TFN

"Theory without practice is empty; and practice without theory is blind"

History of Nursing

 Florence Nightingale - "notes on nursing"

 Columbia school

- Focus on biomedical model

- on what nurses do (functional roles)

Practice focus is patient problems and needs

 Yale School

- focus: Relationship between the nurse and patient

....................development and evolution of nursing theory

ERAS OF NURSING KNOWLEDGE

 Curriculum Era (1900-1940)

-Focus in curricular content; Goals is standardized curricula
- Art of nursing to science of nursing
 Research Era (195-1970)
- Research become the driving force
- emphasized scholarship and need to disseminate research findings to scholarly publications
 Graduate Education Era
- nursing research ,clinical specialty practice, and leadership
 Theory Era
-Emphasized on theory development
 Theory Utilization Era
- Theory application and utilization

Nursing.....
1. ............. As a Discipline
2. ............. As a Profession
3. ............. As a Science
4. ..............As a Philosophy
5. ..............As a practice science
6. ..............As a Human Science

Nursing as Academic Discipline

  A Discipline is specific to academia and refers to a branch of education , or a domain of
knowledge.
 A discipline is "a branch of knowledge ordered through the theories and methods evolving
from more than one worldview of the phenomenon of concern" (Parse 1997,p.74)

Nursing as a Distinct Discipline

 An identification philosophy
 At least one conceptual framework (perspective) for delineation of what can be defined as
nursing
 Acceptable methodologic approaches for the pursuit and development of knowledge.
( Oldnall,1995)

Nursing as a Profession

 A Profession refers to a specialized field of practice,founded upon the theoretical structure of

the science or knowledge of that discipline and accompanying practice abilities.

Characteristics of a profession

 Defined and specialized knowledge base

 Control and authority over training and education
 Credentialing system or registration to ensure competence
 Altruistic service to society
 A code of ethics
 Formal training within institutions of higher education
 Lengthy socialization to the profession
 Autonomy (control of professional activities)

Nursing as science

 Science is concerned with casuality (cause and effect )

 The scientific approach to understanding reality is characterized by observation ,verifiability ,and
experience.

Classification of Science

 Natural Sciences - chemistry, physics , biology ,physiology

 Basic or Pure Sciences - mathematics ,logic ,chemistry ,physics
 Human or Social Sciences - psychology ,anthropology ,sociology ,history and religion
 Practice or Applied Sciences - architecture ,engineering and medicine

Nursing as Philosophy
  Philosophy is concerned with the purpose of human life, the nature of being and reality, and the
theory and limits of knowledge
 Philosophy.... " A study of problems that are ultimate ,abstract , and general .
 Philosophy .. to the belief system or worldview of the profession .

What is nursing?

What is the nature of human caring ?

What is the nature of nursing practice?

Branch Pursuit

Metaphysics study of the fundamental nature of reality and

existence -- general theory of reality

Ontology study of theory of being (what is or what exists)

Cosmology Study of physical universe

Epsimology Study of knowledge (ways of knowing ,nature of

truth ,and relationship between knowledge and belief)

Logic Study of principles and methods of reasoning

(inference and argument )

Ethics (axiology) Study of nature of values ; right and wrong (moral

philosophy)

Esthetics Study of appreciation of the arts or things beautiful

Philosophy of science Study of sciene and scientific practice

Political Philosophy Study of citizen and state

Received View of Science - Hard Perceived View of Science -soft Postmodernism ,

Sciences sciences Postructuralism,and Postcolonialism

Empiricism/positivism /logical Hitoricism /phenomenology Macroanalysis

positivism

Reality/truth /facts considered Reality /truth /facts considered in contextual meaning; narration
acontextual (objective) context (subjective)

Deductive Inductive Contextual ,political ,and structural

analysis

Reality /truth/facts considered Reality /truth/facts considered PA SEND UG PIC

ahistorical

Knowledge Development and Nursing Science

 Epistemology is the study of the theory of knowledge

 Empirics
 Personal knowledge
 Intuitive knowledge - gut feeling🤢
 Somatic knowledge - learning with movement 🏃
 Methaphysical (spiritual) knowledge - there is a higher being 🙏
 Esthetics - harmony ,love, compassion,emotions and beauty ❤️
 Moral or ethical knowledge -study of right and wrong 👍👎
 "Emancipatory knowing" _what they designate as the "praxis of nursing."

