Transcript for:
Overview of Nursing Theories and Concepts

Class 2: The Nursing Metaparadigm and Terminology Purpose of Theory: * They organize knowledge, guide inquiry to advance science, guide practice, and enhance the care of patients * Nursing theories address the phenomena of interest to nursing: human beings, health, and caring in the context of the nurse- person relationship Metaparadigm or Domain * Discipline defined by a statement of its domain * Domain: boundaries or focus of that discipline Paradigm: * A global, general framework composed of assumptions about the nature of the phenomena of concern to the discipline * Paradigms offer particular perspectives on the metaparadigm or disciplinary domain Theory components: Language * To describe a theory we need common terms, definitions, assumptions dor scholarly review and analysis * Each theory will have specific terminology * Concepts: abstract vs concrete * Typologies (systematic arrangements of concepts) * Continuous concepts has dimensions or gradations * Relational statements - rekate concepts to one another * Linkages and ordering - rationale for why theoretical statements are linked Grand theories and conceptual methods * Focus on the phenomena of concern to the discipline * Conceptual models are sets of general concepts that provide perspectives on the major concepts of the metaparadigm Middle range theories * Narrower in scope than grand theories * Broad enough to be useful in complex situations and testable * Help to describe and explain specific nursing phenomena Practice level theories * Most limited scope and level of abstraction * Developed for use within a specific range of nursing situations * More direct effect on nursing practice * Provide frameworks for interventions and outcomes resulting from effect of nursing practice * Day to day practice experiences is a major source of this type of theory Theory Development * Starts with an observation leads to a question * Logical hypothesis through reasoning * Testing: experiment or test * Dissemination: publish findings * Replication through duplication by peers * Theory developed if supported Theory and practice: Praxis * Praxis is the integration of knowing and doing * This pattern is inseparable * Nurse uses this pattern to cultivate awareness of social, political and economic forces - transformation of self and system Class 4: Ways of knowing How do we know? * The epistemology of a discipline refers to the ways in which knowledge is developed * Epistemology is the how to of knowledge development * Knowing within the aesthetic, ethical, personal, and emancipatory patterns, conveys a more complete picture of what is known as a whole and what is possible in the practice of nursing Why is “how we know” important? * Creating expert and effective nursing practice * Empiric knowledge by itself cannot represent the complexity of practice * Brings realm of knowledge and practice together * Provides professional and disciplinary together * Provides specific language which makes nursing practice visible * Provides self identity and confidence from which to base risks, actions and deliberate practice * Promoted professional coherence and purpose Patterns of knowing and focus related to Nursing care * Carper - 1978 * Ethical knowing - nature of right and wrong * Personal knowing - awareness of self and others * Aesthetic knowing - unique meaning and intent in nursing situations * Empiric knowing - how things work and the nature of what we can know through sensory experiences * Chinn and Kramer - 2010 * Emancipatory knowing - issue of social justice Ethical knowing * Ethical knowing is the moral component of nursing * Understanding what ought to be done that is right and just * Ethical knowing guides and directs how nurses morally behave in their practice, what they select as being important Personal knowing * Personal knowing encompassess knowing one’s self as well as the self in relation to others * Meaning for the individual comes from the personal experience * In practice, personal knowing is expressed in the form of therapeutic use of self. This means that each nurse draws on their own interpretation and meaning of a particular situation to connect with the experience of the patient Aesthetical knowing * Aesthetical knowing in nursing is a way of knowing realities that are not empirically observable - the deep meanings in a situation * In practice the nurses way of being and relating in a situation and the ways of speaking and acting, form a work of art that responds to the meaning of the situation Empirical Knowing * Empiric knowing is what is often understood to be the science of nursing - the models and theories as well as research evidence that affirm the “truth value” of that which can be observed through human physical senses * Empiric knowing is often associated with quantitative research methods; however, empiric knowledge can be built through qualitative inquiry as well Emanipatory knowing * Emancipatory knowing is the human capacity to be aware of and critically reflect on the social cultural and political status quo and to figure out how and why it came to be that way * Emacipatory knowing focuses on the knowledge required to remove barriers that make health and well beings difficult or impossible for those who are disadvantaged and create environments that promote health and well being for all Why is theory important to Nursing * Stimulate the development of empiric knowledge * Serve as an organizing framework for deliberately examining that knowledge * Improve practice, and therefore health and quality of life * Advances discipline and practice of nursing Why is nursing theory important to you * Provides language for us to share and communicate * Ways to organize our thinking about the complexities of situations * Lens that will colour the way that we view person and health * Inform how we approach the person, how we relate and what we do Description and critical reflection * Used to scrutinize theory to determine if useful, and whether to apply * Without careful examination, care decisions guided by the theory will be less than effective, and research outcomes that are grounded on or that extend the theory will likely be flawed Components of a theory: definitions and questions for describing a theory * Purpose * Concepts * Definitions * Relationships * Structure * Assumptions Purpose * Def: if a theory is purposeful, a purpose can be found. The purpose of a theory may not be stated explicitly but it should be identifiable * Question: what is the purpose of a theory: this question addresses why the theory was formulated and reflects the contexts and situations to which the theory can be applied Concepts * Def: if a theory represents a structuring of ideas, the ideas will be in the form of concepts that are expressed through language * Question: what are the concepts of this theory? This question identifies the ideas that are structured and related within the theory Definitions * If the concepts of a theory are integrated systematically, their meanings will be conveyed by definitions. Definitions vary with regard to precision and completeness, but conceptual meaning should be identifiable and consist in a theory * Question: how are the concepts defined within this theory? This question clarifies the meanings of concepts within the theory. It questions what empiric experience is represented by the ideas within the theory Relationships and structure * If the concepts are related and structured into a systematic whole, the overall whole of the theory is identifiable by examining the network of interrelationships among concepts * Question: what is the nature of the relationships within this theory? This question addresses how concepts are linked together. It focuses on the various forms that relationship statements can take and how they give structure to the theory * Question: what is the structure of the theory? This question addresses the overall form of the conceptual interrelationships. It discerns whether the theory contains partial structures or has one basic form Structure * The structure of a theory gives overall form to the conceptual relationships within it. The structure emerges from the relationships of the theory * Question: what is the structure of the theory? This question addresses the overall form of the conceptual interrelationships. It discerns whether the theory contains partial structures or has on basic form Assumptions * Def: if a theory is tentative, assumptions form the underlying taken for granted truths on which the theory was developed, thus leaving open possible theoretic interpretations that can come from different sets of assumptions * Question: on what assumptions does the theory build? This question addresses the basic truths that are believed to underlie theoretic reasoning. It questions whether those assumptions reflect philosophic values or factual assertions Class 5: Florence Nightingale and Patricia Benner Nightingales assumptions 1. Nursing is separate from medicine 2. Nurses should be trained 3. The environment is important to the health of the patient 4. The disease process is not important to nursing 5. Nursing should support the environment to assist the patient in healing 6. Research should be used through observation and empirics to define the nursing discipline 7. Nursing is both an empirical science and an art 8. Nursings concern is with the person in the environment 9. The person is interacting with the environment 10. Sickness and wellness are governed by the same laws of health 11. The nurse should be observant and confidential The 10 major concepts of the environment theory also identified as nightingales canons 1. Ventilation and warming 2. Light and noise 3. Cleanliness of the area 4. Health of houses 5. Bed and bedding 6. Personal