eBook Fundamentals of Nursing 3e By Joanne Tollefson, Sue C. DeLaune, Patricia K. Ladner, Lauren McT
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Get Complete eBook Download By email at student.support@hotmail.com FUNDAMENTALS OF NURSING Australia & New Zealand 3rd edition DeLAUNE • LADNER • McTIER • TOLLEFSON Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com FUNDAMENTALS OF NURSING Australia & New Zealand 3rd edition Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com FUNDAMENTALS OF NURSING Australia & New Zealand 3rd edition DeLAUNE • LADNER • McTIER • TOLLEFSON Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com Fundamentals of Nursing 3rd Edition Sue C. DeLaune Patricia K. 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Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com v CONTENTS Guide to the text x Guide to the online resources xiv Prefacexvi Language and terminology xix About the authors xx xxiii Acknowledgements UNIT 01 NURSING PERSPECTIVES: PAST, PRESENT AND FUTURE 1 CHAPTER 01 Evolution of Nursing Education and Theory 2 Introduction Evolution of nursing education in Australia and New Zealand Trends in nursing education in Australia and New Zealand Theoretical foundations Scope of theories Evolution of nursing theory Selected nursing theories Chapter resources 3 3 11 14 16 16 19 25 CHAPTER 02 Research and Evidence-Based Practice 29 Introduction Research: substantiating the science of nursing Research process Research utilisation Evidence-based practice Evidence reports Trends in research and evidence-based practice Chapter resources 30 30 32 35 37 38 39 40 CHAPTER 03 Health Care Delivery 42 Introduction Health care delivery: organisational frameworks Health care team Factors influencing the delivery of health care Responses to health care changes and challenges Continuum of care Quality management in health care Organisational structure for quality management Nursing’s role in quality management Trends in health care delivery Chapter resources 43 43 44 45 47 48 51 53 55 56 56 UNIT 02 NURSING PROCESS: THE STANDARD OF CARE 59 CHAPTER 04 Critical Thinking, Decision-Making and the Nursing Process 60 Introduction Critical thinking The nursing process Five steps of the nursing process Critical thinking applied in nursing Chapter resources 61 61 64 64 69 70 CHAPTER 05 Clinical Assessment 72 Introduction Purpose of assessment The three types of assessment Data collection Situational awareness Verifying and organising data Interpreting and documenting data Data documentation Chapter resources 73 73 74 75 82 84 85 86 94 CHAPTER 06 Problem Identification 97 Introduction What is problem identification? Importance of problem identification Components of problem identification Clinical judgement in nursing: identifying problem statements Avoiding errors in the development and use of problem identification Chapter resources 98 98 99 100 101 103 105 CHAPTER 07 Planning 107 Introduction Purpose of planning Process of planning Establishing goals and expected outcomes Components of goals and expected outcomes Problems frequently encountered in planning Planning nursing interventions Nursing care plan Chapter resources 108 108 108 110 111 112 113 116 117 Get Complete eBook Download By email at student.support@hotmail.com vi C o n t e n t s Get Complete eBook Download By email at student.support@hotmail.com CHAPTER 08 Implementation 119 Introduction Purpose of implementation Requirements for effective implementation Implementation activities Delegation of tasks Chapter resources 120 120 120 120 126 128 CHAPTER 09 Evaluation 130 Introduction Evaluation of care Components of evaluation Methods of evaluation Evaluation and quality of care Evaluation and accountability Multidisciplinary collaboration in evaluation Chapter resources 131 131 131 132 133 135 135 137 UNIT 03 PROFESSIONAL ACCOUNTABILITY 139 CHAPTER 10 Leadership and Delegation 140 Introduction Professional nursing practice Professional accountability Legislative accountability Individual accountability Leadership in nursing Power Chapter resources 141 141 142 144 145 147 152 155 CHAPTER 11 Legal and Ethical Responsibilities 158 Introduction Legal foundations of nursing Legal responsibilities and roles of nurses Legislation affecting nursing practice Ethical foundations of nursing Ethical principles Values and ethics Ethical codes of practice Ethical dilemmas and ethical decision-making Chapter resources 159 159 168 170 171 174 175 176 177 179 UNIT 04 PROMOTING HEALTH 207 CHAPTER 13 Nursing, Healing and Caring 208 Introduction Nursing’s therapeutic value Theoretical perspectives of caring Health care relationship Caring and communication and characteristics of therapeutic nurses Therapeutic value of the nursing process Chapter resources 209 209 211 214 217 221 223 CHAPTER 14 Communication 227 Introduction The communication process Modes of communication Types of communication Barriers to therapeutic communication Communication roadblocks Communication, critical thinking and nursing process Chapter resources 228 228 233 235 238 240 242 245 CHAPTER 15 Health and Wellness Promotion 249 Introduction Health, illness and wellness Behaviours impacting on health Health promotion The individual as a holistic being Needs and health Promoting sexual health Chapter resources 250 250 252 255 259 259 260 263 CHAPTER 16 Family and Community Health 267 Introduction Family health Characteristics of healthy families Family development theories Threats to family integrity Community health and public-health nursing Disaster preparedness Chapter resources 268 268 268 271 271 275 276 277 CHAPTER 17 CHAPTER 12 Documentation and Informatics 183 Introduction The role of informatics Clinical information systems Documentation as communication Principles of effective documentation Methods of documentation Computers in nursing Chapter resources 184 184 184 186 192 196 201 203 The Life Cycle 281 Introduction Fundamental concepts of growth and development Factors influencing growth and development Theoretical perspectives of human development Holistic framework for nursing Stages of the life cycle: the adult Chapter resources 282 282 282 284 290 290 300 Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com C o n t e n t s CHAPTER 18 CHAPTER 23 Paediatric Care 304 Rural and Remote Health 434 Introduction The prenatal and neonate periods The infant The toddler and the preschool-aged child The school-age child and preadolescent The adolescent Chapter resources 305 305 309 315 320 327 331 Introduction Characteristics of rural and remote communities Determinants of health Access to and use of health care Providing sustainable health care Role of the rural and remote nurse Health promotion Chapter resources 435 435 440 448 450 455 457 459 CHAPTER 19 The Older Adult 335 Introduction Defining old age Changes associated with ageing Medications and the older adult Abuse of the older adult Nursing process and the older adult Chapter resources 336 336 339 350 351 352 360 CHAPTER 20 Palliative Care 364 Introduction Understanding palliative care Palliative care Disease trajectories Working in palliative care Provision of palliative care Psychosocial, spiritual and emotional concerns The dying process Chapter resources 365 365 367 368 369 370 378 380 384 CHAPTER 21 Cultural Diversity 388 Introduction Health of culturally and linguistically diverse populations Multicultural communities working to improve health outcomes The health and wellbeing of multicultural communities Concepts of culture Culture in nursing care First Nations cultures in Australia and Aotearoa New Zealand Culture in the nursing process Chapter resources 389 389 390 390 393 395 396 401 404 CHAPTER 22 Aboriginal and Torres Strait Islander Peoples’ Health 410 Introduction Culturally safe and responsive practice History Strength in partnerships Communication in clinical practice Chapter resources 411 411 413 419 425 429 CHAPTER 24 Health Care Education 464 Introduction The importance of contemporary health education Barriers to learning Professional responsibilities related to teaching Learning throughout the life cycle Teaching–learning and the nursing process Chapter resources 465 465 466 468 468 471 482 UNIT 05 RESPONDING TO BASIC PSYCHOSOCIAL NEEDS 485 CHAPTER 25 Self-Concept 486 Introduction Components of self-concept Development of self-concept Factors affecting self-concept Nursing process and self-concept Chapter resources 487 487 489 491 493 500 CHAPTER 26 Stress, Anxiety, Adaptation and Change 503 Introduction Stress, anxiety and adaptation Types of stress Manifestations of stress Outcomes of stress Stress and illness Stress and change Nursing process with anxious people Personal stress-management approaches for the nurse Chapter resources 504 504 506 506 506 511 512 514 519 523 CHAPTER 27 Spirituality 526 Introduction Spirituality defined Health and spirituality in Australian and New Zealand First Nations’ cultures Spirituality and aged care Nursing process and spirituality Chapter resources 527 527 Get Complete eBook Download By email at student.support@hotmail.com 529 531 531 535 vii viii C o n t e n t s Get Complete eBook Download By email at student.support@hotmail.com CHAPTER 32 CHAPTER 28 Loss and Grief 539 Introduction Loss Grief Death Care after death Nurse’s self-care Chapter resources 540 540 541 546 554 555 557 CHAPTER 29 Mental Health 560 Introduction What is mental health? The history of mental health care The recovery model of mental health care Common mental disorders Assessment of mental disorders Treatment of mental disorders Dealing with stigma Mental health promotion Specialising in mental health nursing Working with culturally and linguistically diverse populations in mental health Chapter resources 561 561 562 564 565 569 570 571 572 573 574 576 UNIT 06 RESPONDING TO BASIC PHYSIOLOGICAL NEEDS 579 CHAPTER 30 Vital Signs 580 Introduction The physiological principles of oxygen delivery Recording of vital signs 1. Pulse 2. Blood pressure 3. Respirations 4. Temperature 5. Oxygen saturation 6. Level of consciousness The nursing process and vital signs Chapter resources 581 581 582 587 591 600 605 608 611 612 615 CHAPTER 31 Physical Assessment 619 Introduction Purposes of physical examination Preparation for physical examination Assessment techniques Diagnostic testing Physical assessment: areas to be assessed Post-assessment care of the person Data documentation Chapter resources 620 620 622 627 630 639 675 676 676 Safety, Infection Control and Hygiene 680 Introduction Creating a culture of safety for people needing health care Safety for health care workers Infection-control basic practice Hygiene Assessment Problem identification and interventions Outcome identification and planning Implementation Evaluation Chapter resources 681 681 687 690 698 700 705 707 708 731 733 CHAPTER 33 Medication Administration 739 Introduction Medication standards and legislation Pharmacokinetics Medication nomenclature Medication action Professional roles in medication administration Systems of weight and measure Medication dose calculations Safe medication administration Medication compliance and legal aspects of administering medications Assessment Problem identification and planning and outcome identification Implementation Evaluation Chapter resources 740 740 741 743 743 748 750 751 751 757 760 762 763 777 779 CHAPTER 34 Traditional and Complementary Therapies 783 Introduction Historical influences on contemporary practices Allopathic medicine Contemporary trends in T&CM Holism and nursing practice Complementary therapies and interventions Nursing and T&CM approaches Chapter resources 784 785 787 788 789 790 805 807 CHAPTER 35 Oxygenation 813 Introduction Physiology of oxygenation Factors affecting oxygenation Assessment Problem identification Planning and outcomes Implementation Evaluation Chapter resources 814 814 819 824 835 838 838 848 851 Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com C o n t e n t s CHAPTER 40 CHAPTER 36 Fluids and Electrolytes 854 Skin Integrity and Wound Healing 1027 Introduction Physiology of fluid and acid-base balance Disturbances in electrolyte and acid-base balance Assessment Problem identification Implementation Evaluation Chapter resources 855 855 860 871 875 878 892 896 Introduction Physiology of wound healing Factors affecting wound healing Wound classification Wound assessment Problem identification Planning and outcomes Implementation Pressure injuries Chapter resources 1028 1028 1030 1033 1036 1038 1039 1039 1046 1059 CHAPTER 37 Nutrition 899 Introduction Physiology of nutrition Understanding nutrients Promoting proper nutrition Factors affecting nutrition Assessing nutrition Problem identification Implementation Evaluation Chapter resources 900 900 903 909 912 914 921 923 934 936 CHAPTER 38 Pain Management, Comfort and Sleep 941 CHAPTER 41 Sensation, Perception and Cognition 1064 Introduction Physiology of sensation, perception and cognition Factors affecting sensation, perception and cognition Sensory, perceptual and cognitive alterations Assessment Problem identification Implementation Evaluation Chapter resources 1065 1065 1071 1072 1073 1078 1078 1084 1085 CHAPTER 42 Introduction 942 Pain 942 Physiology of pain 944 A person-centred pain assessment 948 Pharmacological pain management 956 965 Non-pharmacological interventions 968 Evaluation Rest and sleep 969 Factors affecting rest and sleep 971 Nursing interventions that promote comfort, rest and sleep 973 978 Chapter resources Elimination 1088 Introduction Physiology of elimination Factors affecting elimination Assessment Problem identification: common alterations in elimination Planning and outcomes Implementation Evaluation Chapter resources 1089 1089 1093 1093 1099 1104 1105 1117 1119 CHAPTER 39 Perioperative Nursing Care 1123 Introduction Surgical interventions Preoperative phase Intraoperative phase Post-op phase Chapter resources 1124 1124 1127 1143 1149 1156 Answers to review questions 1159 Mobility 982 Introduction Overview of mobility Physiology of mobility Physical activity Factors affecting mobility Physiological effects of mobility and immobility Assessment Problem identification Planning and outcomes Implementation Evaluation Chapter resources 983 983 985 986 994 996 998 1003 1004 1006 1022 1024 CHAPTER 43 Glossary1162 Symbols and abbreviations 1188 Index1192 Get Complete eBook Download By email at student.support@hotmail.com ix Get Complete eBook Download By email at student.support@hotmail.com Guide to the text As you read this text you will find a number of features in every chapter to enhance your study of nursing and help you understand how the theory is applied in the real world. UNIT OPENING FEATURES Unit opening pages list the chapters included in each Unit. UNIT 01 NURSING PERSPECTIVES: PAST, PRESENT AND FUTURE CHAPTER 01 EVOLUTION OF NURSING EDUCATION AND THEORY 2 CHAPTER 02 RESEARCH AND EVIDENCE-BASED PRACTICE 29 CHAPTER 03 HEALTH CARE DELIVERY 42 CHAPTER OPENING FEATURES Learning outcomes give you a clear sense of what topics each chapter will cover and what you should be able to do after reading the chapter. CHAPTER 31 PHYSICAL ASSESSMENT LEARNING OUTCOMES 1 Discuss the purposes of physical assessment of a person throughout their health care. 2 Describe the preparation of the person required for performing a physical examination. 3 Discuss the adaptation of skills to physically assess a person who is severely obese or aged and frail. 4 Explain the techniques used in conducting a physical examination. 5 Outline the care of the person following their physical examination. BK-CLA-DELAUNE_3E-230060-Chp01.indd 1 6 Discuss the documentation of data obtained from a physical examination. 7 Describe common invasive and non-invasive diagnostic procedures, and laboratory studies to discuss the relevant care of the person before, during and after diagnostic testing, including teaching guidelines. 8 Describe the physical examination and the significance of assessment findings obtained from a physical examination of each of the following areas: head and neck, thorax and lungs, heart and vascular system, breasts and axillae, abdomen, musculoskeletal, neurological, reproductive, rectum and anus. 1 22/06/23 12:21 PM CLINICAL SKILLS The following procedures are to be found in CPS8 (Tollefson & Hillman, 2022): ■ 22 Focused gastrointestinal health history 16 Mental status assessment ■ 17 Focused cardiovascular health history and and abdominal physical assessment ■ 24 Focused musculoskeletal health history physical assessment ■ 19 Focused respiratory health history and and physical assessment and range of motion exercises physical assessment ■ 20 Focused neurological health history and physical assessment ■ The Clinical skills box in select chapters identifies relevant clinical skills covered in Clinical Psychomotor Skills 8th edition (Tollefson & Hillman, 2022), sold separately. Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com G U I D E TO T H E TE X T FEATURES WITHIN CHAPTERS Learn about the importance of evidence and clinical research in nursing with the Evidence-based practice boxes which link research to nursing practice. Respecting our differences boxes explore some considerations for nursing clients with diverse backgrounds, needs and abilities. CULTURALLY SAFE CARE Continuing your learning journey Consider approaches to safe and respectful care for clients from diverse cultural backgrounds with the Culturally safe care boxes. › Acquire new knowledge from the IAHA’s online cultural safety training modules, which uses a cultural responsiveness framework: https://iaha.com.au/iahaconsulting/cultural-responsiveness-training/ › Learn from the CATSINaM cultural safety training e-learning modules: https://catsinam.org.au/culturalsafety-1-day-workshop/ › Discover these clinical yarning e-learning modules: https://www.clinicalyarning.org.au/ › Explore Aboriginal and Torres Strait Islander peoples’ experiences and learn about local cultures near you: https://www.welcometocountry.com/ › Learn about and practise dadirri: https://www. miriamrosefoundation.org.au/dadirri/ › Visit the Healing Foundation website to learn more about the Stolen Generations and how to educate all age groups: https://healingfoundation.org.au/ › Learn more about Aboriginal kinship systems from Sydney University: https://www.sydney.edu.au/about-us/ vision-and-values/our-aboriginal-and-torres-straitislander-community/kinship-module.html › Watch this video to understand intergenerational trauma: https://healingfoundation.org.au/intergenerational-trauma/ › Explore more about the history of stolen wages: https://www.creativespirits.info/aboriginalculture/ economy/stolen-wages/stolen-wages › Invest in learning First Nations’ words: https://www. abc.net.au/radionational/programs/wordup; https:// australianaudioguide.com/podcast/word-up/ Identify important client health and safety issues and the appropriate response to critical situations with the Safety first boxes. Learn key information and issues in nursing with the Nursing highlights boxes. Get Complete eBook Download By email at student.support@hotmail.com xi eBook Download By email at student.support@hotmail.com G U I D E TO T HGet E TE XComplete T FEATURES WITHIN CHAPTERS Review and revise useful lists of important concepts in nursing, client teaching and the nursing process with the Nursing checklist boxes. Follow an individual person’s case and the process of planning care, identifying problems, performing interventions and evaluating outcomes for that person with the detailed Nursing care plans and associated visual Nursing concept maps. Link theory to key clinical skills with the Clinical skills icon throughout the chapters. These icons direct you to PRACTICE corresponding clinical skills EVIDENCE-BASED in more TitleSkills of study detail in Clinical Psychomotor 8th ‘Mind the gap’: exploring paediatric nurses’ perceptions of the theory and practice edition (Tollefson & Hillman,2022), soldof caring for children and families Authors separately. E Yehene, G Goldzweig, H Simana and A Brezner Purpose To investigate how paediatric nurses interpret and conceptualise theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care. END-OF-CHAPTER FEATURES Paediatric nurses completed surveys in which they were Methods asked to what extent practices related to paediatric concepts are expected from their role or are actually implemented in their clinical work. Survey items were derived from a nursing textbook which outlines the ‘art of paediatric nursing’ along with scenarios. E v o l U T I o N o f N U R s I N g E d U C AT I o N A N d T H E o R y endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to paediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nursechild-family triad, and navigating oneself boundaries. 