Nursing Theories and Conceptual Frameworks Chapter 3

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Client

a person who engages the advice or services of another person who is qualified to provide this service, in nursing the recipient of nursing care, includes individuals, families, groups, and communities

Conceptual framework

a group of related concepts

Critical theory

describes theories that help elucidate how social structures affect a wide variety of human experiences from art to social practices, in nursing critical theory research helps explain how these structures such as race, gender, sexual orientation and economic class affect client experiences and health outcomes.

Environment

all of the conditions , circumstances, and influences surrounding and affecting the development of an organism or person, in nursing the internal and external surroundings that affect the client, this includes people in the physical environment, such as families, friends, and significant others

Grand Theories

articulage a broad range of the significant relationships among the concepts of a discipline, only occassionally direct nursing research

Health

the degree of wellness or well-being that the client experiences

Metaparadigm

originates from the Greek meta, meaning with, and paradigm meaning pattern based on four theoretical concepts of nursing: person, environment, health, and nursing

Midlevel theories

focus on exploration of concepts such as pain, self-esteem, learning and hardiness, nursing research is often informed by midlevel theories that focus on the exploration of concepts such as pain, self-esteem, learning and hardiness.

Nursing

the attributes, characteristics, and actions of the nurse providing care on behalf of, or in conjunction with, the client

Paradigm

a pattern of shared understandings and assumptions about reality and the world, inxcludes our notions of reality that are largely unconscious or taken for granted

Philosophy

an early effort to define phenomena that serves as the basis for later theoretical formulations

Practice discipline

field of study in which the central focus is performance of professional role (nursing, teaching, management, making music), term not common until the end of the 20th century,

Theory

a system of ideas that is proposed to explain a given phenomenon (e.g. theory of gravity)

What is used to describe, predict and control phenomena?

theory

Who wrote the first book on home care and community health and what was the name?

Florence Nightingale, Notes on Nursing: What It Is, and What It Is Not

Disciplines without a strong theory and research base were referred to?

soft, a negative comparision with the hard sciences

When do we become aware of paradigms?

when realities clash

What was the primary use of nursing theory?

to establish the profession's place in the university

What does nursing research identify?

the philosophical assumptions or conceptual frameworks from which it proceeds because all thinking, writing, and speaking is based on previous assumptions about people and the world.

What type of research can theory be used?

qualitative research, theory can be used to help select the phenomenon, frame the philosophical underpinnings of the study, and guide date analysis and interpretation.

Qualitative research in nursing and social sciences can be grounded in what theories?

theories from philosophy or the social sciences

What are the five environmental factors that Nightingale described?

1. pure or fresh air 2. pure water 3. efficient drainage, 4. cleanliness and 5. light, especially direct sunlight (deficiencies in these five factors produced lack of health or illness

When did Peplau introduce her interpersonal concepts?

1952

What is Peplau's theory?

the existence of a therapeutic relationship between the nurse and the client, nurses enter into a personal relationship with an individual when a need is present

What are the four phases of Peplau's theory?

orientation, identification, exploitation, resolution

What is orientation?

the client seeks help and the nurse assists the client to understand the problem and the extent of the need for help

What is identification?

the client assumes as posture of dependence, interdependence, or independence in relation to the nurse, the nurse's focus is to assure the person that the nurse understands the interpersonal meaning of the client's situation

What is exploitation?

the client derives full value from what the nurse offers through the relationship, the client uses available services based on self-interest and needs, power shifts from the nurse to the client

What is resolution?

this is the final phase, old need and goals are put aside and new ones adopted, once older needs are resolved, newer and more mature ones emerge

How do nurses fulfill their clients needs?

assume many roles, stranger, teacher, resource person, surrogate, leader and counselor

When is Peplau's model used by clinicians?

when working with individuals who have psychological problems

When year was Virginia Henderson's definition of unique function of nursing?