cleanliness 7. Variety 8. Offering hope and advice 9. Food 10. observation Patricia Benner: Major Concepts * Skill acquisitions * Novice * Advanced beginner * Competent * Proficient * Expert * Reflective practices From Novice to Expert: This nursing theory proposes that expert nurses develop skills and understanding of patient care over time through a proper educational background as well as a multitude of experiences. Dr. Benner's theory is not focused on how to be a nurse rather on how nurses acquire knowledge and skills without ever learning the theory. Benners Contribution to Nursing Theory: From Novice to Expert Concept 1. Novice: a beginner with no experience. They are taught general rules to help perform tasks, and their rule-governed behaviour is limited and inflexible. They are told what to do and simply follow instruction 2. Advanced beginner shows acceptable performance and has gained prior experience in actual nursing situations. This helps the nurse recognize recurring meaningful concepts so that principles, based on those experiences begin to formulate in order to guide actions 3. Competent nurse generally has 2-3 years experience on the job in the same field. For example 2-3 years in intensive care. The experience may also be similar to day to day situations. These nurses are more aware of long term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization 4. Proficient nurse perceives and understands situations as whole parts. He or she has a more holistic understanding of nursing, which improves decision-making. These nurses learn from experiences what to expect in certain situations, as well as how to modify plans as needed. 5. Expert nurses no longer rely on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and an intuitive grasp of clinical situations. Their performances are fluid, flexible, and highly-proficient. Benner’s writings explain that nursing skills through experience are a prerequisite for becoming an expert nurse. Dr. Benners stages of Clinical Competence Stage 1 Novice: This would be a nursing student in his or her first year of clinical education; behavior in the clinical setting is very limited and inflexible. Novices have a very limited ability to predict what might happen in a particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after a novice nurse has had experience with patients with similar symptoms. Stage 2 Advanced beginner: Those are the new grads in their first jobs; nurses have had more experiences that enable them to recognize recurrent, meaningful components of a situation. They have the knowledge and the know-how but not enough in-depth experience. Stage 3 Competent: These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners. Stage 4 Proficient: At this level, nurses are capable to see situations as “wholes” rather than parts. Proficient nurses learn from experience what events typically occur and are able to modify plans in response to different events. Stage 5 Expert: Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don’t occur as expected. Week 6: Sister Callista Roy (Roy Adaptation Model) and Madeleine Leininger: (Theory of Culture Care Diversity and Universality) Why Roy? * Focuses on human adaptive system responses and environmental stimuli, which are constantly changing * Goal of nursing: promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions Why Leininger? * Focuses on the discovery of human care diversities and universalities and ways to provide culturally-congruent care to people worldwide. * Goal of nursing: improve and provide culturally congruent care that is beneficial, will fit, and be useful to the client, family, or culture group healthy lifeways and to provide culturally congruent nursing care to improve or offer a different kind of nursing care service to people of diverse or similar cultures. Management of stimuli * Goal of nursing: the promotion of adaptation in each of the four adaptive modes, thereby contributing to health, quality of life, or dying with dignity * Goal of nursing intervention: to maintain and enhance adaptive behaviour and to change ineffective behaviour to adaptive * Nurse’s role: to promote adaptation in situations of health and illness and to enhance the interaction of human systems with the environment, thereby promoting health Environmental Stimuli * Focal: the internal or external stimulus most immediately in the awareness of the individual or group * Contextual: all other stimuli present that contribute to the effect of the focal stimulus * Residual: environmental factors within or outside human systems, the effects of which are unclear in the situation Coping process * Regulator: the regulator subsystem responds through neural, chemical, and endocrine, coping channels. Stimuli from the internal and external environment act as inputs through the senses producing an automatic, unconscious response to it * Cognator: responds through four cognitive-emotional channels: perceptual and information processing, learning, judgment, and emotion * Perceptual and information processing includes activities of selective attention, coding, and memory * Learning involves imitation, reinforcement, and insight * Judgment includes problem solving and decision making * The cognator-regulator subsystems function to maintain integrated life processes. These life processes-whether integrated, compensatory, or compromised are manifested in behaviours of the individual or group Adaptive Modes * The behaviours observed in four categories, or adaptive modes: * Physiologic-physical * Self-concept / group identify * Role function * Interdependence mode * Through these four modes that responses to and interaction with the environment can be carried out and adaptation can be observed Physiologic Mode * Physiologic-physical mode: * Manifestation of the physiologic activities of all cells, tissues, organs, and systems making up the body * 5 basic needs: oxygenation, nutrition, elimination, activity and rest, and protection * Four processes involved in physiologic adaptation: the senses; fluid, electrolyte, and acid base balance; neurologic function; and endocrine function * Underlying need: physiologic integrity Self concept and group identity * The self-concept-group identity mode includes the components of the physical self, including body sensation and body image, and the personal self, including self-consistency, selfideal, and moral-ethical-spiritual self. * The basic need underlying the self-concept mode for the individual is psychic and spiritual integrity-that is, the need to know who one is so that one can be or exist with a sense of unity Role Function: The role function mode focuses on the roles of the person in society and the roles within a group. The basic need underlying the role function mode is social integrity-that is, the need to know who one is in relation to others so that one will know how to act. Role Function Mode: 1. Primary: Determines the majority of behaviour engaged in by the person during a particular period of life, determined by age, sex and developmental stage 2. Secondary: Roles that a person assumes to complete the task associated with a development stage and primary role 3. Tertiary: Roles related primarily to secondary roles and ways in which individuals meet their role associated obligations; they are normally temporary in nature, freely chosen and may include activities such as clubs or hobbies Interdependence * The interdependence mode is a category of behavior related to interdependent relationships. * Interactions related to the giving and receiving of love, respect, and value. * Basic need: relational integrity, or the feeling of security in nurturing relationships. * Two specific relationships are the focus: the individual and significant others and support systems. * For the group, the interdependence mode relates to the social context in which the group operates; important factors in this case include infrastructure and member capability Nursing Metaparadigm * Person: An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes * Environment :All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups, with particular consideration of mutuality of person and earth resources * Health :A state and process of being and becoming an integrated and whole that reflects person and environment mutuality * Nursing The goal of nursing is "to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behavior and factors that influence adaptive abilities and to enhance environmental factors * Adaptation: “process and outcome whereby thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to create a human and environmental integration Assumptions of roy's Model * Three categories * Philosophic assumptions i.e. Persons have a mutual relationship with the world and a God-figure * Scientific assumptions: .i.e. Awareness of self and environment is rooted in thinking and feeling * Cultural assumptions: i.e. There may be a concept that is central to the culture and that will influence some or all of the elements of the Roy model Need for Leininger’s Theory * Cultural blindness, cultural shock, cultural imposition and ethnocentrism by nurses greatly reduces the quality of care offered to clients from diverse cultures * Nursing diagnoses and medical diagnoses that are not culturally based lead to unfavorable and sometimes serious outcomes * Nurses cannot separate worldviews, social structure factors, and cultural beliefs or practices (lay/folk/generic and professional) from health, wellness, illness, because these factors are closely interrelated Universality and the diversity of Care * Universality of care reflects the common nature of human beings and humanity * Diversity of care reflects the discovered variability and unique features of human beings * Directed toward nurses to discover and document the world of the client and to use their emic (insider) viewpoints, knowledge, and practices with appropriate etic (outsider), as bases for making culturally congruent professional care actions and decisions Factors Affecting Care * Cultural and social structure factors such as technology, religion, family and kinship, politics, cultural beliefs and practices, economics, physical conditions, and biological factors are significant forces affecting care and influencing health/wellness patterns and well-being. Leininger’s Tenets: (Assertioons by a theorist) 1. Culture care expressions, meaning, patterns, and practices are diverse and yet there are shared commonalities and some universal attributes. 