Chapter 2Frameworks for Professional Nursing Pract.docx
- 1. Chapter 2 Frameworks for Professional Nursing Practice Definitions • Concept • Conceptual model • Propositions • Assumptions • Theory • Metaparadigm Central Concepts in Nursing • Person receiving the nursing • Environment within which the person exits
- 2. • Health-illness continuum within which the person falls at the time of the interaction with the nurse • Nursing actions Nightingale’s Environmental Theory • Person: Recipient of nursing care • Environment: External (temperature, bedding, ventilation) and internal (food, water, and medications) • Health: Not only to be well, but to be able to use well every power we have to use • Nursing: Alter or manage the environment to implement the natural laws of health Nightingale’s 13 Canons • Ventilation and warmth • Health of houses
- 3. • Petty management • Noise • Variety • Food intake • What food? • Bed and bedding • Light • Cleanliness of rooms and walls • Personal cleanliness • Chattering hopes and advises • Observation of the sick Virginia Henderson: Definition of Nursing and 14 Components of Care • Person: Recipient of nursing care who is composed of biological, psychological,
- 4. sociological, and spiritual components • Environment: External environment • Health: Based upon the patient’s ability to function independently • Nursing: Assist the person, sick or well, in performance of activities The Nurse−Theorists Virginia Henderson Promo Video https://youtu.be/c3mnNPozt_w https://youtu.be/c3mnNPozt_w Henderson’s 14 Basic Care Needs (1 of 2) • Breathe normally • Eat and drink adequately • Eliminate bodily wastes • Move and maintain postures • Sleep and rest
- 5. • Dress and undress • Maintain body temperature within normal range Henderson’s 14 Basic Care Needs (2 of 2) • Keep body clean and protect integument • Avoid dangers • Communicate with others • Worship according to one’s faith • Work (sense of accomplishment) • Recreation • Learn and discover, leading to normal development and health, and use health facilities Jean Watson: Philosophy and Science of Caring (1 of 2) • Goal is to help persons attain a higher level of harmony within the mind-body-spirit • Goal pursued through transpersonal caring
- 6. guided by 10 caritas processes Jean Watson: Philosophy and Science of Caring (2 of 2) • Person (human): A unity of mind-body-spirit/nature; embodied spirit • Healing space and environment: A nonphysical energetic environment; a vibrational field integral with the person where the nurse is not only in the environment but “the nurse IS the environment” • Health (healing): Harmony, wholeness, and comfort • Nursing: Reciprocal transpersonal relationship in caring moments guided by caritas processes The Nurse Theorists−Jean Watson Promo Video https://youtu.be/qX1fxKfZifo https://youtu.be/qX1fxKfZifo
- 7. Benner’s Clinical Wisdom in Nursing Practice: 9 Domains of Critical Care Nursing • Diagnosing and managing life- sustaining physiological functions in unstable patient • Using skilled know-how to manage a crisis • Providing comfort measures for the critically ill • Caring for patients’ families • Preventing hazards in a technological environment • Facing death: End-of-life care and decision making • Communicating and negotiating multiple perspectives
- 8. • Monitoring quality and managing breakdown • Using the skilled know-how of clinical leadership and the coaching and mentoring of others Benner’s Clinical Wisdom in Nursing Practice: 6 Aspects of Clinical Judgment and Skilled Comportment (1 of 2) • Reasoning-in-transition: Practical reasoning in an ongoing clinical situation • Skilled know-how: Also known as embodied intelligent performance; knowing what to do, when to do it, and how to do it • Response-based practice: Adapting interventions to meet the changing needs and expectations of patients • Agency: One’s sense of and ability to act upon or influence a situation
- 9. Benner’s Clinical Wisdom in Nursing Practice: 6 Aspects of Clinical Judgment and Skilled Comportment (2 of 2) • Perceptual acuity and the skill of involvement: The ability to tune into a situation and hone in on the salient issues by engaging with the problem and the person • Links between clinical and ethical reasoning: The understanding that good clinical practice cannot be separated from ethical notions of good outcomes for patients and families Benner’s Clinical Wisdom in Nursing Practice • Person: Embodied person living in the world who is a “self-interpreting being, that is, the person does not come into the world pre-defined but gets defined in the
- 10. course of living a life” • Environment: A social environment with social definition and meaningfulness • Health: The human experience of health or wholeness • Nursing: A caring relationship that includes the care and study of the lived experience of health, illness, and disease The Nurse Theorists V2−Patricia Benner Promo Video https://youtu.be/ZM315_5Jqss https://youtu.be/ZM315_5Jqss Martha Rogers’ Science of Unitary Human Beings (1of 2) • Person (human being): An irreducible, irreversible, pandimensional, negentropic energy field identified by pattern
