framework of practice chapter 3. 3-2 copyright 2004 by delmar learning, a division of thomson...
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Framework of Practice
Chapter 3
3-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Theoretical Foundation of Nursing
Nursing theory provides the theoretical foundation of the profession.
Theory defines what nursing is, what it does, and the goals or outcomes of nursing care.
Nursing is the synthesis of many theories.
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Components of the Theoretical Foundation
A theory is a set of concepts and propositions that provides an orderly way to view phenomena.
Concepts and propositions are the structural elements of a theoretical foundation.
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Concepts
Building blocks of a theory Labels or names for
phenomena/observable facts Assist us in formulating a mental image
about an object or situation
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Concepts
Theories are formed by linking concepts together.
A conceptual framework links global concepts together.
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Conceptual Model
The “symbolic representation of empiric experience in words, pictorial, or graphic diagram, mathematical notations or physical material.”
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Propositions
A proposition is a statement that proposes a relationship between concepts.
Propositional statements in a theory represent the theorist’s view of which concepts fit together.
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Theories
A theory helps us to organize our thoughts and ideas.
In science, the purpose of a theory is to guide research, support existing knowledge, or generate new knowledge.
The term theory is not restricted to the scientific world.
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Importance of Nursing Theories
Framework for thought in which to examine situations
Structure for organization, analysis, and decision making
Structure for communicating with other nurses and other health team members
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Importance of Nursing Theories
Assist the nursing discipline in clarifying beliefs, values, and goals.
Help to define the unique contribution of nursing in the care of clients.
Standards of clinical practice are developed out of nursing theories.
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Process of Knowledge Development
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Scope of Theories
Grand Theories Middle-Range Theories
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Grand Theory
Provides an overall framework for structuring broad, abstract ideas.
Composed of concepts representing global and extremely complex phenomena.
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Middle-Range Theory
Provides a perspective from which to view complex situations and a direction for interventions in three levels of abstractness.• High middle-range• Middle middle-range• Low middle-range
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Florence Nightingale’s Influence on Knowledge Development in Nursing
Described nursing as both an art and a science.
Stressed the importance of caring for the ill person rather than the illness.
Viewed a person’s health as the direct result of environmental influences (cleanliness, light, pure air, pure water, efficient drainage).
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Florence Nightingale’s Influence on Knowledge Development in Nursing
The turn of the 20th century marked the beginning of hospital-based schools of nursing.
Nightingale’s principles were incorporated into modern nursing theory.
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The Evolution of Nursing Theory
Since the early 1950s, many nursing theories have been systematically developed to help describe, explain, and predict the phenomena of concern to nursing.
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Knowledge Development in Nursing
Paradigm• A particular viewpoint or perspective• A “worldview” about the phenomena of
concern in a discipline (Kuhn, 1970)
Metaparadigm• The major concepts in a discipline that
names the phenomena of concern
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Knowledge Development in Nursing
Metaparadigm of Nursing• Person: Individual, family or group• Health: Continuum of wellness to terminal
illness• Environment: Place or community where
care is provided• Nursing: Actions; interactions of the nurse
with the person
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Knowledge Development in Nursing
Two individuals with different paradigmatic views can look at the same phenomenon and view the phenomenon differently.
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Knowledge Development in Nursing
The prevailing paradigm in a discipline represents the dominant view of particular concepts.
A paradigm revolution is the turmoil and conflict that occur in a discipline when a competing paradigm gains acceptance over the dominant paradigm.
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Knowledge Development in Nursing
A paradigm shift refers to the acceptance of the competing paradigm over the prevailing paradigm or a shifting away from one worldview toward another worldview.
Members of a discipline cannot subscribe to two competing paradigms at the same time.
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Knowledge Development in Nursing
Four Levels of Knowing• Empirical• Aesthetic• Personal• Ethical
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Early Nursing Theorists
Hildegard Peplau• Defined concepts of stages of nurse-client
relationships.
Virginia Henderson• Defined basic human needs as the unique
focus of nursing practice.
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Maslow’s Hierarchy of Needs
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Early Nursing Theorists
Faye Abdellah• Identified 21 nursing problems that became
the foundation of nursing diagnoses.
Joyce Travelbee, Josephine Paterson and Loretta Zderad• Emphasized the humanistic and existential
basis of nursing practice to understanding the uniqueness of patients.
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Contemporary Nursing Theorists
The work of contemporary theorists form the theoretical basis for many interventions in current nursing practice.• Myra Levine• Dorothea Orem• Sister Callista Roy
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Contemporary Nursing Theorists
Myra Levine’s Conservation Theory (1969) • Four universal principles of conservation
designed to apply concepts of nursing practice in different environments
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Dorothea Orem
Self-Care Deficit Theory of Nursing• Theory of Self-Care• Theory of Self-Care Deficit• Theory of Nursing Systems
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Roy Adaptation Model
Developed by Sister Callista Roy, 1976. Combined general systems theory with
adaptation theory. Goal of nursing is “promotion of
adaptation” in each of four modes of adaptation.
Applicable to the home setting.
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Roy Adaptation Model
The goal of nursing is “the promotion of adaptation” in each of four adaptive modes.• Physiologic• Self-concept• Role function• Interdependence
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Theories for the New Worldview of Nursing
Describe, explain, and predict the phenomena of concern to nursing from a more holistic perspective.• Jean Watson• Martha Rogers• Rosemarie Parse
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The Theory of Human Caring
Developed by Jean Watson in the 1980s. Conceptualizes human-to-human
transactions that occur daily in nursing practice.
Ten carative factors are classified as nursing actions or caring processes.
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The Science of Unitary Human Beings
Developed by Martha Rogers in 1990.• The person is characterized as a human
energy field that unites all aspects of the person into a unified whole.
• Nursing aims to repattern the rhythm and organization of these energy fields to heighten the integrity of the person.
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Gordon’s Functional Health Patterns
Influenced by Maslow’s Hierarchy of Basic Human Needs and Von Bartlaffny’s general systems theory.
Offer a holistic approach to the development of nursing diagnoses and client care.
Provides an appropriate method for organization of textbook topics.
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Continuing Evolution of Nursing Theory
Nursing is always in a state of change. Nursing knowledge continues to expand
in a multiplicity of ways. New theories will come from a global
perspective and international nursing leaders in the 21st century.