2. The worldview, multiple social structure factors, ethnohistory, environmental context, language, and generic and professional care are critical influencers of culture care patterns to predict health, well-being, illness, healing, and ways people face disabilities and death. 3. Generic emic (folk) and etic (professional) health factors in different environmental contexts greatly influence health and illness outcomes. 4. From an analysis of the above influencers, three major decision and action modes (culture care preservation or maintenance; culture care accommodation or negotiation; and culture care repatterning or restructuring) were predicted to provide ways to give culturally congruent, safe, and meaningful health care to cultures Culture Care Decision and Action Modes. * Culture care preservation and/or maintenance: Assistive, supportive, facilitative, or enabling professional acts or decisions that help cultures to retain, preserve, or maintain beneficial care beliefs and values or to face illness, disability, dying, and death. * Culture care accommodation and/or negotiation: Assistive, accommodating, facilitative, or enabling creative provider care actions or decisions that help cultures adapt to or negotiate with others for culturally congruent, safe, and effective care for their health, well-being, or to deal with illness, injury, disability, and dying * Culture care repatterning and/or restructuring: Assistive, supportive, facilitative, or enabling professional actions and mutual decisions that would help people reorder, change, modify, or restructure their lifeways and institutions to achieve better health care patterns, practices, or outcomes. Modes of Decisions and Actions Guide the Provision of Culturally Congruent Care * Modes of decisions and actions guide the provision of culturally congruent care. The theory of culture care diversity an universality supports a sound, culturally, and socially responsible discipline and profession, and it guides nursing practices to meet the care and health needs of a multicultural world Leininger’s Theory purpose and Goal * Theory: Leininger described transcultural nursing as a major area of nursing focused on the comparative study and analysis of diverse cultures and subcultures worldwide with respect to their caring values, expressions, and health-illness beliefs and patterns of behavior. * Purpose: To discover human care diversities and universalities in relation to worldview, cultural and social structure dimensions, and then to discover ways to provide culturally congruent care for people of different or similar cultures to maintain or regain their well-being or health or to face death * Goal: To improve and provide culturally congruent care to people that is beneficial and will fit with and be useful to the client, family, or cultural group Class 7: Impact of DIgital Health and Nursing Practice CNO Practice Standards Nursing standards outline the expectations for nurses that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. The standards apply to all nurses regardless of their role, job description or area of practice CNO & Telepractice * Increasingly, virtual technologies are being used to provide care, conduct consultations and deliver education or transmit information over geographical distances. * While the forms of technologies continue to evolve, the use of information and virtual technologies does not alter a nurse’s accountability * No matter how a nurse provides care (for example, in-person, virtual or by telephone, they remain accountable to the Code of Conduct along with other CNO practice standards Principles of Nursing Telepractice: Under review by the CNO The following principles broadly outline nurses’ accountabilities in telepractice and can be used to guide individual practice. 1. The therapeutic nurse-client relationship 2. Providing and documenting care 3. Roles and responsibilities 4. Consent, privacy and confidentiality 5. Ethical and legal considerations 6. Competencies RNAO and the CNO. Who are they? * RNAO represents more than 51,650 registered nurses (RN), nurse practitioners (NP) and nursing students across Ontario. For nearly a century, the association has advocated for changes that improve people’s health through the full expertise of nurses. RNAO welcomes the opportunity to provide feedback to the CNO on the draft practice guideline titled Virtual Care * A key mandate of the College of Nurses of Ontario (CNO) is to protect public safety. This obliges the CNO to develop and disseminate comprehensive, yet clear and pragmatic practice standards and guidelines to support nurses in delivering safe and ethical nursing care. To this end, virtual care practice guidelines too must be comprehensive, clear and pragmatic, especially in today’s context where virtual care is being utilized widely. Digital Health * Broad term that refers to the field of knowledge and practice associated with the development and use of digital technologies to improve health * Digital technologies refer to tools, systems or devices that can generate, create, store or process data, enabled through microprocesses that are programmed to perform specific functions. * Digital health encompasses other uses of digital technologies for health such as AI, machine learning, big data and robotics; it encompasses eHealth, mHealth, health informatics, & emerging areas such as advanced computing sciences Digital Health Literacy: * Having the personal competencies to use digital health technologies and services efficiently, competently and safely. * It includes eHealth literacy, which refers to having the skills and abilities necessary to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. Benefits of Digital Health Technologies * Allow nurses to make informed decisions * Facilitate more timely diagnosis and treatment decisions * Achieve efficient and coordinated services — by streamlining the nursing process and improving workflow * Potential for nurses to spend more time with persons receiving care and less time completing administrative tasks * Promote person- and family-centred care, as digital connectivity can transcend physical barriers and allow increased access for persons receiving care Social and Digital determinants of health and equity considerations * Potential to transform system and engage more meaningful care * WHO’s global strategy promotes appropriate, adaptable technologies * Equity, diversity and inclusion principles to ensure no individual left behind * i.e. access to technologies limited by socioeconomic status, health literacy, Digital Divide * Growing gap between underserved and underserved populations —access to internet or technologies * Urban populations have greater access to technologies * Underserved and underserviced populations include but not limited to: Black & Indigenous People of Colour (BIPOC) Communities, Two-Spirit, lesbian, gay, bisexual, trans, queer, intersex, and other people who identify as a sexual or gender minority (2SLGBTQI+), persons experiencing homelessness, persons in rural communities, older adults, persons living with substance use disorder, persons living with mental health issues, and persons with disabilities * Education levels and race also contributing to the widening digital divide * “digital determinants of health” must be considered for equitable care delivery Ethical Considerations * Populations may hesitate to use digital health technologies * Fear how their personal information will be stored and used * Historical trauma around misuse of personal health information * Health providers use digital health technologies in a culturally safe manner. * Provide education about: * how the technology is being used to enhance care delivery; security/privacy measures * how to get support for technology issues * how the data is used to enhance health * when to call a health provider Ethical Considerations * Ethical situations arise as health service organizations increasingly adopt digital health technologies * Ethics, a key consideration as policies and procedures are created to support new models of care, new nursing roles, new workflows, and changes to scope of practice AI and Clinical Judgement * Ethical concerns pertaining to the use of AI driven predictive analytics and robotic devices in nursing * Impact of AI on clinical judgment, health providers inability to validate the accuracy of risk scores generated by AI - clinical practice in a digital health environment * Providing a rationale for one’s clinical decisions is a professional and ethical responsibility * Updated professional codes of ethics and standards of practice: use of digital health technologies support rather than replace nurse judgement * The potential for bias in data used to develop algorithms for AI-driven technologies and health providers must be educated and aware of these biases when interpreting judgments made by technology Emerging Considerations * Little empirical evidence exists on the impact of digital health technologies on nurses, persons and families receiving care, risks and to their experiences of compassionate care * Issues related to access to technologies