Nursing Theory

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cgordon05
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Nursing Theory
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2010-03-05 22:20:40
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Test 1 Study Guide
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Material for test 1
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  1. 7 Ways of Knowing
    • Empirics
    • Personal knowledge
    • Intuitive knowledge
    • Somatic knowledge
    • Metaphysical (spiritual) knowledge
    • Esthetics
    • Moral or ethical knowledge
  2. Ways of Knowing: Empirics
    (define and example)
    • Scientific form of knowing.
    • Comes from observation, testing, and replication.

    What I have learned from books based on scientific knowledge.
  3. Ways of Knowing: Personal Knowledge
    (define and example)
    Knowledge gained from thought alone.

    What I know from my collective education and experiences.
  4. Ways of Knowing: Intuitive Knowledge
    (define and example)
    • Feelings and hunches.
    • Not guessing, but relying on unconscious pattern recognition and experience.

    gut feelings from "signs"
  5. Ways of Knowing: Somatic Knowledge
    (define and example)
    • Knowing of the body in relation to physical movement.
    • Includes experiential use of muscles and balance to perform a physical task.

    how to walk, balance while walking on ice, playing the piano, starting an IV
  6. Ways of Knowing: Metaphysical
    (define and example)
    • Spiritual knowledge.
    • Seeking the presence of a higher power.
    • Include magic, miracles, psychokinesis, ESP, and near-death experiences.

    Religion, believing in ghosts.
  7. Ways of Knowing: Esthetics
    (define and example)
    • Knowledge related to beauty, harmony, and expression.
    • Incorporates art, creativity, and values.

    Arranging a room to be comfortable and appealing, music.
  8. Ways of Knowing: Moral / Ethical Knowledge
    (define and example)
    • Knowledge of what is right and wrong.
    • Values and social/cultural norms.

    • "Do the right thing".
    • Values taught to us by our parents, religion, school, etc.
  9. 7 Criteria for THEORY ANALYSIS
    • Origin - How did the theory come to be? What are its origins? Inductive or deductive? Come from practice? Empirical support in literature & research? What is already known?
    • Meaning - How do the concepts relate to each other? What kinds of concepts are in the theory (concrete, abstract)? What kinds of definitions (theoretical, operational)? What kinds of statements (descriptive, relational, causal)?
    • Logical Adequacy - Is the structure logical? Free of fallacies? Accuracy in predictions? Premises accurate & correctly drawn? Format accurate? Content make sense to experts in the field?
    • Usefulness - Provide new insights? Explain phenomena better than previous theories? Allow better prescriptions? Potential to benefit nursing practice?
    • Generalizability - the extent generalization can be made; the wider the usage = more generalizable. Where can this info be used?
    • Parsimony - simplicity; simply stated. Statements do not overlap.
    • Testability - Hypotheses can be generated; definitions are operational or observable level. If already tested, then testable.
  10. Theory Analysis
    • Systematic examination of theory
    • Determines theory's strength and weaknesses
    • Determine if there's need for further theory development
  11. Theory Evaluation
    • Follows theory analysis
    • Considered a higher level of analysis
    • Evaluator makes judgments about worth of theory for making decisions and taking action
  12. Difference between theory analysis and theory evaluation
    • Theory analysis - puts aside personal biases and values; concentrates on exploring the theorist's values
    • Theory evaluation - evaluator's personal values and biases are considered during evaluation
  13. 4 types of Relational Statements
    • Existence - something "is"
    • Correlational / associational - one concept does NOT cause the other; they occur together; positive or negative
    • Probabilistic - "this" + "that" will probably result in "the other"
    • Deterministic / sufficient - cause and effect; most POWERFUL type
  14. Steps of Theory Development (8)
    • Identify concepts to put together in the theory (building blocks, nouns)
    • Identify assumptions - statements we accept as true without systematically studying them or collecting data. Implicit = implied, NOT stated. Explicit = stated
    • Develop definitions - Descriptive = describe attributes. Operational = how the concept will be measured. Theoretical = gives meaning to the terms in the context of the theory (the story of the theory)
    • Develop relational statements
    • Order or Systematize relational statements in a logical way that makes sense
    • Test
    • Revise
    • Test again
  15. Philosophies of science
    • Study of science and scientific practice
    • Seeks to describe and understand how science works within a wide range of sciences
  16. 3 Philosophies of Science
    • Rationalism - received view
    • Empiricism - received view
    • Human science / phenomenology - perceived view
  17. Perceived view
    • Descriptions derived from collectively lived experiences, interrelatedness, human interpretation, & learned reality
    • Subjective
    • Inductive reasoning
    • Multiple truths
    • Constructivism - theory of knowledge that argues that humans generate knowledge and meaning from their experience
    • Qualitative research
  18. Received view
    • Individuals learn by being told or receiving knowledge
    • Objective
    • Empiricism - scientific knowledge R/T evidence; discovered in experiments
    • Positivism - belief that knowledge is based on sensory experience and positive verification
    • Deductive reasoning
    • Validation and replication
    • Quantitative research
  19. Post-Positivism
    Accepts subjective nature of inquiry but still supports rigor and objective study through quantitative research methods.

