NURSING PHILOSOPHIES.WEEK 3-4 PART 1.pptx

Foundation of Nursing

1. NURSING PHILOSOPHIES

2. Florence Nightingale

3. Florence and the Patient Nightingale believed that caring for the sick was a component of Christianity Cures were not limited to medical acts but also acts of God Patient’s needs should be prioritized according to Maslow’s Hierarchy

4. Florence and the Patient Health Promotion occurred through providing a sanitary environment, adequate nutrition, patient comfort, and conservation of the patient’s energy Considered a client to have the capability to be healthy, however, he/she did not have the power to control their unsanitary environment or poor access to essential nutrients

5. Florence’s Theory and Health Although Florence Nightingale was bedridden, she continued to campaign to improve the heath standards, publishing 200 books, reports and pamphlets. She believed that infection arose spontaneously in dirty and poorly ventilated places Her belief led to improvements in hygiene and healthier living and working environments Florence Nightingale’s vision of health care included professional nursing for the sick and the poor

6. Florence’s Theory and Health One of the first people to examine data on occupational health and safety Systemic approach to health care with a major role for prevention, clean air, clean water, decent housing and good infant care Promoted uniform hospital statistics so that results could be compared by country, institution and type of treatment

7. Florence and the Environment Mother’s responsibility to teach her children cleanliness in mind, body, and spirit This included waste management and tidiness in and around the home Bad smells were to be considered a sign of danger

8. Florence and the Environment In order for healing to occur, all environmental and sanitary conditions must improve Ventilation/ Clean Air and light were considered key factors in hygiene

9. Florence and Nursing Florence Nightingale is the reason why nursing is considered a profession today and recognized that educated nurses would be viewed by the public as professional. First nursing school at St. Thomas Hospital in London She believed that God called her to be a nurse and that He had natural laws that were to be followed

10. Florence and Nursing According to Nightingale, the aim of nursing education was to train women to become nurses in order to serve society for the alleviation of the suffering of the sick, for the amendment of the living conditions of the poor, and for the improvement of the health of the population (Nightingale 1859).

11. The Effect on Nursing Practice Stressed the importance of hygiene and believed that it aided in the prevention of disease spreading Focused on a holistic caring perspective Aseptic practices Nursing is a continuous learning process because new and better practices are always being developed

12. What it is, or what it should be? Maintaining a clean environment within the healthcare setting is essential to prevent nosocomial infections: Gloves and other PPE bed linens Handwashing Keeping a clear path for fire safety

13. What it is, or what it should be? However, not everyone always follows the rules: Carts, etc. obstructing the hallways Not everyone wears gloves when they are supposed to Handwashing Florence Nightingale’s Theory is one that every nurse should strive to achieve by maintaining a healthy environments not only for their patients, but also for themselves.

14. JEAN WATSON

15. “Theory of Transpersonal Nursing ” JEAN WATSON

16. The Major elements of her theory are: A. Carative factors B. Transpersonal caring relationship C. The caring occasion/ caring moment Jean Watson: “Theory of Transpersonal Nursing”

17. Carative means caring with love “caritas”- to cherish, appreciate, and give special attention Jean Watson: “Theory of Transpersonal Nursing”

18. Watson views the “ Carative factors” as guide for the core of nursing. Caring is central to nursing. Caring is more “ healthogenic ” than is curing. Effective caring promotes health and individual or family growth . Jean Watson: “Theory of Transpersonal Nursing”

19. 1. Humanistic-altruistic system of values. 2. The instillation of faith-hope 3. The cultivation of sensitivity to one’s self and to others. 4. Developing helping-trust relationship, caring relationship 5. Expressing positive and negative feelings and emotions 10 carative factors

20. 6. The systematic use of the scientific problem-solving method for decision making. 7. Promotion of interpersonal teaching-learning 8. Provision of a supportive, protective and/or corrective mental, physical, socio-cultural and spiritual environment. 9. Assistance with gratification of human needs. 10. Allowance for existential-phenomenological forces. 10 carative factors

21. “transpersonal”- means to go beyond one’s own ego and the here and now, as it allows one to reach deeper spiritual connections in promoting the patient’s comfort and healing. Transpersonal caring relationship