25 CHAPTER 01 xii Implications Nurses’ ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families. Variability in nurses’ theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training. At the end of each chapter you will find several tools to help you to review, practise and extend your knowledge of the key learning outcomes. Findings In both Expected and Actual practices, the highest level of endorsement for items focused on concepts core elements The Summary section highlights thewasimportant covered in the chapter and links back to the of family-centred care (80–96%), and moderate-low learning outcomes. EHENE, E., goldZWEIg, g., sIMANA, H. & BREZNER, A. (2022). ‘MINd THE gAP’: EXPloRINg PEdIATRIC NURsEs’ PERCEPTIoNs of THE THEoRy ANd PRACTICE of CARINg foR CHIldREN ANd fAMIlIEs. JOURNAL OF PEDIATRIC NURSING, 21. doI: 10.1016/J.PEdN.2021.12.024 CHAPTER RESOURCES SUMMARY Nursing is an art and a science in which people are assisted in learning to care for themselves whenever possible and cared for when they are unable to meet their own needs. The professionalisation of nursing has been influenced by key issues such as: the status of women, the development of the biomedical model, employment opportunities, class structures and religion. New Zealand was the first country to register nurses. ■ As the nursing profession continues to evolve and respond to the challenges within the health care system, nurses will remain responsive to societal needs. ■ ‘Concepts’ are abstract vehicles of thought and are the building blocks of theory, while ‘propositions’ are relational statements that link concepts together. ‘Theories’ are an organised, coherent and systematic articulation of a set of statements related to significant questions. Nursing uses theories from other disciplines in conjunction with nursing theory to enhance knowledge, understanding and practice. ■ The complexity of theoretical frameworks is categorised as ‘grand theory’, ‘middle-range theory’ and ‘micro-range theory’. Grand theories, or conceptual models, focus on phenomena of concern to the discipline. Middle-range theories provide a bridge from grand theories to effectively describe and explain specific nursing phenomena. Microrange theories view phenomena in the everyday practice of nurse–patient interactions. ■ The work of early nursing theories focused on the traditional tasks of nursing. Challenged to create synergy between the art and science of nursing, nursing theories have developed. Nursing theorists such as Peplau, Henderson, Orlanda, Rogers and Orem, to name a few, have created philosophies, frameworks, models and theories to achieve this synergy. Contemporary nursing philosophy embraces caring and nurturance with increasing prominence in recent nursing theories. ■ Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com G U I D E TO T H E TE X T 26 N U R s I N g P E R s P E C T I v E s : PA s T, P R E s E N T A N d f U T U R E END-OF-CHAPTER FEATURES UNIT 01 REVIEW QUESTIONS 5 Nursing’s metaparadigm includes: 1 Since the formalisation of nursing, notably with Florence Review questions give you the opportunity to test your knowledge and consolidate your learning. Answers to a concepts, theory, health and environment Nightingale, social and political influences on the role of b health, clinicians, environment and nursing 26 N U Rnursing s I N g P Ehave R s P Eincluded C T I v E s : (select PA s T, Pall R Ethat s E Napply): T ANd fUTURE review questions can be found at the back of the book. c providers, standards, models and patients a the cost of living for sick people UNIT 01 b the role of women in society c technological advances improving health outcomes d access to clean water, hygiene and employment REVIEW QUESTIONS 6 21 5 e registration and professionalisation of nurses. In the the 19thformalisation century, the Anglican High Church Since of nursing, notably withnuns: Florence aNightingale, began training at St Thomas’ Hospital socialnurses and political influences on the role of bnursing introduced university-based education have included (select allnursing that apply): ca set-up training at the Sydney Hospital the costtheir of living for school sick people db were theofdominant of nursing reform in England the role women inmodel society ec developed theadvances first nursing theories.health outcomes technological improving 3 Which wastothe first water, country to enact legislation to register d access clean hygiene and employment nurses? e registration and professionalisation of nurses. Australia 2 aIn the 19th century, the Anglican High Church nuns: ba New beganZealand training nurses at St Thomas’ Hospital cb Britain introduced university-based nursing education dc United States set-up their training school at the Sydney Hospital ed Germany were the dominant model of nursing reform in England 4 Identify some of thefirst keynursing moments in the development of e developed the theories. practice andcountry nursing to education (select allto that apply): 3 nursing Which was the first enact legislation register anurses? 1811 Sydney Hospital opens, New South Wales, Australia ba 390–407 Australiaearly Christianity, deaconesses, like deacons, b also Newministered Zealand to the sick and poor c 2011 Royal College of Nursing (RCN) Australia and the Britain CollegeStates of Nursing unite to form the Australian College d United of Nursing (ACN) e Germany d 1945 some the psychiatric nurse qualification is 4 Identify of the key moments in the development of acknowledged and administered by(select the Nurses nursing practice and nursing education all thatand apply): Midwifery in New Zealand a 1811 SydneyBoard Hospital opens, New South Wales, Australia 1901 the early Nurses’ Registration Act is passed be 390–407 Christianity, deaconesses, likeindeacons, Newministered Zealand to the sick and poor also c 2011 Royal College of Nursing (RCN) Australia and the College of Nursing unite to form the Australian College SPOTLIGHT ON CRITICAL THINKING of Nursing (ACN) d are 1945 psychiatric nurseItqualification is that nursing You onthe a clinical practicum, has been argued acknowledged and administered by the Nurses and history has been presented from a feminist perspective. Midwifery Board in New Zealand 1 How could this have impacted the role of men in the e nursing 1901 theand Nurses’ Registration Act is passed in midwifery profession? New Zealand 2 Explain how this could imply that ‘caring’ is a female trait? 6 7 78 d the person, environment, health and nursing e theory, health, environment and person. A micro-range theory: a is composed of concepts representing global and complex phenomena includes: Nursing’s metaparadigm is the mosttheory, concrete andand narrow of theories that ab concepts, health environment establishes nursing care guidelines b health, clinicians, environment and nursing describes, standards, explains and predicts c providers, models andcomplex patients situations andperson, directs environment, interventions health and nursing d the provideshealth, an overall framework structuring broad, ed theory, environment andfor person. abstract ideas A micro-range theory: answers questions about representing nursing phenomena without ae is composed of concepts global and covering phenomena the full range of concern to the discipline. complex organised, concepts and theirthat bAn is the most coherent concreteset andofnarrow of theories relationship to each other thatguidelines is proposed to explain a given establishes nursing care defines of the following options? cphenomenon describes,best explains andwhich predicts complex situations a and A concept directs interventions A proposition db provides an overall framework for structuring broad, c abstract A theory ideas A discipline ed answers questions about nursing phenomena without e covering A paradigm the full range of concern to the discipline. Why are nursing theories to the An organised, coherent setimportant of concepts andprofession? their (select all that apply): relationship to each other that is proposed to explain a given a To guide nursing practice phenomenon best defines which of the following options? Toconcept promote problem identification ab A Toproposition guide nursing research bc A Totheory develop a language for nurses cd A Todiscipline define professional nursing practice de A e A paradigm Why are nursing theories important to the profession? (select all that apply): a To guide nursing practice b To promote problem identification c To guide nursing research Identify which paradigm of nursing aligns with your d To develop a language for nurses personal beliefs and values. e To define nursing practice Many nursesprofessional state ‘they want to help people’ as a Spotlight on critical thinking questions challenge you to reflect on and discuss complex issues in relation to nursing. 8 5 6 reason for entering the nursing profession. Explain how nurses might ‘help’ people who are unwell using one nursing theorist from the following: Explain why you think nursing history, until recently, has ■ excluded groups of nurses from its history. grand nursing theory SPOTLIGHT ON CRITICAL THINKING ■ You are on a clinical practicum, Nursing history is reflecting a middle-range theory more comprehensive understanding nursing practice and micro-range theory. of nursing aligns with your 5 ■ Identify which paradigm You are on a clinical practicum, It has of been argued that nursing nursing participants. It is now a more complex area of study. You personal are on a clinical practicum, beliefs and values.Both Australian and New history has been presented from a feminist perspective. 41 Why do you think, from a historical perspective, that it is Zealand are practice 6 ManyRNs nurses state ‘they How could this have impacted the role of men in the E v osubject lUTIo Ntoostandards fwant N U Rto s I help N for g Epeople’ d U C AT Ias oor NaA N d T H E o R y 27 important to midwifery represent profession? the nursing profession within the competency domains. reason for entering the nursing profession. Explain how nursing and of society as aimply whole? 7 Discuss how these used in nursing practice. nurses might ‘help’ are people who are unwell using one 2 context Explain how this could that ‘caring’ is a female trait? You are on awhy clinical practicum, Nursing sit within 8 Discuss how these assist in curriculum development for nursing theorist from the following: 3 Explain you think nursing history,theories until recently, has ■ two excluded main paradigms: thenurses ‘totality paradigm’ and ‘simultaneity undergraduate degrees groups of from its history. grand nursing theoryand ensure ongoing assessment 9 Explain what each term means. It is suggested that you both incorporate an ■ and paradigm’. of critical reflection You are on a clinical practicum, Nursing history is reflecting a middle-range theory by practising RNs. 10 How can you apply this in your everyday interactions acknowledgment of cultural diversity and maintain cultural ■ more comprehensive understanding of nursing practice and micro-range theory. with patients? safety in your nursing practice. nursing participants. It is now a more complex area of study. You are on a clinical practicum, Both Australian and New 4 Why do you think, from a historical perspective, that it is Zealand RNs are subject to standards for practice or important to represent the nursing profession within the competency domains. REFERENCES context of society as a whole? 7 Discuss how these are used in nursing practice. BK-CLA-DELAUNE_3E-230060-Chp01.indd 26 practicum, Nursing theories sit within You are on a clinical 8 Discuss howThe these assistinin2050. curriculum development for 20 (3), 22/06/23 12:21 PM Best, O., & Fredricks, B. (2021). Yatdjuligin: Godden, J. (2006). Matching the ideal? Nursing Science Quarterly, two Aboriginal main paradigms: theStrait ‘totality paradigm’ and ‘simultaneity undergraduate ensure ongoing assessment and Torres Islander first generation of Nightingale nursing degrees and 226–29. doi: 10.1177/0894318407303440 paradigm’. of and critical by practising RNs. nursing and midwifery care. (3rd ed.). probationers, Sydney Hospital, 1868–84.reflection McDonald, L. (2013). Florence Nightingale, 3 Extend your understanding with the list of References relevant to each chapter. Victoria, Australia: Cambridge University Press. Borbasi, S., Jackson, D., & East, L. (2019). Navigating the maze of research: Enhancing nursing and midwifery practice. (5th ed.). Australia: Elsevier. BK-CLA-DELAUNE_3E-230060-Chp01.indd 26 Colins, Y., & Kippen, S. A. (2003). The ‘sairy gamps’ of Victorian nursing? Tales of drunk and disorderly wardsmen in Victorian hospitals between the 1850s and the 1880s. Health and History, 5 (1), 42–64. Retrieved from www.jstor.org/stable/40111499 Cushing, A. (1997). Convicts and care giving in colonial Australia, 1788–1868. In A. M. Rafferty, J. Robinson & R. Elkan (Eds.), Nursing, history and the politics of welfare (pp. 108–32). London and New York: Routledge. Dickens, C. (1844). The life and adventures of Martin Chuzzlewit. Sumner & Stillman. Dixson, M. (1999). The real Matildas: Women and identity in Australia 1788 to the present (4th ed.). Sydney, Australia: University of New South Wales Press. Donohue-Porter, P. (2014). The creative élan of nursing theory: Indispensable to leadership. Nursing Science Quarterly, 27 (4), 330–35. doi: 10.1177/0894318414546413 Evans, K., Nizette, D., & O’Brien, A. (2017). Psychiatric and mental health nursing. (4th ed.). Australia: Elsevier. Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of conceptual models of nursing (3rd ed.). Philadelphia: F. A. Davis. Fee, E., & Garofalo, M. (2010). Florence Nightingale and the Crimean War. American Journal of Public Health, 100 (9), 1591. Finkelman, A. (2019). Professional nursing concepts: Competencies for quality leadership. (4th ed.). Jones & Bartlett Learning. Gage, J. D., & Hornblow, A. R. (2007). Development of the New Zealand nursing workforce: Historical themes and current challenges. Nursing Inquiry, 14 (4), 330–34. Health and History, 5 (1), 22–41. Retrieved from www.jstor.org/stable/4011498. Hancock, K. (2013). Australian wage policy: Infancy and adolescence. Adelaide, Australia: University of Adelaide Press. Helmstadter, C. (2007). Florence Nightingale’s opposition to state registration of nurses. Nursing History Review, 15, 155–65. Helmstadter, C., & Godden, J. (2011). Nursing before Nightingale, 1815–1899. Farnham, Surrey: Ashgate. Henderson, V. (1966). The nature of nursing: A definition and its implication for practice, research, and education. New York: Macmillan. Kani, Kingi, T. (2007). The TReaty of Waitangi: A framework for Māori health development. New Zealand Journal of Occupational Therapy, 54 (1), 4–10. Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied nursing research (ANR), 27 (2), 147–150. https://doi.org/10.1016/j. apnr.2014.02.004 Kuhn, T. (1970). The structure of scientific revolutions (2nd ed.). Chicago: University of Chicago Press. Lam, M (2011). Constitutional recognition of Indigenous Australians needs more than a preamble. Law Society Journal 49 (9), 19. Leininger, M. (1991). The theory of culture care diversity and universality. In M. Leininger (Ed.), Cultural care, diversity and universality: A theory of nursing (pp. 5–65). New York: National League for Nursing. Levine, M. E. (1996). The conservation principles in nursing: A retrospective. Nursing theories in practice. Nursing Science Quarterly, 9 (1), 38–41. doi:10.1177/089431849600900110. Levine, M. E. (1989). The conservation principles: Twenty years later. In J. P. Riehl (Ed.), Conceptual models for nursing practice (3rd ed). Norwalk, CT: Appleton & Lange. Lowry, L., Beckman, S., Gehrling, K., & Fawcett, J. (2007). Imagining nursing practice: The Neumann systems model statistics and the Crimean War. Journal of the Royal Statistical Society Statistics in Society Series A, 177. Part 3, 569–86. Meleis, A. (2007). Theoretical nursing: Development and progress. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. 22/06/23 12:21 PM Meleis, A. (2017). Theoretical nursing: Development and progress. (6th ed.). Philadelphia: Lippincott Williams & Wilkins. Monk, L. (2009). Working in the asylum: Attendants to the insane. Health and History, 11 (1), 83–101. Retrieved from http// www.jstor.org/stable/20534505 Neuman, B. (1995). The Neuman systems model (3rd ed.). Norwalk, CT: Appleton & Lange. Nightingale, F. (1946). Notes on nursing: What it is and what it is not. London: Harrison & Sons. [Original work published 1859] Nursing and Midwifery Board of Australia (NMBA). (2016). Registered nurse standards for practice. Retrieved from http://www.nursingmidwiferyboard.gov.au/ codes-guidelines-statements/professionalstandards.aspx O’Lynn, C., & Tranbarger, R. (2012). Men in nursing: History, challenges, and opportunities. New York: Springer Publishing Company, LLC. Orem, D. (1991). Nursing concepts of practice (4th ed.). New York: McGraw-Hill. Parse, R. R. (1981). Man-living-health: A theory of nursing. New York: Wiley. Parse, R. R. (1998). The human becoming school of thought: A perspective for nurses and other health professionals. Nursing Ethics in Applied Ethics. Parse, R. R. (2000). Paradigms: A reprise. Nursing Science Quarterly, 13 (3), 275–76. Parse, R. R. (2006). Rosemarie Rizzo Parse’s human becoming school of thought. In M. Parker (Ed.), Nursing theories and nursing practice (2nd ed., pp. 187–93). Philadelphia: F. A. Davis. Peplau, H. (1952). Interpersonal relations in nursing. New York: Putnam. Peterson, S., & Bredow, T. (2020). Middle range theories: Application to nursing research. (5th ed.). Philadelphia: Wolters Kluwer Health/Lippincott, Williams & Wilkins. Get Complete eBook Download By email at student.support@hotmail.com xiii Get Complete eBook Download By email at student.support@hotmail.com Guide to the online resources FOR THE INSTRUCTOR Cengage is pleased to provide you with a selection of resources that will help you to prepare your lectures and assessments, when you choose this textbook for your course. Log in or request an account to access instructor resources at au.cengage.com/instructor/account for Australia or nz.cengage.com/instructor/account wfor New Zealand. MINDTAP Premium online teaching and learning tools are available on the MindTap platform – the personalised eLearning solution. MindTap is a flexible and easy-to-use platform that helps build student confidence and gives you a clear picture of their progress. We partner with you to ease the transition to digital – we’re with you every step of the way. MindTap for DeLaune Fundamentals of Nursing Australia and New Zealand 3rd edition is full of innovative resources to support critical thinking, and help your students move from memorisation to mastery! Includes: • DeLaune Fundamentals of Nursing Australia and New Zealand 3rd edition eBook • Media quizzes • Polling and revision quizzing • Videos and animations • Heart and lung sounds • And more! MindTap is a premium purchasable eLearning tool. Contact your Cengage learning consultant to find out how MindTap can transform your course. INSTRUCTOR’S MANUAL The Instructor’s Manual includes: • Instructional strategies • Resource aids • Evaluation strategies • Links to useful online resources • Solutions to end of chapter review and spotlight on critical thinking questions. COGNERO® TEST BANK A bank of questions has been developed in conjunction with the text for creating quizzes, tests and exams for your students. Create multiple test versions in an instant and deliver tests from your LMS, your classroom, or wherever you want using Cognero. Cognero test generator is a flexible online system that allows you to import, edit, and manipulate content from the text’s test bank or elsewhere, including your own favourite test questions. Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com G U I D E TO T H E ON L I NE R ESO U R C ES POWERPOINT™ PRESENTATIONS Use the chapter-by-chapter PowerPoint slides to enhance your lecture presentations and handouts by reinforcing the key principles of your subject. ARTWORK FROM THE TEXT Add the digital files of graphs, tables, pictures and flow charts into your learning management system, use them in student handouts, or copy them into your lecture presentations. FOR THE STUDENT MINDTAP MindTap is the next-level online learning tool that helps you get better grades! MindTap gives you the resources you need to study – all in one place and available when you need them. In the MindTap Reader, you can make notes, highlight text and even find a definition directly from the page. If your instructor has chosen MindTap for your subject this semester, log in to MindTap to: • Get better grades • Save time and get organised • Connect with your instructor and peers • Study when and where you want, online and mobile • Complete assessment tasks as set by your instructor When your instructor creates a course using MindTap, they will let you know your course key so you can access the content. Please purchase MindTap only when directed by your instructor. Course length is set by your instructor. Get Complete eBook Download By email at student.support@hotmail.com xv xvi Get Complete eBook Download By email at student.support@hotmail.com PREFACE We are very excited to share this third edition of Australian and New Zealand Fundamentals of Nursing with you! We hope this text will encourage you to develop an inquiring stance based on the joy of discovery and a love of learning. Nursing is facing new challenges in delivering quality care to vulnerable peoples in a variety of settings. These settings are rapidly expanding and challenge all nurses to think creatively in applying best practices based on current research. This edition presents the most current advances in nursing care, nursing education and research relative to the demands of delivering care across a continuum of settings. Multiple theories of nursing are embraced, and nursing’s elements of theory metaparadigm – human beings, environment, health and nursing – are threaded throughout this text. The organisation of units and chapters is sequential; however, every effort has been made to allow for the varying needs of diverse curricula and students. Each chapter may be used independently of the others according to the specific curriculum design. This comprehensive edition addresses fundamental concepts to help prepare novice graduate nurses to apply an understanding of human behaviour to issues encountered in clinical settings. Physiological and psychosocial responses of both an individual and their nurse are addressed in a holistic manner. Integrative modalities are presented in an environment that encourages the individual to participate in determining their own care. Skills and procedures have been relegated to another text: J. Tollefson and E. Hillman’s Clinical Psychomotor Skills: Assessment Tools for Nursing Students (eighth edition), published by Cengage in 2022. This was done to decrease the size of this textbook and permit more discussion of the individual skills. Using contemporary clinical information based on sound theoretical concepts, and scientific evidence, the skills in the latest edition of Tollefson and Hillman both supplement and complement the material in this text. Therapeutic nursing interventions reflect the current Registered Nurse Standards of Practice (2016) and emphasise safety, communication skills, clinical reasoning and interdisciplinary collaboration in delivering nursing care. You will be referred to the appropriate procedure within the text. CONCEPTUAL APPROACH This edition presents in-depth material in a clear, concise manner using language that is easy to read, by linking related concepts. Nursing knowledge is formulated on the basic concepts of scientific and discipline-specific theory, health and health promotion, the environment, holism, health care teaching, spirituality, research and evidence-based practice, and the continuum of care. Emphasis is placed on cultural diversity, care of the older adult, and ethical and legal principles. The nursing process provides a consistent approach for presenting information. Assessment tools specific to selected topics are presented to assist you with pertinent data collection. Critical thinking and reflective reasoning skills are integrated throughout the text. The safe and appropriate use of technology has been incorporated throughout the text to reflect contemporary nursing practice. The conceptual approach used as an organisational framework for this Australian and New Zealand edition falls into four categories: 1 Individuals are viewed as holistic beings with multiple needs and strengths, and the abilities to meet those needs. Holism implies that individuals are treated as whole entities rather than fragmented parts or problems. Each person is a complex entity who is influenced by cultural values, including spiritual beliefs and practices. Every person has the right to be treated with dignity and respect regardless of race, ethnicity, age, religion, socioeconomic status or health status. Traditional terms for people who are being treated for their health care such as ‘patient’ or ‘client’ are avoided as these terms do not reflect the conceptual value of the individual. 