Evolution of Nursing- INTRODUCTION TO NURSING THEORY OF NURSING THEORY PDF

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INTRODUCTION TO NURSING THEORY
OF NURSING THEORY, HIGHLIGHTS OF SIGNIFICANT EVENTS IN THE HISTORY, THEORY AND NURSING THEORIES...

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EVOLUTION OF NURSING

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Theorists of the Columbia School operated from a biomedical model that focused primarily on what nurses do, that is their functional roles. They considered patient problems and needs to be the practice focus.

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Independent of the Columbia theorists, Johnson suggested that nursing knowledge is based on a theory of nursing diagnosis that is different from medical diagnosis

INTRODUCTION TO NURSING THEORY OF NURSING THEORY 1. HISTORY OF NURSING THEORY • •

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Beginning of nursing theory development can be traced to Florence Nightingale To develop nursing as an academic discipline and a profession, a body of knowledge to guide nursing practice is essential. Theory development is significant to develop a body of substantive knowledge to guide nursing practice to establish nursing as a profession and an academic discipline.

NURSING THEORIES •

Play vital role in guiding critical thinking in nursing practice

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Provide the nurse with patient focus and framework to sort patient data in practice

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Guides both thinking and nursing action

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Informs practice and also that practice informs theory

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“Theory without practice is empty and practice without theory is blind.”

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Backbone of clinical care

HIGHLIGHTS OF SIGNIFICANT EVENTS IN THE HISTORY 1. Nightingale (1859/1992), “Notes on Nursing” presents the first nursing theory that focuses on the manipulation of the environment for the benefit of the patient

3. The Yale School-The 1960s •

The focus of theoretical thinking moved from a problem/need and functional role focus to the relationship between the nurse and the patient.

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The Yale’s School theoretical position was influenced by the Columbia Teacher’s School graduates who became faculty members there (Henderson & Wiedenbach)

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Theorists of the Yale School view nursing as a process rather than an end in itself. Their theories look at how nurses do what they do and how the patient perceives his or her situation.

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Orlando (Nursing process) and Wiedenbach (the helping art of Clinical Nursing)

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Levine presented her 4 conservation principles of nursing

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Yale faculty- Dickoff, James, Wiedenbach presented a definition of nursing theory and goals for theory development in nursing

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Federal funds were made available for doctoral study for nurse educators. The resulting doctorally-prepared individuals became the next wave of nurse theorists

2. The Columbia School - The 1950s •

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The need to prepare nurses at the graduate level for administrative and faculty positions was recognized Columbia University’s Teachers College developed graduate education programs to meet these functional needs The first theoretical conceptualizations of nursing science came from graduates of these programs (Peplau, Henderson, Hall, and Abdellah)

4. The 1970s Many nursing theories were presented. Many theories have been revised since their original presentation. THEORIST M. Rogers

YEA R 1970

I. King

1971

TITLE An Introduction to the Theoretical Basis of Nursing Toward a Theory for

Nursing: General Concepts of Human Behavior Nursing: Concepts of Practice

D. Orem

1971

M. Levin

1973

Introduction to Clinical Nursing

B. Neuman

1972

A Model for Teaching Total Person Approach to Patient Problems (with R.J Young) The Betty Neuman Health-Care Systems Model: A total Person Approach to Patient Problems Introduction to Nursing: An Adaptation Model Theory Development in Nursing Nursing: The Philosophy and Science of Caring

1974

Sr. C. Roy

1978

M. Newman

1979

K. Watson

1979

Theorist Year Theorist Year A. Boykin & 1993 S.Schoenhofe D.Johnso 1980 r n H. King J. Leininger R. Parse H. Erickson, F. Tomlin, and M. Swain J. Leininger

1995 1980 a 1995 b 1981 1996 1983

1997 1996

M.E.Levine

1996

A. Neuman

1995

1996

M.A.Newman

1994

5. The 1980s •

Many nursing theories were revised based on the research findings that expanded them.

1997

D.E. Orem 6. 1990s  

1991 1995

Many research studies that tested and expanded nursing theory “Nursing Science Quarterly” devoted exclusively to the presentation of nursing theory-based research findings and theoretical topics

1997

Title TitleTheory New New Theories Nursing as Caring The Behavioral System Model for Evolving Theories Nursing ACaring: systems A Framework Central for Nursing Focus of Nursing and The Theory ofServices Goal Health Care Attainment Man-living-health: A The Theory Goal Theory for of Nursing Attainment in Role Modeling and Research Modelingand Practice King’s Theory of Goal Attainment in Practice Culture Care Theory, Research and Practice The Conservation Principles: A Retrospective The Neuman: Systems Model, 3rd ed. The Neuman Systems Model in Research and Practice Health as Expanding Consciousness, 2nd ed. Evolution of the Theory of Health as Expanding Consciousness Nursing:Concepts of Practice, 4th ed. Nursing:Concepts of Practice, 45h ed. Views of Human Beings Specific to Nursing

THE ERAS OF NURSING KNOWLEDGE 1. Curriculum Era (1900-1940s) •

Efforts to understand the nature of the knowledge needed for the practice of

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Nursing are evident from an emphasis on curricular content and the movement

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toward high goal of standardized curricula

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The difference between a medical view of the patient and the view of the nurse are visible.