1966

What did Virginia Henderson's function of nursing help to emerge?

it was a major stepping stone in the emergence of nursing as a discipline separate from medicine

What do Virginia Henderson and Florence Nightingale have in common?

the both describe nursing in relation to the client and the clients environment.

What is different in how Virginia Henderson and Florence Nightingale view nursing?

Henderson sees the nurse as concerned with both healthy and ill individuals, acknowledges that nurses interact with clients even when recover may not be feasible, and mention the teaching and advocacy roles of the nurse.

What is well recognized and emphisized from Virginia Henderson?

the importance of nursing's independence from and interdependence with other health care disciplines is well recognized

When did Martha Rogers present her theory?

1970

What is Martha Rogers theory?

unitary human beings-contains complex conceptualizations related to multiple scientific disciplines, views the person as an irreducible whole, the whold being greater than the sum of its parts, humans are dynamic energy fields in continuous eschange with environmental fields, both of which are infinite. The human field image perspective surpasses that of the physical body. Both human and environmental fields are characterized by pattern, a universe of open systems, and four dimensionality.

According to Rogers, unitary man:

is irreducible, four-dimensional energy field identified by pattern, manifest characteristics different from the sum of the parts, interacts continuously and creatively with the environment, behaves as a totality, as a sentient being, participates creatively in change

How does a nurse apply Roger's theory in practice?

focus on persons wholeness, seek to promote symphonic interaction between the two energy fields (human and environment) to strengthen the coherence and integrity of the person, coordinate the human field with the rhythmicities of the environmental field and direct and redirect patterns of interaction between the two energy fields to promote maximum health potential

What is the nurse's use of noncontact therapeutic touch based on?

the concept of human energy fields

When was Dorothea Orem's theory published?

1971

What are the three related concepts or Orem's theory?

self-care, self-care deficit, and nursing systems

What is the self-care theory based on?

self-care, self-care agency, self-care requisites, and therapeutic self-care demand

What does self-care refer to?

activities an individual performs independently throughout life to promote and maintain personal well being

What does self-care agency refer to?

the individuals ability to perform self-care activities. it consists of two agents (an individual who perform self-care independently) and a dependent care agent( a person other than the individual who provides the care

What are self-care requisites?

also called self-care needs, are measures or action taken to provide self-care.

What are the three categories of self-care requisites

1. universal requisites are common to all people, include maintaining intake and elimination of air, water, food, balancing rest, solitude, social interaction, preventing hazards to life and well being, promoting normal human functioning.
2. developmental requisites result from maturation, or associated with conditions and events, such as adjusting to a change in body image or the loss of a spouse
3. health deviation requisites result from illness, injurty, disease or treatment, include actions such as seeking health care assistance, carrying out prescribed therapies, learning to live with the effects of illness or treatment

What does therapeutic self-care demand refer to?

refers to all self-care activites require to meet exitsing self-care requisites or actions to maintain health and well being

When does self-care deficit occur?

when self-care agency is not adequat5e to meet the known self-care demand.

What are the three types of nursing systems Orem identifies?

1. Wholly compensatory sysems required for individuals who are unable to control and monitor their environment and process information
2. Partly compensatory systems designed for individuals who are unable to perform some, but not all, self-care activities
3. Supportive-educative (developmental) systems are designed for persons who need to learn to perform self-care measures and need assitance to do so.

What year was Imogene King's theory of goal attainment?

1981

What are the concepts of King's theory

her conceptual framework, which shows the relationship of personal systems (individuals), interpersonal systems (groups such as nurse-client) and social systems (education, health care system)

What are the 15 concepts she selected from nursing literature?

self, role, perception, communication, interaction, transaction, growth and development, stress, time, personal space, organization, status, power, authority and decision making (all essential knowledge for use by nurses)

How was the transaction process model designed?

within the theory of the ten concepts in the framework that were selected as essential knowledge for use by nurses in concrete nursing situations

What does the process in the transaction model describe?

the nature of and standard for nurse-client interactions that lead to goal attainment-that nurses purposefully interact and mutually set, explore, and agree to means to achieve goals.