and ethical considerations are lacking high quality empirical evidence * Need for current evidence to guide nursing practices regarding safe and effective use of digital health technologies in clinical practice RNAO: Good Practice Statements for Digital Health Environments * Practice * Education * Organization and policy Good Practice Statements: Practice 1. It is good practice that nurses and health providers complete an initial and ongoing assessment to determine accessibility, motivation, knowledge and preferences of persons and families, including the suitability of the digital health technologies being used in their care. 2. It is good practice that nurses and health providers provide education to persons and families related to the digital health technologies being used to deliver their care. 3. It is good practice that nurses and health providers be actively involved and engaged in the procurement, adaptation, adoption and implementation of digital health technologies when used in clinical practice Good Practice Statement: Education 4. It is good practice that organizations provide nurses and health providers with protected time for education related to the digital health technologies being used to deliver care. Good Practice Statement: Organization and Policy 5. It is good practice that organizations implement policies related to digital health technologies to protect privacy, security and confidentiality 6. It is good practice that regulatory bodies embed digital health competencies into nursing and health provider entry-to-practice exams Clinical Reasoning and Clinical Judgement Clinical judgment is defined as the observed outcome of critical thinking and decision-making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. National Council of State Boards of Nursing * *THE NCSBN IS THE BODY THAT WRITES THE LICENSING EXAMS FOR REGISTERED NURSES IN CANADA * *THE NCSBN IS THE BODY THAT WRITES THE LICENSING EXAMS FOR REGISTERED NURSES IN CANADA * NEW GRADUATES ARE EXAMINED ON HOW TO MAKE SAFE PATIENT CARE DECISIONS NCLEX (NGN) * Your nursing licensing exam, called the NCLEX and the new format Next Generation NCLEX (NGN), starting in 2023 focuses on clinical judgement * Clinical judgment is one of the most important topics you will study in your nursing program * Clinical Judgement is a major factor in keeping patients safe and improving patient outcomes Clinical Judgement and the Next Generation NCLEX (NGN) * The NCSBN created the NCLEX Clinical Judgment Measurement Model (NCJMM) to better evaluate an exam writer’s ability to make clinical judgments. * The new exam format is based on NCSBN research that stems from Tanner’s Clinical Judgement Model (2006). A measurement model was developed from this reflective, humanistic, theoretical model to determine whether candidates for registration are able to demonstrate minimal competence with respect to clinical judgement and clinical decision-making (Dickison, et al., 2016). NEXT GENERATION NCLEX * There are different styles of exam questions such as * 1. Unfolding Case Studies * The case could be organized in headings in a patient chart that has * History and physical * Nurses and Interdisciplinary Notes * Laboratory/Diagnostic Tests * Flow Sheets * Prescriptions/Orders * There will be 3-5 case studies on all exams * The NCLEX-RN consists of 74-145 questions * Part marks scoring * Exam is still adaptive, but the cases are not * There may be charts to complete for a diagnosis: * Action Taken: * Potential Condition: * Parameter to Monitor: * Or Information about a Medication: * Classification * Indications * Side Effects * Adverse Effects * Nursing Considerations * *You maybe asked to highlight important information to follow-up on about a patient situation * *You maybe asked to prioritize patient problems and situations * You maybe asked to order items * You maybe asked about cause and effect Tanners Model * Noticing * Interpreting * Responding * Reflecting Steps of nursing process * Assessment * Diagnosis * Planning * Implementing * Evaluating Clinical Judgement Model: 6 Cognitive Processes 1. Recognize Cues: Identifying relevant data in a clinical situation that require the nurse’s attention * Determining important information to collect * Scanning the environment * Identifying signs and symptoms * Assessing systematically and comprehensively * Ensuring accurate information 2. Analyze Cues: Organizing and linking the recognized cues to the clinical situation * Clustering related information * Identifying assumptions * Recognizing inconsistencies * Distinguishing relevant from irrelevant information * Judging how much ambiguity is acceptable * Comparing and contrasting * Predicting potential complications * Collaborating with healthcare team members * Determining patient care needs/healthcare environment issues 3. Prioritize Hypotheses: Evaluating and ranking hypotheses according to priority (e.g. urgency, likelihood, risk). * Setting priorities 4. Generate Solutions: Identifying expected outcomes and using hypotheses to determine interventions to meet the expected outcomes. * Selecting interventions * Managing potential complications * Setting priorities 5. Take Action: Implementing the intervention(s) that address(es) the highest priorities. * Determining how to implement the planned interventions * Delegating * Communicating * Teaching others 6. Evaluate Outcomes: Comparing observed outcomes with expected outcomes. * Evaluating data * Evaluating thinking Self Directed Learning * Self-directed learning involves becoming aware of and managing one’s own process of learning. It includes developing dispositions that support motivation, self-regulation, perseverance, adaptability, and resilience. * Calls for a growth mindset – a belief in one’s ability to learn – combined with the use of strategies for planning, reflecting on, and monitoring progress towards one’s goals, and reviewing potential next steps, strategies, and results. * Self-reflection and thinking about thinking (metacognition) support lifelong learning, adaptive capacity, well-being, and the ability to transfer learning in an ever-changing world * A nursing student who is a self directed thinker—that is one who can direct their own thinking without prompts or guidance. * Becoming a self-directed thinker is what is absolutely needed when taking the Next Gen NCLEX and when providing safe patient care. Class 8: R.R Parse’s - Human Becoming Theory DR. ROSEMARY RIZZO PARSE CREDENTIALS & BACKGROUND * Received master’s and doctorate degrees from the University of Pittsburgh * Faculty member of University of Pittsburgh, Dean of the Nursing School at Duquesne University (1977–1982), Professor and Coordinator of the Center for Nursing Research at Hunter College of the City University of New York (1983–1993), Professor and Niehoff Chair at Loyola University Chicago (1993–2006), and Distinguished Professor Emeritus at Loyola University Chicago (2006 to present) * Founder and current editor of Nursing Science Quarterly and President of Discovery International. She founded the Institute of Humanbecoming, where she teaches the humanbecoming paradigm in nursing * Fellow in American Academy of Nursing, where she initiated and chaired the nursing theory–guided practice expert panel * Received several honors: two Lifetime Achievement Awards (one from the Midwest Nursing Research Society and one from the Asian American Pacific Islander Nurses Association) * Published 10 books and more than 150 articles and editorials about matters pertinent to nursing and other health-related disciplines * Presented at more than 300 local, national, and international presentations and workshops in more than 35 countries on five continents DR. PARSE’S CONTRIBUTIONS TO DISCIPLINE AND PROFESSION OF NURSING * Dr. Parse has made outstanding contributions to discipline and profession of nursing through progressive leadership in nursing knowledge development, research, education, and practice * She explored ethics of human dignity, set forth humanbecoming tenets of human dignity and developed teaching-learning, mentoring, leadingfollowing, community, and family models used worldwide. She also developed a humanbecoming concept inventing model (Parse, 2018) * She is well-known internationally for the humanbecoming paradigm—a nursing perspective focused on living quality and human dignity from the perspective of patients, families, and communities HUMANBECOMING THEORETICAL SOURCES * Humanbecoming theory evolved over time. First, it was humanbecoming nursing theory, then it became the humanbecoming school of thought; by 2016, it evolved to humanbecoming paradigm * Humanbecoming paradigm makes explicit that “cocreating reality as a seamless symphony of becoming is the central thought foundational to the ontology of humanbecoming” and is grounded in human science, as humans cannot be reduced to component parts and be understood. Rather, persons are living beings who are different from schemata that divide them * The theory challenges traditional medical view of nursing and distinguishes discipline of nursing as a unique, basic science - focused on universal humanuniverse living experiences; supporting notion that nurses require a unique knowledge base that informs their living the art and sciencing- essential to fulfill commitment to humankind * Parse uses prefix co- on many of her words to denote participative nature of persons. Co- means “together with,” and, for Parse, humans can never be separated from their relationships with the universe—thus her conceptualizations of humanbecoming and humanuniverse as one word. Relationships with the universe include linkages humans have with other people and with ideas, projects, predecessors, history, and culture * Humans are intentional – they have an open and meaningful stance with the universe and