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Nursing began to embrace science in the curricula.

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Nursing procedures were taught and practiced in a ward-like room called a “nursing arts” laboratory, later, when nursing curricula emphasized science and research, rooms were referred to as “skills lab.”

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“Art of Nursing” was changed to “Science of Nursing” with the emergence of baccalaureate nursing programs; “art and science of nursing” is more supported in the present times

2. Research Era (1950-1970s) •

Nurses saw the need for nursing research which led to the research era

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Research became the driving force; nurses conducted research and developed specialized body of knowledge

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Research alone was needed to generate the body of knowledge or science to form a basis for nursing practice Emphasized scholarship & the need to disseminate research findings in scholarly publications 1960s-1970s= new emphasis on graduate education that included research emerged Research & graduate education eras seem to overlap; this explains the relationship between theory & research

3. Graduate Education Era (1950--1990s)

what had been learned in their doctorate programs in other fields that could address nursing’s knowledge-building needs •

Doctorate education began to flourish. The driving force was the need to develop a specialized body of knowledge and the conclusion that the knowledge should be developed by nurses prepared in the discipline of nursing

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Rogers (1970)advocated that nurses needed framework that addressed the phenomena of concern for the discipline of nursing to frame their research and develop nursing knowledge

Published their nursing frameworks: A. Johnson (1980) B. King (1971) C. Levine (1967) D. Roy (1970) D. Neuman (1972) E. Orem (1971) F. Rogers (1970) •

(Evidences of the recognition of the need for a nursing theoretical approach)

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Batey (1977) identified conceptualization as the greatest limitation of published nursing research

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Understanding that a theory is a set of related concepts

4. Theory Era (1980-1990s) •

Began with a strong emphasis on development

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1960-1970s- curricula for master’s level preparation included courses in nursing research, clinical specialty practice and leadership

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1980-1990- nursing theory development stimulated phenomenal growth, which has been noted to be cornerstone of the development of the discipline of nursing

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Nurses started to advance with doctorate programs from a wide range of related disciplines as they were being prepared for research and teaching roles in nursing

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Coupled with the research era, led to the understanding of the scientific process for the production of a scientific product

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Series of conferences brought nurses together to exchange ideas and evaluate

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Proliferation of nursing literature and new nursing journals, national and international nursing conferences and opening of new

nursing doctoral program is evidence of growth in this era •

Fawcett proposed a metaparadigm understanding of nursing knowledge based on Kuhn’s ideas, for the discipline of nursing, proposing the boundaries of nursing knowledge to be person, environment, health, and nursing.

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5. Theory Utilization Era (21st century) •

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Nursing has moved into a new era of utilization of philosophies, models or theories in practice and referred to as theory-based nursing practice. Shift from theory development to theory application and utilization recognizes the importance of a framework for critical thinking and decision-making in professional nursing practice Critical thinking- “intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action

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HISTORY AND PHILOSOPHY OF SCIENCE •

• SIGNIFICANCE FOR THE: DISCIPLINE & THE PROFESSION •

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DISCIPLINE- specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge. PROFESSION- refers to a specialized field of practice founded on the theoretical structure of the science or knowledge of the discipline and accompanying practice abilities For the significance of theory for the discipline of nursing is that the discipline is dependent on theory for its continued existence- that is nursing can be a vocation, or nursing can be a discipline with a professional style of theory-based practice. The theoretical works have taken nursing to higher levels of education and practice as

nurses moved from functional focus with emphasis on what nurses do, to a patient focus, emphasizing what nurses know for thought, decision-making and action Knowledge of persons, health and environment forms the basis for recognition of nursing as a discipline, and this knowledge is taught to those who enter the profession. Nursing theory is vital to the practice of professional nursing. Nursing is recognized as a profession today because its development was guided by the criteria for a profession. Nursing as an academic discipline depends on the existence of nursing knowledge. Nursing theories led to the recognition of nursing as an academic discipline and a profession. Nursing theories ushered the development of a body of substantive knowledge to guide nursing practice to establish nursing as a profession and an academic discipline Nursing theories play vital role in guiding critical thinking in nursing practice

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SCIENCE is a method for describing, explaining and predicting causes or outcomes of interventions Scientific activity has helped to establish the evidence we use to guide practice in the delivery of nursing care We desire to know the unknown, and identify the casue, the effect, and the significant difference that an intervention can make to increase the longevity of life Being a scientific discipline means identifying nursing's unique knowledge for the care of patients, families and communities. TWO PHILOSOPHICAL PERSPECTIVES USED IN SCIENCE 1. RATIONALISM

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Epistemological view that “regards reason as the chief source and test of knowledge’ or any view appealing to reason as a source of knowledge or justification