22. Goal- correspond to protecting, enhancing and preserving the person’s dignity, humanity, wholeness, and inner harmony. Transpersonal caring relationship

23. Nurse + another person= human caring It becomes “transpersonal” when “it allows for the presence of the spirit of both- then the event of the moment expands the limits of openness and has the ability to expand human capabilities” (Watson, 1999) Caring occasion/ caring moment

24. Watson’s theory & the nursing process

25. Personhood(human being) Viewed holistically wherein the body, mind and soul are interrelated; each part a reflection of the whole, yet the whole is greater than and different from the sum of parts. (Watson, 1979,1989) Concepts:

26. Personhood(human being) Human being- valued person The soul fully participates in healing. Concepts:

27. B. Healing space & environment The nurses’ role… A caring attitude is not transmitted from generation to generation. It is transmitted by the culture of the profession as a unique way of coping with its environment. Concepts:

28. B. Healing space & Environment The nurse becomes the environment in which “sacred space” is created Concepts:

29. C. Health, Illness & Disease Health- unity and harmony within the body, mind and soul Concepts:

30. C. Health, Illness & Disease Illness- subjective turmoil or disharmony within a person’s inner self or soul at some level of disharmony within spheres of mind, body & soul. Concepts:

31. C. Health, Illness & Disease Disease- associated with disharmony between the person and the environment or nature Concepts:

32. C. Health, Illness & Disease Within the transpersonal caring relationship and the caring moment, there is healing potential . Concepts:

33. “THE FACT REMAINS THAT WE HOLD ANOTHER’S LIFE IN OUR HANDS.” ( Watson, 2005)

34. PATRICIA BENNER Novice-Expert Model

35. Patricia Benner, RN, PhD, FAAN, FRCN

36. Benner : As Author Dr. Benner is the author of books including: 1.From Novice to Expert The Primacy of Caring Int e r p r e t i v e P hen o m e no l og y: E m bod i m en t, Caring and Ethics in Health and Illness The Crisis of Care P r a ct i c e : C a r i n g, Expertise in Nursing Clinical Judgment, and Ethics Caregiving 7 . C li n i c a l W i s d om a nd I n t e r ve nt i on s i n Critical Care: A Thinking-In-Action Approach.

37. Is an internationally noted researcher and lecturer on health, stress and coping, skill acquisition and ethics. Recently elected an honorary fellow of the Royal College of Nursing. Staff nurse in the areas of medical-surgical, emergency room, coronary care, intensive care units and home care. Currently, her research includes the study of nursing practice in intensive care units and nursing ethics.

38. An Influential Nurse in the Development of the Profession of Nursing P a tri c ia B e n n er’s and theory work t he p r o fe s s i on o f r e se ar c h p ro vi d es nursing w i t h w h a t w e n o w k no w as t he No v i ce t o E xp e r t a lso kn o w n as S t a ge s o f model , B e n n e r ’s Clinical Competence . Benner’s work as applied to the nursing pr o fe s sion is a d a p te d f r o m th e D r e y f us Model of Skill Acquisition .

39. Skill Acquisition “The utility of the concept of skill acquisition lies in helping the teacher understand how to assist the learner in advancing to the next level” (McClure, 2005)

40. T h e D r e yfu s M o d e l o f S k il l Acquisition

41. Dr. Benner categorized nursing into 5 levels of capabilities: novice, advanced beginner, competent, proficient, and expert. She believed experience in the clinical setting is key to nursing because it allows a nurse to continuously expand their knowledge base and to provide holistic, competent care to the patient. Her research was aimed at discovering if there were distinguishable, characteristic differences in the novice ’ s and expert ’ s descriptions of the same clinical incident.

42. N ovi c e The person has no background experience of the situation in which he or she is involved. There is difficulty discerning between relevant and irrelevant aspects of the situation. a r e a o f p r a ct i ce to p r o fess i on o r n u rse ( F r i sc h ,  Beginner c h a ng i n g 2009)  Generally this level applies to nursing students.

