Unit 1: Evolution of Nursing 1. History of Nursing Theory- nursing theory development traced back to Florence Nightingale. - Second half of twentieth century - to develop nursing as an academic discipline and a profession, a body of knowledge to guide nursing practice is essential. - Nursing Theory - backbone of clinical care. 2. Highlights of Significant Events in Nursing History: a. Florence Nightingale - “Notes on Nursing”. - The first nursing theory that focused on the manipulation of the environment for the benefit of the patient. - Nightingale did not present her works as “nursing theory”, but she has directed nursing practice for over 140 years. b. The Columbia School (1950s) - Johnson suggested that nursing knowledge is based on a theory of nursing diagnosis that is different from medical diagnosis. - In the 1950’s, the need to prepare nurses at the graduate level for administrative and faculty positions was recognized. c. The Yale School (1960s) - The focus of theoretical thinking in nursing moved from a problem/need and functional role focus to the relationship between the nurse and the patient. - Nursing as a process rather than an end in itself. Their theories look at how nurses do what they do and how the patient perceives his or her situation. - Federal funds were made available for doctoral study for nurse educators. The resulting doctorally - prepared individuals became the next wave of nurse theorists. d. The 1970s - many nursing theories were first presented. e. The 1980s - many nursing theories were revised based on new research findings that expanded them. f. The 1990s - research studies that tested and expanded nursing theory were numerous. 3. Eras of Nursing Knowledge - Early 20th century - nurses saw the need to and began to transition from vocation to profession. - Movement towards professionalism - provides a context to understand the emphases of the eras as the search for a body of knowledge took place over the decades. a. Curriculum Era (1900-1940s) - efforts to understand the nature of the knowledge needed for the practice of nursing are evident from an emphasis on curricular content and the movement toward the goal of standardized curricula. - Nursing arts laboratory or skills lab - ward wherein nursing procedures were taught and practiced. - “Art and science of nursing” is more supported in the present times. - Emphasizes on courses included in nursing programs - Goal is to develop specialized knowledge and higher education b. Research Era (1950-1970s) - The move of nursing into schools of higher learning brought with it a significant change in the search for a substantive body of knowledge. As nurses were introduced to research, they saw the need for nursing research. - The level of understanding was such that many believed research alone was what was needed to generate a body of knowledge or science to form a basis for nursing practice. - Emphasizes role of nursing and what to research - Goal, recognition that isolated studies do not yield unified knowledge. c. Graduate Education - Emphasis is caving out an advanced role and basis for nursing practice. - Goal is to focus graduate education on knowledge development. - During this era, a series of conferences brought nurses together to exchange ideas and evaluate what had been learned in their doctorate programs in other fields that could address nursing knowledge - building needs. - Many began to include a core course in nursing theory or nursing models in a core curriculum organized with a nursing philosophy and conceptual framework. d. Theory Era (1980-1990s) - Began with strong emphasis on development. - Proliferation of nursing literature and new nursing journals, national, and international nursing conferences, and opening of new nursing doctoral programs is evidence of growth in this era. - Nursing theory development stimulated phenomenal growth, which has been noted to be the cornerstone of the development of the discipline of nursing. - Emphasis - there are many ways to think about nursing - Goal- theories guide nursing research and practice. e. Theory Utilization Era (21st Century) - Emphasis - nursing theory guides research, practice, education, and administration. - Goal - nursing frameworks produce knowledge (evidence for quality care). - Nursing has moved into a new era of utilization of philosophers, models, theories in practice and referred to as theory-based nursing practice. - Importance of a framework for critical-thinking and decision making. - Critical-thinking - intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information as a guide to belief action. 4. Significance of Nursing Theory for the Discipline - discipline is dependent on theory for its continued existence - Knowledge of persons, health, and environment forms the basis for recognition of nursing as a discipline, and this knowledge is taught to those who enter the profession. 5. Significance of Nursing Theory for the Profession - essential for the existence of nursing as an academic discipline, it is also vital to the practice of professional nursing. 6. Criteria for Development of the Professional Status of Nursing - The use of theory amplifies knowledge development and enhances the quality of nursing practice. - Theory without practice is empty and practice without theory is blind. 