THE_NATURE_OF_NURSING_THEORY_TFN_NEW_LECTURE6.pptx

nature of nursing

1. THE NATURE OF NURSING THEORY

2. I. NURSING THEORY The word ‘theory’ in general as defined by nursing leaders mentioned the following important concepts. In order to understand an event or phenomenon this requires theory to provide an explanation, description, prediction or prescription of such phenomenon.

3. DEFINITIONS OF THEORY ACCORDING TO SCHOLARS NURSING SCHOLAR/THEORIST DEFINITION OF THEORY Streubert-Spezeale & Carpenter A systematic explanation of an event in which constructs and concepts are identified and relationships are proposed and predictions Chinn & Kramer A creative and rigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena Kerlinger A set of interrelated concepts, definitions, and propositions that present a systematic way of viewing facts/ events by specifying relations among the variables, with the purpose of explaining and predicting the fact or event

4. DEFINITIONS OF THEORY ACCORDING TO SCHOLARS Abdellah A general principle, an explanation of a phenomenon or an abstract generalization that systematically explains the relationship among given phenomena, for purposes of explaining, predicting and controlling such phenomenon

5. NURSING THEORY The key ideas of these definitions are interrelationship of concepts, propositions and purposes of explaining or predicting facts or events. These definitions state that theory suggests direction on how to view facts and events Nursing theory presents some aspect of reality communicated for the purpose of describing nursing

6. NURSING THEORY phenomena, explaining relationships between phenomena, predicting consequences, or prescribing nursing care In sum, theories answers specific questions. Hence, frameworks and models provide direction for research projects. Conceptual framework explains the background or historical basis of the concepts or variable

7. NURSING THEORY u sed in the study and provide a critical perspective of how the problem evolved and how the study will proceed. Theoretical framework presents theory or derivable theories relevant to the study. These theories explains the relationship of concepts or variables of the study and the reasons why the problem exist.

8. NURSING THEORY Theoretical framework help justify or support the need to conduct further investigation for clarity of purpose. Theoretical and conceptual frameworks evolved from theories and research literature and can be used interchangeably. Both are important in research but either one suffice its use for a research study.

9. NURSING THEORY There are six types of nursing theory definitions: Structure . Theory presents its form and style using shapes and arrows indicating flow of directions, interactions, and interrelationship of concepts accompanied by textual explanations Practice goals . Theory should explain what it intends to accomplish or achieve Tentativeness . Theory is never absolute. It is open to change through hypothesis testing

10. NURSING THEORY Research . Theory supports the inquiry of a phenomenon to arrive at accepting, rejecting or refining existing theory Creativity in practice theory and research . Change is always the goal of knowledge to explore and expand the phenomenon through research and theory for inductive and deductive learning process Progression from conceptual framework to theory . A theory is geared to wards generalization of knowledge that can explain casual relationship of phenomenon.

11. NURSING THEORY Nursing theory should have context , content , and process . Context is the environment in which n ursing action takes place Content is the subject matter of theory Process is the method in which the nurse uses in applying then theory The nurse acts on, with, or through the content elements of the theory

12. NURSING THEORY AND ITS USES Nursing theory makes research findings meaningful and credible. Nursing theory is necessary for nurses to make valid, safe and accurate decisions an to demonstrate it’s unique contributions to nursing care. While a thorough body of practical knowledge is indispensable, nursing theory is, still essential. Theory helps avoid a random approach to client care and guides the nurse in making pertinent observations, analysing deviations from normal, and planning nursing care activities. There are three areas where nursing theory can have an impact. Such as in clinical practice, education and research.