- 11. • Environment: An irreducible, pandimensional, negentropic energy field, identified by pattern and manifesting characteristics different from those of the parts and encompassing all that is other than any given human field Martha Rogers’ Science of Unitary Human Beings (2 of 2) • Health: Health and illness are a part of a continuum • Nursing: Seeks to promote symphonic interaction between fields, to strengthen the integrity of the human field, and to direct patterning of the human and environmental fields for realization of maximum health potential Principle of Hemeodynamics
- 12. • Helicy • Resonancy • Integrality Martha Rogers Interview Part I Video https://youtu.be/V1XN3rPKndE https://youtu.be/V1XN3rPKndE Martha Rogers Interview Part II Video https://youtu.be/f6qWm8sGut0 https://youtu.be/f6qWm8sGut0 Dorothea Orem’s General Theory of Nursing • Composed of three related theories: – Theory of self-care – Theory of self-care deficit
- 13. – Theory of nursing systems Types of Self-Care Requisites • Universal self-care requisites (found in all human beings and associated with life processes) • Developmental self-care requisites (related to different stages of human life cycle) • Health-deviation self-care requisites (related to deviations in structure or function) Dorothea Orem’s General Theory of Nursing (1of 2) • Person (patient): A person under the care of a nurse; a total being with universal, developmental needs and capable of self care • Environment: Physical, chemical, biologic, and social contexts within which human beings
- 14. exits; environmental components include environmental factors, elements, and conditions, as well as the developmental environment Dorothea Orem’s General Theory of Nursing (2 of 2) • Health: A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning • Nursing: Therapeutic self-care designed to supplement self-care requisites. Nursing actions fall into one of three categories: Wholly compensatory, partly compensatory, or supportive educative system The Nurse Theorists; Excellence in Action−Dorothea Orem Promo Video
- 15. https://youtu.be/O_ie_504B7U https://youtu.be/O_ie_504B7U Callista Roy’s Adaptation Model • Person (human system): A whole with parts that function as a unity • Environment: Internal and external stimuli; the world within and around humans as adaptive systems • Health: A state and process of being and becoming an integrated and whole human being • Nursing: Manipulation of stimuli to foster successful adaptation Roy’s 6-Step Nursing Process • Assessing behaviors manifested from the 4 adaptive modes • Assessing and categorizing stimuli • Making a nursing diagnosis
- 16. • Setting goals to promote adaptation • Implementing interventions aimed at managing stimuli to promote adaptation • Evaluating achievement of adaptive goals The Nurse Theorists−Callista Roy Promo Video https://youtu.be/fC2zMcTquaU https://youtu.be/fC2zMcTquaU Betty Neuman’s Systems Model (1 of 3) • Wellness model based on general systems theory • Focus of the model is on the client system in relationship to stressors • Client system is protected by a circular series of buffers known as lines of defense – Flexible line of defense
- 17. – Normal line of defense – Lines of resistance Betty Neuman’s Systems Model (2 of 3) • Person (client system): A composite of physiological, psychological, sociocultural, developmental, and spiritual variables in interaction with the internal and external environment Betty Neuman’s Systems Model (3 of 3) • Environment: All internal and external factors of influences surrounding the client system; three relevant environments identified are the internal environment, the external environment, and the created environment • Health: A continuum of wellness to illness;
- 18. equated with optimal system stability • Nursing: Prevention as intervention; concerned with all potential stressors The Nurse Theorists−Betty Neuman Promo Video https://youtu.be/UilhyIGg8jA https://youtu.be/UilhyIGg8jA King’s Interacting Systems Framework and Theory of Goal Attainment (1 of 3) • Conceptualizes 3 levels of dynamic interacting systems that include personal systems (individuals), interpersonal systems (groups), and social systems (society) • Concepts important to understanding the theory include communication, interaction, role, stress, and transaction
- 19. King’s Interacting Systems Framework and Theory of Goal Attainment (2 of 3) • Person (human being): A personal system that interacts with interpersonal and social systems. • Environment: Can be both external and internal; the external environment is the context within which human beings grow, develop, and perform daily activities. The internal environment of human beings transforms energy to enable them to adjust to continuous external environmental changes. King’s Interacting Systems Framework and Theory of Goal Attainment (3 of 3) • Health: Dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external