NURSING VIEW ON THE NATURE OF SCIENCE

RATIONALISM EMPIRICISM

Reason is the source of all knowledge Mind is a " tabula rasa" (clean state)

Mind contains innate ideas Model of Knowledge :Biology

Model of knowledge :Math Senses are the sources of all knowledge

Knowledge can be gained a priori (deductive logic) Knowledge gained through postpriori (inductive)

Knowledge can be certain Knowledge can be probable

Senses are easily fooled

LOGICAL POSITIVISM (Galeh ,1979)

- believed empirical and logical analysis - to produce scientific knowledge

Then there was a "PARADIGM SHIFT "

- a scientific development within a discipline (Khun,1970)

Phenomenology - how we experience the objects of the external world

- Postpositivism - discovering patterns

- Interpretive understanding the meaning

PHILOSOPGY OF NURSING

LOGICAL POSITIVISM HISTORCISM

science - "product" Science -" Process"

Quantitative Research Qualitative Research

Theories are predictive Theories - Descriptive /Explanatory

Human body - "parts" Human Body - more than the sum of its parts

Paradigm - "Totality" Paradigm - "Simultaneously"

- Exam. Orem;Roy;King Exam. Roger, Parse, Newman , Watson

NURSING PHILOSOPHIES

Florence Nightingale :Modern Nursing

Jean Watson: Watson's Philosophy and Theory of Transpersonal Caring

Marilyn Anne Ray : Theory of Bureaucratic Caring

Patricia Benner: Caring ,Clinical Wisdom , and Ethics in Nursing Practice

Kari Martinsen: Philosophy of Caring

Katie Erikson: Theory of Caritative Caring

What is a theory ?

 As a systematic explanation of an event in which constructs and concepts are identified, and
relationships are proposed and predictions made .
 Constructs exist at a higher level of abstraction (e.g. Beauty, Happiness , Health)
  Concepts are based on our experiences and treat and real phenomena (e.g. income , education
level,age)

Some Terms :

 Assumptions are beliefs about phenomena one must accept as true

 A borrowed or shared theory is a theory developed in another discipline
 Concepts are the elements or components of a phenomenon necessary to understand the
phenomenon
 A conceptual model is a set of interrelated concepts that symbolically represents and conveys a
mental image of phenomenon.

Assumptions

Technological Competency as caring in Nursing is a middle range Theory grounded in nursing as caring .It
is illustrated in the practice of nursing grounded in the harmonious coexistence between technology and
caring in nursing . The assumptions of the theory are:

1. Persons are caring by virtue of their humanness (Boykin & Schoenhofer ,2001)

2. Persons are whole or complete in the moment (Boykin & Schoenhofer ,2001)

3. Knowing persons is a procss of nursing that allows for continuous appreciation of persons moment to
moment (Locsin,2005)

4. Technology is used to know wholeness of persons moment to moment

5.Nursing is a discipline and a professional practice.

CONCEPTS

 Building blocks of a theory

 Labels or names by phenomena /observable facts

PROPOSITION

 Is a statement that proposes a relationship between concepts

 Propostitonal statements in a theory the represent the theorist's view of which concepts fit
toegether
 A theory is a set of concepts and propositions that provides an orderly way to view
phenomena .
 An abstract generalization that explain how phenomena are interrelated
 NEEDS TO BE PROVEN
Concepts and propositions are the structural elements of theoretical foundation.
IMPORTANACE OF THEORY IN NURSING :

1. Theory offers structure and organization to nursing knowledge .

2. Promotes rational and systematic practice
3. Make nursing practice more overtly purposeful
4. Leads to ccordinated and less fragmented care
5. Assist the nursing discipline in clarrifying beliefs, values and goals.

* NURSING THEORY IS THE BACKBONE OF CLINICAL CARE.

METAPARADIGM VS. PARADIGM

 A mtapadigm represents the worldview of a dscipiline.
 A paradigmis an organizing framework that contains, concepts theories,
assimptios ,beliefs,values and principles that form the way a discipline interprets the subject
matter.

METAPATADIGM IN NURSING

Person or client - Recipients for nursing care

Envitonment - internal and external surroundings that affect the client

Health - degree of wellness ot well being that the client experiences

Nursing - Attributes ,characteristics ,and actions of the nurse providing care on behalf of or in
conjunction with, the client.