13. NURSING THEORY AND ITS USES In Clinical Practice - In clinical practice, theory assists nurses to describe, explain and predict everyday experiences. Theory also provides several ways of making nurses perform their tasks with ease and care such as the following: Guides in assessing, planning, implementing and evaluating nursing care Provides a rationale for collecting reliable and valid data about the health status of clients, which are essential to effective decision making and implementation Establishes criteria to measure the quality of nursing care

14. NURSING THEORY AND ITS USES Builds a common nursing terminology to use in communicating with other health professionals Enhances autonomy of nursing by defining its own independent functions Guides nurses in making accurate clinical decisions for safe and effective care. - Nursing theories are sources of nursing knowledge that form the basis of nursing practice. The nursing process theory is a problem-solving approach used by nurses in many different practice settings. Its specific steps include assessment, diagnosis, planning, implementation and evaluation, which are particularly helpful to nurses.

15. NURSING THEORY AND ITS USES Take the scenarios below: Client : post-appendectomy; pressing the button calling for the nurse repeatedly Nurse A : Responds without theory : Exasperated, angry, disgusted, tired, bored, avoidant, and felt helpless. This response may lead to the nurse’s likelihood of committing error or complaining, scolding, or avoiding such patients. Nurse B : Responds with theory: Recognizes patient’s inability to maintain an image of the nurse when they cannot see him or her caring about them, unaware of the nurse caring attitude and unable to maintain a helping

16. NURSING THEORY AND ITS USES relationship about them, hence, the nurse being aware of the patient’s feelings of insecurity in hospital settings, consciously plan theoretically-based nursing care interventions for patients. Outcome : Bothe the nurse and the patient responds harmoniously, negotiates and arranges plan of care safely and accurately to the satisfaction of both, the nurse and the patient .

17. NURSING THEORY AND ITS USES In Education - In nursing education, theory integrates an eclectic body of knowledge such that, theory: Provides a general focus for curriculum design, planning, implementation and evaluation Guides curricular decision making Directs related learning experiences (RLE) of students; Clarifies issues and trends in nursing education; and

18. NURSING THEORY AND ITS USES Promotes effective teaching – learning situations for students to appreciate what was learned in terms of knowledge, skills and right professional values. In Research - In research, theory offers a framework for generating knowledge and new ideas such that, theory: Assists in discovering knowledge gaps in the specific field of study Offers a systematic approach to identify research questions for study, select

19. NURSING THEORY AND ITS USES variables, interpret findings and validate nursing interventions Shows the relevance of theory to inform the ongoing development of nursing knowledge and continue to the improvement of nursing practice. Clinical practice informed by theory gives nurses the necessary foundation to enlighten and restructure health care decisions and improve quality of care at all practice levels

20. NURSING KNOWLEDGE Theories generate knowledge which enriches nursing practice Knowledge is the “accurate representation of perceived world of a discipline.” It is the kind of knowing that can be shared or communicated with others.

21. TYPES OF KNOWLEDGE Knowledge is typically categorized in several ways. Theory-based vs. Practice-based Knowledge - There are at least two ways nurses will acquire knowledge. a. Theory-based knowledge . This is acquired from the study of theories and acquisition of other information pertinent to nursing through readings and journal reflections b. Practice-based knowledge . This is acquired from nursing practice and other world of related learning experiences as nurses go through their day patient care activities

22. TYPES OF KNOWLEDGE A Priori vs. A Posterior Knowledge A priori knowledge . This type of knowledge is independent of experience, for example, “All spinsters are un married.” This is knowledge that is known not of experience but prior to experience. This may also come from an assumed knowledge derived from literature. A posteriori knowledge . This is dependent on experience alone or empirical evidence, for example, :Some spinsters are very happy.” This knowledge may be proven through experience.

23. TYPES OF KNOWLEDGE Research-Based or Factual vs. Inferential Knowledge Factual knowledge . This is based on direct observation. It is still not free of uncertainty, as errors of observation or interpretation may occur, requires repeated observations and hypothesis testing to prove its validity and reliability. Inferential knowledge . This is based on reasoning from facts to theory or from theory to facts. Such knowledge may be processed through inductive or deductive technique and may not be verifiable by observation or testing. For example, all knowledge of the cell is inferential knowledge.