    Belief that human knowledge is not based on unchallengeable, rock-solid foundations, but is conjectural.

    Believe there are real grounds, or warrants, for asserting these beliefs or conjectures, but these warrants can be modified or withdrawn in light of further investigation.
  20. Usefulness of Theory
    • Guides interventions
    • Helps determine desired outcomes
    • Provide evidence of effectiveness of interventions
  21. Usefulness of Theory
    (Raudonis article)
    • Logically interpret and organize collected data
    • Focus on what's important to make purposeful decisions
    • Predicts outcomes
    • Allows planning of nursing care
  22. Focus of theory
    • Describe
    • Explain
    • Predict
    • Control
  23. Research
    • Inquiry
    • Experimentation
    • Collecting information
  24. Science
    • Process - systematic inquiry based on empirical observations
    • Product - empirical knowledge; results of investigation
    • Focus on cause and effect
    • Validates theory
    • Result of relationship between theory and research
  25. Relationship between theory, research, and practice
    Cycle with entry @ any point, but most likely at practice
  26. Inductive reasoning
    • From specific to general
    • Make a generalization from many specific observations
    • All premises must be validated
    • If all premises true, conclusion probably true
    • Conclusion provides new information
  27. Deductive reasoning
    • Format: All A are B. All B are C. Therefore, all A are C.
    • From general to specific
    • Clarify information
    • Provide no new information
    • Must answer following questions:
    • Are premises sound? (criteria 2)
    • Does argument follow logical format? (criteria 1)
    • Does conclusion make sense?
  28. Steps of Concept Analysis (8)
    • Choose a concept.
    • Determine aims/purposes of analysis.
    • Identify uses of concept.
    • Determine defining attributes.
    • Identify model cases.
    • Identify borderline, related, contrary, invented, and illegitimate cases.
    • Identify antecedents and consequences.
    • Define empirical referents.
  29. Types of Concepts (5)
    • Primitive - cannot be explained; defined by example. Ex. colors, soft or hard
    • Concrete - simple; directly observable; seen, felt, heard; limited by time and space. Ex. tree, chair, bird chirping
    • Abstract - not observable directly or indirectly; defined in terms of observable concepts. Ex. love, hope, desire, fear
    • Variable (continuous) - describe phenomena based on dimensions of the phenomena. Ex. BP, pain; measurement on scale
    • Non-variable (discrete) - categories or characteristics; can be single-variable categories. Ex. gender, ethnicity, religion, marital status, can require yes or no answers
  30. Primitive Concept
    • Cannot be explained
    • Defined only by example
    • Ex.: colors, concepts like soft or hard
  31. Concrete Concept
    • Simple, directly observable
    • Can be seen, felt, heard
    • Limited by time and space
    • Ex.: tree, chair, bird chirping
  32. Abstract Concept
    • Not observable directly or indirectly
    • Defined in terms of observable concepts
    • Independent of time and space
    • Ex.: love, hope, fear, desire
  33. Variable Concept
    (continuous)
    • Concepts that describe phenomena based on dimensions of that phenomena