- 20. environment through optimum use of one’s resources to achieve maximum potential for daily living • Nursing: A process of human interaction; the goal of nursing is to help patients achieve their goals The Nurse Theorists−Imogene King Promo Video https://youtu.be/1sZPaj-RioE https://youtu.be/1sZPaj-RioE Johnson’s Behavioral System Model: 7 Subsystems of Behavior • Achievement • Affiliative • Aggressive • Dependence • Sexual
- 21. • Eliminative • Ingestive Johnson’s Behavioral System Model (1 of 2) • Person (human being): A biopsychosocial being who is a behavioral system with 7 subsystems of behavior • Environment: Includes internal and external environment • Health: Efficient and effective functioning of system; behavioral system balance and stability Johnson’s Behavioral System Model (2 of 2) • Nursing: An external regulatory force that acts to preserve the organization and integrity of the patient’s behavior at an
- 22. optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found The Nurse Theorists−Dorothy Johnson Promo Video https://youtu.be/3TJ8g232PL8 https://youtu.be/3TJ8g232PL8 Parse’s Humanbecoming Theory: Themes and Processes • Three themes: – Meaning – Rhythmicity – Transcendence • Three processes: – Explicating
- 23. – Dwelling – Moving beyond Parse’s Humanbecoming Theory • Person: An open being, more than and different than the sum of parts in mutual simultaneous interchange with the environment who chooses from options and bears responsibility for choices • Environment: Co-exists in mutual process with the person • Health: Continuously changing process of becoming • Nursing: A learned discipline; the nurse uses true presence to facilitate the becoming of the participant The Nurse Theorists−Rosemarie Parse Promo Video https://youtu.be/yezjnbA5ln0 https://youtu.be/yezjnbA5ln0
- 24. Leininger’s 3 Modalities • Cultural care preservation and/or maintenance • Cultural care accommodation and/or negotiation • Cultural care repatterning or restructuring Madeleine Leininger’s Cultural Diversity and Universality Theory (1 of 2) • Person: Human being, family, group, community, or institution • Environment (environmental context): Totality of an event, situation, or experience that gives meaning to human expressions, interpretations, and social interactions in physical, ecological, sociopolitical, and/or cultural settings
- 25. Madeleine Leininger’s Cultural Diversity and Universality Theory (2 of 2) • Health: A state of well-being that is culturally defined, valued, and practiced • Nursing: Activities directed toward assisting, supporting, or enabling with needs in ways that are congruent with the cultural values, beliefs, and lifeways of the recipient of care The Nurse Theorists−Madeleine Leininger Promo Video https://youtu.be/uyS-VIfxagk https://youtu.be/uyS-VIfxagk Peplau’s Theory of Interpersonal Relations (1 of 4) • Six nursing roles that emerge during the phases of relationship:
- 26. –Teacher –Resource –Counselor –Leader –Technical expert –Surrogate Peplau’s Theory of Interpersonal Relations (2 of 4) • Three phases in the nurse–patient relationship: – Orientation – Working – Resolution Peplau’s Theory of Interpersonal Relations (3 of 4) • Person: Encompasses the patient (who has
- 27. problems for which expert nursing services are needed or sought) and the nurse • Environment: Forces outside the organism within the context of culture Peplau’s Theory of Interpersonal Relations (4 of 4) • Health: Implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living • Nursing: The therapeutic, interpersonal process between the nurse and the patient The Nurse Theorists−Hildegard Peplau Promo Video https://youtu.be/96OsVRsebuA
- 28. https://youtu.be/96OsVRsebuA Pender’s Health Promotion Model: 3 Major Categories to Consider • Individual characteristics and experiences (biological factors, psychological factors, sociocultural factors) • Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity- related affect) • Behavioral outcome Pender’s Health Promotion Model (1 of 2) • Person: The individual, who is the primary focus of the model • Environment: The physical, interpersonal, and economic circumstances in which
- 29. persons live • Health: A positive high-level state Pender’s Health Promotion Model (2 of 2) • Nursing: The role of the nurse includes raising consciousness related to health- promoting behaviors, promoting self- efficacy, enhancing the benefits of change, controlling the environment to support behavior change, and managing barriers to change The Nurse Theorists V2−Nola Pender Promo Video https://youtu.be/WYiE8-U0PCg https://youtu.be/WYiE8-U0PCg Afaf Ibrahim Meleis:
- 30. Transitions Theory (1 of 3) • Transition is a process triggered by a change that represents a passage from a fairly stable state to another fairly stable state • Transitions can be described in terms of types and patterns of transitions, properties of transition experiences, transition conditions, process indicators, outcome indicators, and nursing therapeutics Afaf Ibrahim Meleis: Transitions Theory (2 of 3) • Person: Persons are active beings who experience fundamental life patterns and who have perceptions of and attach meaning to transition experiences • Environment: Environmental conditions expose persons to potential damage,