What does goal attainment represent?

outcomes

When the information is recorded in the client record, nurses have data the represent what?

evidence-based nursing

What does King's theory offer insight into?

nurses interactions with individuals and groups within the environment, it highlights the importance of a clients participation in decisions that influence care and focuses on both the process of nurse-client interactions and the outcomes of care.

What does King believe about her theory?

used in evidence theory-based practice, it blends the art and the science of nursing, she also believes the process of transactions will not change but be influences by altered communication strategies using technology.

What year Neumans Systems Model?

2002

What is Neumans model based on?

the individual's relationship to stress, the reaction to it and reconstitution factors that are dynamic in nature. Reconstitution is the state of adaptation to stressors.

How doe Nueman vies the client?

as an open system consisting of a basic structure or central core of energy resources

What are Neumans energy resources?

physiologic, psychologic, sociocultural, developmental and spiritual, surrounded by two concentric boundaries or rings

What are the concentric boundaries of rings referred as?

lines of resistance

What do the lines of resistance represent?

internal factors that help the client defend against a stressor

What is an example of a line of resistance?

an increase in the body's leukocyte count to combat an infection

What are outside the lines of resistance?

two lines of defense

What is the inner or normal line of defense?

represents the person's state of equilibrium or the state of adaption developed and maintainede over time and considered normal for the person

What is the flexible line of defense?

is dynamic and can be rapidly altered over a short period of time, is a protective buffer that prevents stressors from penetrating the normal line of defense

How does Neuman categorize stressors?

intrapersonal stressors- those that occur within the individual ex. infection, interpersonal stressors- those that occur between individuals ex; unrealistic role expectations, and extrapersonal stressors: those that occur outside the person ex; financial concerns

What does the individual's reaction to stressors depend on?

the strength on the linds of defense

What happens when the lines of defense fail?

the resulting reaction depends on the strength of the lines of resistance

What is the effect known as reconstitution?

a person's systems can adapt to a stressor

What do nursing interventions provide for the systems stability?

they focus on retaining or maintains sytem stability

How are nursing interventions carried out?

1. primary prevention focuses on protecting the normal line of defense and strengthening the flexible line of defense
2. secondary prevention focuses on strengthening internal lines of resistance, reducing the reaction, and increasing resistance factors
3. tertiary prevention focuses on readaptation and stability and protects reconstitution or return to wellness following treatment

What are Betty Neumans model of nursing applicable to?

a variety of nursing practice settings involving individuals, families, groups and communities

What does Betty Neumans model emphasize?

the client's own views and the importance of partnership with caregivers to retain, attain and maintain the wholistic goal of client system optimal wellness

When was Roy's Adaption model?

2008

Define Roy's Adapation model defines adaption as?

the process and outcome whereby the thinking and feeling person uses conscious awareness and choice to create humans and environmental integration.

What does Roy;s work focus on?

increasing complexity of person and environment, self-organization, and on the relationship between and among persons, universe and what can be considered a supreme being of God.

Roy focuses on the individual as?

a biopsychosocial adaptive system that employs a feedback cycles of input throughput and output. individual and enbironment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response

What is the goal of Roy's model?

to enhance life processes through adaption in four adaptive modes

What are Roy's four adaptive modes?

1. physiological mode-involves bodys basic physiological needs and ways of adapting with regard to fluids, electrolytes, activity, rest, circulation, oxygen, nutrition, eliminiation, protection, senses, and neurologic and endocring function
2. self concept-two componets, physical self which involves sensation, body image, and the personal self which involves self ideal, self consistency, moral ethical self.
3. role function-determined by the need for social integrity, refers to the performance of duties based on given positions within society
4. interdependence mode- involves one's relations with significant others and support systems that provide help, affection and attention

What does Roy believe about nurses?

That they can envision the possible and create and transform the future

Who established the Journal of Transcultural nursing in 1986 ?