2 Environment is a complex interrelationship of internal and external variables. Internal variables include one’s self-concept, self-efficacy, cognitive development and psychological traits. The external environment affects an individual’s health status by facilitating or hindering the person’s achievement of needs. 3 Health is viewed as a dynamic force that occurs on a continuum ranging from wellness to death. An individual’s actions and choices effect Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com changes in their health status. Individuals who are experiencing illness have strengths that may improve their health status. On the other hand, individuals who are experiencing a high degree of health generally have areas that can be improved. 4 Nursing is an active, interpersonal, professional practice that seeks to improve the health status of individuals. Nursing’s focus is person-centred and communicates a caring intent. Caring and compassion are demonstrated through nursing interventions. Nursing is a professional practice based on scientific knowledge and is delivered in an artful manner. Other important conceptual threads used to direct the development of this book include the following: ■ Health promotion encourages individuals to engage in behaviours and lifestyles that facilitate wellness. ■ Standards of practice are discussed, with information from national and specialty organisations (both from Australia and New Zealand) incorporated into each chapter as appropriate. ■ Critical thinking is an essential skill for blending science with the art of nursing. It is woven into each chapter with challenges and questions. ■ Evidence-based practice derived from scientific research is emphasised across chapters. ■ ■ ■ ■ ■ ■ ■ ORGANISATION This textbook provides you with a bridge that presents theory to support clinical practice. The intent of the authors is to help you become a proficient critical thinker who is able to use the nursing process with diverse individuals in a variety of settings. Research-based knowledge that reflects contemporary practice is presented in a reader-friendly, practical manner. Features that challenge you to use critical-thinking skills are incorporated into each chapter, and critical-thinking questions appear at the end of each chapter. Critical information is highlighted throughout the text in a format that is easily accessed and understood. Similar concepts have been grouped together to encourage you to learn through association; this method of presentation also prevents the duplication of content. Australian and New Zealand Fundamentals of Nursing presents 43 chapters organised in six units: ■ Unit 1: Nursing’s perspectives: past, present and future provides a comprehensive discussion of nursing’s evolution as a profession and its contributions to health care based on standards of practice. The theoretical frameworks for guiding professional practice and the significance of incorporating research into nursing practice are emphasised. Chapters are reflective of the parallel evolution of nursing and nursing education. ■ ■ ■ Preface Cultural diversity is defined as individual differences among people resulting from racial, ethnic, religious and cultural variables. Continuum of care is viewed as a process for providing health care services in order to ensure consistent care across practice settings. Community, as both an aggregate focus for health care and as the setting for the delivery of care, is evidenced in Chapter 16 and is threaded throughout the text. Holism recognises the body–mind connection and views the person as a whole rather than as fragmented parts. Spirituality encompasses the relationship with oneself, a sense of connection with others, and a relationship with a higher power or divine source. It is discussed in depth in Chapter 27. Caring, a universal value that directs nursing practice, is incorporated throughout the text, and is described in depth in Chapter 13. Alternative and complementary modalities are treatment approaches that can be used in conjunction with conventional medical therapies. Chapter 34 is dedicated to this integrative approach, and related information featuring integrative concepts is included throughout the text. Examples are provided showing the incorporation of theory into the nursing process. The concept of evidence-based practice is emphasised along with research utilisation. Quality is discussed from the perspective of health care delivery and the continuum of care. Unit 2: Nursing process: the standard of care discusses recognised competencies and standards of care established by Australian and New Zealand nursing registration bodies, the Australian Nursing and Midwifery Federation, and nursing specialty organisations. Each stage of the nursing process is discussed, with an emphasis on critical thinking. Unit 3: Professional accountability describes the nurse’s responsibilities to the individual in their care, the community and the profession. Nursing leadership is discussed in Chapter 10. Chapter 11 combines legal and ethical aspects of nursing practice to reflect the interfacing of these concepts. An in-depth discussion of informatics appears in Chapter 12, which focuses on documentation. Unit 4: Promoting health was created to integrate information on health promotion, consumer demand and facilitating empowerment for the person seeking health care. Chapter 13 provides nursing theoretical perspectives on caring. Chapter 15 emphasises the nurse’s role in empowering the person seeking health care to assume more personal accountability for their own health-related behaviours. Chapter 16 addresses the health needs of families and communities. Get Complete eBook Download By email at student.support@hotmail.com xvii xviii Preface ■ ■ Get Complete eBook Download By email at student.support@hotmail.com to every area of nursing practice. Concepts such as safety and infection control, medication administration, assessment of the person, their comfort, mobility, fluid and electrolyte balance, oxygenation, skin integrity, nutrition and elimination are all described within the nursing process framework. Unit 5: Responding to basic psychosocial needs stresses the importance of the holistic nature of nursing. Spirituality is spotlighted in order to emphasise its impact on individuals’ health. Unit 6: Responding to basic physiological needs discusses aspects of nursing care that are common NEW TO THE THIRD AUSTRALIAN AND NEW ZEALAND EDITION All the material has been settled into an Australian and New Zealand context, using culturally appropriate and relevant examples, Australian and New Zealand government and non-government organisation information, research, legal and ethical material and laws, evidence-based practice information, and ratified nursing standards. All chapters have been extensively reviewed to reflect contemporary Australian and New Zealand nursing practice. Contributions for specific chapters were sought from Australian and New Zealand nurses who are expert in their fields. Additional features include the following: ■ At the end of every chapter, a set of ‘Review questions’ is presented. For this third edition, Review questions have been revised. The answers and rationales are located in the Instructor’s Manual. ■ ‘Spotlight on critical thinking’ at the end of the chapter focuses attention on issues relating to the caring, compassion, legal, ethical and professional components of nursing practice. ■ ‘Safety first’ identifies critical health and safety situations and highlights strategies for the appropriate nursing response and management. ■ ■ ■ ■ These boxes are highly visible to emphasise the critical nature of the information. ‘Evidence-based practice’ emphasises the importance of clinical research by linking theory to practice. Relevant and recent research into appropriate subjects is presented. Most chapters have more than one Evidence-based practice box. ‘Respecting our differences’ challenges you to consider approaches to respectful and appropriate care for populations of people who may differ in a variety of ways, including culture, gender, age and developmental level. ‘Nursing highlights’ provide key information on nursing practice. ‘Nursing checklists’ are provided to assist you with the revision of information. EXTENSIVE TEACHING/ LEARNING PACKAGE The complete supplements package was developed to achieve two goals: 1 to assist you in learning the essential skills and competencies needed to secure a career in nursing 2 to assist your instructors in planning and implementing their programs for the most efficient use of time and other resources. Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com xix LANGUAGE AND TERMINOLOGY ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES This textbook has a full chapter on health issues pertaining to Aboriginal and Torres Strait Islander peoples, as well as integrated material throughout the book relating to issues, events, policies and groups. We have sought to use inclusive, appropriate and non-discriminatory terminology throughout, and for this purpose we have followed the published guidelines provided by NSW Health in Communicating Positively: A Guide to Appropriate Aboriginal Terminology. CULTURAL SAFETY IN NEW ZEALAND New Zealand has a bicultural society by legislation. This diversity creates a vibrant, rich background to daily living. Issues may arise when people of a different culture, ethnicity or religion interact and do not understand each other. These misunderstandings can result in insult, feelings of isolation and inequality of service. Culturally unsafe practices are those that ‘diminish, demean or disempower the cultural identity and well-being of an individual’ (NCNZ, 2012, p. 9). This definition is supported by laws on antidiscrimination that are made at the national level in New Zealand. In Australia legislation exists at Commonwealth, state and territory levels, which make it an offence to discriminate against a person because of their race, ethnicity, culture or religion. GENDER DIVERSITY Gender diversity describes people who identify themselves by self expression as beyond binary. Much of the language used to describe these experiences is still evolving. We have tried to use gender diverse language (names, pronouns) to acknowledge the expectation of inclusivity and to respect the gender diverse and the choices they make in their lives. NURSING DIAGNOSIS Fry (1953) first used the term ‘nursing diagnosis’, but it was not until 1974, after the first meeting of the North American Nursing Diagnosis Association (NANDA), that nursing diagnosis was added as a separate and distinct step in the nursing process. Prior to this, nursing diagnosis had been included as a natural conclusion to the first step in the nursing process – assessment. While the notion of nursing diagnosis is imperative for the Australian and New Zealand nursing context, the specific language used by NANDA and the term ‘nursing diagnosis’ are not widely used in clinical practice. In the Australian and New Zealand setting, the term ‘nursing diagnosis’ is routinely replaced with ‘problem identification’, the term we have chosen to use in this text. The exact language used to name the problem is not as important as ensuring that all problems are identified in a systematic way. Get Complete eBook Download By email at student.support@hotmail.com xx Get Complete eBook Download By email at student.support@hotmail.com ABOUT THE AUTHORS Lauren McTier is a Professor and Deputy Head of School and Associate Head of School (Teaching and Learning) in the School of Nursing and Midwifery at Deakin University. She commenced her nursing career over 25 years ago with a Bachelor of Nursing and has subsequently gained formal qualifications in Critical Care Nursing, Education, Statistics and Research. Lauren leads teaching and learning in the nursing and midwifery programs at Deakin University. She is passionate about ensuring every student has the knowledge, skills, tools and mind-set to provide quality and safe nursing care for individuals and their families. Joanne Tollefson earned her registered nurse certification in Canada and continued her studies throughout her career. She completed a Bachelor of General Studies from a Canadian University, and a Master of Tropical Medicine, then a PhD, from James Cook University in northern Queensland. An experienced clinician (15 years of rural nursing, women’s health, medical, surgical and mental health care) in Canada, Australia and Nigeria, she turned to education and taught in hospital and tertiary courses for the next 30 years in all capacities, from clinical facilitator to Principal Nurse Educator in hospital programs, Lecturer and Senior Lecturer at James Cook University. She was privileged to work with Fijian nurses at the Fiji School of Nursing to create an international-level nursing curriculum for the nurses of the South Pacific. She has written a well-accepted clinical psychomotor skills text, now in its eight edition (currently under review for the ninth edition). Joanne has been honoured with two National Awards for Outstanding Contributions to Student Learning (Carrick Award, 2007; Australian Teaching and Learning Council Award, 2008). She is now retired from formal teaching but continues to engage in nursing via researching, writing and editing nursing texts. Sue Carter DeLaune earned a Bachelor of Science in nursing from Northwestern State University, Natchitoches, Louisiana, and a master’s degree in nursing from Louisiana State University Medical Center, New Orleans. She has taught nursing in diploma, associate degree and baccalaureate schools of nursing as well as in RN degree-completion programs. With over 35 years of experience as an educator, clinician and administrator, Sue has taught the fundamentals of nursing, psychiatric–mental health nursing, professionalism and nursing leadership in a variety of programs. She also presents seminars and workshops across the country that assist nurses to maintain competency in areas of communication, leadership skills, patient education and stress management. Sue is a member of Sigma Theta Tau, the National League for Nursing, and the American Nurses Association. She has been recognised as one of the ‘Great 100 Nurses’ by the New Orleans District Nurses Association. Sue is a prolific author, having written several professional journal articles and textbook chapters in the areas of nursing education and mental health nursing. Currently, Sue is an Associate Professor and RN-to-BSN Coordinator at William Carey University School of Nursing, New Orleans. She also is President of S DeLaune Consulting, an independent education consulting business based in Mandeville, Louisiana. Patricia Ann Kelly Ladner obtained an associate degree in science from Mercy Junior College, St Louis, Missouri; a Bachelor of Science in nursing from Marillac College, St Louis, Missouri; a Master of Science in counselling and guidance from Troy State University, Troy, Alabama; and a master’s degree in nursing from Louisiana State Medical Center, New Orleans, Louisiana. She has taught at George C. Wallace Junior Community College, Dothan, Alabama; Sampson Technical Institute, Clinton, North Carolina; and Touro Infirmary School of Nursing and Charity/ Delgado School of Nursing in New Orleans, Louisiana. She has also been the Director of Touro Infirmary School of Nursing and a Director of Nursing at Tulane University Medical Center in New Orleans. With 35 years’ experience as a clinician and academician, Ms Ladner has taught the fundamentals of nursing, medical-surgical nursing and nursing seminars while maintaining clinical competency in various critical care and medical-surgical settings. Her professional career has provided her with the necessary knowledge and skills to be an effective lecturer and community leader. Ms Ladner received a governor’s appointment to serve on an Advisory Committee of the Louisiana State Board of Medical Examiners, and she also served on an Advisory Committee for Loyola University in Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com A BOUT THE AUTHORS New Orleans. She maintains membership in Sigma Theta Tau, the American Nurses Association, and the Louisiana Organization of Nurse Executives. She served for over 10 years on the Louisiana State Nurses Association’s Continuing Education Committee. She is the recipient of the New Orleans District Nurses Association Community Service Award and has been recognised as one of the ‘Great 100 Nurses’ by the New Orleans District Nurses Association. Ms Ladner has been listed in Who’s Who in American Nursing. She is a former Nursing Practice Consultant for the Louisiana State Board of Nursing. Since Hurricane Katrina in 2004, Ms Ladner has coordinated the volunteer services for the Catholic Church in DeLisle, Mississippi, and presented inservice education programs on such topics as hygiene, infection control, and grief and loss. CONTRIBUTING AUTHORS FOR THE 3RD EDITION Cengage would like to thank the numerous contributors who assisted in this publication. Amy Montgomery NP, RN, BN, MSc (Dementia Care), MN (Nurse Practitioner); Lecturer, School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong ■ Chapter 33: Medication Administration Amy Shepherd RN, RM, BSc (Nursing), MMid, GCertN (Clinical Nursing & Education), MACM; Clinical Nurse Educator (Maternity), Northwest Private Hospital, QLD ■ Chapter 12: Documentation and Informatics ■ Chapter 17: The life cycle ■ Chapter 37: Nutrition Dr Chris Taua ■ Kaiwhakahaere/Director at Pumahara Consultants, NZ; Sessional Academic at Queensland University of Technology; FNZCMHN ■ Chapter 29: Mental health Prof Christine Neville RN, PhD, FACMHN; Professor, School of Nursing & Midwifery, University of Southern Queensland. ■ Chapter 19: The older adult ■ Chapter 29: Mental health Associate Professor Elizabeth Forster RN, BN, MN, Grad Cert Higher Ed, Grad Cert Positive Psych, PhD, SFHEA, Centaur Fellow; Program Director Postgraduate Nursing & Infection Prevention and Control, Program Advisor Paediatric Nursing, School of Nursing and Midwifery, Griffith University ■ Chapter 18: Paediatric clients Elspeth Hillman Academic Lead Professional Practice, Nursing and Midwifery, College of Healthcare Science, James Cook University ■ Chapter 38: Pain management, comfort and sleep ■ Chapter 41: Sensation, perception and cognition Fiona McLeod RN, MANP - Palliative Care, Cert IV Workplace Assessment & Training; Independent Nurse Practitioner ■ Chapter 20: Palliative care Frances Calleja RN, RM, B.Nsg Sc., Grad Dip Rural Nsg, Grad Cert Child & Family Health, M Nsg Studies (Clinical Teaching), Grad Cert Bus.Mgmt, Research Higher Degree Candidate; Adjunct Senior Lecturer, Mount Isa Centre for Rural and Remote Health, James Cook University; Nurse Educator – Central West Hospital & Health Service, Office of the Executive Director of Nursing & Midwifery Central West Hospital and Health Service ■ Chapter 13: Nursing, healing and caring ■ Chapter 23: Rural and Remote Health Dr. Helen Donovan PhD, RN/RM Med, Med, FACN, ACM SFHEA (Formal Mentor), AFHEA (Indigs), QUT School of Nursing ■ Chapter 15: Health and wellness promotion ■ Chapter 24: Health care education Leanne Ferris Cert IV TAE, DipProfManage, Cert Mid, BNurs, MClinNur&Teach, ANMAC Assessor, Member of Australian College of Midwives and Australian Nurse Teachers Society ■ Chapter 11: Legal and ethical responsibilities ■ Chapter 14: Communication ■ Chapter 25: Self-Concept ■ Chapter 26: Stress, Anxiety, Adaptation, and Change Lisa Woodman PhD, Med(Prof) MMgt (Aged Care), GDip (Ger), BN, RN; Founder and Consultant, Dementia with Dignity and Care ■ Chapter 19: The Older Adult Lucinda Brown RN, MPH, Grad Dip Health Sci, Grad Cert Tertiary Education, Prof Cert Allergy Nursing; PhD Candidate, School of Nursing, Midwifery & Social Sciences, CQUniversity ■ Chapter 16:Family and Community Health Dr. Marilyn Richardson-Tench PhD., M.Ed.Stud., B.App.Sc.(Adv.Nsg.).,Cert.Clin. Teach.