people, projects, and ideas that constitute living experiences * Being intentional means humans’ involvements are not random. They are chosen for reasons known and not known. Intentionality is also about purpose and how persons choose direction, ways of thinking, and acting with projects and people. People choose attitudes and actions with illimitable options * The basic tenet, human subjectivity, is viewing humans not as things or objects, but as indivisible, unpredictable, everchanging beings and as a mystery of being with nonbeing * Humans live all-at-onceness as the becoming visible–invisible becoming of the emerging now. Humans’ presence with world is personal and they live meaning as they’re becoming who they are * People choose meanings and projects according to their value priorities, they coparticipate with the world in indivisible, unbounded ways. A person’s becoming is complex and full of explicit-implicit meaning * Coconstitution is any moment cocreated with the constituents of the situation. Humans choose meaning with particular constituents of day-to-day life. Life happens, events unfold in expected and unexpected ways, and humans coconstitute personal meaning and significance * Situated freedom/human freedom is when “reflectively and prereflectively one participates in choosing the situations in which one finds oneself as well as one’s attitude toward the situations” Humans always choose what is important in their lives and decide the attention to give to situations, projects, and people. In day-today living, people choose and act on their value priorities, and these shift as life unfolds. Personal integrity is intimately connected to situated freedom Humanbecoming Theory Updated In 2007 Parse specified four postulates that permeate all principles of humanbecoming. The four postulates are illimitability, paradox, freedom, and mystery. * Illimitability is the ‘unbounded knowing extended to infinity, the all-at-once remembering and prospecting with the moment’ - indivisible, unbounded knowing “is a privileged knowing accessible only to the individual living the life” * Paradox has always been affiliated with humanbecoming, “paradoxes are not opposites to be reconciled or dilemmas to be overcome but, rather, are lived rhythms . . . expressed as a pattern preference” “incarnating an individual’s choices in day-to-day living” Humans make choices about how they will be with paradoxical experiences and continuously make choices about where to focus their attention * Freedom, a theoretical cornerstone, updated to “contextually construed liberation” - people have freedom within their situations to choose ways of being * Mystery, is something special that transcends the conceivable and as the unfathomable and unknowable that always accompanies the “indivisible, unpredictable, everchanging humanuniverse” Empirical Evidence * In 2016, Parse presented two basic science methods that are consistent with the new humanbecoming paradigm: humanbecoming hermeneutic sciencing and Parse-sciencing. She no longer uses term research, but rather uses term sciencing. “From a humanbecoming perspective, sciencing is ongoing, indivisible, unpredictable, everchanging coming to know” * “The [humanbecoming] theory does not lend itself to testing, since it is not a predictive theory and is not based on a cause-effect view of [humanuniverse]. The purpose of the research [sciencing] is not to verify theory or test it but, rather, the focus is on uncovering the essences of lived phenomena to gain further understanding of universal [humanuniverse living experiences] which evolves from connecting descriptions given by people to theory, thus making more explicit the essences of being human.” MAJOR ASSUMPTIONS Parse (2014) updated theory assumptions to make clear that humans and universe are inseparable. Assumptions describe beliefs about humanuniverse, living quality, and the ethos of humanbecoming. Three themes arise from the assumptions of the humanbecoming paradigm: (1) meaning, (2) rhythmicity, and (3) transcendence (Parse, 1998, 2014). The postulates illimitability, paradox, freedom, and mystery (Parse, 2007b) permeate the three themes: * Meaning is borne in the messages that persons give and take with others in speaking, moving, silence, and stillness. Meaning indicates the significance of something and is chosen by people. Outsiders/nurses cannot decide the meaning or significance of something for another person * Rhythmicity is about patterns and possibility. People live unrepeatable patterns of relating with others, ideas, objects, and situations. Their patterns of relating incarnate their priorities, and these patterns are changing constantly as they integrate new experiences and ideas with what is becoming visible–invisible in the emerging now. People are recognized by their unique patterns and change their patterns when they integrate new priorities, ideas, and dreams and show consistent patterns that continue like threads of familiarity and sameness throughout life * Transcendence is about change and possibility, the infinite possibility that is humanbecoming. “The possibilities arise with . . . [humanuniverse] . . . as options from which to choose personal ways of becoming” To believe one thing or another, to go in one direction or another, to be persistent or let go, to struggle or acquiesce, to be certain or uncertain, to hope or despair—all these options surface in day-to-day living. Considering and choosing from these options is cotranscending with the possibles Person, Environment, Health Viewed as Humanuniverse, Humanbecoming, and Living Quality * Parse (1998, 2007b, 2012b) views the concepts human and universe as inseparable and irreducible. * To emphasize this inseparability, she specified humanuniverse and humanbecoming as one word (Parse, 2007b). Parse no longer refers to health in the new humanbecoming paradigm. What is important is the concept of living quality (Parse, 2014). Living quality is the becoming visible–invisible becoming of the emerging now as humans live their lives structuring meaning, configuring rhythmical patterns, and cotranscending with possibles (Parse, 2012a). * Living quality conveys the idea that people are constantly changing. Living quality has three core knowings: “fortifying wisdom, discerning witness, and penetrating silence” (Parse, 2013, p. 112). * In living fortifying wisdom, persons choose ways of being according to their value priorities. * In living discerning witness, a person chooses certain pattern preferences that create both opportunities and restrictions all-at once. * In living penetrating silence, an individual ponders in silence the illimitable opportunities available to them for creating anew. “ Humanbecoming theoretical assertions * Parse’s principles are the assertions of the humanbecoming theory * Each principle interrelates the nine concepts of humanbecoming: (1) imaging, (2) valuing, (3) languaging, (4) revealing–concealing, (5) enabling– limiting, (6) connecting–separating, (7) powering, (8) originating, and (9) transforming * Principle 1: structuring meaning is the imagining and valuing of language * Principle 2: configuring rhythmical patterns is the revealing concealing and enabling limiting of connecting separating * Principle 3: condescending with possibilities is the powering and originating of transforming SUMMARY * Work with the humanbecoming paradigm continues to evolve, as does the theory itself * As schools of nursing introduce and teach the humanbecoming paradigm, more nurses explore the theory in practice. Learning the theory requires formal study, quiet contemplation, and creative synthesis. As more nurses use the theory in living the art and in sciencing and leadership, their scholarly dialogue advances the nursing discipline * The theory of humanbecoming continues as a theory for the future. As nurses question how they are relating with others and question the knowledge base of the discipline, the humanbecoming theory provides a perspective and field of possibilities for change and growth Class 8: Jean Watson: Transpersonal Caring Dr. Jean Watson: Watson’s CREDENTIALS & BACKGROUND * Margaret Jean Harman Watson, PhD, RN, AHN-BC, FAAN, was born and grew up in the small town of Welch, West Virginia * Watson continued her nursing education at the University of Colorado. She earned a baccalaureate degree in nursing in 1964, a master’s in 1966, and a doctorate in educational psychology and counseling in 1973 * She joined the School of Nursing faculty at the University of Colorado Health Sciences Center, serving in faculty and administrative positions * In the 1980s, Watson and colleagues established the Center for Human Caring at the University of Colorado, the nation’s first interdisciplinary center using human caring knowledge for clinical practice, scholarship, administration, and leadership (Watson, 1986) * The Watson Caring Science Institute (WCSI) was established by Watson from groundwork laid by the Center for Human Caring. WCSI is a nonprofit organization devoted to advancing caring science in Global World Caring Science programs and projects * At the University of Colorado School of Nursing, Watson served as chairperson and assistant dean of the undergraduate program, implementing the nursing PhD program, and served as director of the PhD program from 1978 to 1981 * Watson was Dean of the University of Colorado School of Nursing and Associate Director of Nursing Practice at the University Hospital from 1983 to 1990. As dean, she developed a postbaccalaureate nursing curriculum in human caring, health, and healing that led to a nursing doctorate (ND), a clinical doctorate that became doctor of nursing practice (DNP) in 2005 * Watson’s combined works reflect an evolution of theoretical thought and personal journey. Watson describes two personal