    • Classification of dimension or graduation of phenomena on a continuum
    • Ex.: BP, pain; measured on a scale
  34. Non-Variable Concept
    (discrete)
    • Categories of characteristics
    • Can be single-variable categories
    • Ex.: gender, ethnicity, religion, marital status; may require yes-or-no answer
  35. Why do we define and analyze concepts?
    • To understand what we observe
    • Use concepts to develop theories, frameworks, research studies
    • Breaking down concepts makes it easier to understand and convey to others
  36. Why do we develop theories for nursing?
    • Organize data in systematic way
    • Provide insight - guide interventions
    • Describe / explain significant phenomena
    • Predict outcomes
  37. Nursing as a profession.
    What are Characteristics of a Profession?
    • Defined knowledge base
    • Power and authority over training and education
    • Registration
    • Altruistic service
    • Code of ethics
    • Lengthy socialization
    • Autonomy
    • Institutionalized goal or social mission
    • Group of scholars, investigators, researchers who work continually to advance knowledge with goal of improving practice
    • Responsible and accountable to public for their work
  38. Is nursing a profession?
    What professional characteristics are present and which ones are missing?
  39. Nursing's Metaparadigm
    • Person - that which makes one human; the holistic being; physical, intellectual, biochemical, and psychosocial needs
    • Health - being able to function to fullest capacity, independently; unity of body, mind, and soul
    • Nursing - science, art, and practice discipline involving caring
    • Environment - external and internal forces influencing the individual; patient's support system
  40. How does Florence Nightingale view nursing as separate from medicine?
    • Knowledge developed and used by nurses should be separate and distinct from medical knowledge
    • Insisted nurses control and staff nursing schools and manage nursing practice in homes and hospitals
  41. What does Florence Nightingale believe about nursing?
    • Role of the nurse = put client in best condition possible for nature to act upon him
    • Formal training - necessary to teach what to do and HOW to do it
    • Teaching symptoms and what they mean
    • Importance of rationale for actions
    • Significance of trained powers of observation and reflection
    • Proposed basic premises for nursing practice
    • Nurses make astute observations of the sick and their environment
    • Nurses should record observations and develop knowledge about factors that promote healing
    • Nursing framework emphasized utilization of empiric knowledge
  42. What is Florence Nightingale's definition of nursing?
    To "nurse" is to be in charge of the personal health of another.
  43. Key events in the life of Florence Nightingale:
    • Formal nurse training - Kaiserwerth, Germany
    • Served British Army in the Crimean War
    • After Crimean War, established first nursing school in London
    • In 1859, published Notes on Nursing
    • Distinguished statistician
  44. How did Florence Nightingale envision nursing?
    • To "nurse" = being in charge of the personal health of another
    • Role of the nurse = put client in best condition for nature to act upon him

