Theoretical Foundations of Nursing Practice PDF

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Theoretical Foundations of Nursing Practice: Ch4 Identify the purpose of nursing theories.  Theories offer well-grounded rationales for how and why nurses perform specific interventions and for predicting patient behaviors and outcomes  A nursing theory helps to identify the focus, means, and goals of practice  Nursing theories enhance communication and accountability for patient care Define the following terms: theory, phenomenon, concepts, definitions, and assumptions.  Theory: A theory contains a set of concepts, definitions, and assumptions or propositions that explain a phenomenon.  Phenomenon: Is the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations o Phenomena may be temporary or permanent. o Examples of phenomena of nursing include caring, self-care, and patient responses to stress.  Concepts: Concepts are the words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon” o Think of concepts as ideas and mental images. They can be abstract such as emotions or concrete such as physical objects. o For example, in Watson's transpersonal theory of caring concepts include meeting human needs and instilling faith-hope. o Theories use concepts to communicate meaning.  Definitions: Theorists use definitions to communicate the general meaning of the concepts of a theory o Theoretical/conceptual  Theoretical/conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on the theorist's perspective  Ex] Pain = physical discomfort o Operational  Operational definitions state how concepts are measured  For example, a nursing concept conceptually defines pain as physical discomfort and operationally as a patient reporting a score of three or above on a pain scale of zero to ten  Assumptions: are the “taken-for-granted” statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory. o Assumptions are accepted as truths and are based on values and beliefs o For example, Watson's transpersonal caring theory has the assumption that a conscious intention to care promotes healing and wholeness o Everything that makes up a theory Identify the four major domains that nursing theories address. 1. Person/Client  is the recipient of nursing care, including individual patients, groups, cultures, families, and communities.  The person is central to the nursing care you provide.  Because each person's needs are often complex, it is important to provide individualized patientcentered care. 2. Health  as different meanings for each patient, the clinical setting, and the health care profession.  It is a state of being that people define in relation to their own values, personality, and lifestyle.  It is dynamic and continuously changing.  Your challenge as a nurse is to provide the best possible care based on a patient's level of health and health care needs at the time of care delivery. 3. Environment  includes all possible conditions affecting patients and the settings where they go for their health care.  There is a continuous interaction between a patient and the environment.

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 This interaction has positive and negative effects on a person's level of health and health care needs.  Factors in the home, school, workplace, or community all influence the level of these needs.  For example, an adolescent girl with type 1 diabetes needs to adapt her treatment plan to adjust for physical activities of school, the demands of a part-time job, and the timing of social events such as her prom 4. Nursing  is the “… protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations”  the scope of nursing is broad. For example, a nurse does not medically diagnose a patient's health condition as heart failure. However, he or she assesses a patient's response to the decrease in activity tolerance as a result of the disease and develops nursing diagnoses of fatigue, activity intolerance, and ineffective coping from these nursing diagnoses the nurse creates a patientcentered plan of care for each of the patient's health problems. Use critical thinking skills to integrate knowledge, experience, attitudes, and standards into the individualized plan of care for each of your patients. Explain the influence of nursing theory on a nurse's approach to practice.  Theories offer well-grounded rationales or reasons for how and why nurses perform specific interventions.  Learning about theories is important because these theories help to describe, explain, predict, and/or prescribe nursing care measures.  Although nursing theory will help the nurse in graduate school, it is also an important basis for the nurse’s approach to daily patient care, and it expands scientific knowledge of the profession Describe the relationship among nursing theory, the nursing process, and patient needs.  The nursing process is used in clinical settings to determine individual patient needs.  Although the nursing process is central to nursing, it is not a theory. It provides a systematic process for the delivery of nursing care, not the knowledge component of the discipline. However, nurses use theory to provide direction in how to use the nursing process.  For example, the theory of caring influences what nurses need to assess, how to determine patient needs, how to plan care, how to select individualized nursing interventions, and how to evaluate patient outcomes. Differentiate among components of selected nursing practice theories: Nightingale’s, Henderson’s, Neuman’s, Orem’s and Roy’s conceptual models of nursing.  Nightingale’s o Environmental Theory  Focus is the client and the client’s environment  Her theory was founded on her belief that nursing could improve a patient’s environment to facilitate recovery and prevent complications  Nightingale believed nurses should manipulate (e.g., ventilation, light, decreased noise, hygiene, nutrition) so nature is able to restore a patient to health  she linked the patient's health status with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War.  Nightingale taught and used the nursing process, noting that “vital observation [assessment] … is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort”  Henderson’s o 14 fundamental needs of the client o Nurses assist patients with 14 needs: 1. Breathing 2. eating/drinking 3. Elimination 4. movement/positioning 5. sleep/rest 6. Clothing 7. body temperature