life-altering events that contributed to her writing. In 1997, she experienced an accidental injury that resulted in the loss of her left eye, and soon after, in 1998, her husband died. Watson states that she has “attempted to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friends and colleagues” (Watson, personal communication, August 31, 2000) What is transpersonal caring * Creating a union with the patient and working as a team and * High regard for the patient as a whole and their existence * Watson (1999) describes it as a 'special kind of human care relationship' * Nursing ='caring' * Caring promotes health as it increases healing and decreases disease 10 Caritas Processes (Caritas= Cherish) 1. Cultivating the Practice of Loving-Kindness and Equanimity Toward Self and Other as Foundational to Caritas Consciousness 2. Being Authentically Present: Enabling, Sustaining, and Honoring the Faith, Hope and Deep Belief System and the Inner-Subjective World of Self/Other 3. Cultivation of One's Own Spiritual Practices and Transpersonal Self, Going Beyond EgoSelf 4. Development and Sustaining a Helping-Trust Caring Relationship 5. Being Present to, and Supportive of, Expression of Positive and Negative Feelings 6. Creative Use of Self and All Ways of Knowing as Part of the Caring Process; Engage in the Artistry of Caritas Nursing 7. Engage in Genuine Teaching-Learning Experience that Attends to Unity of Being and Subjective Meaning-Attempting to Stay Within the Other's Frame of Reference 8. Creating a Healing Environment at All Levels 9. Administering Sacred Nursing Acts of Caring-Healing by Tending to Basic Human Needs 10. Opening and Attending to Spiritual/Mysterious and Existential Unknown of Life-Death The transpersonal Caring moment * A caring moment is any occasion where the nurse and client come together in a human-to-human connection * For the moment to be transpersonal, it must go beyond a normal interaction and involve a true, intentional, spiritual connection * It "transcends time and spaсе"; involves recognition of the common humanity in each person Conscious dying * "Conscious Dying is a framework rooted in a human caring ontology, which strives to deepen the nurse healer's awareness in tending to a patient's dying and death" * Conscious Dying is a an emerging paradigm centered around nurseclient connection during end-of-life planning and care Nursing Metaparadigm * Nursing * Nursing consists of "knowledge, thought, values, philosophy, commitment and action, with some degree of passion." * Nurses are interested in understanding health, illness and the human experience; promoting and restoring health and preventing illness. * Trim of nursing → Core of nursing. * "Curing" according to Watson is the elimination of a disease, but caring is equally as important. * "Humans cannot be treated as objects and that humans cannot be separated from self, other, nature and the larger universe." * Person * Human being = person = life = personhood = self. * Person = "unity of the mind/body /spirit /nature." * "Personhood is tied to notions that one's soul possesses a body that is not confined by objective time and space." * Health * WHO "The positive state of the physical, mental, and social well-being with the inclusion of three elements: 1. A high level of overall physical, mental, and social functioning. 2. A general adaptive-maintenance level of daily functioning. 3. The absence of illness * "Illness is not necessarily disease; [instead it is a] subjective turmoil or disharmony within a person's inner self or soul at some level of disharmony within the spheres of the person." * Environment * Original explanation: * "Attending to supportive, protective, and/or corrective mental, physical, societal, and spiritual environments." * Recent explanation: * The caring science is not only for sustaining humanity, but also for sustaining the planet… belonging is to an infinite universal spirit world of nature and all living things * Healing spaces can be used to help others transcend illness, pain, and suffering, emphasizing the environment and person connection How can watsons theory be applied in clinical practice * Aside from tasks such as assisting with ambulation, bathing, feeding, and taking vital signs, let’s think about the “in between” moments * What if we took the time to just be with our clients? * Our compassionate presence can be just as important as all of the other tasks that we are learning to do * Sharing a transpersonal caring moment with a client, where we focus on that authentic connection, can provide meaning to our work and education as nursing students Class 9: Rogers, Martinsen, Orem, King Martha rogers: Unitary Human Beings What is a unitary Human Being * View: human beings as deeply connected to their environment * Recognizes that individual’s health mainly influenced by constant exchange of energy between them and their environment * Focus: health is more than the physical aspect → balance, energy, & the way person connects to the world * Theory laid foundation of alternative healing practices → meditation, energy healing, therapeutic touch Principles of Homeodynamics * Resonancy: Continuous change in wave patterns within energy fields from lower to higher frequencies * Helicy: Unpredictable, non-linear evolution of energy fields characterized by increasing diversity * Integrality: Mutual, continuous interaction between human environmental energy fields Key concepts and ideas * Energy fields * Fundamental units of living and non-living entities, representing the dynamic nature of individuals and their environments. * Openness * Idea that human and environmental energy fields are open systems, allowing continuous and unrestricted energy flow between them. * Pattern * Distinguishing characteristic of an energy field perceived as a single wave, reflecting the unique attributes of individuals * Pandimensionality * Nonlinear domain without spatial or temporal attributes, representing the infinite nature of the human-environment interaction What are the ideas of the theory 1. Unitary human beings: * Rogers viewed humans as whole, individual entities that cannot be divided into parts. * She emphasized the interconnectedness of humans with their environment, suggesting that people are dynamic and ever-changing. 2. Energy Fields: * One of her central ideas is that both humans and their environments are energy fields. This means that they interact continuously, influencing each other. * She believed that health and illness are part of a continuum of energy exchange. 3. Homeodynamics: * Rogers introduced the concept of homeodynamics, which refers to the continuous change and evolution of human beings and their environments. * Rather than striving for a static state of balance, she emphasized the importance of adapting to changes in the environment. 4. Nursing as a science and art: * Rogers believed that nursing should focus on the whole person and their relationship with the environment. * She saw nursing as both a science, based on knowledge and research, and an art, requiring intuition and empathy. 5. Nursing Practice: * Rogers' theory encourages nurses to focus on the patient's experience and their interactions with the environment. * It promotes holistic care, where the nurse considers the patient as a whole and recognizes the importance of the environment in health and healing In summary, Martha Rogers' theory of unitary human beings emphasizes: * Wholeness of individuals * The importance of energy fields, * The dynamic relationship between humans and their environments. This perspective has significantly influenced nursing practice and education. How does this relate to the nursing Metaparadigm Person: * The person is viewed as a unitary being * This perspective shifts the focus from treating symptoms to understanding the patient as a complete entity with unique experiences, needs, and interactions. Environment: * Emphasizes the interconnectedness of humans and their environments, this aligns with the nursing paradigm view that the environment plays a crucial role in health and well-being. * Nurses must consider the environmental factors that influence a patient's health and how they interact with their surroundings. Health: * Health is a dynamic state that encompasses more than just the absence of illness. It involves a continuous process of adaptation and well-being. * This holistic view complements the nursing paradigm focus on: * promoting health and preventing illness, encouraging nurses to support patients in achieving optimal health. Nursing: * Nursing is both a science and an art that requires understanding the complex interactions between the person and their environment. * The nursing paradigm emphasizes the importance of a therapeutic relationship and the role of nurses in facilitating healing and promoting health through holistic care. Kari Martinsen: Philosophy of Caring What is this theory About? * Caring goes beyond the being the job of a nurse, it is embedded in human nature * Humans are dependent creatures therefore requiring care * Care does not only come from a place of emotion or empathy * It is acknowledging patient needs and then acting on it from a moral standpoint (Martinsen, 2011) * Describes a nurses role as being attentive and present in order to provide the best care possible Key concepts 1. Care: 1. A trinity: relational, practical, moral 2. Directed outward towards the situation of a client, thus requiring professional education/training 3. Precondition to living 2. Person-oriented professionalism: 1. Professional knowledge which takes into consideration the condition of a suffering client whilst maintaining their dignity 3. Professional Judgement/ Discernment: 1. Seeing, listening, and touching the client in a way that evokes a connection between the nurses impression