(UK)., RN, RCNT (UK); Sessional Tutor, James Cook University ■ Chapter 2: Research and Evidence-Based Practice ■ Chapter 43: Perioperative nursing care Get Complete eBook Download By email at student.support@hotmail.com xxi xxii Complete eBook Download By email at student.support@hotmail.com A B O U T T H E Get AUTHO RS Nicole Hewlett A proud palawa woman from lutruwita (Tasmania). Project Manager, The First Nations Cancer & Wellbeing Research Program, School of Public Health, Faculty of Medicine, The University of Queensland ■ Chapter 22: Aboriginal and Torres Strait Islander Peoples’ Health Dr Nina Sivertsen RN, BN(Hons), Grad Cert Ed (Higher Ed), PhD, MACN; Flinders University, College of Nursing and Health Sciences, Kaurna Country; Associate Professor at Arctic University of Norway ■ Chapter 21: Cultural Diversity Sharon Stanton RN, BN, MN (Urol. & Cont.), GCTAE, Cert IV TAE, NSWUNS/ANZUNS (Member), MACN; Lecturer in Nursing, University of Canberra Chapter 1: Evolution of Nursing Theory and Education ■ Chapter 42: Elimination Wyatt Butcher Master of Health Science (Mental Health); Post Graduate Diploma in Teaching; Bachelor of Ministry (Biblical Studies and Pastoral Care); Chaplain for the Canterbury District Health Board Specialist Mental Health Services; Registered Baptist Minister (Reverend); Executive member and past President of the New Zealand Healthcare Chaplains Association; Fully Registered Chaplain (NZHCA) ■ Chapter 27: Spirituality ■ Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com xxiii ACKNOWLEDGEMENTS This textbook is the product of many dedicated, knowledgeable and conscientious individuals. We would like to thank all the contributors who persevered to produce an outstanding contribution to the nursing literature. Your clinical expertise is evident in this final product. Likewise, we need to thank all the reviewers who critically read and commented on the manuscript. Your clinical and academic expertise provided valuable suggestions that strengthened the text. Our friends and professional colleagues provided encouragement throughout the development of this manuscript. Our families deserve recognition and accolades for their daily queries relative to the book, which often stimulated humour, easing an enormous and sometimes arduous task. From Lauren McTier: To Mark, Max and Isabella, thank you for your wisdom, support and entertainment. To Bruce and Robyn, thanks for the generous opportunities you have provided to me. From Joanne Tollefson: To Ken, wholehearted thanks and much love to you for your understanding, support, humour and for cups of tea throughout this iteration of both ‘Fundamentals’, and all the editions of ‘Clinical Psychomotor Skills’ and for the past 50 years of marriage. Thanks also to my sons, Geoffrey and Christopher and their families for the joy they give and the reality/sanity they infuse into this time of intense focus. The authors and Cengage extend special thanks to Nicole Hewlett, Dr Nina Sivertsen and Dr Mark Lock for their generous guidance and advice regarding cultural diversity and cultural safety in Australia and New Zealand. The authors and Cengage would like to thank Joanne Lawrence for her contributions to previous editions of the text. Cengage would also like to thank the following contributors for their work on previous editions of the text: Jan Edwards, Penny Harrison, Anne Jackson, Imogen Mitchell, Nicole Slater, Theresa Angert-Quilter, Christine Fejo-King, Diana Jefferies, Tanya Langtree, Helen McCabe, Paul McDonald, Glo Neilsen, Peter Thomas, Peter Wall, Jen Walters. The authors and Cengage would like to thank the following reviewers for their incisive and helpful feedback across several editions: ■ Penny Harrison, University of Sunshine Coast ■ Jann Fielden, Southern Cross University ■ Helen Nightingale, La Trobe University ■ Ruth Wei, Murdoch University ■ Laurina Schmidt, Swinburne University of Technology ■ Carley Jans, University of Wollongong ■ Danielle Noble, University of Newcastle ■ Lynne Brown, Griffith University Every effort has been made to trace and acknowledge copyright. However, if any infringement has occurred, the publishers tender their apologies and invite the copyright holders to contact them. Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com UNIT 01 NURSING PERSPECTIVES: PAST, PRESENT AND FUTURE CHAPTER 01 EVOLUTION OF NURSING EDUCATION AND THEORY 2 CHAPTER 02 RESEARCH AND EVIDENCE-BASED PRACTICE 29 CHAPTER 03 HEALTH CARE DELIVERY 42 Get Complete eBook Download By email at student.support@hotmail.com 1 Get Complete eBook Download By email at student.support@hotmail.com CHAPTER 01 EVOLUTION OF NURSING EDUCATION AND THEORY LEARNING OUTCOMES 1 Explore the evolution of nursing, identify the major historical events leading to current nursing education, and describe the impact of 19th- and 20th-century nursing leadership on current nursing practice in Australia and New Zealand. 2 Describe the trends in nursing education specifically relating to the issues of competency development and delivery of care. 3 Define the terms ‘theory’, ‘concept’ and ‘proposition’. 4 Describe the three scopes of theory: ‘grand theories’, ‘middle-range theories’ and ‘micro-range theories’ and discuss knowledge development in nursing. 5 Identify and interpret major nursing theories in relation to practice. 2 Get Complete eBook Download By email at student.support@hotmail.com INTRODUCTION This chapter will incorporate a historical overview of both the foundation of modern nursing and nursing education in the 19th, 20th and 21st centuries. It will also explore the development of nursing theory and how these theories support and define nursing practice in Australia and New Zealand today. Examining social forces that have influenced the development of the professional nurse and nursing education will provide foundation knowledge of how contemporary nurses have evolved. This will be followed by the stages of modern nursing education highlighting the role of the forerunner of formalised nursing education – Florence Nightingale. It is important at this stage to mention how nurses have been regulated by law and to introduce the concept of ‘scope of practice’. As nurses, our profession is defined by our unique contribution to health care, which is based in nursing theory, combining art and science to care for people based on scientific knowledge, critical-thinking skills and caring behaviours. An overview of the contribution of nursing theorists will be explored giving the reader an understanding of each theorist and their contribution to the profession. Your understanding of these concepts will lead to ongoing professional responses to a changing world. EVOLUTION OF NURSING EDUCATION IN AUSTRALIA AND NEW ZEALAND It is important to acknowledge that nursing has a long history with origins in religious orders and the military (Roux & Halstead, 2018). As a result, the framework of early nursing education reflects characteristics of each. The following discussion will provide a brief overview of nursing education in Britain followed by a focus on the Australian and New Zealand perspectives. The evolution of nursing education demonstrates that educational opportunities and approaches are continuing to develop and to be challenged. Understanding our past directs our perceptions of the present and assists us in planning for our profession’s future. Nursing history has traditionally been presented using familiar stories of famous nurses, nursing leaders and events. It has been explored from a grand narrative perspective, describing the ‘big picture’ of nursing history and practice. However, expectations and interpretations of what a nurse is and does have altered based on the influence of social and political factors. The delivery of nursing education in Australia began with the arrival of the Nightingale nurses in 1868. The basis of practice for these nurses was both religious and military. Areas of conflict, such as the Crimean War and both world wars, have also served to shape the changes in education of nurses in Australia and New Zealand. It has helped to change the skills and knowledge of nurses from handmaidens for doctors to nurses with specific specialties. Although the role of the male-identifying nurse is important in our history, aligning with the emancipation of women, nurses began to reflect and theorise about what nurses ‘do’. This has led to increasing self-determination, expansion of their role, and the professionalisation of nursing. Finally, the shift from nursing schools to modern tertiary education has cemented the perception of nursing as its own pursuit. When reading this chapter, consider nursing from the historical viewpoint influenced by nursing theory and how you will contribute to this body of knowledge. Theory and practice globally, nationally and locally have been shaped by political, social, cultural, economic and gender perspectives. These perspectives and influences explain how the modern landscape of nursing practice occurs and provides insight into future potential development by emerging nurse leaders. There are polarised viewpoints about the role of Florence Nightingale, yet the value of her contributions cannot be ignored. Her influences both past and present will be discussed providing a basis for future nurse contributions in theory, practice and research. Adding to Nightingale’s contributions, early nurse leaders in Australia and New Zealand provide the narrative for ongoing development of the nursing education system. The role of nursing theorists in this context has led to a reputable profession valued internationally due to unique influences. The contributions of Aboriginal and Torres Strait Islander peoples and male-identifying nurses continue to be explored. This approach places nursing within the wider context of the societies that it is practised within. Geographic, social, political and economic structures contributed to nursing theory in Australia and New Zealand, which developed an almost parallel practice. Contemporary nurses practice in a manner that is a mix of the historical as well as educational, scientific, social and political influences. The evolution of these influences and development of theories have resulted in Australia and New Zealand nursing today. These theories advocate nursing individuals and communities as being a delicate balance between promoting a person’s independence and dependence. The approach focuses on illness, the person’s response to illness or disability, defines caring, and supports the delivery of care across the life span. This aspect of nursing also includes assisting a person with a terminal illness to maintain comfort and dignity in the final stage of life. While there is not a definitive starting date, in recent years nurses have been further supported and Get Complete eBook Download By email at student.support@hotmail.com 3 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 4 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com encouraged to participate in policy discussions. This includes the creation and modification of health policy at all levels of government, although there are concerns about the level of power or equity in the process (Rumsey et al., 2021). It is important to acknowledge at this point that nursing and midwifery have a shared history and are not entirely separate entities. While this discussion will centre on nursing, some aspects of midwifery will be included because of their close association. Table 1-1 highlights some of the key moments in the development of nursing practice and education, identifying early aspects of nursing development while concentrating on Australian and New Zealand nursing educational history. TABLE 1-1 Historical events influencing the evolution of nursing DATE EVENT 1500–600 BCE Health religions of India – medicinal practices of the Vedic period 390–407 CE Early Christianity – deaconesses, like deacons, also ministered to the sick and poor 1095 Antonines establish the Brothers of St Anthony Hospital in London, England 805 The first general hospital was built by Harun Al-Rashid in Baghdad, Iraq 1811 Sydney Hospital opens, New South Wales (NSW), Australia 1815 Sisters of Charity founded by Sister Mary Aikenhead in Ireland 1820 Florence Nightingale born in Florence, Italy 1836 Foundation of the Deaconess Mutterhaus next to the Kaiserswerther Market in Kaiserswerth, in the City of Düsseldorf, Germany 1838 Irish Sisters of Charity nurses arrive in Sydney, Australia, visiting workhouses, hospitals, orphanages schools and jails 1840 Treaty of Waitangi signed by the British Crown and Māori chiefs in New Zealand Elizabeth Fry establishes the Institution of Nursing Sisters and a three-month nurse training course in England 1853–56 Crimean War 1859 Nightingale’s Notes on nursing published in England 1860 First Nightingale School of Nursing, St Thomas’ Hospital, London, England 1868 Lucy Osburn arrives in Sydney to develop a Nightingale-based training school for nurses at the Sydney Hospital, Australia 1873 Grace Neill begins training at St John’s Hospital in London, England 1887 British Nurses Association (BNA) is founded 1888 Australia and New Zealand are requested to form chapters of the BNA BNA publishers the journal The Nursing Record 1890–95 Royal Commission into Charitable Institutions is held in Victoria, Australia 1896 Mereana Tangata becomes the first Māori hospital-trained nurse in New Zealand 1899 Australasian Trained Nurses Association (ATNA) is established in NSW, Australia Foundation of International Council of Nurses (ICN) proposed by Ethel Gordon Fenwick at the Annual Conference of the Matron’s Council of Britain and Ireland 1900 The first issue of the American Journal of Nursing (AJN) is published 1901 The Nurses’ Registration Act 1901 is passed in New Zealand New Zealander, Ellen Dougherty, becomes the first registered nurse (RN) in the world The Victorian Trained Nurses Association (VTNA) is established in Victoria, Australia 1908 Public health nursing commences in both Melbourne and Sydney, Australia Ākenehi Hei is the first Māori RN and midwife in New Zealand 1909 The first three-year nursing diploma course starts at the University of Minnesota, US District nurses replace Māori health inspectors in New Zealand 1911 Queensland becomes the first state in Australia to register general and psychiatric nurses and midwives 1915 Establishment of the New Zealand Army Nursing Service 1919 The Nursing Act 1919 is passed in Britain 1939 New Zealand’s Nurses’ Registration Act is amended to allow men to train and register as nurses 1940 New Zealand assumes state responsibility for public general and psychiatric hospitals 1943 The Australian hospital ship Centaur sinks off the Queensland coast Get Complete eBook Download By email at student.support@hotmail.com DATE EVENT 1945 The psychiatric nurse qualification is acknowledged and administered by the Nurses and Midwifery Board in New Zealand 1956 Faith Thomas is one of the first Aboriginal people to complete her nursing training in South Australia 1970 The community health movement begins in Australia 1971 The Carpenter report recommends the transfer of nursing education to the tertiary education sector in New Zealand The Nursing Council of New Zealand (NCNZ) is established Sally Goold, Fred Hollows and Dulcie Flower establish the Aboriginal Medical Service 1973 Postgraduate nursing education commences at Victoria and Massey universities in New Zealand 1974 The amended Australian Nurses’ Registration Act 1974 (Tasmania) allows men to train, register and practise as midwives for the first time 1976 John Chapman is the first man to qualify as a midwife in Tasmania 1978 The Alma Ata Conference on Primary Health Care and Community Development, supported by the World Health Organization (WHO), is convened in Almaty (then called Alma-Ata), Kazakhstan 1983 Australia’s first diploma-level course is introduced by the College of Nursing NSW Government announces it will transfer pre-registration nursing to the tertiary sector by 1985 Medicare and universal health care is introduced by the Australian Government National Council of Māori Nurses is established in New Zealand 1984 Hawke Labor Government announces that all Australian registered nursing education will be transferred to the tertiary sector by 1992 1989 Last hospital training school closes in New Zealand 1990 Last intake of hospital-trained nurses in Australia 1991 Degree nursing programs replace the Diploma in Nursing in Australia 1992 Degree nursing programs replace the Diploma in Nursing in New Zealand The NCNZ introduces cultural safety as a curriculum requirement for all nursing students 1993 The first Māori midwives meeting in New Zealand 2000 Ngā Maia (Māori Midwives Aotearoa) is established in New Zealand 2004 Nurse practitioners receive practice rights in Australia and New Zealand 2010 Establishment of the Australian Health Practitioner Regulation Agency, which implements a national registration and accreditation system for health professionals, including nurses and midwives Pharmaceutical Benefits Scheme, prescribing rights for Nurse practitioners in Australia 2011 Royal College of Nursing (RCN) Australia and the College of Nursing unite to form the Australian College of Nursing (ACN) 2016 Medication prescribing rights for designated specialist RNs in New Zealand 2020 The International Year of the Nurse and Midwife COVID-19 becomes a pandemic The introduction of nursing training and the development of nursing care are frequently attributed to Florence Nightingale, who remains a much-celebrated individual in nursing circles. The following section highlights her contribution to nursing practice and education. It also identifies some of the inconsistencies in her practice. While Nightingale’s practices were innovative at the time, scientific and practice advances have naturally outdated some of her ideas in relation to patient care. Florence Nightingale (1820–1910) Florence Nightingale was born on 12 May 1820 in Florence, Italy into an affluent British family. The way she conducted herself during her life consistently reflected the ideas of her time – the Victorian era. This was a period of economic, political and social expansion for Britain, which contributed to the growth of the British Empire. Britain continued to colonise regions of the world, allowing the Empire to expand production and manufacturing at home. This was the time of the Industrial Revolution (Roux & Halstead, 2018). In 1844, Nightingale began studying in Germany and then developed her nursing practice on the European continent with French and German religious orders. She was subsequently appointed the superintendent of an English hospital for ailing governesses, which gave her an opportunity to practise and develop her form of nursing care. Nightingale maintained that control of the environment was essential for the restoration of health, and her care regimen included fresh air and cleanliness. She advocated rest and a quiet environment for patients. Get Complete eBook Download By email at student.support@hotmail.com 5 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y FIGURE 1-2 Male medical ward, Ipswich Central Hospital, Queensland, 1927 Figure 1-3 demonstrates how people were encouraged to spend time outdoors. Note that one person has a camp stretcher to rest on and another has a chair with the capacity to support and elevate their leg. MUSEUM VICTORIA [MM 003512] UNIT 01 In 1853, the Crimean War began. Newspapers reported that resources were scarce and that soldiers were living and dying in squalid conditions. Political pressure required action, and Nightingale was asked to take a team of 34 nurses to Turkey to oversee a military hospital at Scutari (Fee & Garofalo, 2010). This crucial time epitomises the popularised notion of Nightingale. To understand Nightingale’s nursing theory and the practices that led her to Turkey, it is essential to contextualise Nightingale within the time that she lived. One of the results of the Industrial Revolution in Britain was rapid urbanisation characterised by poor housing and sanitation, and the overpopulation of rapidly expanding city suburbs. These were filthy, diseased communities (Finkelman, 2019). In 19th-century Britain there were two general theories relating to the spread of infections and disease. The ‘theory of miasma’, which originated in the Middle Ages, argued that the vapours released from rotting organic materials were poisonous and the offending smell was the cause of disease. The ‘germ theory’, which originated in the 18th century, was a newer development in understanding disease. It was gaining some momentum but did not become the accepted theory until the start of the 20th century. Considering the stench and poor sanitation that permeated suburban Britain in the 19th century, it is understandable that health reformers believed that cleanliness and fresh air was the key to good health. IPSWICH HOSPITAL MUSEUM COLLECTION, PICTURE IPSWICH, QUEENSLAND Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com 6 SHUTTERSTOCK.COM/EVERETT HISTORICAL FIGURE 1-3 Nurses with patients in the grounds of Nhill Hospital, Victoria, 1928 FIGURE 1-1 Florence Nightingale in the Crimea The Nightingale principle of ‘fresh air and light’ continued to dictate nursing care into the 20th century. The image of the Ipswich ward presented in Figure 1-2 shows how people were kept in open wards with high ceilings and large windows that provided natural light and fresh air. The image of the Nhill Hospital in Nightingale supported the miasma theory over the germ theory (Fee & Garofalo, 2010), remaining committed to the principles of fresh air and a clean environment while arguing against the ‘new’ concepts of bacteria and viruses. As such, her achievements while in the Crimea remain contentious and a topic of historical debate. The standard accepted narrative is that she increased the survival rates of injured soldiers in her care (Fee & Garofalo, 2010), but this has been questioned in recent decades. It has been argued that infection and death rates at Nightingale’s hospital rose following her arrival (McDonald, 2013) due to the hospital being built over an open sewer (not unusual for 19th-century hospitals). Due to her misunderstanding of infection control, Nightingale did not correlate sanitation and illness, and conditions only improved after the War Office sent the Sanitation Commission to investigate the high death rates and subsequently ordered that the sewers be flushed. Following this, the death rates dropped dramatically (Fee & Garofalo, 2010). Get Complete eBook Download By email at student.support@hotmail.com Regardless, on her return to London Nightingale was celebrated. She was awarded prize money that she invested to develop nursing training at London’s St Thomas’ Hospital. Her nursing model required strict discipline. It supported the notion that nursing was a vocation for women and that nurses should be unquestioningly obedient to senior staff and doctors. It was in Nightingale’s time that nursing became increasingly identified as a female role offering middle-class women a respectable occupation and the opportunity of economic independence (McDonald, 2013). Nightingale was a prolific writer who published a series of nursing texts and wrote letters to various individuals in search of data understand health care needs, record statistics and to continue to reform practice across the Empire (Shellam, 2012). She also used a variety of techniques to advocate for improved health care, including political, administrative, educational and statistical methods. She became an iconic figure in her lifetime and remains a celebrated member of the nursing community today – we celebrate International Nurses Day each year on the anniversary of Nightingale’s birthdate. Her nursing