7. Structure Level of Analysis of Nursing - Positivism - dominant view of modern science. Empirical research and logical analysis. - Phenomenology - describes how we experience the external world. - Postpositivism - focus on discovering patterns - Interpretive - promote understanding a. Concept - a term of label that describes a phenomenon or group of phenomenon b. Metaparadigm - global concept that identifies phenomena of central interest. - Person, Environment, Health, Nursing c. Philosophies of Nursing - set forth the general meaning of nursing - Assumptions - accepted as truth and represent the values and beliefs of the theory. - Proposition - statement about a concept or a statement of the relation between two or more concepts. d. Nursing Theories - more specific than conceptual model - Grand theory - highly abstract - Middle range theory - more concrete and practical 1. Florence Nightingale - Environmental Theory - manipulation of physical environment - Case- Miss Eva D.; landfill and salmonellosis ● Ventilation and Warmth ● Light ● Cleanliness of rooms and walls ● Health of Houses ● Noise ● Bed and Beddings’ ● Personal cleanliness ● Variety ● Chattering hopes and advices ● Taking food ● What food ● Petty management ● Observation of the sick 2. Margaret Jean Watson - Theory of Transpersonal Caring - Oscar Major Elements - carative factors, transpersonal caring relationship - Caring moment ● Humanistic-altruistic system of values ● Faith-hope - when modern nursing has nothing further to offer, nurse can continue to provide a sense of well-being ● Cultivation of sensitivity - feel emotion ● Helping-trust - congruence, empathy, warmth ● Expression of feelings - such expression improves one’s level of awareness ● Scientific problem-solving method of decision making ● Interpersonal teaching-learning ● Supportive, protective, corrective ● Gratification of human needs ● Existential-phenomenological factors - Personhood, Health (illness and disease), Healing space and environment, Nursing - Case History of Mr. Oscar H. 3. Patricia Benner - Stages of Nursing Expertise Nursing Philosophies. Case History of Mrs. Gina T. ● Novice - skill acquisition ● Advanced Beginner ● Competent ● Proficient ● Expert - Domains ● Helping Role Domain ● Teaching-Coaching Function ● Diagnostic and Monitoring ● Effective Management of Rapidly Changing Situation ● Administering and Monitoring Therapeutic Interventions and Regimens ● Monitoring and Ensuring Quality of Health care practices ● Organizational and Work-Role Competencies 4. Katie Eriksson - Theory of Caritative Caring. Case Study Ulf Donner - Caritas - love and charity - Caring Communion - structure that determines caring reality - - Human - entity of body and soul - Environment - ethos of caring - Health - soundness, and well-being - Nursing - caritas e. Nursing Conceptual Models 1. Martha Rogers - Theory of Unitary Human Beings lily h - Pattern appraisal, mutual patterning, evaluation - Energy Field - fundamental unit - Pattern - Distinguishing identity - Openness - Pandimensionality - non-linear domains without spatial or temporal attributes - Homeodynamic principles - postulate the way of viewing unitary human beings - Resonancy - ordered arrangement - Helicy - unpredictable, nonlinear evolution - Integrality - mutual relationship 2. Dorothea Orem - Self-Care Deficit Nursing Theory estella C. - Diagnostic, Prescriptive, Regulatory, Control ● Theory of Self-care a. Self-Care b. Self-care Agency c. Therapeutic self-care demand -Conditioning factors -Age, Gender, Developmental state, Health state, health care system factors, pattern of living, family system factors, sociocultural factors, availability of resources, external environmental factors. d. Self-care requisites - universal, developmental, health deviation ● Theory of Dependent Care a. Dependent Care b. Dependent-care agency c. Dependent care deficit d. Dependent care demand ● Theory of Self-care deficit - Methods of helping - Acting for and doing for others - Guiding others - Supporting another - Providing an environment to promote patient’s ability - Teaching another ● Theory of Nursing Systems - Wholly Compensatory - Partially Compensatory - Supportive-educative 3. Imogene King - Nursing System and Middle-Range theory of Goal Attainment. Case History of Baby Inno ● Personal System - Perception - Self - Growth and Development - Body Image - Learning - Time - Personal Space - Coping ● Interpersonal System - Communication - Interaction - Role - Stress - Stressos - Transaction ● Social System - Organization Authority - Power - Status - Decision making 4. Betty Neuman - Systems Model. Case History of Mr. Renato H. a. Personal Variable - physiological, psychological, developmental (empty nest syndrome and sandwich generation), sociocultural, spiritual b. Central Core - survival factors stressors c. Flexible Line of Defense d. Normal Line of Defense ● Primary Prevention - general knowledge ● Secondary Prevention - reaction to stressors ● Tertiary Prevention - adjustive process 5. Sister Callista Roy - Adaptation Model of Nursing a. Physiological-physical mode Lily G. Mateo S. diabetes b. Self-concept-group identity mode c. Role function model d. Interdependence Mode ● Assessment of behavior Patient to adjust to environment ● Assessment of stimuli ● Nursing diagnosis ● Goal setting ● Intervention ● Evaluation 6. Dorothy Johnson - Behavioral System Model Christian L. a. Behavior, System, Behavioral System, subsystems, Equilibrium, regulation/control, tension, stressor b. Subsystems ● Attachment ● Dependency ● Ingestive ● Eliminative ● Sexual Behavior sa patient absorb ● Aggressive-protective ● Achievement c. Structural - goal, preservative, preparatory, choice, action