of the client's situation, professional knowledge, and prior experience 4. Moral Practice: 1. The expression of care within nursing as a result of empathy and reflection working together 2. The act of discovering the best manner to help a client 5. The Untouchable Zone: 1. Boundaries that must be respected and never crossed 2. Ensures impartial care founded on theory and professionalism 6. Vocation: 1. Ethical demand to take care of one’s neighbor 2. Nursing requires both personal attunement/refinement and professional knowledge to ensure care 7. The Registering Eye: 1. The objective role of the observer; concerned with finding connections, patterns and systematically ranking correlations by significance 2. Must be balanced with the Eye of the Heart, as too much objectivism desensitizes the observant (nurse) 8. The Eye of the Heart (Perceiving heart): 1. Concept derived from the parable of the Good Samaritan 2. Sensation of being moved prior to systematizing Concepts of the nursing metaparadigm * Nursing: * - Caring is fundamental to nursing. * “Relational” in the essence of caring needs at least two people actively concerned for one or the other to ensure meaningful and compassionate interactions. * “Practical” in caring is acquired through trained and learned experiences to ensure competent care. * “Moral” requires personal accountability, empathy and ethical reflection in caring to foster genuine interpersonal relationships. * Health/ Environment * Appreciates various aspects in terms of an individual's social determinants of health and well-being. * Emphasis on health being more than just the absence of disease but deeply subjective and relational * Awareness of how surroundings affect care: the person is always in a situation at a given space. * Cure sometimes, help often, and comfort always * Person * The person is not merely an object but a unified being of the soul and flesh. * Emphasizes mutual recognition, respect, and dignity. * Cannot be separated from their social environment and community. Consideration of holistic care is highlighted! Orem’s self care deficit theory: What is the theory about Orem's theory emphasizes the need for individuals to engage in self-care to maintain health. The framework identifies self-care deficits when individuals cannot meet their own care needs, necessitating nursing intervention. The theory consists of three key interrelated concepts (Orem, 2001): * Self-Care – Activities individuals perform on their own to maintain health and wellbeing. * Self-Care Deficit – Occurs when a person is unable to meet their own self-care needs due to illness, injury, or other conditions. This is when nursing intervention is needed. * Nursing Systems - The ways nurses help patients based on the level of self-care deficit: * Wholly Compensatory - Nurse provides total care when the patient is unable to do anything. * Partially Compensatory – Nurse and patient share self-care responsibilities. * Supportive-Educative - Nurse provides guidance and education when the patient can perform self-care but needs assistance in learning or decision-making. In summary, Orem's theory emphasizes helping individuals regain independence in selfcare whenever possible, with nursing intervention tailored to the degree of deficit (Orem, 2001.) Key concepts and ideas of the theory The key concepts of this theory (Orem, 2001) are derived from four other different theories: * The theory of self-care: Why and how people care for themselves * The theory of dependent-care: How family members and/or friends provide dependent-care for a socially dependent person * The theory of self-care deficit: Why people can be helped through nursing * The theory of nursing systems: Describes relationships that must be brought about and maintained for nursing to be produced * These can be found on pages 202 of the Nursing Theory and Knowledge Development Textbook (10th ed) * * The main question: What is the condition that indicates that a person needs nursing care? (Violeta A. Berbiglia, Luu Thi Thuy, page 209) "The self-care deficit nursing theory by Orem, self-care is a human need, and nursing is required in situations of self-care deficits. Self-care deficits can comprise limitations in knowledge, the ability to perform actions, or making decisions." How does the theory relate to the nursing paradigm? * Person: The individual plays a part in receiving the care/ while becoming educated about their health by the nurse through their self-care deficits. (Feeding themself or taking appropriate medications). * Environment: Being a supportive nurse by assisting the client/patient through their self care deficits can help foster a healthy environment for wellbeing/health. (Helping to feed the client and being patient can promote a good trusting environment which is important for therapeutic relationships). * The environment includes external factors that impact a person's ability to perform self-care, such as family, culture, social support, and access to healthcare. (Orem, 2001) * Orem acknowledges that environmental factors can either support or hinder a person's self-care abilities. (Orem, 2001) * Health: Acknowledging how self-care deficits may affect the client should be important to the nurse. (Think of the physical/mental barriers this may have on someone: embarrassment). * Nursing: Appropriate and professional actions (Such as helping to feed a client, clean them, and providing education for the patients wellbeing. Imogene King: Theory of Goal Attainment Key Concepts of Goal Attainment * Personal System * This system considers the individual, including concepts such as perception, self, body image, growth and development, space, and time * Interpersonal System * This system looks at interactions and relationships between two or more individuals which include stress, roles and communication (Alligood, 2022, p. 218) * Social System * This system considers broader social factors that influence individuals and groups, such as authority, decision-making, power, and organization (Alligood, 2022, p. 218). Theory of Goal Attainment This theory explains the process of nurse-patient interactions that lead to the achievement of goals. Imogene highlights the importance of having mutual goals between both the nurses and patients. This process involves being able to perceive each other, making judgements and taking actions that lead to reaction, interaction and finally transactions (Alligood, 2022, p. 222). King’s goal attainment theory identifies problems through the communication between nurses and care recipients and sets goals that must be achieved reciprocally Nursing Metaparadigm * Person: King’s system identifies human beings as the basic element in the system. (Alligood, 2022, p. 220) King specifically states that:“individuals are spiritual beings, Individuals have ability through language and other symbols to record history and preserve culture, Individuals are unique and holistic of intrinsic worth and capable of rational thinking and decision-making in most situations, Individuals differ in their needs, wants * Environment: King's framework looks at human transactions in different kinds of environments and not with fragmenting human beings and the environment * Health: King defined health as dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living * Nursing: Nursing is an interpersonal process of action, reaction, interaction, and transaction Goal oriented nursing record * King developed the Goal-oriented Nursing Record (GONR) as a tool to document goals and outcomes, facilitating data collection, problem identification, and care evaluation. “The major elements in this record system are: (a) data base, (b) nursing diagnosis, (c) goal list, (d) nursing orders, (e) flow sheets, (f) progress notes, and (g) discharge summary” Kings theory in Practice * Nurse-patient communication is critical for recognizing concerns and establishing clear goals. * The principle is put into reality through collaborative goal-setting, in which both the nurse and the patient actively participate. * Using King's approach, nurses focus on developing mutually agreed-upon goals, resulting in better patient outcomes and stronger relationships. * This method guarantees that patient-centered care is at the heart of nursing practice, allowing nurses to tailor their services to individual requirements. Week 10: Neuman, johnson, pender, and mercers theory Betty Neuman: Systems Model What is neumnas system model * Views humans as open systems affected by internal/external environments * Provides a holistic care approach, emphasizing client-system interactions * The model draws influences from the theories and philosophies of Gestalt, de Chardin, Marx, Selyes and Caplan, sourcing it’ s major concepts such as adjustment, dynamic systems, stressors and levels of prevention Key concepts and structure Open system perspective * Individuals, groups, or communities as open systems with defined boundaries. * Influenced by input/output variables and internal/external environments. Holistic Approach * Broad focus on interactions between variables (not specific domains). * Emphasizes the “ whole ” influencing awareness of the “ parts ” Stress and response * Centered on client reactions to stressors. * Assesses degree of reaction to maintain homeostasis Levels of prevention * Primary: Prevent stressor impact. * Secondary: Reduce reaction to stressors. * Tertiary: Support recovery and stability. Defense Structure * Comprises physiological, psychological, sociocultural, developmental, and spiritual variables. * Forms the basic energy resources protecting the system. Relation to Nursing Metaparadigm Nursing: * Concerned with the whole person and all variables * Requires assessing caregiver and client perceptions Health * A dynamic continuum from wellness to illness. * Optimal