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8. Hygiene 9. Safety 10. Communication 11. Socialization 12. Play 13. practice of faith 14. learning o until patients can meet these needs for themselves; or they help patients have a peaceful death  Neuman’s: Client System’s Model o Client is an open system that has exchanges with both internal and external environments o Nurses view a patient (physical, psychological, sociocultural, developmental, and spiritual) as being an open system that is in constant energy exchange with both internal and external environments. o Nurses help a patient/client (individual, group, family, or community) cope with intrapersonal, interpersonal, and extra-personal stressors that can break through the patient's line of defense and cause illness. o The role of nursing is to stabilize a patient or situation, and the focus is on wellness and prevention of disease  Orem’s o Focuses on patient’s self-care needs o a nurse continually assesses a patient's ability to perform self-care and intervenes as needed to ensure that the patients meets physical, psychological, sociological, and developmental needs. o According to Orem, people who participate in self-care activities are more likely to improve their health outcomes o Nursing care becomes necessary when patients are unable to fulfill biological, psychological, developmental, or social needs. o Nurses continually assess and determine why patients are unable to meet these needs, identify goals to help them, intervene to help them perform self-care, and evaluate how much self-care they are able to perform. o For example, a patient may need a nurse to bathe or feed him or her while acutely ill; but as his or her condition improves, the nurse encourages the patient to begin doing these activities independently.  Sister Callista Roy o Focus on adaptation o Help client to cope with or adapt to changes o Nurses help patient cope with or adapt to changes in physiological, self-concept, role function, and interdependence domains Review selected shared theories from other disciplines.  To practice in today's health care systems, nurses need a strong scientific knowledge base from nursing and other disciplines such as the biomedical, sociological, and behavioral sciences. Also known as a borrowed or interdisciplinary theory, a shared theory explains a phenomenon specific to the discipline that developed the theory  Human needs o Need motivates human behavior. Maslow's hierarchy of basic human needs includes five levels of priority (e.g., physiological, safety and security, love and belonging, self-esteem, and self-actualization)  Stress/adaptation o Humans respond to actual or perceived threats by adapting to maintain function and life  Developmental o Humans have a common pattern of growth and development.  Biomedical o Theory explains causes of disease; principles related to physiology.  Psychosocial

Theory explains and/or predicts human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains  Educational o Theory explains the teaching-learning process by examining behavioral, cognitive, and adult learning principles  Leadership/management o Theory promotes organization, change, power/empowerment, motivation, conflict management, and decision-making. Describe Maslow's Hierarchy of Human Need.  Blueprint for how we care for our patients  Meet lower needs before moving up in the pyramid  Maslow believed that human behavior was motivated by needs in a hierarchy o

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Describe theory-based nursing practice.  Nursing theories guide nursing practice.  When using theory-based nursing practice, you apply the principles of a theory in delivering nursing interventions.  Grand theories: o are abstract, broad in scope, and complex; therefore, they require further clarification through research so they can be applied to nursing practice. o A grand theory does not provide guidance for specific nursing interventions; but it provides the structural framework for general, global ideas about nursing. o Grand theories intend to answer the question, “What is nursing” and focus on the whole of nursing rather than on a specific type of nursing. o The grand theorists developed their works based on their own experiences and the time in which they were living, which helps to explain why there is so much variation among the theories. o Grand theories address the nursing metaparadigm components of person, nursing, health, and environment.  Middle-range theories o continue to advance nursing knowledge through nursing research  Practice theories o also known as situation-specific theories, bring theory to the bedside o An example of a practice theory is a pain-management protocol for patients recovering from cardiac surgery. o help you provide specific care for individuals and groups of diverse populations and situations...