Nursing Standards & Nursing Theories Delaune & Ladner Ch 2, Roy Chapter 2 Elements of a Profession Provide service to support social welfare Possess a specialized body of knowledge Educate its practioners in institutions of higher learning Life long commitment Formulates policy and controls its membership Practitioners function autonomously Have a Code of ethics Have a professional organization that contributes and ensures quality of practice The Nursing Profession Nursing is both a profession and a practice discipline. The professional nurse is an occupation that requires extensive education, specialized training and competence. Nursing services are delivered in variety of settings. The amount of autonomy and accountability for decisions differs with the practice setting. Another Definition of Nursing Nursing is concerned with the health and well being of clients/patients. It involves the delivery of services to promote, maintain, and restore health as well as prevent illness. Nursing also coordinates services to improve continuity of care. Nursing Is a Science Science A process of research and inquiry empirical knowledge examination of phenomenon definition and consensus of terms model building theory testing Nursing is not Medicine Uses a similar body of knowledge BIO, psych, chem….. Medicine diagnosis, to cure Nursing diagnosis to facilitate change Nursing holistic wellness focus Nursing is a Science Based on theories Supported by research That defines describes and directs practice A Science Is a Process That: Identifies to categorize and structures in order to understand and manipulate The statements of science are : “true” coherent logically ordered focused on definite areas result in universal statements Two Major Types of Research Quantitative/ empirical Observed and measured Give us numbers, numerical data Relationships revealed in statistics Qualitative/Ethics, Esthetics, Personal knowing Observed and described Give us stories, narrative data Relationships revealed in patterns Knowledge development Combination of scientific and research process Documentation and analysis of cause and effect Result is theories that organize and communicate concepts Theory An idea or set of concepts that describe, organize or explain a phenomenon Describes relationships between significant constructs within the theory Theories Evolve Are tested by research Contain elements of assumption Contain agreed upon definitions Theories Roy, Pg 87, Delaune pg 27 Grand –Give us broad definitions, very abstract, Man, society. Meta theories. Systems, situation producing theory. Middle range. Nursing focus, family dynamics, stress, maternal bounding. Practice – Micro. goal directed, research related to proper tube feeding. Example The biological system called man can be Meta assisted in preventing illness by nurses Grand giving immunizations. Middle range Practice Often Theories Example Require Mathematics Elements of Agreement 0 X 1 = 0 Agreement 0 Not 1 Chemistry The Ph of Water Is 7.0, Not 10.0 Selected Models and Theories Systems theory – operations, biology Maslow Needs theory - motivation Roy adaptation model – nursing Systems Theory Assumption/agreements Relationship exists between the whole and its parts The whole is more than a sum of its parts A system is goal directed An open system changes - evolves Systems have boundaries - open/closed Systems Theory Input raw materials Out put result of process Through put work of the system Feedback loop – message that becomes part of input Systems Theory Input Output Throughput Products Knowledge Process Skills Decisions Analysis Abilities Raw material Feedback Evaluation Internal environment External environment Example GI System, Newborn Child, First Feeding Input - anatomy, food, water. Through put - digestion. Out put - waste, energy, water. Feedback - some food tastes better, digests easier and causes less gas. Input - anatomy, different foods, new enzymes for digestion. Human Needs Theory Maslow Hierarchy Physiological – food, water Safety- clothing, shelter Love, affection,friendship Esteem- self respect Self-Actualization –altruism Maslow: Holistic-dynamic Theory Human needs are organized in hierarchy of prepotency Prepotency- higher needs emerge as lower ones are satisfied Needs do not disappear when the are satisfied, they decrease in priority Can emerge in a different order in different people Nursing Theory Builds Upon and Incorporates Knowledge Form Many of the Other Arts and Science Disciplines Nursing Theory Provides the foundation and definitions for the development of nursing knowledge. The accumulation of nursing knowledge knowledge is based upon a combination of research form Nursing and related human research. Combines research and practice. Nursing Science, Pg. 59 Focused on the problems and concerns of nursing Man- person Bio psycho social spiritual being Biology Psychology Sociology Culture Spirituality Religion Sample Nursing Agreement Man/person A biological system A psychological make up A social being in a community Existing in an environment Is an open system Has an internal drive That experiences a series of developmental changes through a life span Definition of Nursing Science observes, measures, validates Artists observes, interprets based upon obtained knowledge and chooses an approach Nursing A practice discipline that incorporates knowledge and techniques from both science and art. The products of Nursing. care. education. research. Where a nurse practices can effect how the practitioner defines Nursing. Roy Model of Nursing (Roy Pg. 31-37 Delaune pg. 35) Scientific Systems Model Open, complex, holistic, interdependence Adaptation theory Humans adapt to maintain integrity, purposeful Philosophic view Humanistic, goal directed, Nursing provide raw materials to facilitate healthy adaptation Sister Calista Roy A Theoretical System That Analyzes and Prescribes Behavior Related to the Care of Ill or Potentially Ill Roy anchored in Meta theory System theory Wholeness Adaptation Equilibrium Environment Discuss the Relationship of Systems Theory to Roy Model. Based on assumptions of von Bertalanffy’s General Systems Theory Based on assumptions of Helson’s Adaptation-Level theory Humanism Veritivity Veritivity Principle of human nature that affirms a common purposefulness of human existence, activity and reactivity for the common good and value and meaning of life. Goal directed Discuss the Concepts of Adaptation Model. Adaptive: Human system has the capacity to adjust effectively to changes in the environment and affects the environment. Promote survival, growth, reproduction & mastery. System (Human) Set of parts connected to function as a whole for some purpose and through the interdependence of the parts. Input--Through put--Output--Feedback Chronology of Nursing Theory Development Table 2-1 Pg. 28 Theories of Nursing Were Developed Beginning in the 1950’s As an Effort to Separate From Medicine and Describe Nursing Essence. First Definitions Nursing Health Client Environment Some Nursing Facts 1970 Nursing model became synonymous with Nursing theory Nursing theory continues to develop Conceptual Framework Underlying set of ideas: a set of ideas, principles, agreements, or rules that provides the basis or the outline for something that is more fully developed at a later stage A group of related concepts. A model that organizes a group of ideas into a meaningful configuration. Conceptual Framework Con’t Creates a method of deciding if something is relevant to a discipline. Relationships are inferred and constructed through logical associations. More general than a theory. Conceptual Framework: Example Computer Technology Anxiety Fear Change - Conflict Not math fear Not technology fear Relationship, presence of anxiety to decreased function Need for preparation Teaching - Learning Nursing Process & Systems Theory Activities Assessment Input Data collection Data analysis Diagnosis Through diagnostic statements put goals, priorities Planning Perform interventions Implement Output Compare results, revise plan Evaluate Feedback Selected Nursing Theories Box 2 - 1, Page 84 These are the surviving Models and theories that are currently in common use today. They approach the idea of Nursing from different directions so it has an effect on the assumptions, focus and emphasis. There has yet to be a grand theory of Nursing. I leave this challenge to you.