Classification of theories in nursing

Based on scope , which refers to complexity and degree of abstraction .

THEORY Level of Abstraction

Methatheory Most Abstract

Grand theories

Middle range theories

Practice theories Least Abstract

GRAND Nursing Theories

BASED ON HUMAN NEEDS

1. Florence Nightingale : evnironmental

2. Virginia Henderson: Nursing Need Theory
3. Faye Abdellah :21 Nursing Problems
4. Dorethea Orem: Self Care Deficit Theory
5. Dorothy Johnson: The Behavioral System Model
6. Betty Neuman: The Neuman Systems Model

BASED ON INTERACTIVE PROCESS

1. Myra Estrin Levine : The Conservation Model

2. Erikson, Tomlin , and Swain : Modeling and Role - Modelling
3. Barbara Artinian: The Intersystem Model
4. Imogene King: Theory of Goal Attainment and Transactional Process
5. Sr. Callista Roy : The Roy Adaptaion Model
6. Jean Watson : Caring Science as Sacred Science

BASED ON UNITARY PROCESS

1. Martha Rogers : The Science of Unitary and Irreducible Human Beings

2. Margaret Newman : Health as Expanding Consciousness
3. Rosemarie Parse: Human Becoming Paradigm

NURSING THEORIES :

1. Anne Boykin and Savina O. Schoenhofer : The theory of Nursing as Caring : A Model for
Transforming Practice
2. Afaf Ibrahim Meleis: Transitions Theory
3. Nola J. Pender : Health Promotion Model
4. Madeleine M. Leininger : Culture Care theory of diversity and universality
5. Gladys L. Husted and James H. Husted: Symphonological Bioethical Theory

MIDDLE RANGE THEORIES:

1. Ramona T. Mercer : Maternal Role Attainment - Becoming a Mother

2. Merle H. Mishel :Uncertainty in Illness Theory
3. Pamela G. Reed :Self- Transcendence Theory
4. Carolyn L. Weiner and Marylin J. Dodd: Theory of Illness Trajectory
5. Eakes , Burke , and Hainsworth: Theory of Chronic Sorrow
6. Phill Barker: The Tidal Model of Mental Health Recovery
7. Katharine Kolcaba : Theory of Comfort *ni gawas sa PNLE
 8. Cheryl Tatano Beck: Postpartum Depression Theory
9. Kristen M. Swanson : Theory of Caring
10. Cornelia M. Rulan and Shirley M. Moore : Peaceful End-of-Life Theory
FLORENCE NIGHTINGALE : ENVIRONMENTAL THEORY

Nightingale's Philosophy are:

 Healing
 Leadership
 Global action

CLIENT :

 Ventilation
 Variety
 Health of houses
 Air
 Noise
 Light
 Bedding
 Cleanliness
 Chattering Hopes
 Nutrition

Virginia Henderson 14 Needs theory :

 The theory presents the patient as a sum of parts with biopsychosocial needs
 ... Nurses care for patients until patients can care for themselves once again
 "The unique function of the nurse is to assist the individual ,sick or well.... To help gain
independence again .
PHYSIOLOGICAL
*in the PNLE choose the answer that will promote patient's independence
1. Breathe normally.
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable posture
5. Sleep and rest
6. Select suitable clothes
7. Maintain body temperature within normal range
8. Keep the body clean and well groomed and protect the integument .
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions,needs ,fears or opinions.

SPIRITUAL :
11. Worship according to one's faith .

SOCIAL NEED :

12. Work in such a way that there is a sens of accomplishment

13. Play or participate in various forms of recreation .

14. Learn and discover or satisfy curiosity that leads to normal development and health.

FAYE G. ABDELLAH : PATIENT- CENTERED APPROACHES TO NURSING

Typology

BRIEFLY ... PROMOTE, FACILITATE,MAINTAIN , CREATE , USE AND UNDERSTAND:

1) Hygiene comfort
2) Optimal activity
3) Safety
4) Good body mechanics
5) Supply of oxygen
6) Nutrition
7) Elimination
8) Fluid and electrolyte balance
9) Recognize the physiologic responses of the body to disease
10) Maintenance of regulatory mechanisms
11) Sensory function
12) Feelings
13) Emotions and organic illness
14) Verbal and nonverbal communication
15) Interpersonal relationships
16) Spiritual goals
17) Therapeutic environment
18) Awareness of self with varying needs
19) Optimum possible goals use community resources
20) Use community resources
21) Role of social problems as influencing factors in the causes of illness.