Madeleine Leininger, a nurse anthropologist

Who published her book Culture Care Diversity and Universality: A theory of Nursing?

Madeleine Leininger

What does Leininger state?

Care is the essence of nursing and the dominan, distinctive and unifying feature of nursing

What doe Leininger emphasizes

that human caring varies among cultures in its expressions, processes and patterns, it is largely culturally derived

What does Leiningers Sunrise model depict?

her theory of cultural care diversity and universality, model emphisizes that health care are influenced by elements of the social structure, such as technology, religious and philosophical factors, kinship and social systems, cultural values, and educational factors

How are leiningers social factors addressed?

within environmental contexts, language expressions, ethnohistory

What are Leiningers three intervention modes?

Culture care preservation and maintenance
Culture care accommondation, negotiation, or both
Culture care restructing and repatterning

What does Leininger state about her theory?

that it is the only one focued unequivocally on Culture Care, examining what is universal among cultures and what varies

What does Jean Watson believe?

that the practice of caring is central to nursing; it is the uniftying focus for practice

What are her carative factors?

1. formation of humanistic-alturistic system of values become practice of loving-kindness and equanimity within context of caring consciousness
2. Instillation of faith-hope becomes authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared for
3. Cultivation of sensitivity to one's self and to others becomes cultivation of ones own spiritual practics and transpersonal self, going beyond ego self
4. Development of helping, trusting, relationships, human caring relationship becomes developing and sustaining a helping trusting authentic caring relationship
5. Promotion and acceptance of the expression of positive and negative feeling becomes being present to and supportive of the expression of positive and negative feelings as a connection with deeper spirit self and the one-being cared for
6. Systematic use of a creative problem- solving caring process becomes creative use of self and all ways of knowing as part of the caring process, to engage in artistry of careing healing practices
7. Promotion of transpersonal teaching-learning become engaging in genuine teaching learning experience that attent to unity of being and meaning attempting to stay within other's frame of reference.
8. provision for a supportive, protective and/or corrective mental, physical, societal, and spiritual enbironment becomes creating healing environment at all levels, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity and peace are potentiated
9. Assitance with gratification of human needs becomes assisting with basic needs with an intentional caring consciousness, administering human care essentials, which potentiate alignment of minebodyspirit, wholeness and unity of being in all aspects of care, tending to both embodied apirit and evolving spiritual emergence
10. Allowance for existential-phenomenological-spiritual forces becomes opening and attending to spiritual mysterious, and existential dimensions of ones own life-death, soul care for self and one being cared for

In the 2008 study by Finch what theory evolved?

three phases: connecting as family, conveying genuine concern, and taking care of needs, also derivied a definition of careing phases: an authentic way of being with a person for whom there is a family-like connection, genuine concern and personalized knowledge

In 1999 what are the three assumptions about human becoming by Parse?

1. Humans becoming is freely choosing personal meaning in situations int he intersubjective process of relating value priorities
2. Human becomine is cocreating rhythmic patterns or relating in mutual process with the universe
3. Human becomin is cotranscending multidimensionally with the emerging possibles

What do the three assumptions focus on?

meaning, rhythmicity and cotranscendence

What does Parse's model of human becoming emphasize on?

how individuals choose and bear responsibility for patterns of personal health, client not nurse is the authority figure and decision maker

What does the Parse nurse use?

true prescence in the nurse-client process, the nurse's whole being is immersed with the client as the other illuminates the meaning of his or her situation and moves beyone the moment

In natural sciences, what is the main function of theory?

guide research

In practice disciplines what is the mian function of theory?

and research is to provide new possibilities for understanding the discipline's focus (music,art, nursing)

To Nightingale the knowledge required was?

to provide good nursing was neither unique or specialized

How did Nightingale view nursing?

as a central human activity grounded in observation, reason, and commonsense health practices

During the latter half of the 20th century, disciplines seeking to establish themselves in universities had to demonstrate something that Nightingale had not envisioned?

a unique body of theoretical knowledge

What do theories articulate?

significant relationships between concepts in order to point to something larger, such as gravity, the unconscious or the experience of pain

Define Pardigms

pardigms include out notions of reality that are largely unconscious or taken for granted.

