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Nursing Theory

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					知识来源 Source of knowledge
       

Superstition Tradition School learning Authority Trial and Error Media and experience Logical reasoning: deductive and inductive Scientific Methods

学习的层次结构 Hierarchy of Learning
Create Evaluate Analyze Apply Understand Remember

理论研究的层次结构 Level of theoretical discourse
Level World view Frameworks Theories Models Content Implicit assumptions Products Vision Wisdom Knowledge Intelligence

Concepts/principles
Relationship among concepts

Mechanism for relations Taxonomic classification Phenomena

Descriptive generalizations
Observation

Information
Data

New Vision: Earth Rising as seen from the Moon

第一章 护理理论概述
Introduction to Nursing Theory

Faculty of Nursing School of Medicine Xi’an Jiaotong University

第一节 护理理念 Nursing philosophy
一、理念的概念
理念(philosophy), 拉丁文philia(爱)及sophia (智慧),智慧之爱。寻找真理。 “理念是指导个人思维及行为的价值观与信念”。 以原则的形式左右及指引个人的思维方式及行为举 止 协助个人判断是非 决定事物的价值

二、护理理念(nursing philosophy)
是引导护理人员认识及判断护理及其它相关 方面的价值观及信念。(concerned with the values and beliefs of a discipline and provide a guidance for the members of discipline)

为护理人员研究护理学的四个核心概念,人、 健康、环境及护理提供专业理念体系。 (Providing the framework for asking questions about central concept of the discipline)

三、护理理念的发展过程
禁欲主义阶段(asceticism )(1850~1920)
浪漫主义阶段 (romanticism) (1921~1940) 实用主义阶段 (pragmatism) (1940~1960) 人本存在主义(humanistic existentialism) (1960~至今)

四、护理理念与护理理论的关系
不同的护理学家,由于其理论的研究重点不 同,对护理理念的四个要素有不同的认识, 也采用了不同的词来描述这四个基本概念。

社会 环境 人 护理 健康

概念之间的相互关系 护理理论

第二节 护理学的核心概念 Central concepts of nursing 一、定义
Webster: 概念是人们对周围环境中的某种物 体所形成的印象,是人们对客观事物属性及 本质的理性认识。

What is a Concept?
“A thought or a notion conceived in the mind” Two types:
Empirical - observed or experienced through senses
• i.e. stethoscope, cup, chair, etc.

Abstract - not observable
• i.e. self-concept, beliefs, oxygen, etc.

二、分类
(1)根据人们对概念的认识:  抽象概念

 具体概念
(2)根据概念的性质及应用范围:  列举性概念

 关联性概念
 联合性概念  统计性概念  总结性概念

三、概念的形成过程 (concept formation)
思考、科研、系统观察会形成概念。

Concept Formation

A concept as a thought, idea or notion

A concept as an abstract idea generalized from particular instances

Relationship of the Stimulus to the concept Internal Stimulus External Stimulus

Scope
Examples Simple Complex Concrete Abstract

Value in Scientific Inquiry

四、概念与理论的关系
概念的组成部分为理论(Basic ingredients of a theory)

五.护理学的概念(Nursing concepts)
Such as health, caring, interaction, stress, adaptation, growth, grief, illness, needs, etc.

Four Basic Concepts of Nursing
Person Environment

Health
Nursing

Person (description)
Each person is a unique individual viewed in holistic terms. By holistic it meant that the individual is considered a total human being with biopsychosocial needs. Each person has the right to dignity, respect, autonomy and the opportunity to grow and develop to their full potential and to achieve optimal functioning. Each person is seen within a social context.

Person
Human beings-unique individuals, family or friends Bio-psychosocial Functioning-needs, strengths Rights, responsibilities, dignity Culture Developmental, lifespan Adaptable, self-responsible

Health (description)
Health is the multidimensional concept which contains bio-psychosocial elements on a functional continuum. Health is intrinsically related to notions of quality of life, harmony and well-being. Health can be defined objectively and from subjective experience.

Health
Well-being, quality of life

Continuum-health-illness
Equilibrium

Biopsychosocial dimensions
Able to do things one wants Feeling good

Objective and subjective elements

Environment (description)
The enrironment is the major determinant of the health of individuals, families, and communities. It provides the context for nursing practice. The environment can be considered along two dimensions: The physical and socio-cultural environment which includes social values, beliefs and customs and internal/external dimension. The environment is ever changing in the context of time and space.