DORETHEA E. OREM : THE SELF-CARE DEFICIT NURSING THEORY

4 related theories :

1. Theory of self-care
2. Theory of Dependent Care

3. Theory of Self-Care Deficit

4. Theory of Nursing Systems

-(wholly compensated; partly-compensated;supprortive -educative system

Self-Care Demand

Totality of self-care actions to be performed.

3 categories of self care requisisites :

1.) UNIVERSAL associated with life process and maintenance of integrity of human structure and
functioning : Ex. Food,water and elimination .

2.) DEVELOPMENTAL - Conditions and events occuring during various stages of the life cycle .. events
that can adversely effect development .. Example ; adjusting to a new job , body changes such as facial
lines, hair loss.

3.) HEALTH DEVIAITON - genetic and constitutional defects human and structural functioning deviations

-Performed when there are medical measures use to diagnosed/correct certain condition.

Example: Learning to walk using crutches ff.the casting of a fractured leg .

THEORY OF NURSING SYSTEM

 Designed by the nurse.

 Based on the assessment of an individual's self care needs, abilities of the patient to perform
self care activities.

3 CLASSIFICATIONS OF NURSING SYSTEM TO MEET THE SELF- CARE REQUISITES OF THE PT.

1) Wholly compensatory -unable to engage self care actions ex. Coma pt, mentally retarded
2) Partly compensatory - both nurse and pt. Perform care measures
- actions involving manipulative tasks ot ambulations Ex. Pt. Who has had a recent abdominal
surgery .

3) Supportive - educative system

- person is able to perform

- can and should learn to perform required measures of externally/internally oriented

therapeutic self care but cannot do so without assistance.
Example: 16 y.o. who is requesting birth control information role of nurse : teacher or consultant.

DOROTHY JOHNSON: THE BEHAVIORAL SYSTEM MODEL

 The focus is on needs , the human as a behavioral system, and relief of stress as nursing care.
 Behavioral system encompasses the patterened ,repetitive, and purposeful ways of behaving .

7 SUB- SYSTEMS :

1) Attachment -Affiliative Subsystem

2) Dependency Subsystem
3) Ingestive Subsystem
4) Eliminative Subsystem
5) Sexual Subsystem
6) Achievement Subsystem
7) Aggressive - Protective Subsystem

BETTY NEUMAN: THE NEUMAN SYSTEMS MODEL

 Human Beings as a "client/client system , as a composite of variables ....physiological ,

psychological, sociocultural ,developmental, and spiritual
 Focuses on the impact of stressors on health and addresses stress and the reduction of
stress.

Basic structure energy resources

1. Line of resistance
2. Normal lines of defense
3. Flexible lines of defense

LEVELS OF PREVENTION (PRIMARY - health promotion and early prevention AND SECONDARY -early
detection) *practice ani sa mga examples

Major concepts:

 Open system (including function , input and output , feedback , negentropy, and stability )
 Environment (including created environment)
 Client system (including five client variables, basic structure , lines of resistance , normal line
defense and flexible line of defense.
 Health (wellness to illness),stressors , degree of reaction prevention as intervention

CLASSIFICATION OF STRESSORS

 INTRAPERSONAL - occur within the client system boundary and correlate with the internal
environment
 INTERPERSONAL - occur outside the client system boundary , are proximal to the system.
  EXTRAPERSONAL - occur outside the client system boundary but are greater at greater distance.

MYRA ESTRINE LEVINE: CONSERVATION PRINCIPLE (MODEL)

GOAL: To promote adaptation and maintain wholeness using the principles of conservation .

The model guides the nurse to focus on the influences and responses at the organismic level.

WHOLENESS

- Exist when the interactions or constant adaptations to the environment permit the assurance of
integrity .

ADAPTATION

- A life process by which , over time, people maintain their wholeness or integrity as they respond to
environmental challenges.

CONSERVATION " To keep together"

- The product of adaptation.

-Defends the wholeness of living systems by ensuring their ability to confront change appropriately and
retain their unique identity.

CONSERVATION PRINCIPLES:

1. Conservation of energy
2. Conservation of structural integrity
3. Conservation of personal integrity
4. Conservation of social integrity