43. T h es e i n e x p er i ence d nur s e s f u n c t i o n a t t he l eve l o f i n s truct i o n f r o m nur s in g s c h oo l . T hey are unable to make the leap from the classroom lecture to individual patients. Often, they apply rules learned in nursing school to all patients and are unable to discern individual patient needs. These nurses are usually new graduates, or those nurses who return to the workplace after a long absence and are re- educated in refresher programs. Novice

44. Advanced Beginner  T he ad v a n c e b e g i n n e r st a g e i n t h e D r e y f u s model develops w h e n t h e p e r so n ca n demonstrate marginally acceptable performance having coped with enough real situations to note, or to have pointed out by mentor, the recurring meaningful components of the situation. Nurses functioning at this level are guided by rules and oriented by task completion. Still requires mentor or experienced nurse to assist with defining situations, to set priorities, and to integrate practical knowledge (English, 1993)

45. Competent After two to three years in the same area of nursing the nurse moves into the Competent Stage of skill acquisition. The competent stage is the most pivotal in clinical learning because the learner must begin to recognize patterns and determine which elements of the situation warrant attention and which can be ignored. The competent nurse devises new rules and reasoning procedures for a plan while applying learned rules for action on the basis of the relevant facts of that situation.

46. P r o f ic i e n t After three to five years in the same area of nursing the nurse moves into the Proficient Stage “The nurse possesses a deep understanding of situations as they occur, less conscious planning is necessary, critical thinking and decision-making skills have developed” (Frisch, 2009) T h e p erforme r p e rce i ves th e i nform a t i o n a s a w ho l e (total picture) rather than in terms of aspects and performance. Proficient level is a qualitative leap beyond the competent. Nurses at this level demonstrate a new ability to see changing relevance in a situation including the recognition and the implementation of skilled responses to the situation as is it evolves.

47. E xp e r t This stage occurs after five years or greater in the same area of nursing (experienced nurses changing areas of nursing practice may progress more quickly through the five stages) The expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect her or his understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions. The expert operates from a deep understanding of the total situation.

48. Benner’s Original Research Goal: – Compare Novice & Expert Nurse’s descriptions and responses to the same clinical situations Participants: – – – – 21 nurse preceptors & 21 new graduate nurses 51 experienced nurses 11 newly graduated nurses 5 senior nursing students Collection of Research: – – Interviews with narrative accounts of situations Observation of behaviors in clinical settings (Benner, 1984)

49. Nursing Education Incorporates Benner’ s G oa l : – Theory Identify if simulating unstable patient scenarios by providing interactive teaching will transition nursing students to higher levels of expertise Participants: 190 Adult Health Nursing Students Collection of Research: Observation of students in simulated patient rooms with manikins providing clues to clinical scenarios Conclusion: Development of nursing competency requires practice and clinical simulation provides a safe, structured learning experience (Larew, Lessans, Spunt, Foster, and Covington, 2006)

50. N u r s i n g Ap p li c a t i o n of Benner’ s Theory Nursing applies Benner’s Theory through: Nursing school curriculum Building clinical ladders for nurses ( Frisch, 2009 ) Developing mentorship programs Preceptors for student nurses Mentors for newly graduated nurses (Dracup and Bryan- Brown, 2004) Development of the Clinical Simulation Protocol ( Larew et al., 2006)

51. F ou r D o m a i n s o f N u r s i n g Paradigm Client/Person Health Environment/Situation Nursing

52. C li e n t / Pe r so n “ The person is a self- interpreting being, that is the person does not come into the world predefined but gets defined in the course of living a life. ” - Dr. Benner

53. Hea l t h  Dr. Benner focuses on the lived experience of being healthy and being ill.  Health is defined as what can be assessed, whereas well being is the human experience of health or wholeness.  Well being and being ill are understood as distinct ways of being in the world.

54. Environment/Situation Benner uses situation rather than environment because situation conveys a social environment with social definition . “ To be situated implies that one has a past, present, and future and that all of these aspects … influence the current situation. ” - Dr. Benner

55. Nursing N u r s i n g i s d e sc ri b e d a s a c a r i n g r e l a t i o ns h i p , a n “ e n ab li n g co n d i t i o n o f co n ne ct io n a n d c on c e r n . ” -Dr. Benner “ Caring is primary because caring sets up the possibility of giving and receiving help. ” Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care and responsibility. Dr. Benner understands that nursing practice as the care and study of the lived experience of health, illness, and disease and the relationships among the three elements.

