focuses on self care
The nurse is necessary just when the care patients need is beyond their capacity and ability
In this case, the nurse educates/guides/supports & care for the patient (based on their needs)
Calista Roy’s Focus
ADPIE to help patients adapt
Patricia Benner’s model
TLDR for each stage
Novice to Expert Model
Novice: zero experience
Advanced beginner: follows rules, unable to prioritize
Competent: 2-3 years experience, able to plan for the long term (able to prioritize and manage contingencies)
Proficient: Speed + Flexibility + Holistic understanding
Expert: deep background and understanding of clinical situations
What is Singapore’s strategy to sustain quality healthcare as the demand rises?
The 3 beyonds
Healthcare → Health
Hospital → Community
Quantity → Value
What are the nursing initiatives in place to increase the nursing workforce?
- Expanding nursing intake
- Enable nurses to expand professional capabilities (specialize/further studies)
- Training opportunities such as community nursing
- supporting mid-career entrants (PCP)
- Utilizing technology to ↑ patient care
Describe: Autonomy
The principle of self-governance
Freedom to make choices to issues that affect one’s life
Respecting a client’s rights values and choices is synonymous to
respecting the person’s autonomy
Informed consent is a method that promotes and respects a
person’s autonomy
For a client to make a autonomous decision and action,
he or she must be offered enough information and options
to make up his/her mind to make a decision free from cohersion
or external/internal influences
2 related deratives
Privacy - requires avoid intruding the personal space of the patient
In healthcare, patients lose a great deal of privacy.
Small considerations like seeking permission before touching
someone can go a long way towards protecting privacy and
respecting patient autonomy
Confidentiality - confers an obligation to protect the personal
information collected on the patient. This means being vigilant and
holding conversations away from the ears of people who do not
need to know about the patient as well as keeping patient’s
records in a safe and protected area
Justice
Promotion of equity, fairness in every situation a nurse encounters
E.g. ensure fair allocation of resources
appropriate staff to patient ratio: to ensure patient care is not
compromised
How about distributive justice?
The application of principle: justice focuses primarily on the fair
distribution of goods and services
Beneficence
Doing good for the patient - helping one to gain what is beneficial to them
Groundwork for the trust patients place in nurses
Objective vs Subjective
Non-maleficence
Doing no harm
So what constitutes as harm?
Fidelity
Keeping one’s promise
Requirement to actively uphold one’s end of the patient clinican
relationship and all that in it involves
This principle requires healthcare providers to maintain their
promise implicit in the relationship like maintaining confidentiality,
acting in the best interest of the patient, being honest, educating
the patient and being responsive to the needs of the patient
Society has granted nurses the right to practice nursing through
the process of licensure and certification
The process of licensure is one that ensures that no one can
practice within the domain of nursing as defined by society and
the profession. Thus to accept licensure and become legitimate
members of the profession mandates that nurses uphold the
responsibilities inherent in the contract
Veracity
Truth telling
Derived largely from Beneficence
Patients cannot act in their interest unless they are fully informed
of their medical condition
Hence, a patient’s pursuit of QoL is hampered by not knowing the
relevant facts of his/her health
Confidentiality + Is the duty of confidentiality absolute?
Patient-client relationship?
Duty of confidentiality is not absolute
For confidentially to be breached, there needs to be strong grounds
It will be voided in the case of self harm & risk of harm to others
Ethical dilemma is defined as
A situation that requires a choice between 2 equally unfavourable alternatives
Moral distress is defined as
Occurs when one knows the right thing to do but constraints make it impossible to pursue the right course of action
Why Mental Capacity Act?
The proliferation of this new demographic profile (gradually aging population) raises a host of pressing issues, particularly that of rising incidences of dementia among the aged
This act was designed to provide a regulatory framework whereby a person who does not have the capacity to make a
decision for him/herself because of an impairment of,
or disturbance in the functioning of, the mind or brain may appoint someone to do so on his/her behalf
TLDR? protects against?
Protects those who lack the capacity to make decisions from being taken advantage of
What approach did the MCA use to guide decision making?
Which ethical principle can be affected due to this approach?
Paternalistic approach - to make decisions for the best interests for the patient
This may affect the autonomy of the individudal
What are the 5 principles for the purposes of the MCA?
- To assume capacity unless proven otherwise
- Bad decisions does not equate to inability to make decisions
- To not treat as unable to make a decision unless all
practicable steps fails - To make decisions in the best interest of the patient
- Before the decision is made, it must be achieved effectively in a
way that is less restrictive of the person’s rights and freedom
of action
What is the key derivative ethical principle in the MCA?
The key derivate ethical principle from autonomy
is the respect for persons
What are the other ethical principles related to the MCA?
Justice
Beneficence
Non-maleficence
As a whole, is the MCA based on good ethics?
The MCA is well anchored by principle of ethics, and serves to
promote respect for and protection of those who suffer from loss
of mental capacity
What are the safeguards to prevent abuse of the MHCT Act?
The safeguards to prevent abuse are
1. Mentally disordered persons may only be detained in
psychiatric institutions designated by the Minister for Health
(psychiatric wards can be designated as psychiatric institutions)
2. It is to be inspected regularly by visitors appointed by the
Minister for Health
3. Only medical practitioners that have been designated by name
or office in writing by the Director of Medical Services may sign
an order for admission and detention
4. There are penalties for improper reception or detention of
mentally disordered persons
5. A Magistrate’s order is required if the period of detention
exceeds 6 months
Describe the LPA process
The donor >21 years old and mentally capable to make decisions
can establish a LPA (Advance planning)
The donee will have to meet certain criterias
1. >21 years old
2. not declared bankrupt
3. duty to act in the best interest of the donor
4. trustworthy, reliable and competent to make decisions
Can be a family member, relative or a trusted friend
Both signs and registers LPA @ the Office of the Public Guardian
Certificate issuer can be
1. Lawyer
2. Practicing Psychiatrist
3. Accredited Medical Practitioner
Principle of the double effect, what is it?
- Action is not itself morally evil
- Bad consequences must not be intended
- Good consequences is intended
- The good consequences must be proportionate to the bad consequences
How do you explain the procedure to the patient with regards to respecting the person’s autonomy as a right?
Think Autonomy
Self-governance
To make decisions for self
To information that will aid informed decisions
Provide ample time (prevent feelings of coercion)
Understandable words and language
Documentation
What is needed to make a informed decision/consent?
Think the process of explaining to the patient
Comprehensive discussion on
need for alternatives
benefits/risks and complications
Documenting the discussion
Who are the non autonomous persons?
Childrens/stress/sedation/persons with limited mental capacity
Patients seeking medical care: registration process involves
Providing personal data for medical purposes
She consents to the collection, use and disclosure for medical care
But does not cover purpose outside for which the personal data
was provided
What did Madeleine Leininger talk about in culture?
She said that understanding a person’s culture involves
understanding the person as a whole
List henderson’s 14 needs
1 Breathe normally.
2 Eat and drink adequately.
3 Eliminate body wastes
4 Move and maintain desirable postures
5 Sleep and rest.
6 Select suitable clothes-dress and undress
7 Maintain body temperature within normal range by adjusting clothing and modifying environment
8 Keep the body clean and well groomed and protect the integument
9 Avoid dangers in the environment and avoid injuring others
10 Communicate with others in expressing emotions, needs, fears, or opinions
11 Worship according to one’s faith
12 Work in such a way that there is a sense of accomplishment
13 Play or participate in various forms of recreation
14 Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities
define ethics
Ethics are moral principles that guide a person’s behavior and choices.