    • Nurses were to:
    • Make astute observation of the sick and their environment
    • Record these data
    • Develop knowledge about factors that promote healing
  45. What was nursing like in late 1800s to early 1900s?
    • Education - provided by MDs in evenings after nursing students worked hard all day
    • Curricula - little theory, some A&P, occasional lecture on special disease, few nursing books
    • Practice - performance-focus, emphasis on carrying out MD orders, submissive and obedient, fulfilling duties without question, apprenticeship model, students learn from more advanced students
    • Exploited as cheap labor - all patient care done by student nurses; may have only been one graduate nurse in the hospital; most hospitals had nursing programs = cheap labor
    • Adherence to medical model - focus on cure and treatment; view mind and body separately
  46. What forces drove increasing development of nursing theory?
    • 1920s - two landmark reports reveal deplorable state of nursing and physician education --> development of nursing curriculum
    • 1924 - Yale University began first school of nursing
    • Nursing shortage after WWII - Esther Brown, PhD blamed nursing education model as central to problems in profession; recommended formal nursing education - in universities, NOT hospital-based
    • Hill-Burton Act - dramatic increase in # of hospitals
    • Professional organizations for nurses
    • By 1949 - 41 states required licensing and registration for nursing
    • 1956 - Health Amendment Act - provided financial aid to promote graduate nursing education
    • 1954 - first nursing doctoral program at University of Pittsburgh
  47. How did the forces influence theory development?
    • Nurse scholars began to debate ideas, viewpoints, and research methods used in nursing literature
    • Nurses began to question ideas previously taken for granted in nursing
  48. List 5 stages of development in nursing theory:
    • Silent knowledge
    • Received knowledge
    • Subjective knowledge
    • Procedural knowledge
    • Constructed knowledge
  49. Describe the Silent Knowledge stage of theory development
    • 1st stage
    • Non-questioning obedience to MDs - carrying out orders, performing tasks
    • Limited research
    • Minimal theory development
  50. Describe the Received Knowledge stage of theory development
    • 2nd stage
    • Learning through listening to others
    • Nurse licensing and registration
    • Nursing shortage
    • Borrowed theories
    • Non-nursing doctoral degrees
    • Research - educational, sociological
  51. Describe the Subjective Knowledge stage of theory development
    • 3rd stage
    • Revolution in nursing - beginning attempts to define nature of nursing practice and theory development
    • Nursing models - developed from experience and perceptions of ideal nursing practice
    • Theories - define distinct relationship between nurse role and health
  52. Describe the Procedural Knowledge stage of theory development
    • 4th stage
    • Nursing viewed as scientific discipline
    • Nursing curriculum = conceptual frameworks
    • Consensus = common elements of nursing
    • Theory in practice = under-emphasized; emphasis on procedures to acquire knowledge
  53. Describe the Constructed Knowledge stage of theory development
    • 5th stage
    • Recognition of different types of knowledge - intuition, reason, self-knowledge
    • Nursing theory based on:
    • empirical studies
    • literature
    • patient reports of clinical experience and feelings
    • nurse intuition
    • related knowledge
    • Theory-development based on:
    • evidence-based research
    • application of nursing process
  54. Discipline
    • Branch of educational instruction
    • Department of learning or knowledge
    • Field of study; branch of knowledge
  55. Academic discipline
    • Aim to know
    • Descriptive theories
    • Research - applied and basic
    • Examples: basic sciences - chemistry, physics, biology, sociology, anthropology
  56. Professional discipline
    • Practical
    • Research - prescriptive and descriptive
    • Examples - medicine, law, nursing, social work
  57. Science
    • Process - systematic inquiry; empirical observations; procedures/methods to acquire knowledge
    • Product - empirical knowledge grounded in testing and experience; result of investigation; knowledge
    • Focus on cause and effect
    • Validates theory
  58. Humanity
    • Branches of learning that investigate human constructs and concerns as opposed to natural processes and social relations
    • Deal with various aspects of humans and human interactions
    • Ex.: philosophy, arts, languages vs. physics, chemistry, anthropology, economics
  59. Hypotheses
    • Tentative suggestions that specific relationship exists between 2 concepts or propositions
    • Educated guess to be proven
  60. Law
    • Proposition about relationship between concepts in theory that has been repeatedly validated
    • Usually observable and measurable
  61. Metaparadigm
    • Broad view of a discipline
    • Most global perspective
  62. Conceptual model
    • Interrelated concepts that convey mental image of phenomenon
    • Symbolic representation of concept
    • Allows visualization of concept in images
  63. Grand theory
    • Attempt to explain broad areas of a discipline
    • May incorporate numerous theories
    • Non-specific
    • Relatively abstract concepts lacking operational definitions - not easily tested
    • Majority of nursing conceptual frameworks
    • Ex.: theories of Orem, Rogers, Roy
  64. Middle Range nursing theory
    • Encompass limited # of concepts and limited aspect of real world
    • Relatively concrete concepts; measurable and testable
    • Ex.:
    • description of phenomena - discomfort, grief
    • explanation of relationship between phenomena - end-of-life issues, novice-to-expert
    • prediction of effects of phenomena - adopting healthy behaviors
  65. Critical thinking
    Skillful and responsible thinking in which you study the problem from all angles, and then exercise your best judgment to draw conclusions
  66. Logic
    • Science of correct reasoning
    • Valid induction or deduction

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