- 31. problematic recovery, or delayed or unhealthy coping contributing to vulnerability related to transitions Afaf Ibrahim Meleis: Transitions Theory (3 of 3) • Health: Health consists of complex and multidimensional transitions that are characterized by flow and movement over time; healthy outcomes are defined in terms of the transition process • Nursing: Nursing means being the primary caregiver for individuals and their families during the transition process and applying nursing therapeutics during transitions to promote healthy outcomes The Nurse Theorists V2−Afaf Meleis
- 32. Promo Video https://youtu.be/xSn2qqmcwaA https://youtu.be/xSn2qqmcwaA Swanson’s Theory of Caring (1 of 3) • Five basic processes of caring: – Maintaining belief – Knowing – Being with – Doing for – Enabling Swanson’s Theory of Caring (2 of 3) • Person: Unique beings who are in the midst of becoming and whose wholeness is made manifest in thoughts, feelings, and behaviors • Environment: Any context that influences or is influenced by the designated client
- 33. Swanson’s Theory of Caring (3 of 3) • Health and well-being: To live the subjective, meaning-filled experience of wholeness; wholeness involves a sense of integration and becoming wherein all facets of being are free to be expressed • Nursing: Informed caring for the well-being of others Kolcaba’s Theory of Comfort (1 of 4) • Comfort care encompasses 3 components: – An appropriate and timely intervention to meet the comfort needs of patients – A mode of delivery that projects caring and empathy – The intent to comfort
- 34. Kolcaba’s Theory of Comfort (2 of 4) • Comfort needs include patients’ or families’ desire for or deficit in relief, ease, or transcendence in the physical, psychospiritual, sociocultural, or environmental contexts of human experience • Comfort measures refer to interventions that are intentionally designed to enhance patients’ or families’ comfort Kolcaba’s Theory of Comfort (3 of 4) • Person: Recipients of care may be individuals, families, institutions, or communities in need of health care • Environment: Includes any aspect of the patient, family, or institutional setting that can be manipulated by the nurse, a loved one, or the institution to enhance comfort
- 35. Kolcaba’s Theory of Comfort (4 of 4) • Health: Considered optimal functioning of the patient, the family, the healthcare provider, or the community • Nursing: The intentional assessment of comfort needs, design of comfort interventions to address those needs, and reassessment of comfort levels after implementation compared with baseline Reed’s Self-Transcendence Theory (1 of 3) • Three major concepts are central to the theory of self-transcendence: – Self-transcendence – Well-being – Vulnerability
- 36. • Additional concepts include: – Moderating–mediating factors – Points of intervention Reed’s Self-Transcendence Theory (2 of 3) • Person: Human beings who develop over the life span through interactions with other persons and within an environment • Environment: Composed of family, social networks, physical surroundings, and community resources Reed’s Self-Transcendence Theory (3 of 3) • Health (well-being): A sense of feeling whole and healthy, according to one’s own criteria for wholeness and health • Nursing: The role of nursing activity is to
- 37. assist persons through interpersonal processes and therapeutic management of their environment to promote health and well-being The Nurse Theorists V2−Pamela Reed Promo Video https://youtu.be/d0Kq9mckER4 https://youtu.be/d0Kq9mckER4 Merle Mishel: Uncertainty in Illness Theory (1 of 4) • Uncertainty is defined as the “inability to determine the meaning of illness-related events inclusive of inability to assign definite value and/or to accurately predict outcomes” • Second central concept, cognitive schema, defined as a “person’s subjective interpretation of illness-related events”
- 38. Merle Mishel: Uncertainty in Illness Theory (2 of 4) • The revised theory incorporates two new concepts: Self-organization and probabilistic thinking • Uncertainty in illness theory is organized around 3 themes: – Antecedents of uncertainty – Appraisal of uncertainty – Coping with uncertainty Merle Mishel: Uncertainty in Illness Theory (3 of 4) • Person: The concept of the person is the central focus of the theory and may be an individual or the family of ill individual; the individual is viewed as a biopsychosocial being who is an
- 39. open system exchanging energy with the environment • Environment: Not explicitly defined but is acknowledged to exchange energy with the person system Merle Mishel: Uncertainty in Illness Theory (4 of 4) • Health: Defined in terms of uncertainty in the context of the illness experience, with the concept of health or well-being being congruent with the formulation of a new life view and probabilistic thinking • Nursing: Nurses are viewed as a part of the antecedent variable of structure providers The Nurse Theorists V2−Merle Mishel Promo Video