theory will be revisited later in this chapter. NURSING CHECKLIST Nightingale’s basic principles of nursing education were: • placement of the program in an institution supported by public funds and associated with a medical school • affiliation with a teaching hospital, but also independent of it • a nursing program directed and staffed by trained nurses • a residency to teach students discipline and character. The sisterhoods Florence Nightingale’s biographers have often presented her as the sole reformer of modern nursing – indeed, as its founder – but this is far from the truth. There are several other reformers who contributed to the education and training of nurses in Nightingale’s time. While it is the experience of Britain, Australia and New Zealand that will be discussed here, it should be acknowledged that nursing reform occurred in various parts of the Western world during the same period. In the early 19th century, hospitals were not places where individuals chose to go. Along with asylums, they were places of last resort, places where the poor, homeless and destitute went for assistance, for shelter and to die. Most individuals paid private nurses to care for them in their home when they were ill or in need of midwifery services. All classes of society sought the assistance of private nurses although this was difficult for the very poor. They were autonomous practitioners and often competed with the medical profession for work (Finkelman, 2019). Nursing was not regulated at this time. It was not until the late 19th century that the certificated, uniformed woman based in a clean hospital environment began to be the dominant image of a nurse. It is worth noting that at the time men were excluded from this version of nursing. In the 19th century, diverse approaches to nursing practice and training existed. The Nightingale system of nursing training was but one of many. Some religious orders offered limited training that was usually only available to members of the order. In London, Anglican High Church nuns, known as ‘sisterhoods’, were the dominant model of nursing reform. These orders acted as social service agencies for their communities, providing care for those who could not support themselves. The church and sisterhoods worked for specific hospitals and developed training methods to support a medical practice that was beginning to make advances in disease management and surgery (Helmstadter & Godden, 2011). The Anglican nuns had a vocational drive to care for the acutely sick, disabled and vulnerable in their communities. The nuns expanded their training beyond their order and trained lay nurses (not part of a religious order). Both Australia and New Zealand benefited from this model of nursing training. Benefits included larger numbers of nursing students for the workforce and the alignment with other health professionals. Mary Weeden, who trained at London’s Charing Cross Hospital from 1878 to 1881, immigrated to Australia and was appointed matron of the Brisbane Hospital. She established the first comprehensive training program for the colony of Queensland. Grace Neill, who was largely responsible for campaigning for nursing registration in New Zealand, had been attributed as training at Nightingale’s St Thomas’ Hospital, but she trained under the Anglican nuns at St John’s Hospital from 1873 to 1876 (Helmstadter & Godden, 2011). Similarly, it was an All Saints sister, Helen Bowden, who established the first training school in the United States (US). For their time, the sisterhood hospitals took a unique approach to patient care, advocating for nurse–patient ratios to be established and for nurses to be self-directed, autonomous practitioners. But when the Anglican Church began to establish modern administrative practices in its hospitals, and because health care was funded by charitable organisations and by subscription, conflict arose between the sisterhood’s principles of practice and the economic reality of supporting its model of patient care and nursing training. It was determined to be too expensive to continue to fund. Due to such conflict and different health agendas, the Anglican nuns Get Complete eBook Download By email at student.support@hotmail.com 7 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 8 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com increasingly withdrew their services and training programs from London’s hospitals. This had two major outcomes. First, it allowed them to re-establish their practices in community-based environments (Helmstadter & Godden, 2011). Second, it opened the way for the Nightingale model to become more widely adopted. By the end of the 19th century, it had become the template for nursing training, creating a cheaper training program and more compliant nurses who infrequently challenged the decisions made by hospital administrators and medical officers. Nursing registration Professionalisation, training and education reform are common themes in nursing history. All three topics encompass the increasing demands made by nursing leaders from the late 19th century into the early 20th century. Medicine had been regulated in Britain from the 1830s and was beginning to make advances in professional standing and political influence, and in improving health care outcomes for people. Utilising scientific advances, medical research was developing new surgical and medical treatments. To support the medical model of care, medicine required the support of nurses trained specifically for hospital work. It was in the late 19th century that medicine began to advocate for hospital care to be the linchpin of health care services. It was an efficient method of administering complex treatments (Helmstadter & Godden, 2011). British nursing leaders had seen the advances made by medicine since it had become a formalised and regulated profession. They recognised the application and potential benefits for the nursing profession. Ethel Bedford Fenwick, matron of St Bartholomew’s Hospital, was the chief advocate for nursing registration in Britain. In 1887, she formed the British Nurses Association (BNA), which lobbied for such registration. The vision of the BNA was that registration would define nursing as a recognised profession, offering equal ranking with other professions and improving nurses’ social standing and rates of pay while disallowing non-trained nurses to continue to practise. Fenwick’s specific goal was to make nursing a legally recognised profession where only hospitaltrained women could call themselves a nurse. She wanted nursing to become a self-regulated, self-determining profession where doctors were not able to credential or determine nursing practice. Yet due to the complexity of the issue and the lack of female influence in political and economic circles at this time, her ambitions for nursing were not realised. She had to compromise, due to her dependence on the support of the medical profession and its influence in holding key positions within the BNA (Helmstadter, 2007). The presence of medicine within the structures of the BNA resulted in it determining the function, role and credentialling of nurses. Doctors wanted nursing training to support their interests, and nurses to just follow their orders. It would be over 50 years before nurses were able to determine their profession without the presence of medical officers on nursing boards. Nursing was being confined to hospital-based training and service delivery, and in the process it became increasingly subordinate to medicine. The educational structure of hospital training encouraged this subordination, isolating nursing from the communities that it had traditionally served – something medicine did not allow. Doctors maintained private practices that were based in the community and increasingly determined who was admitted to a hospital and who remained in their home. In 1888, the BNA asked NSW and New Zealand to form chapters of the organisation to encourage an expansion of its vision for nursing training and practice within the British Empire (Helmstadter, 2007). Fenwick’s world vision for advancing nursing was further apparent as she was the founder of the International Council of Nurses (ICN). To achieve nursing registration, the unqualified and untrained private nurse had diminished areas of employment, so there were several campaigns to discredit their work. However, the private nurse played a pivotal role in the community, attending births, caring for the sick and laying out the dead. Charles Dickens, the social commentator, social reformer and author, included an uncomplimentary depiction of the private nurse in The life and adventures of Martin Chuzzlewit (1844). Dickens characterised the private nurse as drunk, addicted to gin and snuff, immoral and of low character. Those requesting reform, formalised training and regulation used the characterisation to their advantage. Only now are historians starting to explore the practices of the time and questioning the validity of the depiction of the private nurse by Dickens and the supporters of nursing regulation (Colins & Kippen, 2003). Not everyone supported registration and the professionalisation of nursing. Florence Nightingale was one vocal critic of the plan. She did not support a written examination because it did not test a nurse’s moral or personal character. It also excluded a large group of nurses, those from the working class, who at this time had marginal literacy and numeracy skills. Interestingly, Australian and New Zealand nurses would achieve registration prior to nurses in Britain. An introductory history of nursing education in Australia and New Zealand Australia and New Zealand had established societies prior to European settlement. The ancestral owners had instituted complex methods to care for and treat Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y CHAPTER 01 COLLECTION MUSEUM SYDNEY HOSPITAL/SYDNEY EYE HOSPITAL the sick and injured. The complexity of Aboriginal, Torres Strait Islander and Māori peoples’ health care and treatments are only now beginning to be understood and appreciated (Best & Fredricks, 2021). In 1840, the British Crown and Māori chiefs in New Zealand established the Treaty of Waitangi (Kani Kingi, 2007). In contrast, Aboriginal and Torres Strait Islander peoples in Australian were not given any constitutional status (Lam, 2011). The impact of this is seen in the ongoing disparity of health outcomes between ancestral owners and their descendants, and non-Indigenous people. This history is important when considering nursing theorists such as Madeline Leininger (described later in this chapter) and the inclusion of First Peoples in nursing. Upon European settlement in Australia, convicts and soldiers offered care to the sick, injured and infirm (Cushing, 1997). The disparate demographic in Australia of an overpopulation of men compared with women, which lasted into the early decades of the 20th century, was the consequence of the transportation of predominantly male convicts. As a result, Australia has a rich history, yet to be fully explored, of male nurses, or attendants as they were often known. In fact, the first trained nurses to reach Australia were five Irish Sisters of Charity, who arrived in Sydney in 1838. Their practice was based in the community and did not offer any nursing training. It is important to acknowledge that men have always been nurses and there have only been very specific periods when they experienced social or legal exclusion from nursing. There are many traditional masculine working environments, such as religious orders, ships, armies and mines, where men have always been required to provide nursing care (O’Lynn & Tranbarger, 2012). Sydney Hospital opened in 1811, and was originally staffed by 23 male attendants and five female caregivers who were drawn from the reformed convict population. The hospital was managed by a board of directors who were elected annually by the subscribers. The administration was continually in conflict and mismanagement prevailed. The premises were in an awful state, with vermin, lack of water and poor sanitation. The nurses were often reported as being drunk while on duty. In 1867, Sir Henry Parkes, a prominent NSW politician, wrote to Florence Nightingale requesting the introduction of her model of nursing training to the Sydney Hospital (Godden, 2006). Consequently, Lucy Osburn (1836–91), pictured in Figure 1-4, who trained at St Thomas’ Hospital, arrived in Sydney in 1868 with five other Nightingale-trained nurses. Formal nursing training had arrived in Australia, and it immediately impacted on how nursing care was offered. 9 FIGURE 1-4 Lucy Osburn The Nightingale model was predominantly a female-centric model, so when Osburn became the matron of the hospital, she advocated the training of female nurses at the exclusion of males. This put her in conflict with previous administrators (Godden, 2006). New Zealand does not share a history of convict transportation with Australia. Instead, it was settled by the British when convict transportation was in decline. Until the 1860s, New Zealand had limited health services, primarily cottage hospitals in the settled regions. By the end of the 19th century, the role and function of nurses had become more defined as in Australia and the British model of nursing was introduced. Historically, nursing care in New Zealand, as elsewhere, had been performed in various environments, including institutional care, with which it has a long association. Men and women have long worked together in institutions, such as asylums and psychiatric hospitals. Asylum employees in the 19th century were given the title of ‘attendant’; although some women that worked in this environment were trained nurses. Asylum workers have often been represented as desperate individuals with no choice but to seek employment in such an institution. However, this is now being questioned. There were some attractive aspects of asylum work, such as it being an autonomous work environment with limited interference and supervision. It is often assumed that men were sought to work in asylums Get Complete eBook Download By email at student.support@hotmail.com Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com CHRISTCHURCH CITY LIBRARIES [CCL-PHOTOCD11-IMG0062] UNIT 01 because of the need to restrain patients, but it has become evident that asylum administrators sought skilled employees who had carpentry skills and other trades, or who could teach music and literacy to assist in keeping patients busy and calm (Monk, 2009). Although asylums required the participation of both men and women to deliver care to long-term patients, nursing registration and leadership did not always support this. New Zealand was the first country to register its nurses under the Nurses’ Registration Act 1901. This legislation defined nursing as a profession and began to legitimise nursing training as a requirement to identify and practise as a registered nurse (RN) (Evans, Nizette & O’Brien, 2017). The Nurses’ Registration Act required three years of training, at the completion of which the student had to sit a state examination (Wood, 2011). Part of the training involved the care of people with infectious diseases. When an epidemic broke out, nurses were sent to care for patients in tent hospitals or the meeting houses in Māori kainga (villages). It was a process of quarantining and isolating those who were infected. They could be refused admission to hospital, and in response hospital boards began setting up fever camps within the grounds of hospitals or on the edge of town. In 1913, a fever camp was established in an isolated northern region of the country, where three nurses offered 50 patients round-the-clock care and maintained cleanliness and infection barriers. Figure 1-5 illustrates the structure of a fever camp tent. It demonstrates the mobility and responsiveness of the fever nursing care model in going out to communities and setting up a portable hospital ward. FIGURE 1-5 Māori nurse at a tent hospital In New Zealand, fever nursing was part of every nurse’s training and reinforced the notion of self-sacrifice – a nurse ensuring patient comfort before their own (Wood, 2011). It became a nursing specialty in New Zealand. The introduction of nursing registration did not result in the immediate loss of private or domiciliary nurses. In fact, registration did not inhibit their ability to practise at all. But they were excluded from the register and could not identify themselves as a RN. Private nurses, like the one depicted in Figure 1-6, continued to offer care as they always had, but now people had the option of being cared for by a RN. Nurses could train in hospitals and after completing this they would usually practise out in the community. MUSEUM VICTORIA [MM 001739] 10 FIGURE 1-6 A private nurse at her private hospital The private nurse and fee-paying system for nursing care slowly came to an end once government began taking increased responsibility for hospital funding. In the 1940s, the New Zealand Government funded several health and welfare reforms, including accepting responsibility for general and psychiatric hospitals and introducing broad welfare support (Gage & Hornblow, 2007). In Australia, it was a sporadic process that began in 1944 when the Queensland Government offered free health care to all Queensland residents. Once such policy initiatives were enacted, nurses were increasingly required to work in full- or part-government-funded hospitals at collectively agreed pay rates. To gain employment in hospitals, nurses were required to be registered; they no longer had the capacity to be self-employed. The introduction of free or heavily subsidised health care complemented the demands of the medical profession. There was greater medical specialisation and advances in treatment, which resulted in more complex treatment regimens that had to be managed by nurses within the bounds of a hospital environment. Grace Neill (see Figure 1-7) was a much-celebrated nursing leader who was instrumental in achieving Get Complete eBook Download By email at student.support@hotmail.com NEW ZEALAND NURSES ASSOCIATION RECORDS REF-79-032-18/01-01. ALEXANDER TURNBULL LIBRARY, WELLINGTON, NEW ZEALAND/RECORDS/22852548 were also managed by administrators who were accountable to hospital patrons and subscribers. To place nursing within a broader political and social context, at the time of Federation in Australia in 1901 there was an atmosphere of industrial unrest. A decision by Justice Higgins in the Arbitration Court in 1907 assisted in settling the issue of wages. Justice Higgins ruled that every male worker should receive a minimum wage that was based on the cost of living for a worker and his family. This became known as the ‘Harvester decision’. The minimum wage was based on what was fair and reasonable rather than on what an employer was willing to pay (Hancock, 2013). Women were not covered by the basic wage, however, and on average earned 54 per cent of a male’s wage, even when they were doing the same job. The consequences of this decision are yet to be fully explored in relation to gender and nursing, but it could be argued that women were more appealing to employ by hospital boards because their wages could be considerably less than the set male minimum wage. It made health care cheaper. It was not until the late 1970s that the inequalities of the 1907 Harvester decision began to be fully addressed in Australia. FIGURE 1-7 Grace Neill was instrumental in establishing nursing registration in New Zealand registration for New Zealand nurses. But the Nurses’ Registration Act, which regulated nursing practice in New Zealand was an exclusionary Act that prohibited men from practising as nurses. Nursing training and registration was legally restricted to being a female occupation. The Act was finally amended in 1939. Australian states and territories, meanwhile, individually introduced nursing registration in the early decades of the 20th century. The legislation did not exclude men from seeking registration. However, Tasmania and Victoria did exclude men from training and registering as midwives. By the 1950s, men started campaigning against this legislation. This was a professionally inhibiting policy for men as it restricted their educational and professional opportunities to gain further qualifications and expand their practice options, including working in rural and remote communities (Pitman & Fitzgerald, 2011). In Australia, hospital administrators decided who would be accepted into a RN-training program. Men were accepted into nursing training, but it was at the discretion of the hospital matron. As already highlighted, to the detriment of the Anglican sisterhood hospitals in Britain, Australian hospitals TRENDS IN NURSING EDUCATION IN AUSTRALIA AND NEW ZEALAND Reforming nursing education has been openly discussed in New Zealand since the 1920s. Nursing training was based on an apprenticeship model – students were learning on-the-job, were the main source of labour and were confined to serving a specific hospital or health service. In 1970, a commissioned review of the New Zealand nursing training system began and in the following year the Carpenter report was presented to the government. It advocated for the education of nurses to be removed from hospitals and instead transferred to an educational institution. It was ultimately decided to transfer nursing education to the polytechnic and not the university system. The result was that nurses were restricted to the qualification of a diploma for the next 20 years. The Education Amendment Act 1990 finally enabled polytechnics to offer degree standard courses (Gage & Hornblow, 2007), and nursing is now an established academic discipline in New Zealand’s university system. For Australia, the journey was not as simple. The complexity of the federated states and a lack of political will slowed the process of nursing education reform. From the 1960s to the mid-1980s, there was a barrage of expert committee reports compiled at the state/territory and federal levels by government departments, nursing organisations and unions that Get Complete eBook Download By email at student.support@hotmail.com 11 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com recommended the transfer of nursing education to the tertiary education sector. The reports usually contained the same comments, especially that the