What do most theories reflect?

the dominant paradigm of a culture, although some may grow out of a developing rival paradigm

In the late 20th century what did most of the theoretical work in nursing focus on?

articulating relationships between four major concepts, person, environment, health and nursing

What are the metapardigm for nursing?

articulating relationships between four major concepts, person environment, health and nursing

How do nursing theories vary?

in their a. level of abstraction b. conceptualization of the client, health/illness, environment, and nursing c. ability to describe, explain or predict phenomena

What do the debates about the role of nursing theory provide evidence of?

nursing is maturing, as both an academic discipline and a clinical profession

A supposition or system of ideas that is proposed to explain a given phenomenon best defines?

A theory

A group of related ideas or statement best defines?

A conceptual framework

A set of shared understanding and assumptions about reality and the world is a definition of?

A paradigm

What provides the best explanation for describing nursing as a practice discipline?

Nursing focuses on performing the professional role

Person, environment, health, and nursing constitue the metapardigm for nursing because they do?

they can be utilized in any setting when caring for a client

What is the role of nursing theory?

Practice theories assist nurses to reflect on the effectiveness of what they do

The purpose of theory in science is?

Help scientists interpret phenomena

In nursing what does critical theory explain?

critical theory explains how these structures such as race, gender, sexual orientation and economic class affect client experiences and health outcomes

When nursing theory is employed in a clinical setting its primary contribution is?

the facilitation of reflecting, questioning and thinking about what nurses do

Why are practice theories important to the field of nursing?

they describe the relationships among variables as applied to specific clinical situations, important contributors to effective evidence based practice

What is Philosophy used for in nursing?

used to explore both clinical and theoretical issues

What do debates in nursing theory prove?

nursing is maturing both as an academic discipline and as a clinical profession

Who is considered the first nursing theorist?

Nightingale

What did Nightingale link health to?

1. pure or fresh air
2. pure water
3. efficient drainage
4. cleanliness
5. light (especially direct sunlight)
deficiences in these five factors produced lack of health or illness

What else did Nightingale stress?

importance of keeping the client warm, maintaining a noise-free environment, and attending to the client's diet in terms of assessing intake, timeliness of the food and its effect on the person.

Nurses applying Rogers' theory in practice?

a.focus on the person's wholeness
b. seek to promote symphonic interaction between the two energy fields (human and environment) to strengthen the coherence and integrity of the person
c. direct and redirect patterns of interaction between the two energy fields to promote maximum health potential

What is nurse use on noncontact therapeutic touch based on?

concept of human energy fields

What does goal attainment represent?

outcomes

What does King's theory offer insight into?

nurses's interactions with individuals and groups within the environment and highlights the importance of a clients participation in decisions about care

What does King believe about technology?

the process of transactions will not change but will in influenced by altered communication strategies using technology

reconstitution

a person's system can adapt to a stressor

What is the main function of theory?

to guide research

Nightingale view nursings as?

neither unique nor specialized, she viewed nursing as a central human activity grounded in observation, reason and commonsense health practives

What did universities have to demonstrate that Nightingale had not envisioned for nursing?

a unique body of theoretical knowledge

What do theories articulate?

relationships between concepts in order to point to something larger, such as gravity, the unconscious, or the experience of pain

What do paradigms include?

our notions of reality that are largely unconscious or taken for granted

Most theories reflect?

dominant paradigm of a culture, although some may grow out of a deveolping rival paradigm

Articulating relationships between four nursing concepts are referred to as a?

in the late 20th century most of the theoretical work focused on articulating relationships between four major concepts: person, environment, health and nursing,because they are superimposed on almost any work in nursing they are collectively referred to a metaparadigm for nursing

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