- 40. https://youtu.be/E31I9TgikKM https://youtu.be/E31I9TgikKM Cheryl Tatano Beck: Postpartum Depression Theory (1 of 3) • Two major concepts: Postpartum mood disorders and loss of control • Four stages in the coping process • Postpartum Depression Screening Scale (PDSS) used in screening Cheryl Tatano Beck: Postpartum Depression Theory (2 of 3) • Person: Described in terms of wholeness with biological, sociological, and psychological aspects, with personhood understood in the context of family and community
- 41. • Environment: Viewed broadly in terms of individual factors and external factors Cheryl Tatano Beck: Postpartum Depression Theory (3 of 3) • Health: Not defined explicitly; traditional ideas of physical and mental health with health are viewed as a consequence of women’s responses to the contexts of their lives and environments • Nursing: A caring profession with caring obligations; the nurse accomplishes the goals of health and wholeness through interpersonal interactions Synergy Model for Patient Care (1 of 4) • Framework for designing practice competencies to care for critically ill patients • Goal of optimizing outcomes for patients and
- 42. families • Optimal outcomes realized when the competencies of the nurse match the patient and family needs Synergy Model for Patient Care (2 of 4) • 8 patient characteristics identified are resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability • 8 nurse characteristics are clinical judgment, advocacy, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and facilitation of learning Synergy Model for Patient Care (3 of 4) • Persons: Viewed in the context of patients who are biological, social, and spiritual
- 43. entities who are present at a particular developmental stage • Environment: The concept is not explicitly defined; however, included in the assumptions is the idea that environment is created by the nurses for the care of the patient Synergy Model for Patient Care (4 of 4) • Health: The concept of health is not explicitly defined; an optimal level of wellness as defined by the patient is mentioned as a goal of nursing care • Nursing: The purpose of nursing is to meet the needs of patients and families and to provide safe passage through the healthcare system during a time of crisis
- 44. The Nurse of the Future: Nursing Core Competency Graphic • Illustrates through use of broken lines, the reciprocal and continuous relationship between each competency and nursing knowledge, that the competencies may overlap and are not mutually exclusive, and that all competencies are of equal importance • Nursing knowledge is placed as the core in the graphic to illustrate that nursing knowledge reflects the overarching art and science of professional nursing practice NOF Core Competency Model • Essential knowledge, attitudes, and skills (KAS), reflecting cognitive, affective, and psycho-motor learning domains are specified for each
- 45. competency • The KAS identified in the model reflect the expectations for initial nursing practice following the completion of a pre-licensure professional nursing education program The NOF Core Competencies • Patient-centered care • Professionalism • Leadership • Systems-based practice • Informatics and technology • Communication • Teamwork and collaboration • Safety
- 46. • Quality improvement • Evidence-based practice NOF Core Competency Model (1 of 2) • Human being/patients: Recipient of nursing care or services; may be individuals, families, groups, communities, or populations • Environment: The atmosphere, milieu, or conditions in which one lives, works, or plays • Health: Experience often expressed in terms of wellness and illness, that may occur in the presence or absence of disease or injury NOF Core Competency Model (2 of 2) • Nursing: The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation
- 47. of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations Overview of Selected Non-Nursing Theories • General System Theory (von Bertalanffy) • Social Cognitive Theory (Bandura) • Stress and Coping Process Theory (Lazarus) • General Adaptation Syndrome (Selye) Guide for Selecting a Framework for Theory-Based Practice (1 of 3) • Consider the values and beliefs that you truly hold in nursing • Write a philosophy of nursing that clarifies your beliefs related to person, environment,
- 48. health, and nursing • Survey definitions of person, environment, health, and nursing in nursing models Guide for Selecting a Framework for Theory-Based Practice (2 of 3) • Select 2 or 3 frameworks that best fit with your beliefs related to the concepts of person, environment, health, and nursing • Review the assumptions of the frameworks that you have selected • Make applications of those frameworks in a selected area of nursing practice Guide for Selecting a Framework for Theory-Based Practice (3 of 3) • Compare the frameworks on client focus, nursing action, and client outcome
- 49. • Review the nursing literature written by persons who have used the frameworks • Select a framework and develop its use in your nursing practice