Environment
Working, family, community, global
Animate and inanimate Time and space

Cultural, customs, rituals
Internal and external

Dynamic, changing

Nursing( Description)
The essence of nursing is caring. Nursing is a practice-based profession involving both art and science, the art is the process in terms of the nurse-client relationship. The science is the knowledge and skills the nurse contributes to nursing practice. The aim of nursing is to promote well-being, prevent illness, maintain and restore health, and to help people attain a peaceful death.

Nursing
Caring for individuals, families, communities Promotion of well-being Peaceful death Technical skills A process Supporting life Practice-based Relationship with patient and others

第三节 护理理论 Nursing Theory
一、有关护理理论的基本概念
1、知识(Knowledge)is an awareness or

perception of reality acquired through learning
or investigation) 通过学习或研究而获得的对

现实世界的认识

2、科学(Science )refers to a body of knowledge, including facts and theories, generated by the use of controlled, rigorous, and precise methods within a delimited area of concern. 通过系统科学的研究而获得的知识 体系(自然、社会、思维三大知识领域)

3、Metaparadiam (学科领域或观点)
Domain is the perspective and the territory of the discipline. It contains the subject matters of a discipline, the main agreed upon values and beliefs, the central concepts the phenomenon of interest, its central problems, and the methods that are used to provide some answers in the discipline.(学科的主要学术价值及观点,主 要问题)

4、Paradigm(科学观)
A paradigm is a conceptual diagram, it can be a
large structure used to organize theory, that are shared by its scientific community.

5、Model (模式)
A model is an idea that explains by using symbolic and physical visualization.(用图示或 符号对概念及其关系的解释)

6、理论(Theory)
An abstract general plan that presents a systematic explanations and relationships among concepts. Theories embody principles for describing, explaining, predicting, and controlling phenomena Ultimate goal of science Make scientific findings meaningful and generalizable

理论是人们对自然界及人类社会现象的规律的
系统性认识。 每个理论都由一个以上的概念及概念之间的相 互关系如并列、相关、因果等关系而组成。

Metaparadigm of Nursing
Components Paradigm Metaparadigm Philosophies Levels of Abstraction Most Abstract

Conceptual Models
Theories Empirical Indicators

Most Concrete

二、理论的分类
用途:基础理论及应用理论; 应用范围:宏观理论及微观理论; 专业性:护理理论、生物学理论、医学理论 等。 功能:描述性、解释性及预测性理论

三.理论的功能
描述
解释

预测客观事物
指导实践。

Characteristics of a Theory
Interrelate concepts to create new way of looking at a particular phenomenon Logical in nature Relatively simple yet generalizable Bases for hypotheses to be tested for theory expansion Contribute to body of knowledge of a discipline Can be used by practitioners to guide and improve practice Must be consistent with other validated theories, laws and principles

第四节 护理理论
一、护理理论的概念
护理理论是对护理现象及本质的规律性系 统性认识。 卡渤(Carper)认为护理的对象是人,护理学 的概念及知识需要从以下四个方面综合来获 取:

1.伦理学知识(ethics) 即对护理学的职业道德 及伦理的规律性认识。 2.美学知识(Esthetics ):即护理艺术或护理行 为方 面的知识。 3.个人知识 (Intuition):即通过个人的直感而获 取服务对象的认识。 4.科学知识(Science):即通过科学实验的方法 所获取的护理学知识。

二、发展背景
1.南丁格尔时代 2.哥伦比亚大学学派时代(二十世纪50 年代) 3.耶鲁大学学派时代二十世纪60年代 4.二十世纪70年代 5.二十世纪80年代到目前

三、发展阶段
1、南丁格尔时代(Nightingale)
2、医学模式阶段(Medical model)

3、借用阶段(borrowed theories)
4、独特理论阶段(Unique theories )

四、护理理论的特征
妥瑞斯(Torres,1990)理论必须具有以下几 个基本的特征: 1.理论能够将概念以特殊的方式联系起来,从 而提供一个全新的观察事物的方法或角度。 2.护理理论必须具有一定的逻辑性。

3.理论必须简单易懂,并容易推广应用。 4.理论可以作为假设的基础而经受检验。

5.通过对理论的实践及研究,能够增加
护理学科的知识。 6.必须对实践有指导作用。 7.必须与其它已证实的理论及规律一致。

五、护理理论的分类
1.按照护理理论的抽象程度及其对实践的指 导意义(scope of the theory),可以将护理理论 分为以下三类:  Grand theory  Middle range theory  Micro theory or partial theory

Grand Theories 宏观理论
 Broadest in Scope  Conceptual structures  Substantively nonspecific  Being made up of relatively abstract concepts that lack

operational definition,
 Not developed by empirical research, but by thoughtful and

insightful appraisal of existing ideas or creative leaps beyond existing knowledge.