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Methodology or a theory in which the criterion of truth is not sensory but intellectual and deductive Rationalist epistemology (scope of knowledge) emphasizes the importance of a prior reasoning as the appropriate method for advancing knowledge. A prior reasoning uses deductive logic by reasoning from the cause and effect or from a generalization to an instance. Reynols labeled this approach the “theorythen-research strategy (deductive inquiry)

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1st half of the 20th century, philosophers focused on the analysis of theory structure, whereas scientists focused on empirical research

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Positivism, a term used by Comte, emerged as the dominant view of modern science

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Modern logical positivists believed that empirical research and logical analysis were 2 approaches that would produce scientific knowledge

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The logical empiricist argued that theoretical propositions must be tested through observation and experimentation. This perspective rooted in the idea that empirical facts exist independently of theories and offer the only basis for objectivity in science. Objective truth exists independently of the researcher, and the task of science is to discover it, which is an inductive method

2. EMPIRICISM • •

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Scientific knowledge can be derived only from sensory experience Inductive method, based on the idea that the collection of facts precedes attempts to formulate generalizations (research-thentheory strategy) inductive inquiry Reynols labeled this approach the “theorythen-research strategy (deductive inquiry)

Rationalism ✔ Reason is the source of all knowledge ✔ Mind contains innate ideas ✔ Math is a model for knowledge ✔ Knowledge can be gained a priori (deductive logic) ✔ Reason is the source of all knowledge ✔ Knowledge can be certain ✔ Senses are easily fooled ✔ Uses theory-thenresearch strategy

Empiricism ✔ The senses are the source of all knowledge ✔ Mind is the “tabular rasa” (or clean slate) ✔ Biology is a model for knowledge ✔ Knowledge is only gained a posteriori (inductive method) ✔ The senses are the source of all knowledge ✔ Knowledge can ever be probable ✔ Reasons only can give us access to uninformative tautologies ✔ Uses researchthen-theory strategy

4. EMERGENT VIEWS OF SCIENCE AND THEORY IN THE LATE 2OTH CENTURY •

A new perspective in science emerged as several authors presented analyses, challenging the positivist position

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Foucault presented his major thesis which believes that empirical knowledge was arranged in different patterns at a given time and in a given culture and that humans were emerging as objects of study.

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In 1977, Brown argued for an intellectual revolution in philosophy that emphasized the history of science was replacing formal logic as the major analytical tool in the philosophy of science.

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One of the major perspectives in the new philosophy emphasized that science was s processs of continuously building research rather than a production of findings.

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Brown proposed that theories play a significant role in determining what the scientist observes and how it is interpreted. Nurses used evidence-based science to support the intervention performed in the care of patients.

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3. EARLY 20TH CENTURY VIEWS OF SCIENCE AND THEORY

Theoretical Works in Nursing

- categorized as

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A. Philosophies- most abstract B. Conceptual models C. Theories D. Middle-range theories

human being’s significant others and physical surroundings as well as local, regional, national, and worldwide, cultural, social, political, and economic

conditions that are associated with human being’s health 3. HEALTH

CONCEPT: term/label that describes a phenomenon or group phenomena •

may be a word or phrase that summarizes ideas, observations & experiences to provide a mental image for the purpose of facilitating communication and understanding about the phenomena

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the holistic level of wellness that a person experience.

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human processes of living and dying

4. NURSING ⮚

the interventions of the nurse rendering care in support or in cooperation with the client.

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actions taken by the nurses on behalf of or in conjunction with human beings, and the goals or outcomes of nursing actions; the process of which encompasses activities that are referred to as assessment, diagnosis (labeling), planning, intervention and evaluation

: can be empirical or abstract Empirical- can either be observed or experienced through the senses Abstract- not observable, such as hope or caring •

Metaparadigm- from 2 Greek words, meta – with and paradigm- patterns

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most global perspective of a discipline Fawcett global concepts that identify the phenomenon of central interest to a discipline, the global propositions that describe the concepts, and the global propositions that state the relations between or among the concepts

NURSING PARADIGM – ARE PATTERNS OR MODELS USED TO SHOW A CLEAR RELATIONSHIP AMONG THE EXISTING THEORETICAL WORKS IN NURSING.

PHILOSOPHIES OF NURSING •

PHILOSOPHY in general terms, it consists of the general laws that furnish the rational explanation of anything.

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It is known to be the next knowledge level after metaparadigm.

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It specifies the definition of metaparadigm concepts in each of the conceptual models of nursing.

1. PERSON – (human being)- individuals, families, communities, and other groups who are participants in nursing.

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It sets forth the meaning of phenomena through analysis, reasoning and logical argument.

The recipient of nursing care like individuals, families and communities

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Set forth the general meaning of nursing and nursing phenomena through reasoning and the logical presentation of ideas

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Broad and address general ideas about nursing

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Are patterns or models used to show a clear?

CONCEPTS

2. ENVIRONMENT ⮚

the external and internal aspects of life that influence the person.

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Contribute to the discipline by providing direction, clarifying values, and forming a foundation for theory development

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Example: The assumption that all patients who are not able to take good care of themselves need nurses or caregivers.

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Theoretical works that address one or more metaparadigm concepts and are of philosophical natu...