A History of Nursing and Nursing Research
Nursing = caring for the whole patient
 Nursing is an autonomous, collaborative profession
What is nursing?
 Bound by space and time
 Evolved over time
 Not bound to a practice setting
 Unifying ethos
 Educational expectations?
Florence Nightingale = first nurse administrator, created organization within nursing
Mary Sea Cole- took nursing services to the front; had food area, etc. For soldiers in hospital
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Nursing as a Profession
 Caring science
 Numerous roles in nursing
 Scope
o Standards of practice
o Standards of performance
o Code of ethics
Aims of Nursing
 Promote health
 Prevent illness
 Restore health
 Facilitate coping with disability/death (for patient and family)
Nursing Theory
 conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care
 Theory is the foundation for the art and science of nursing
 Theory, research, and practice are bound together in a continuous interactive relationship
What is Theory?
 Helps explain an event by
o Defining
o Explaining
o Predicting
 Metatheory
o Relationships that make up the knowledge of a discipline
 Nursing Theory
o Conceptualization
o Describes, explains, predicts, prescribes nursing care
Uses of Theory
 Guide and improve practice
 Guide research
 Develop knowledge
 Enhance communication
Components of a Theory
 Phenomenon- term given to describe a specific idea or response about an
event/situation/process
 Concepts- thought of idea or reality put into specific words or phrases that help describe a
phenomenon
 Definitions
o Theoretical/conceptual- define a specific concept; something we can find in the
dictionary
o Operational- state how concepts are measured
 Assumptions- an accepted truth
Evolution of Nursing Theory
 First nursing theorist = Florence Nightingale
 Curriculum era: 1900-1940s
 Research era: 1950s-1970s
 Graduate education era: 1950-1970s
 Theory era: 1980-1990s
 Theory utilization era: 2000s – today
 Theories are dynamic and responsive to the changing environment in which we live
Types of Theory
 Grand- abstract, broad, complex
 Middle-range- limited in scope and less abstract; address a specific phenomenon
 Practice- narrow in scope and focus; guide nursing care for a SPECIFIC patient population at
a SPECIFIC time
 Descriptive- describe phenomena and identify circumstances in which phenomena
occur; first level of theory development
 Prescriptive- address nursing interventions for a phenomenon, guide practice change, and
predict the consequences
Theory- based Nursing Practice
 Nursing knowledge
o Derived from sciences, experience, aesthetics, nurses' attitudes, and standards
of practice
o Goal: distinguish nursing as different and distinct from other disciplines
 Theory generates nursing knowledge for use in practice, thus supporting EBP
Shared Theories
 Also known as a borrowed or interdisciplinary theory
 Explain a phenomenon specific to the discipline that developed the theory
 Shared theories (page 46)
o Human needs
o Stress/adaptation
o Developmental
o Psychosocial
Main Nursing Theorists
 Nightingale- environment affects health (environmental theory) – grand theory
 Peplau- nurse/patient communication and relationship (interpersonal theory- 4 phases) –
middle-range theory
 Preorientation (data gathering)
 Orientation (defining issue)
 Working phase (therapeutic activity)
 Resolution (termination of relationship)
 Orem- importance of autonomy (self- care deficit theory) – grand theory
 Leininger- culturally specific nursing care (cultural care theory) – middle-range theory
 Watson- human caring (human caring theory)
Theory and knowledge development
 Nursing knowledge- theoretical and experimental
 Goals- stimulate thinking, create a broad understanding
 Experiential knowledge- based on nurses' experiences
Theories provide direction for nursing research
Nursing Process (ANA Standards of Nursing Practice)
 Assessment
o Gather data
o Establish a data base
o Continuously update data
o Validate data
o Communicate data
o Types
 Complete Database (Total Health Database)
 Includes complete health history and full physical exam, screens
for pathology
 Forms a baseline to compare future health changes
 Usually collected by primary care
 Focused/ Problem-Centered Database
 For limited, short-term problem
 Smaller, more targeted database focusing on one problem
 Can be used in any patient care setting
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Diagnosis
o
o

Follow- Up Database
 Regular evaluations of the status of any identified problems
 What changes?
 Better or worse?
 Can be used for short-term or chronic problems
 Any care setting
Emergency Database
 Urgent, quick collection of important information
 Quick diagnosis
 Usually gathered while lifesaving measures are performed
 May be given by patients or if not possible by family/friends
Problem list using standard language
Nursing diagnoses
 Clinical judgement of altered patient's response
 Provides basis for selecting intervention
 Components
 Defining characteristics
 Etiology
 Diagnostic label
Planning
o


Establish clinical goal
Implementation
o Doing and documenting
o Coordination of care
o Health teaching and health promotion
Evaluation
o Did the plan work?
Benner's Novice to Expert Steps:
 Novice- beginner student with no experience
 Advanced Beginner- nurse with some experience, can identify meaningful aspects of
principles of nursing care
 Competent- nurse with 2-3 yrs experience in same position; can anticipate nursing care and
understands organization within specific types of pts
 Proficient- nurse with more than 2-3 yrs experience in same position; can transfer
knowledge from prior experiences in clinical situations; focuses on managing care rather
than managing and performing skills
 Expert- nurse with diverse experience that has a thorough understanding of clinical
problems; can look at multiple factors in a situation; can identify patient-centered problems
and problems within the healthcare system
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Intuition = immediately recognizing patterns
One primary cause of misdiagnosis is clinician bias
Priority settings
o First-level priority problems- emergent, life threatening (airway intervention)
o
o
II.
Second-level priority problems- requires quick intervention to prevent further
deterioration (acute pain, mental status change, urinary elimination problems,
abnormal lab values, etc.)
Third-level priority problems- problems that are important to patient's health
but can be attended to after the more important health problems are
addressed; require long-term interventions
Evidence- Based Assessment
Clinical decision making depends on 4 factors:
o
The best evidence from a critical review of research literature
o
The patient's own preferences
o
The clinician's own experience and expertise
o
Physical exam and assessment