Grand Theories
Orem Levine Rogers Johnson Roy Neuman King Roper, Logan,and Tierney

Middle Range Nursing Theories 次宏观理论(中层理论)
Substantively specific; Encompassing a limited number of concepts; Limited aspect of the real world; Derived from works in other disciplines related to nursing; From earlier works in nursing such as philosophies and theories, and from nursing conceptual models and grand theories; Specific to nursing practice and specify the area of practice, age range of the client, the nursing action or intervention, and the proposed outcome

Middle Range Nursing Theories
Peplau Orlando Travelbee Riehl Erickson, Tomlin, & Swain Mercer Barnard Leininger Parse Fitzpatrick Newman Adam Pender

2.按照护理理论的着重点不同,可以将 护理理论分为以下四种类型:  以需要及问题为中心的理论  以护患关系为中心的理论  以系统为中心的理论  以能量源为中心的护理理论

Nursing Theories
Categorized by concepts

Person
Travelbee (1966) - person, family, community for whom illness has a special
meaning

Henderson (1966) - mind and body inseparable, individuals unique, 14 basic
needs

Rogers (1970) - unitary human being viewed as an energy field

Orem (1971) - individual integrated whole with varying degrees of self care ability
King (1971) - individuals have ability to perceive, think, feel, choose, set goals and
make decisions

Benner & Wrubel (1989) - individual is self-interpreting being engaged by
human capacities in the world

Nursing Theories
Categorized by concepts

Environment
Nightingale (1860) - environment is central concept Travelbee (1966) - environment is context in which human rapport
is established

Levine (1967) - society is viewed as the total environment of the
individual, family, and nurse

Roy (1976) - environment constantly interacts with the individual
and impacts adaptation

Newman (1986) - environment and person form a unitary pattern
reflected in movement-space-time patterns of consciousness

Nursing Theories
Categorized by concepts

Health
Hall (1966) - self-actualization, self love Henderson (1966) - independent function Levine (1967) - maintaining holism/conservation Orem (1971) - self-care agency Paterson & Zderad (1976) - authentic awareness Roy (1976) - continual adaptation Newman (1986) - expanding consciousness

Nursing Theories
Categorized by concepts

Nursing
Peplau (1952) - therapeutic interpersonal process Orlando (1961) - process of interaction with and ill
individual to meet an immediate need Wiedenbach (1964) - three components: identified need; ministration of help; validation Levine (1967) - supportive and therapeutic

Watson (1985) - human science and an art based on the
moral ideal and value of caring

六、护理理论在护理实践中的应用
1.护理理论与科研 2.护理理论与护理实践 3.护理理论与护理管理 4.护理理论与教育

Cyclical Nature of Theory, Practice and Research
Practice Research

Theory Concepts

七.issues and trends (问题及趋势)
Why Nursing Theories?

(一)问题(issues)
1.Nursing :art or science?
2. Nursing theory Borrowed or Unique? For Nursing or of nursing? Single or multiple nursing theory?

3.Nursing science: basic or applied?

(二)趋势 (trends)
1. Credibility of theory will be tested by empirical evidence or data (from the outcomes of nursing care)
2. Paths to knowledge development

Scientific methods: inductive or deductive
Nonscientific methods: historical and philosophical methods

3. More theories will be developed, specific to culture

第五节 理论的分析与评价 Analysis and evaluation of nursing theory
一、Analysis(分析) 1. Theorist(Background, especially practice areas) 2. Theory goal 3. Theory scope

4. Theory context

5. Theory content
二、评价( Evaluation)

1. Clarity
2. Internal consistency

3. Logical adequacy
4. Parsimony

5. Testability
6. Empirical adequacy 7. Pragmatic adequacy 8. Generality 9. Significance and usefulness


				
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