Australian hospital training system was narrow and confined nursing to an illness paradigm. The hospital training model was designed to suit each hospital’s service needs rather than providing students with an understanding of nursing practice that serviced the community’s interests. Hospital-trained nurses had a limited understanding of public and community health or health services beyond the confines of the hospital where they were trained. Student nurses received limited teaching and were expected to take on responsibilities beyond what would reasonably be expected of a student, such as overseeing a ward. At this time, medical staff were also included in the delivery of education. The first diploma-level course in Australia was introduced by the College of Nursing in 1975. By 1982, every Australian state offered tertiary-based nursing programs that functioned in parallel to hospital nursing training; that is, there were two systems for educating and training Australian nurses (Dixson, 1999). In 1983, the NSW Government announced that all pre-registration nursing programs would be transferred to the tertiary sector from the beginning of 1985. Other Australian states/territories did not follow this lead, however, so in 1984 the Hawke Labor Government intervened and announced that all nursing programs had to be transferred to the tertiary sector by the end of 1992. The last intake of hospital-trained nurses in Australia took place in 1990. Until recently, midwifery in Australia was a post graduate certificate or a postgraduate degree. That is, all registered midwives were RNs who held additional qualifications related to midwifery practice. However, in 2000 the first direct entry courses for midwives were established. Graduates from these courses practise only midwifery, unlike their predecessors. The transfer of nursing education from the apprenticeship model to the higher education sector experienced difficulties. These included a conflict of ideas between practising RNs, educationalists and employers. Understanding the history of nursing education prepares nursing graduates to understand the context and experiences of those already in the health workforce. This promotes both resilience and communication for new graduates. Communication is known to directly impact patient safety (Sheldon & Hilaire, 2015). By understanding the complex historical relationship where medicine has historically dominated nursing, new graduates can employ strategies to minimise this tension. Graduates are learning techniques, such as graded assertiveness (Yianni & Rodd, 2017), and are supported by policy such as Ryan’s Rule (see ‘Nursing highlights’ box). NURSING HIGHLIGHTS RYAN’S RULE ‘Ryan’s Rule is a three-step process to support patients of any age, their families and carers, to raise concerns if a patient’s health condition is getting worse or not improving as well as expected. Ryan’s Rule applies to all patients admitted to any Queensland Health public hospital – including the emergency department – and in some Hospital in the Home (HITH) services’ (Queensland Government, 2018). Figure 1-8 illustrates the change in learning environments, with nursing students learning how to engage with documentation in the classroom prior to practising in the clinical setting, as opposed to undertaking the traditional apprenticeship model of nursing training. The apprenticeship model created nurses that were ‘work-ready’. The university system enhanced a broader scope of knowledge, advanced critical-thinking skills and identified undergraduates as students, not employees. CULTURAL COLLECTIONS, AUCHMUTY LIBRARY, UNIVERSITY OF NEWCASTLE UNIT 01 12 FIGURE 1-8 Students in the 1990s reading a file at the Newcastle College of Advanced Education, Australia Nurses originally rejected the academic content in nursing education because it was not evident in a skilled and task-oriented work environment. As an increasing number of qualified RNs entered the workforce and the student nurse employee disappeared, the structure of patient care was altered to suit the principle of total patient care, where the RN attended to all the care requirements of the people put into their care. This model is now being challenged. Team nursing and task orientation, which never completely left the health care environment, are increasingly becoming the accepted norm, maintaining different levels of nurses in the health care environment. Get Complete eBook Download By email at student.support@hotmail.com NURSING HIGHLIGHTS REGISTERED NURSE STANDARDS FOR PRACTICE Both Australian and New Zealand RNs are subject to standards for practice or competency domains. These assist in curriculum development for undergraduate degrees and ensure ongoing assessment of and critical reflection by practising RNs. Both countries apply four domains which have adopted very similar approaches in defining competence. New Zealand domains of competence: 1 professional responsibility 2 management of nursing care 3 interpersonal relationships 4 interprofessional health care and quality improvement. (NCNZ, 2022) ISTOCK.COM/STURTI One of the gains from the transfer of nursing education occurred in the establishment of nursing research. Research challenges accepted practices, improves patient care and outcomes, and establishes nursing as a unique body of knowledge that is incorporated into nursing care. This is discussed in more detail in Chapter 2. Expanded roles of nurses have been developed in response to greater demands for nursing services. Since the 1990s, nurses have actively assumed more responsibility for the delivery of health care. Evolving technology mandated nurses to continue to advance their knowledge base and skills. Nurses, as individuals and as members of professional organisations, are increasingly becoming involved in shaping policies for health care reform (see Figure 1-9). FIGURE 1-9 Through consultation and the exchange of information, nurses demonstrate their roles as autonomous professionals Today’s health care climate requires nurses to continually acquire knowledge and skills, and to work collaboratively with other health care professionals to deliver safe, competent patient care. In-service RN standards for practice: Thinks critically and analyses nursing practice. Engages in therapeutic and professional relationships. Maintains the capability for practice. Comprehensively conducts assessments. Develops a plan for nursing practice. Provides safe, appropriate and responsive quality nursing practice. 7 Evaluates outcomes to inform nursing practice. (NMBA, 2016) For more detail, refer to the standards and competencies presented in Chapter 11. 1 2 3 4 5 6 NURSING HIGHLIGHTS LEARNING OPPORTUNITIES Challenging learning opportunities in the employment setting include: ■ technology development ■ changing nature of health care and nursing science ■ interdisciplinary practice ■ changing delivery systems ■ new equipment and supplies ■ enlarged roles of nursing related to leadership, management, delegation, supervision, and legal and ethical demands on practice ■ increased cultural diversity in both workforce and patient profiles. education and staff development support the RN in acquiring, maintaining and increasing skills and practice to fulfil assigned responsibilities. Over the past few decades, postgraduate programs have prepared nurses in Australia and New Zealand for various roles as advanced practitioners. Nurses are now completing doctorates and contributing to improved nursing practices and patient care. Lifelong learning is essential to career development and competency achievement in nursing practice. They are also required to know how to obtain and use evidence-based knowledge to achieve quality health care outcomes for people and the community. Technology has expanded the delivery and scheduling flexibility of continuing education for nurses in different geographic sites. Accessibility to continuing education permits nurses to be flexible, factual, futuristic and functional critical thinkers. Refer to Chapter 4 for further clarification of critical thinking in nursing practice. Get Complete eBook Download By email at student.support@hotmail.com 13 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 14 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com The background of nursing education and professionalisation naturally progresses to the exploration of the theoretical foundation of nursing knowledge. This knowledge has defined the nursing profession in the past and continues to do so. Nursing has embraced a wide range of concepts and theories that support its professional identity: the development of theories and models is a relatively recent aspect of nursing. Nursing theory provides a perspective from which to define the what of nursing, to describe the who of nursing (who is the patient), when nursing is needed, and to identify the boundaries and goals of nursing’s therapeutic activities. Therefore, foundation concepts about nursing theory and its relevance to professional nursing will be discussed. THEORETICAL FOUNDATIONS Theory is fundamental to effective nursing practice and research. The use of theory to support practice is ongoing in nursing care, yet it is not always obvious. The following section of this chapter identifies some key points that may already be evident in your practice or that you plan to implement in future practice. What is a ‘theory’? A theory, by traditional definition, is an organised, coherent and systematic articulation of a set of statements related to significant questions in a discipline that are a set of concepts and their relationship to each other that offers descriptions, explanations, and predictions about phenomena. Meleis (2007, p. 37) The common reasoning in ‘theory’ is to describe, explain and predict relationships. A theory not only helps us to organise our thoughts and ideas, but may also communicate in a meaningful whole and direct us in what to do and when and how to do it. Theory is not confined to an academic context; it is used in everyday life and conversation. For example, when telling a friend about a mystery novel you are reading, you may have said, ‘I have a theory about who committed the crime’. Or you may have heard a sports coach saying to the players, ‘I have a theory about how to improve our performance’. The way in which this term is used in these statements is a useful way to think about the meaning of theory. The basic elements that structure a nursing theory are ‘concepts’ and ‘propositions’. What is a ‘concept’? A concept is the basic building block of a theory. A concept is a vehicle of thought. It is the term used to describe that thought or group of thoughts. A concept labels or names a phenomenon, an aspect of reality that can be consciously sensed or experienced. It is an observable fact and assists us in formulating a mental image of an object or situation. Concepts help us to name things and occurrences in the world around us and assist us in communicating with each other about the world. Independence, self-care and caring are just a few examples of concepts frequently encountered in nursing practice. By its nature, a concept is a socially constructed label that may represent more than a single phenomenon. For example, when you hear the word chair, a mental image that probably comes to mind is an item of furniture used for sitting. The word chair could represent many kinds of furniture for sitting, such as a desk chair, a highchair or an easy chair. Furthermore, the word chair could also represent the leader of a committee or the head of a corporation. The meaning of the word chair depends on the context in which it is used. In health care, the concept of wandering may be represented by words such as aimless and random movement, disorganised thought processes, and conversation that is difficult to follow. To be useful, the multiple meanings that often underlie a concept must be clearly understood and clearly defined within the context in which it is used. It is important to remember that the same concept may be used differently in various theories. For example, one nursing theory may use the concept of environment to mean all that surrounds a human being (the external environment), whereas another theory may use this concept to mean the external environment and all the biological and psychological components of the person. What is a ‘proposition’? A proposition (another structural element of a theory) is a statement that proposes a relationship between concepts. An example of a non-nursing proposition might be the statement ‘people seem to be happier in the springtime’. This proposition establishes a relationship between the concept of happiness and the time of the year. A nursing propositional statement linking the concept of helplessness and the concept of loss might be stated as ‘multiple and rapid losses predispose people to feelings of helplessness’. Propositional statements in a theory represent the theorist’s particular view of which concepts fit together and, in most theories, establish how concepts affect one another. Importance of nursing theories Why are there nursing theories? Nursing practice has been limited by its long association with task-oriented Get Complete eBook Download By email at student.support@hotmail.com Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y Nursing practice Nursing theory CHAPTER 01 work. As nursing education has evolved, there has been a need to categorise knowledge and to analyse patient-care situations. This allows the profession to communicate nursing practice in coherent and meaningful ways. Nursing theories can provide a framework for thought in which to examine situations. As new situations are encountered, this framework provides a structure for organisation, analysis, decision-making and critical thinking. In addition, nursing theories provide a structure for communicating with other nurses and with other members of the health care team. Nursing theories assist the discipline of nursing in clarifying beliefs, values and goals, and help to define the unique contribution of nursing to the care of patients. Nursing theory is not always evident in the practical environment, but it does have a connection with nursing research. Knowledge for nursing practice is developed through nursing research that, in turn, is used to either test existing theories or to generate new theories. Nursing research is a means by which nurses can explore and discover knowledge to advance nursing practice (Borbasi, Jackson & East, 2019). Nursing research can directly justify or challenge nursing practice. The following ‘Evidence-based practice’ box demonstrates the connection between theory and research findings and how this can be used to determine approaches to patient-centred nursing care in the clinical environment. The relationship between nursing practice, theory and research is depicted in Figure 1-10. These processes are closely related. Nursing practice is the focal point of the relationship. It provides the raw material for the ideas that are systematically developed and organised in the form of nursing theory. The ideas proposed by nursing theory must be tested and validated Nursing research FIGURE 1-10 Process of knowledge development. Nursing practice, theory and research are interdependent. Nursing theory development and nursing research activities are directed towards developing nursing practice standards. through nursing research. In turn, new knowledge that results from nursing research is used to transform and inform nursing practice. Alternatively, nursing practice generates questions that serve as the basis for nursing research. Nursing research, then, influences the development of nursing theory that, in turn, transforms nursing practice. For example, the ‘Neuman systems model’ (see ‘Betty Newman’ later in this chapter), provides clear direction for the researcher who is interested in ‘helping nurses to organize [sic] their practice regardless of who the clients are …’ (Lowry, Beckman, Gehrling & Fawcett, 2007, p. 227). When nurses explore various nursing theories, they may gain new insights into patient care, implement new care options, and stimulate innovative interventions (Meleis, 2017). Theoretical thinking can enhance and strengthen the role of a nurse. Learning more about specific nursing theories enables the EVIDENCE-BASED PRACTICE Title of study Findings Medication competence: a concept analysis Three defining attributes were identified: pharmacovigilant, effective skills competence, and interprofessionality. Antecedents, consequences, and empirical referents of the concept of medication competence were also highlighted. Author M Thelen Purpose To provide a thorough concept analysis of medication competence, within the context of nursing education. Also, to establish a clear definition of the concept for research purposes, and to improve the communication and use of the concept in health care practice. Methods The Walker and Avant concept analysis was utilized as a framework to develop a comprehensive understanding of the phenomena of medication competence in nursing education. 15 Implications This analysis may enhance the ability of nurse educators to effectively educate and assess medication competence and validates the importance of further research into medication competence in nursing students and other health care specialties. Further, it establishes a starting point for development of a valid and reliable tool. THELEN, M. (2022). MEDICATION COMPETENCE: A CONCEPT ANALYSIS. NURSE EDUCATION TODAY, 111, 1–6. HTTPS://DOI.ORG/10.1016/J.NEDT.2022.105292 Get Complete eBook Download By email at student.support@hotmail.com UNIT 01 16 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com nurse to relate more to one theory than another, or appreciate the ideas contained in several different theories. A specific theory may be used to help guide practice or choose a more eclectic approach and adopt ideas from several theories. Furthermore, some theories may be more appropriate for certain situations. All of these are valid positions to adopt. As the nurse gains expertise in practice, there is a potential to develop another nursing theory. SCOPE OF THEORIES and predictions put forth in a middle-range theory are intended to answer questions about nursing phenomena, yet they do not cover the full range of phenomena of concern to the discipline. A middlerange theory provides a perspective from which to view complex situations and a direction for interventions (Smith & Parker, 2014). An example of a middle-range theory is Peplau’s ‘theory of interpersonal relations’ (see ‘Hildegard Peplau’ later in this chapter). Micro-range theories Three different categories relate to the scope of theories: grand theories, middle-range theories and micro-range theories. This classification is applicable to both nursing and non-nursing theories. Additionally, within a research question, concepts are more specifically defined and propositions are more narrowly focused (Peterson & Bredow, 2020). Scope refers to the relative level of the specifics of a theory and the concreteness of its concepts and propositions. Grand theories A grand theory, also known as a ‘conceptual model’, focuses on phenomena of concern to the discipline. It provides a conceptual framework under which the key concepts and principles of the discipline can be identified. It is the broadest in scope, representing the most abstract level of development, and addresses broad phenomena within a discipline. Typically, a grand theory is not intended to provide guidance for the formation of specific nursing interventions, but rather provides an overall framework for structuring broad, abstract ideas (Smith & Parker, 2014). An example of a grand theory is Jean Watson’s ‘theory of caring’ (see ‘Jean Watson’ later in this chapter). Middle-range theories A theory that has a narrower focus than a grand theory is known as a middle-range theory. It provides an effective bridge from grand theories to provide description and explanation of specific nursing phenomena. Descriptions, explanations A micro-range theory is the most concrete and narrow in scope. A micro-range theory is also known as ‘practice level theory’, owing to the role it plays in researching situation-specific theory. Based on the grand and middle-range theories, micro-range theories view phenomena in the everyday practice of nurse– patient interactions. An example of a micro-range theory could be: Adequate social support systems are effective for children with chronic health conditions. The theoretical basis of using social support systems would then be useful for developing policy when caring for children with chronic health conditions. EVOLUTION OF NURSING THEORY The work of early nursing theorists in the 1950s focused on the traditional and mechanistic tasks of nursing practice. Attempting to establish nursing as a credible profession within the prevailing view of science, many nursing theorists were pioneers for conceptualising the aims and actions of the nursing profession during the 1960s through to the 1980s. The challenge was to make nursing practice, theory and research to match both the science and the art of nursing. Concepts related to the art of nursing included the ‘value of caring’, ‘interpersonal relationships’ and the ‘aesthetics of practice’. Table 1-2 provides a chronological summary of the development of nursing’s theory base through the contributions of noted theorists and influential leaders in nursing. TABLE 1-2 Chronology of nursing theory development DATE THEORIST THEORY/PUBLICATIONS 1859 Florence Nightingale Notes on nursing: what it is and what it is not 1952 Hildegard Peplau Interpersonal relations in nursing 1964 Basic principles of patient counselling 1992 1955 ‘Interpersonal relations: a theoretical framework for application in nursing practice’ Virginia Henderson Textbook for the principles and practice of nursing (with Bertha Harmer) Get Complete eBook Download By email at student.support@hotmail.com DATE THEORIST THEORY/PUBLICATIONS 1966 The nature of nursing: a definition and its implication for practice, research and education 1991 The nature of nursing: reflections after 20 years 1960, 1968, 1973 Faye Abdellah Patient-centred approaches to care (with Beland, Martin & Matheney) 1961, 1990 Ida Jean Orlando (Pelletier) The dynamic nurse–patient relationship 1966, 1971 Joyce Travelbee Interpersonal aspects of nursing 1969, 