56. KATIE ERIKSSON

57. KATIE ERIKSSON “ Caritative caring means that we take “caritas” into use when caring for the human being in health and suffering… Caritative caring is a manifestation of the love that “just exist”… Caring communion, true caring, occurs when the one caring in a spirit of caritas alleviates the suffering of the patient.” Born in Nov. 18, 1943 in Jakobstad , Finland A graduate in Helsinki Swedish School of Nursing in 1965 - Established Department of Caring Science Abo Akademi University in 1987which developed the MA in health and the caring science didactic education program.

58. In 1987, eriksson with hers staff and researchers, has further developed the Caritative Theory of Caring and Caring Science as an academic didcipline . Presented her theory at the 14 th IAHC conference in Melbourne, Australia in 1992. and became clearer in 1997. In 2003, she was honored nationally as a Knight, First Class, of the White Rose in Finland.

59. MAJOR CONCEPTS AND DEFINITION CARITAS – means love and charity . - by nature is unconditional love . - fundamental motive of Caring Science. - from the ideas of caritas, Eriksson derived her whole caritative caring theory. CARING COMMUNION – constitutes the meaning of caring and the structure that determines reality. - characterized by intensity and vitality and by warmth, closeness, rest, respect, honesty and tolerance. - requires meeting in time and space, an absolute lasting presence. - joining in communion means creating possibilities for the other.

60. THE ACT OF CARING – is the art of making something very special out of something less special. CARITATIVE CARING ETHICS – comprises the ethics of caring, the core of which is determined by the caritas motive. - Ethical Caring is what we actually make explicit through our approach and the things we do for the patient in practice.

61. DIGNITY – A human being’s absolute dignity involves the right to be confirmed as a unique human being. INVITATION – refers to the act that occurs when the carer welcomes the patient to the caring communion.

62. SUFFERING – is an ontological concept described as a human being’s struggle between good and evil in the state of becoming. - Suffering related to illness is experienced in connection with illness and treatment. - Suffering related to care is when the patient is exposed to suffering caused by care or absence of caring. - Suffering related to life is when you are being in a situation of being a patient the entire life of a human being may be experienced as suffering related to life. THE SUFFERING HUMAN BEING – is the concept that Eriksson uses to describe a patient.

63. RECONCILIATION – refers to the drama of suffering. - having achieved reconciliation implies living with imperfection with regard to oneself and others but seeing a way forward and a meaning in one’s suffering. CARING CULTURE – is the concept that Eriksson uses instead of environment. - It characterizes the total caring reality and is based on cultural elements such as traditions , rituals, and basic values.

64. MAJOR ASSUMPTIONS Axioms - fundamental truths in relation to the conception of the world. Theses - are fundamental statements concerning the general nature of caring science and their validity is tested through basic research.

65. Axioms The human being is fundamentally an entity of the body, soul and spirit. The human being is fundamentally a religious being. The human being is fundamentally holy. Human dignity means accepting the human obligation of serving with love, of existing for the sake of others. Communion is the basis for all humanity. Human beings are fundamentally interrelated to an abstract and/or concrete other in a communion.

66. Caring is something human by nature, a call to serve in love. Suffering is an inseparable part of life, suffering and health are each others prerequisite. Health is more than the absence of illness. Health implies wholeness and holiness. The human being lives in a reality that is characterize by mystery, infinity and eternity .

67. Theses Ethos confers ultimate meaning on the caring context. The basic motive of caring is the caritas motive. The basic category of caring is suffering. Caring communion forms the context of meaning of caring and derives its origin from the ethos of love, responsibility, and sacrifice namely caritative ethics.

68. Health means a movement in becoming, being, and doing while striving for wholeness and holiness which is compatible with endurable suffering. Caring implies alleviation of suffering in charity, love, faith, and hope. Natural basic caring is expressed through tending, playing, and learning in a sustained caring relationship, which is asymmetrical in nature.