system stability reflects the best wellness state Person * Clients as dynamic systems (individual, family, group, etc.) * Comprises physiological, psychological, sociocultural, developmental, and spiritual factors. Environment * Internal, external, and created forces influencing the client (Neuman, 2011). * Stressors alter system stability; created environment supports coping How is this theory important to nursing today * Nurses evaluate not just the physical recovery but also the patient’ s mental health, social support, and lifestyle. * This theory encourages collaborative care, ensuring that different healthcare disciplines work together for optimal patient outcomes. Dorothy Johnson: Behavioural system Model History and influence of theory * Concepts from nightingale’s book: “The relationship between the person who is ill and their environment not with the illness” * Talco Parsons Social Action Theory: Adopted the structural-functional component approach * Systems Theory: Utilized the idea that an individual is regarded as a whole with several units Relation to Nursing Paradigm Nursing * Goal: “Maintain and restore the person’s behavioural system balance and stability or to help the person achieve a more optimum level of balance and functioning” Person * Viewed as” a behavioural system with patterned, repetitive, and purposeful ways of behaving that link the person with the environment” (Alligood, 2022, p.274). * Behaviour is influenced by prior experience, learning, physical, and social factors. Environment * External factors that influence the individual’s behavioural system. * Provides “sustenal imperatives” of protection, nurturance, stimulation, necessary to maintain health (or behavioral system balance) Health * Defined as “an elusive, dynamic state influenced by biological, psychological, and social factors” (Alligood, 2022, p.275) * Outcomes of behavioural system balance: * Minimal energy expenditure for optimal functioning * Biological and social survival * Personal satisfaction Nola J. Pender: Health Promotion Model What is the health promotion model * The model is based on the idea that people have the ability to actively participate in their own health by making choices that promote well-being and prevent illness based on their unique characteristics, prior experiences, and personal motivations * Unlike disease prevention models, HPM focuses on positive health outcomes through lifestyle modifications, self-efficacy, and proactive health decision-making * The focus of Pender's health promotion is on giving patients the tools they need to take charge of their health by adopting behaviors that preserve and improve their wellbeing. Due to her background in nursing and education, she was able to provide a holistic perspective on forming the Human Promotion Model Key concepts 1. Pender explained how personal factors could influence health issues and predict a particular behavior. * She identified three types; biological, psychological, and sociocultural. * Biological factors are variables such as age, gender, BMI. * Psychological factors being self-esteem, self-motivation, personal competence, and * Sociocultural factors being race, ethnicity, socioeconomic status, etc (Alligood, 2023). * She determined how the desired behavior under consideration could influence these factors Nursing Metaparadigm * Person: Patients are viewed as individuals who have the capacity to regulate their health behaviours (Alligood, pg. 608). They need to be engaged to ensure effectiveness and sustainability of the action plan (Alligood, pg. 609). All persons are understood to desire living conditions that permit the actualization of their human health potential * Environment: Interaction between the person and the environment influence the persons perception of health promoting behaviours. Environment must be modified to manage health behaviours. The person must adjust how they interact with their environment to achieve behavioural change * Nursing: The goal of nursing care is the optimal health of the individual across the human life span * Health: A state of optimal wellbeing and fulfillment that reflect benefits personally valued by the patient achieved through participation in health promotion behaviours Relevance to nursing practice * Health Promotion and Disease Prevention: The Health Promotion Model aligns with nursing roles that focus on preventing illness rather than just treating diseases (Alligood, pg. 610). Nurses use this model in primary care, public health, and community settings to promote wellness through patient education and early intervention. Encourages proactive healthcare strategies, such as vaccinations, screenings, and lifestyle modifications to reduce disease risk. * Patient-Centered Care: Pender's model emphasizes the importance of individualized care plans, recognizing that each patient has unique motivations, barriers, and support systems (Alligood, pg. 610). By assessing personal factors such as beliefs, cultural influences, and readiness for change, nurses can tailor interventions that increase patient engagement. Nurses act as facilitators, helping patients understand how their behavior's impact long-term health. * Chronic Disease Management: It is widely used in managing chronic conditions like diabetes, and hypertension, which require long-term lifestyle modifications rather than relying solely on medical treatment. It provides a structured approach for educating patients on self-care and adherence to treatment plans. Nurses play a key role in educating, motivating, and supporting patients in making viable health changes, such as improving diet, increasing physical activity, and adhering to medication regimens. * Nursing Education and Public Health Initiatives: The model guides health policies and community programs aimed at improving overall wellness. It is integrated into nursing education to prepare nurses for health promotion roles. Nurses in leadership and advocacy toles utilize this framework to design and implement evidence-based strategies for improving community health. Ramona Mercer: Maternal Role Attainment - becoming a mother WHat is the theory about Ramona T. Mercer theory, originally termed maternal role attainment and later revised to becoming a mother, describes the complex, ongoing process through which a woman transitions into motherhood Key influences * Personal Factors: Self-concept, self-esteem, innate personality. * Infant Characteristics: Temperament, responsiveness, health cues. * Environmental Factors: Family dynamics, social support, cultural and societal influences 4 Stages of Maternal Role Attainment 1. Anticipatory Stage: This period occurs prior to giving birth in conjunction with psychological preparation for the mother’s responsibilities. It involves both mental as well as emotional preparedness for the maternal role 2. Formal Stage: This starts right after birth and also is characterized by the mother learning of how she can care for her baby 1. Mother depends on specific external help from nurses and family to care for the baby 3. Informal Stage: Mother begins to develop an individual method of child rearing, instead of relying on external advice - Mother gains reassurances and changes her methods of parenting to suit her needs 4. Personal Stage - Mother becomes complete with her role and feels steady taking on the role of motherhood Factors that affect Maternal Role Attainment 1. Maternal Factors 1. A mother’s shift is influenced by age, self-regard. Prior history and mental state such as anxiety, or postpartum depression 2. Stress or a difficult childbirth may impact and postpone assurance for mothers 2. Infant Factors 1. An infant's temperament (calm against fussy) has influences on bonding. - A mother's caregiving confidence is greatly affected by health status (early premature birth, extended NICU stay). 3. Social and Environmental support 1. An individual along with their family assisting lowers stress for the mother, as well as aids her in connecting to the baby. 2. Community resources like parenting groups or postpartum therapy can aid adjustment. 3. The degree to which people feel secure with their money along with the events at their jobs have an effect on the amount of stress they feel and the things they accomplish. Nursing Metaparadigm Concept Person * Mercer’s theory generally focuses on the mother and her infant * The mother learns her role over time, and the infant’s temperament and health shape her confidence. * Caregivers may advocate for partner engagement as well as relative engagement in the provision of support. Environment * Mercer explains the relation of the environment to her theory through microsystem, mesosystem and exosystem (Bronfenbrenner’s Ecological Systems Theory) * Physical, emotional, social, and economic surroundings also influence maternal role attainment. * A supportive, stable environment promotes maternal confidence, while financial or emotional stress hinders it. Health * A mother's as well as a baby's health status has some effect on becoming a parent. * Postpartum depression, stresses from life, or childbirth issues may delay bonding and adaptation. These issues come from childbirth. * Helpful relationships can decrease normal stress levels and let mothers gain more confidence. Nursing * Nurses play a vital role in helping mothers switch to their brand new role properly * Nurses play a critical role in educating, guiding, and advocating for mothers. * Providing emotional reassurance, health screenings, and support referrals ensures a smoother transition into motherhood. * Nursing Interventions Role of a nurse in a maternal-child setting * Support/Care: both on a physical and psychological/mental level * Educate: provide them with the knowledge required to raise a healthy child and create a lifelong bond with them.