1973 Myra Levine Introduction to clinical nursing 1989 ‘The four conservation principles: twenty years later’ 1991 ‘The conservation principles: a model for health’ 1970 Martha Rogers 1980 An introduction to the theoretical basis of nursing ‘Nursing: a science of unitary humans’ 1989 ‘Nursing: a science of unitary human beings’ 1971, 1980, 1988, 1991 Dorothea Orem 1980 Nursing concepts of practice ‘The behavioral systems model for nursing’ 1976, 1984 Callista Roy Introduction to nursing: an adaptation model 1979, 1980 Callista Roy & Heather Andrews The Roy adaptation model 1987 Theory construction in nursing: an adaptation model 1991 The Roy adaptation model: the definitive statement 1976 Josephine Paterson & Loretta Zderad Humanistic nursing 1978 Madeline Leininger Transcultural nursing: concepts, theories and practice 1980 Caring: a central focus of nursing 1988 Leininger’s theory of nursing: culture care diversity and universality 1979 Jean Watson Nursing: the philosophy and science of caring 1985 Nursing: human science and human care 1988 ‘New dimensions of human caring theory’ 1989 ‘Watson’s philosophy and theory of human caring in nursing’ 1972 Betty Neuman 1982, 1989, 1995 1981, 1989 ‘The Betty Neuman health care systems model: a total person approach to patient problems’ The Neuman systems model Rosemarie Parse 1998 Man-living-health: a theory of nursing ‘The human becoming school of thought: a perspective for nurses and other health professionals’ 1982, 1996 Nola Pender Health promotion model A complementary counterpart to the models of health protection theory 2000 Afaf Ibrahim Meleis Transitions theory: multiple dimensionality of transition experiences 2003 Katherine Kolcaba The comfort theory 2003 Anne Boykin/Savina Schoenhofer The theory of nursing as caring: a model for transforming practice ‘Persons are caring by virtue of their humanness’ Since the early 1950s, many nursing theories have been systematically developed to help describe, define and explain nursing. Each of these established theories provides a unique perspective, and each is distinct and separate from other nursing theories in its view of nursing phenomena. An overview of several nursing theories is presented later in the chapter. Get Complete eBook Download By email at student.support@hotmail.com 17 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 18 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com Reflecting changes in global awareness of health care needs, several nursing theorists projected perspectives for nursing unifying the notion of nursing as both an art and a science. Noted nursing theorists such as Leininger, Watson, Rogers, Parse and Newman have urged the discipline of nursing to embrace the view that is seen as holistic, humanistic, patient focused and grounded in the notion of caring as the core of nursing. Use of theories from other disciplines In addition to using theories specifically constructed to describe, explain and predict the phenomena of concern to nursing, the nursing profession has long used and acknowledged the value of theories from other disciplines. A discipline is a field of study. Theories from biological, physical and behavioural sciences are commonly used in the practice of nursing. For example, non-nursing theories such as Maslow’s ‘hierarchy of basic human needs’ and Erikson’s ‘theory of human development’ have been, and continue to be, useful in nursing practice. These non-nursing theories are often incorporated into nursing practice together with specific nursing theories. When used in conjunction with nursing theory, a non-nursing theory is transformed by the unique approach of adopting a nursing perspective. This perspective provides the specific framework or viewpoint in which to use theories and knowledge from other disciplines. Knowledge development in nursing Theories represent the most concrete conceptual component of a discipline. Several theories that share a common view of the world can be grouped together to form a paradigm. A paradigm is a particular viewpoint or perspective. Each discipline has a defined metaparadigm. The term originates from two Greek words, meta meaning ‘with’ and paradigm meaning ‘pattern’. A metaparadigm is the unifying force that names the phenomena of concern to each discipline. The metaparadigm concepts provide the boundaries and limitations of a discipline, identify the common viewpoint that all members of a discipline share, and help to focus the activities of the members of that discipline. Disciplines are distinguished from each other by differing metaparadigm concepts. Metaparadigm of nursing Nursing is a complex activity characterised by relationships. These relationships can be conceptualised and provide structure. The major concepts that provide structure to the domain of nursing are ‘person’, ‘environment’, ‘health’ and ‘nursing’. NURSING CHECKLIST • ‘Person’ refers to the recipient of nursing care, which can involve individuals, families, groups and the wider community. • ‘Environment’ is the internal and external surroundings that influence the person. • ‘Health’ is the level of wellbeing and wellness of the person. • ‘Nursing’ is the characteristics, influences, skills and actions of the nurse(s) providing care for the person. These metaparadigm elements name the overall areas of concern for the nursing discipline. Each nursing theory presents a slightly different view of the metaparadigm concepts. To clearly define the broadness that a metaparadigm offers a discipline, consider for a moment the different nursing practice required by a school nurse, an emergency room nurse or a psychiatric nurse. Though they care for different groups within our community, they still have some unifying factors. They all work as RNs and have a shared professional identity. Regardless of the setting or the type of person involved, each nurse is concerned with the person, environment, health and nursing. Nursing’s metaparadigm is shared by all nurses despite differences in their individual practices. Nursing’s metaparadigm can be distinguished from that of other helping professions. For example, the metaparadigm of medicine focuses on pathophysiology and the curing of disease. Nursing’s metaparadigm is broader and focuses on the person, health, the environment and the practices of nursing. The metaparadigm of a discipline identifies common areas of concern. A paradigm is a particular way of viewing the phenomena of concern that have been delineated by the metaparadigm of the discipline. The term ‘paradigm’ stems from the seminal work of Kuhn (1970), who referred to a paradigm as a worldview of a discipline of study. Paradigms in nursing The ‘prevailing paradigm’ in a discipline represents the dominant viewpoint of concepts. This viewpoint is supported by theories and research that for the time being adequately address the concerns of the discipline. By consensus, the community of scholars in a discipline accepts and agrees on a particular viewpoint or worldview. When new theories and research surface that challenge the prevailing paradigm, a new paradigm emerges to compete with the prevailing worldview. To explore the relationship between metaparadigms, paradigms and theories, refer to Get Complete eBook Download By email at student.support@hotmail.com Figure 1-11. In this figure there are two paradigms. The first is the totality paradigm, which is centred on the person, who is defined as a combination of biological, psychological, social and spiritual features, and who is in constant interaction with the environment to accomplish goals and maintain balance. (Note: many of the nursing theories developed to date have a view of the discipline of nursing that fits the totality paradigm.) Metaparadigm concepts (person, environment, health, nursing) Paradigms Totality paradigm Simultaneity paradigm Examples of theories Examples of theories Imogene King Dorothea Orem Sr Callista Roy Betty Neuman Madeleine Leininger Jean Watson Martha Rogers Rosemarie Parse Margaret Newman (Parse, 2000). Nursing’s goals in the simultaneity paradigm focus on the quality of life from the person’s perspective. Designation of illness by societal norms is not a significant factor. The authority and prime decision maker regarding nursing is the person, not the nurse (Parse, 2000). Clearly, these two paradigms represent very different viewpoints. These differences give rise to different methods of inquiry and practice and provide sufficient scope to encompass all disciplinary activities. Theory development and research continue within the discipline of nursing. Some nursing scholars argue about the structural elements of the discipline, some debate the value of competing paradigms, and some present alternative metaparadigm elements. Yet with all the uncertainty that is created by these questions and alternative ideas, the ongoing dialogue promotes the development of nursing as a profession with person-centredness remaining the goal of practice. SELECTED NURSING THEORIES FIGURE 1-11 Hierarchy of knowledge development in nursing. In the hierarchical arrangement of knowledge development in a discipline, the metaparadigm concepts are the most abstract. Theories represent the most concrete level in this hierarchy. In the competing paradigm, the simultaneity paradigm, the person–environment interaction is viewed very differently. The simultaneity paradigm is centred on understanding that humanity cannot be separated from the entirety of the universe, as both change continuously in innovative, unpredictable ways whereby health is defined by the individual This chapter identifies many nursing theories, frameworks and models. Further examination of selected theories will discuss the concepts of each (see Table 1-3). The theories discussed have been selected because they represent the development of nursing’s scientific thought. As previously discussed, nursing theories serve several essential purposes to enhance nursing’s scientific knowledge. According to DonohuePorter (2014, p. 331), ‘theory can improve care for our patients, build bridges across disciplines, demonstrate vitality for the profession for students, and strengthen nursing interrelationships’. Examples are provided throughout the following discussion regarding the contributions of nursing theories to nursing practice, education and research. Many nursing theories relating to midwifery and mental health nursing are not included but are of significance. Some of the theories complement the nursing process (see Chapters 4–9 for detailed information on this topic). TABLE 1-3 Summary of selected nursing theorists’ major concepts THEORIST AND MODEL PERSON ENVIRONMENT HEALTH NURSING Nightingale (1859) Environmental theory Physical, intellectual and spiritual being unable to manipulate the environment to promote health Physical elements that affect the healing process: cleanliness, light, pure air and water, comfort State of wellbeing using one’s powers to the fullest extent To facilitate healing and restore health by manipulating the person’s environment Peplau (1952) Interpersonal process Developing organism living in an unstable equilibrium and striving to reduce anxiety External factors and significant others Interpersonal processes that facilitate forward movement of the personality To develop interaction between the nurse and the person Henderson (1955) Basic needs Biological being, with oneness of mind and body, who has 14 fundamental needs The aggregate of all external conditions affecting life and development Wholeness; the ability to function independently in relation to 14 needs To assist the person (well and sick) to perform the 14 essential functions Get Complete eBook Download By email at student.support@hotmail.com 19 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 20 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com THEORIST AND MODEL PERSON ENVIRONMENT HEALTH NURSING Levine (1969) Conservation theory Who the person knows themself to be Context in which the person lives his or her life Response of the person to the environment To use conversation activities aimed at optimising the person’s resources Rogers (1970) Science of unitary beings A unified, irreducible whole; more than the sum of the parts Pandimensional energy field integral with the human energy field Patterns of living in harmony with the environment; defined by the culture or individual Science and art; the art of nursing is the creative use of science for human betterment Orem (1971) Self-care deficit theory A unity who functions biologically, symbolically and socially, and whose functioning is linked with the environment Linked to the individual, forming an integrated system State in which the individual is structurally and functionally whole A triad of interrelated action systems Roy (1976) Adaptation model Bio-psychosocial being interacting with a dynamic environment Internal and external conditions that surround and affect individuals State or process of being or becoming an integrated and whole person through adaptation To support the individual’s adaptation to stimuli Paterson and Zderad (1976) Humanistic nursing Process of becoming in an environment of time and space Awareness of the individual’s uniqueness and commonality with others State of becoming; wellbeing, rather than freedom from disease To respond to human needs and build humanistic nursing science Leininger (1978) Transcultural caring theory Caring, cultural beings Interrelated, interdependent systems of a society State of wellbeing that is culturally defined To provide care; caring is the central, unifying domain for nursing knowledge and practice Neuman (1972/1995) Systems model Holistic patient; dynamic composite of interrelationships among physiological, psychological, sociocultural, developmental and spiritual variables Internal and external factors affecting and affected by the system Health and wellness are a condition or degree of system stability To assist patient adjustments required for an optimal wellness level through accuracy in the assessment of effects and possible effects of environmental stressors Watson (1979/1989) Human caring theory Person possesses three spheres: mind, body and soul; strives to actualise the higher self Internal and external variables Unity and harmony within the mind, body and soul To assist people attain a higher degree of harmony by offering caring relationships that patients can use for personal growth and development Parse (1981/1995) Human becoming theory An open being, coexisting with the environment Inseparable from the individual; humans and the environment interchange energy and influence one another’s rhythmical patterns of relating An open process of becoming that encompasses a lived experience, synthesis of values, and rhythmic process of being or becoming A discipline, the practice of which is a performing art Nightingale’s nursing theory Nightingale did not develop a theory of nursing as theory is defined today (see ‘Scope of theories’), but she provided the nursing profession with the philosophical basis from which other theories have emerged and developed. Nightingale’s ideas about nursing have guided both theoretical thought and actual nursing practice throughout the history of modern nursing. Nightingale considered nursing like a religious calling, one to be answered only by women with an all-consuming and passionate response. She considered nursing to be both an art and a science (Nightingale, 1946). Her writings did not focus on the nature of the person but did stress the importance of caring for the ill person rather than caring for the illness. In Nightingale’s view, the person was a passive recipient of care, and nursing’s primary focus was on the manipulation of the person’s environment to maintain or achieve a state of health (Nightingale, 1946). Get Complete eBook Download By email at student.support@hotmail.com Early nursing theories The development of nursing’s theoretical base has progressed in a methodical and systematic, albeit slow, fashion. Knowledge development is an ongoing process that is often influenced by driving forces outside the discipline of nursing. The early nurse theorists were not attempting to address the metaparadigm concepts because initial consensus on these had not yet been achieved. Rather, these theories were attempting to answer the question ‘What is nursing?’ Hildegard Peplau Hildegard Peplau, a psychiatric nurse, combined her research and experience to develop the ‘theory of psychodynamic nursing’, published in Interpersonal relations in nursing (1952). Drawing from her own knowledge and that from other disciplines, Peplau defined the concepts and stages involved in the development of the patient relationship. From that relationship, she identified the roles of the nurse as stranger, resource person, teacher, leader, surrogate and counsellor. Peplau developed a middle-range theory with a focus on both nursing and the person without incorporating all aspects of the metaparadigm into her theory. Although other theories may view the nurse– patient relationship differently, the primacy of this relationship in nursing has remained. Virginia Henderson Virginia Henderson’s definition of nursing first appeared in 1955. The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. Henderson (1966, p. 15) Henderson attempted to identify those basic human needs viewed as the basis of nursing care. These needs include the need to maintain physiologic balance, to adjust to the environment, to communicate and participate in social interaction, and to worship according to one’s faith. Henderson’s ‘14 basic needs’ were published in the Textbook of the principles and practice of nursing. Henderson viewed the nursing role as helping the person from dependence to independence. As an early nursing theorist, she did not intend to develop a theory of nursing, but rather attempted to define the unique focus of nursing. Henderson’s emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs (Fawcett & DeSanto-Madeya, 2013). Faye Abdellah Faye Abdellah expanded Henderson’s 14 needs into ‘21 problems’ that she believed would serve as a knowledge base for nursing. Throughout her career, she strongly supported the idea that nursing research would be the key factor in helping nursing to emerge as a true profession (Fawcett & DeSantoMadeya, 2013). This foundational research identified common needs or problems that have supported the development of what we now know as problem identification, or nursing diagnoses. For further information on this topic, refer to Chapter 6. Joyce Travelbee Joyce Travelbee, an educator and psychiatric nurse, was influenced by the philosophy of existentialism, a movement that is centred on individual existence in an incomprehensible world, the role that free will plays in it, and the search to find meaning in life’s experiences. She extensively developed the ideas of ‘sympathy’, ‘empathy’ and ‘rapport’ in which the nurse could begin to comprehend and relate to the uniqueness of others. Her work focused on the human-to-human relationship and on finding meaning in experiences, such as pain, illness and distress (Fawcett & DeSanto-Madeya, 2013). Travelbee based most of her theory on her own experiences and readings, and first published her 1966 work in Interpersonal aspects of nursing. Josephine Paterson and Loretta Zderad The work of Josephine Paterson and Loretta Zderad, like that of Travelbee, emphasised the humanistic and existential basis of nursing practice. Their theory encompasses the person’s state of wellness rather than freedom from disease. According to Paterson and Zderad, theory developed from the practice of nursing. Although Paterson and Zderad had some impact with their theory, they did not gain wide popularity and application in nursing. The work of these three theorists most appropriately fits the simultaneity paradigm (Fawcett & DeSanto-Madeya, 2013). Theorists such as Watson, Rogers, Parse, Fitzpatrick and Newman, who have an existential orientation, are rediscovering the merits of Travelbee, Paterson and Zderad. Contemporary nursing theories Early nursing theorists attempted to answer the question ‘What is nursing?’ Contemporary theorists address the metaparadigm concepts in more depth, focus more specifically on nursing actions, and Get Complete eBook Download By email at student.support@hotmail.com 21 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 22 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com attempt to answer, ‘When is nursing needed?’ The work of theorists such as Levine, Orem and Roy form the theoretical basis for many interventions in current nursing practice. Myra Levine Myra Levine’s conservation theory is directly grounded in nursing practice. Levine advocated in 1969 that nursing is a human interaction and proposed four conservation principles to describe, explain and predict the phenomena of concern to nursing. Levine (1989) published a substantial change and clarification about her theory, ‘The conservation principles: twenty years later’ (1989). Conservation is derived from a Latin word meaning ‘to keep together’. Levine believed in the wholeness of the human being, and the primary focus of conservation is to maintain that wholeness. Levine viewed nursing as assisting people with the conservation of their uniqueness by helping them to adapt appropriately. These principles are designed to link concepts to a cohesive framework within which nursing practice in different environments can be performed (Levine, 1996). In Levine’s view, the person is who the person knows themself to be, and the environment is the context in which the person lives their life. In addition, health is socially defined, and the goal of nursing is based on the four conservation principles. The four conservation principles are: ‘conservation of energy’, ‘conservation of structural integrity’, ‘conservation of personal integrity’ and ‘conservation of social integrity’. Levine did not operationally define and relate the metaparadigm concepts in her theory because her original work was initially intended to be a medical-surgical nursing textbook and not a developed nursing theory. Levine’s theory is pragmatic, and the conservation principles can be applied to most nursing situations. Her theory, which is congruent with the characteristics of the totality paradigm, is appropriate for use in situations in which the nurse has had either long-term or short-term relationships. Dorothea Orem In attempting to plan a nursing curriculum for licensed practical nurses, Dorothea Orem was searching for a practical framework to organise nursing knowledge. She focused on the questions ‘What is nursing?’ and ‘When do people need nursing care?’ and from this she derived that people need nursing when they are unable to care for themselves. In 1971, she presented the ‘self-care deficit theory’ of nursing in the book Nursing concepts of practice and continually revised and updated her theory until her death in 2007. Orem’s theory incorporates the medical model rather than rejects it, centres on the individual, is problem oriented, and is easily adaptable in varied clinical situations. As a grand theory, it has three interconnecting theories: ‘theory of self-care’, ‘theory of self-care deficit’ and ‘theory of nursing systems’. Self-care is a learned behaviour and a deliberate action in response to a need (Orem, 1991). This theory implies that nursing care is needed when people are affected by limitations that do not allow them to meet their self-care needs. The relationship between the nurse and the person is established when a self-care deficit is present. Self-care deficits, not medical diagnoses, determine the need for nursing care. This is a compensatory nursing system, where both the nurse and person perform care measures. For example, the nurse can assist the post operative person to ambulate. They may bring in a meal tray for the person who is able to feed themself. The nurse compensates for what the person cannot do. In the supportive-educative nursing system, actions are to help people develop their own self-care abilities through knowledge, support and encouragement. They must learn and perform their own self-care activities. The supportive-educative nursing system is being used when a nurse guides a new mother to breastfeed her baby (Orem, 1991). Orem focused primarily on the needs of the person and the action of nursing to meet those needs. Lesser emphasis was placed on defining health and the environment. Her theory is useful in determining the kind of nursing assistance needed by the person and, therefore, has merit as a theory that guides nursing practice. Orem’s theory is consistent with the characteristics of the totality paradigm. Betty Neuman Betty Neuman was motivated to develop a model to respond to the expressed needs of graduate students at the School of Nursing, University of California, as course content that would present nursing problems prior to content emphasising nursing problem areas. The ‘Neuman systems model’ was first published in 1972 as a teaching approach to patient problems (Neuman, 1995). The Neuman systems model focuses on the wellness of the patient system in relation to environmental stressors and reactions to stressors. Stressors were categorised as follows: ■ Intrapersonal stressors: those that occur within ■ Interpersonal stressors: those that occur between individuals ■ Extrapersonal stressors: those that occur outside the person. (Neuman, 1995) Get Complete eBook Download By email at student.support@hotmail.com Nursing interventions focus on retaining or maintaining system stability on three preventive levels: ■ Primary prevention: protecting the normal line of defence and strengthening the flexible line of defence. ■ Secondary prevention: strengthening internal lines of resistance, reducing the reaction, and increasing resistance factors. ■ Tertiary prevention: readapting, stabilising and protecting the reconstitution (adaptation to a stressor) or return to wellness following treatment. (Neuman, 1995) The Neuman systems model is consistent with the characteristics of the totality paradigm. Madeleine Leininger Madeleine Leininger first published her ‘theory of cultural care diversity and universality’, Transcultural nursing: concepts, theories, and practices, in 1978. Leininger experienced what she describes as a cultural shock when she realised that recurrent behavioural patterns in children appeared to have a cultural basis. This experience was the catalyst for her idea of transcultural nursing. The original theory based on her reflections provides for specific nursing interventions to assist people of diverse cultures: ■ Cultural care preservation or maintenance: the nurse accepts and complies with the person’s cultural beliefs. ■ Cultural care accommodation or negotiation: the nurse plans, negotiates, and accommodates the person’s culturally specific food preferences, religious practices, kinship needs, childcare practices, and treatment practices. ■ Cultural care repatterning or restructuring: the nurse is knowledgeable about cultural care and develops ways to repattern or restructure nursing care to suit the needs of the person. Leininger (1991, pp. 41–2) Transcultural nursing theory has identified that culturally based care is the essence of nursing practice because it contributes to healing (health) and wellbeing and accommodates people who face dying or death. Leininger’s theory is consistent with the characteristics of the totality paradigm. Refer to Chapter 21 for a comprehensive discussion of cultural diversity. CULTURALLY SAFE CARE Belief systems Culturally safe care requires the nurse to acknowledge and deliver care appropriate to the person’s cultural belief system. This means the nurse needs to hear the person and consider their world and daily experiences. Think of reasons why this is an important concept to develop in your practice as a RN. Sister Callista Roy Sister Callista Roy combined general systems theory with adaptation theory to produce the ‘Roy adaptation model’. Roy first published her model in the 1970s. This model has since continued to be refined and developed. She defines a person as a bio-psychosocial being in constant interaction with a changing internal and external environment. Nursing attempts to alter the environment when the person has challenges adapting or has an ineffective coping response. The purposes of adaptation are ‘survival’, ‘growth’, ‘mastery’ and ‘reproduction’. Adaptive responses contribute to these goals, whereas ineffective responses may threaten the person’s survival, growth, reproduction or mastery (Roy & Andrews, 1999). Roy’s new definition of adaptation is ‘the process and outcome whereby thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to create human and environmental integration’ (Roy & Andrews, 1999, p. 30). Roy’s views of the person and the person– environment interaction represent characteristics of the totality paradigm. Theories for the new worldview of nursing There has been a gradual change in the nursing paradigm, which is centred on caring. Theories for the new worldview of nursing describe, explain and predict the phenomena of concern to nursing from a unique, more holistic perspective. In this new worldview, the person has primacy and the patient– environment interaction is of utmost importance. Theories by Jean Watson, Martha Rogers and Rosemarie Parse exemplify the new worldview. Jean Watson In the 1980s, Jean Watson developed the ‘theory of human caring’, which focuses on the art and science of human caring: ‘Caring is the essence of nursing and the most central and unifying focus of nursing Get Complete eBook Download By email at student.support@hotmail.com 23 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 24 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com practice’ (Watson, 1985, p. 33). This theory offers a new way of conceptualising and maximising humanto-human transactions that occur in nursing practice. Watson’s drive in this theory is to challenge nursing to create moments of caring through human-to-human interaction in the fast-paced health care environment of today. Martha Rogers Martha Rogers, a pioneer in the development of nursing’s unique knowledge base, developed the highly abstract ‘theory of the science of unitary human beings’: ‘Nursing is a learned profession: a science and an art. A science is an organised body of abstract knowledge. The art involved in nursing is the creative use of science for human betterment’ (Rogers, 1990, p. 198). Rogers’ contribution to the discipline of nursing was revolutionary and provided new directions for the practice of nursing. Rogers (1970) first presented her ideas in the book An introduction to the theoretical basis of nursing. Rogers’ theory is consistent with the principles of the simultaneity paradigm. Rosemarie Parse Rosemarie Rizzo Parse began her work creating a theory grounded in the human sciences to enhance nursing knowledge. Initially, Parse’s theory was of ‘man-living-health’, which was first published in 1981 as Man-living-health: a theory of nursing. The theory was renamed the ‘theory of human becoming’ in 1990. Parse refined her theory to include a school of thought in the second edition of her book (1998), The human becoming school of thought: a perspective for nurses and other health professionals. The goal of nursing from the human becoming perspective is quality of life (Parse, 2006). The principles of the theory of human becoming are as follows: ■ Structuring meaning multidimensionality (i.e., based on the belief that we live in many realms of the universe all at once) is co-creating reality through the language of valuing, imaging and attaching differing degrees of significance. ■ Co-creating rhythmic patterns of relating is living the paradoxical unity of revealing–concealing and enabling–limiting while connecting–separating. This is a movement to greater diversity of experience. ■ Co-transcending is sharing and reaching out beyond the self. This is a process of transforming. Parse’s theory is consistent with the principles of the simultaneity paradigm. Katherine Kolcaba Katherine Kolcaba reflects the changed worldview in her comfort theory (2003), which returns to the nursing theory origins of Florence Nightingale who argued for the importance of the manipulation of the health care environment to create a caring environment. Kolcaba argues that health care services are increasingly centred on technological advances and machinery to the detriment of the person’s comfort. The comfort theory is organised in three forms and with four contexts of comfort. The three forms are ‘relief’, ‘ease’ and ‘transcendence’. The four contexts are ‘physical’, ‘psycho-spiritual’, ‘environmental’ and ‘sociocultural’ (Krinsky, Murillo & Johnson, 2014). Continuing evolution of nursing theory The context of health care changes daily. Individual needs and problems often change on a minute-byminute basis. Knowledge, information and technology in both health care and nursing are growing at unprecedented rates. Faced with these advances, nursing strives to preserve the notion of caring in health care. Theories are needed to organise knowledge and to guide nursing research, which is then incorporated into nursing practice. Clinicians are focused on the delivery of care and ongoing education assists them to identify and apply nursing theory. The seeming complexity of theory and the practicalities of the clinical environment create division. The nursing process, a model for planning and defining care, has been integrated into many nursing frameworks and theories. Throughout your journey as a student and clinician, you may discover that specific theories will be more appropriate for certain clinical situations connecting theory and practice. In all cases, theories selected for application to nursing practice should be congruent with your own beliefs and values and reflect the needs of the person for whom you provide care. The current emphasis is to apply existing theories to practice and expand existing nursing theories by including concepts such as cultural diversity, spirituality, family and social change. It is important to acknowledge that this process is not confined to nursing theories and utilises a variety of theories and philosophies from other disciplines. The theories that are flexible and adaptable to new discoveries in nursing practices will have the opportunity to develop and assist in defining professional nursing. Those theories that are too theoretical or rigid and difficult to apply or understand in a practical sense will continue to be ignored by clinically based nurses. Get Complete eBook Download By email at student.support@hotmail.com EVIDENCE-BASED PRACTICE Title of study ‘Mind the gap’: exploring paediatric nurses’ perceptions of the theory and practice of caring for children and families Authors E Yehene, G Goldzweig, H Simana and A Brezner Purpose To investigate how paediatric nurses interpret and conceptualise theoretical underpinnings and daily practice scenarios pertaining to their role in pediatric care. Methods Paediatric nurses completed surveys in which they were asked to what extent practices related to paediatric concepts are expected from their role or are actually implemented in their clinical work. Survey items were derived from a nursing textbook which outlines the ‘art of paediatric nursing’ along with scenarios. Findings In both Expected and Actual practices, the highest level of endorsement was for items focused on core elements of family-centred care (80–96%), and moderate-low endorsement levels were observed for items related to therapeutic relationship management and emotional boundaries. A factor analysis yielded 12 factors representing themes related to paediatric nursing. However, the division of items per factor indicated diffusion between key concepts and a discrepancy between theory and practice, especially in regard to maintaining emotional separateness and objectivity, advocacy, managing conflicts within the nursechild-family triad, and navigating oneself boundaries. Implications Nurses’ ability to manage and contain various types of unclear boundaries is crucial for optimal care provision when working with children and families. Variability in nurses’ theoretical role-perception and practical care provision is largely attributed to the way they navigate various ambiguous boundaries in practice and this could be a focal point in educational programs and on-the-job training. EHENE, E., GOLDZWEIG, G., SIMANA, H. & BREZNER, A. (2022). ‘MIND THE GAP’: EXPLORING PEDIATRIC NURSES’ PERCEPTIONS OF THE THEORY AND PRACTICE OF CARING FOR CHILDREN AND FAMILIES. JOURNAL OF PEDIATRIC NURSING, 21. DOI: 10.1016/J.PEDN.2021.12.024 CHAPTER RESOURCES SUMMARY Nursing is an art and a science in which people are assisted in learning to care for themselves whenever possible and cared for when they are unable to meet their own needs. The professionalisation of nursing has been influenced by key issues such as: the status of women, the development of the biomedical model, employment opportunities, class structures and religion. New Zealand was the first country to register nurses. ■ As the nursing profession continues to evolve and respond to the challenges within the health care system, nurses will remain responsive to societal needs. ■ ‘Concepts’ are abstract vehicles of thought and are the building blocks of theory, while ‘propositions’ are relational statements that link concepts together. ‘Theories’ are an organised, coherent and systematic articulation of a set of statements related to significant questions. Nursing uses theories from other disciplines in conjunction with nursing theory to enhance knowledge, understanding and practice. ■ The complexity of theoretical frameworks is categorised as ‘grand theory’, ‘middle-range theory’ and ‘micro-range theory’. Grand theories, or conceptual models, focus on phenomena of concern to the discipline. Middle-range theories provide a bridge from grand theories to effectively describe and explain specific nursing phenomena. Microrange theories view phenomena in the everyday practice of nurse–patient interactions. ■ The work of early nursing theories focused on the traditional tasks of nursing. Challenged to create synergy between the art and science of nursing, nursing theories have developed. Nursing theorists such as Peplau, Henderson, Orlanda, Rogers and Orem, to name a few, have created philosophies, frameworks, models and theories to achieve this synergy. Contemporary nursing philosophy embraces caring and nurturance with increasing prominence in recent nursing theories. ■ Get Complete eBook Download By email at student.support@hotmail.com 25 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y 26 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com UNIT 01 REVIEW QUESTIONS 1 2 3 4 Since the formalisation of nursing, notably with Florence Nightingale, social and political influences on the role of nursing have included (select all that apply): a the cost of living for sick people b the role of women in society c technological advances improving health outcomes d access to clean water, hygiene and employment e registration and professionalisation of nurses. In the 19th century, the Anglican High Church nuns: a began training nurses at St Thomas’ Hospital b introduced university-based nursing education c set-up their training school at the Sydney Hospital d were the dominant model of nursing reform in England e developed the first nursing theories. Which was the first country to enact legislation to register nurses? a Australia b New Zealand c Britain d United States e Germany Identify some of the key moments in the development of nursing practice and nursing education (select all that apply): a 1811 Sydney Hospital opens, New South Wales, Australia b 390–407 early Christianity, deaconesses, like deacons, also ministered to the sick and poor c 2011 Royal College of Nursing (RCN) Australia and the College of Nursing unite to form the Australian College of Nursing (ACN) d 1945 the psychiatric nurse qualification is acknowledged and administered by the Nurses and Midwifery Board in New Zealand e 1901 the Nurses’ Registration Act is passed in New Zealand 5 6 7 8 Nursing’s metaparadigm includes: a concepts, theory, health and environment b health, clinicians, environment and nursing c providers, standards, models and patients d the person, environment, health and nursing e theory, health, environment and person. A micro-range theory: a is composed of concepts representing global and complex phenomena b is the most concrete and narrow of theories that establishes nursing care guidelines c describes, explains and predicts complex situations and directs interventions d provides an overall framework for structuring broad, abstract ideas e answers questions about nursing phenomena without covering the full range of concern to the discipline. An organised, coherent set of concepts and their relationship to each other that is proposed to explain a given phenomenon best defines which of the following options? a A concept b A proposition c A theory d A discipline e A paradigm Why are nursing theories important to the profession? (select all that apply): a To guide nursing practice b To promote problem identification c To guide nursing research d To develop a language for nurses e To define professional nursing practice SPOTLIGHT ON CRITICAL THINKING You are on a clinical practicum, It has been argued that nursing history has been presented from a feminist perspective. 1 How could this have impacted the role of men in the nursing and midwifery profession? 2 Explain how this could imply that ‘caring’ is a female trait? 3 Explain why you think nursing history, until recently, has excluded groups of nurses from its history. You are on a clinical practicum, Nursing history is reflecting a more comprehensive understanding of nursing practice and nursing participants. It is now a more complex area of study. 4 Why do you think, from a historical perspective, that it is important to represent the nursing profession within the context of society as a whole? You are on a clinical practicum, Nursing theories sit within two main paradigms: the ‘totality paradigm’ and ‘simultaneity paradigm’. Identify which paradigm of nursing aligns with your personal beliefs and values. 6 Many nurses state ‘they want to help people’ as a reason for entering the nursing profession. Explain how nurses might ‘help’ people who are unwell using one nursing theorist from the following: ■ grand nursing theory ■ middle-range theory ■ micro-range theory. You are on a clinical practicum, Both Australian and New Zealand RNs are subject to standards for practice or competency domains. 7 Discuss how these are used in nursing practice. 8 Discuss how these assist in curriculum development for undergraduate degrees and ensure ongoing assessment of and critical reflection by practising RNs. 5 Get Complete eBook Download By email at student.support@hotmail.com It is suggested that you both incorporate an acknowledgment of cultural diversity and maintain cultural safety in your nursing practice. 9 Explain what each term means. 10 How can you apply this in your everyday interactions with patients? REFERENCES Best, O., & Fredricks, B. (2021). Yatdjuligin: Aboriginal and Torres Strait Islander nursing and midwifery care. (3rd ed.). Victoria, Australia: Cambridge University Press. Borbasi, S., Jackson, D., & East, L. (2019). Navigating the maze of research: Enhancing nursing and midwifery practice. (5th ed.). Australia: Elsevier. 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Get Complete eBook Download By email at student.support@hotmail.com 27 CHAPTER 01 Get Complete eBook Download By email at student.support@hotmail.com E v o l uti o n o f nur s in g e d ucati o n an d the o r y UNIT 01 28 Get Complete Download N ur s in g per s pecti v e s : pa s t, eBook pre s ent an d f uture By email at student.support@hotmail.com Pitman, E., & Fitzgerald, L. (2011). The campaigns for men to become midwives in the 1970s. Health and History, 13 (2), 158–71. Retrieved from www.jstor.org/ stable/10.5401/healthhist.13.2.0158 Queensland Government (2018). Clinical excellence division: Ryan’s Rule. Retrieved from https://clinicalexcellence.qld.gov.au/ priority-areas/safety-and-quality/ryans-rule Rogers, M. (1970). An introduction to the theoretical basis of nursing. Philadelphia: F. A. Davis. Rogers, M. (1990). Nursing: Science of unitary, irreducible human beings – Update 1990. In E. Barrett (Ed.), Visions of Rogers’ science based nursing. 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G236(P) Pace – ‘Probe, alert, challenge, escalate’ model of graded assertiveness used in paediatric resuscitation. Archives of Disease in Childhood, 102, sup 1, A93–93. Get Complete eBook Download By email at student.support@hotmail.com