24. TYPES OF KNOWLEDGE Explicit vs. Tacit Knowledge Explicit knowledge : This can be articulated into formal language, including grammatical statements such as words and numbers, mathematical expressions, specifications, manuals, among others. Explicit knowledge can be readily transmitted to others Tacit knowledge : This is a form of personal knowledge derived from individual experiences and involves intangible factors, such as personal beliefs, perspective and value system. Tacit knowledge is hard to articulate with formal language which may be difficult but not impossible. It contains subjective insights, intuitions and hunches.

25. TYPES OF KNOWLEDGE Personal, Procedural and Propositional Knowledge Personal knowledge or knowledge by acquaintance . This is knowledge derived from reading books, journals and other materials, or researching using factual data Procedural knowledge or knowledge how to do something . This knowledge refer to steps of doing procedures like driving, inserting a catheter, giving of injections, among others Propositional knowledge or knowledge of facts . This knowledge of established facts proven through research or actual observations like the rotation

26. TYPES OF KNOWLEDGE of the earth around the sun, early ambulation of post- operarive patient resulting to fast healing and recovery

27. STAGES OF NURSING DEVELOPMENT The development of Nursing Theory

28. STAGES OF NURSING DEVELOPMENT STAGE SOURCE OF KNOWLEDGE IMPACT ON THEORY AND RESEARCH Silent knowledge Blind obedience to medical authority Little attempt to develop theory Research was limited to collection of epidemiologic data for disease causation Received knowledge Learning through listening to others Theories were borrowed from other disciplines As nurses acquire graduate degrees, they relied on the authority of educators, sociologists, psychologists, physiologists and anthropologists to provide answers to nursing problems Research was primarily educational research or sociological research

29. STAGES OF NURSING DEVELOPMENT STAGE SOURCE OF KNOWLEDGE IMPACT ON THEORY AND RESEARCH Subjective knowledge Authority was internalized and a new sense of self emerged A negative attitude toward borrowed theories and science emerged Nurse scholars focused on defining nursing and on developing theories about and for nursing Nursing research focused on the nurse rather than on clients and clinical situations Procedural knowledge Includes both separate and interrelated knowledge Proliferation of approaches to theory development. Application of theory in practice was frequently underemphasized Emphasis was placed on the procedure used

30. STAGES OF NURSING DEVELOPMENT STAGE SOURCE OF KNOWLEDGE IMPACT ON THEORY AND RESEARCH to acquire knowledge, with over attention to the appropriateness of methodology, the criteria for evolution, and statistical procedures for data analysis Constructed Knowledge Integration of different types of knowledge (intuition, reason, and self-knowledge) Nursing theory should be based on prior empirical studies, theoretical literature, client reports of clinical experiences and feelings It also include the nurse scholar’s intuition or related knowledge about the phenomenon of concern

31. STRUCTURE OF THEORY DEVELOPMENT Theory development or theory building is a process that primarily follows logical reasoning involving induction, deduction and retroduction . Induction . This process moves from specific to general reasoning. Particular events are observed and analyzed as basis for formulating general theoretical statements often called “grounded theory” or research-to-theory approach - Example: > Premise: Mara, Clara and Juday are senior staff nurses > Conclusion: All senior staff nurses are competent

32. STRUCTURE OF THEORY DEVELOPMENT Deduction. This process moves from general to specific reasoning. It establishes truth by theoretical derivation having two or more relational statements used to explain a phenomenon. Abstract theoretical relationships are used to derive specific empirical hypothesis; theory-to-research approach - Example: > Premise: All senior staff nurses are competent > Conclusion: Michelle and Michael are competent

33. STRUCTURE OF THEORY DEVELOPMENT Retroduction . This combines both induction and deduction. The origin of idea which does not establish truth but suggest lines of thought worthy of exploration and testing - Proposition: The role of care and comfort determines relation between nurse and patient which establishes an influence of the nurse caring attitude to patient

34. THREE TYPES OF KNOWLEDGE REQUIRED FOR NURSING PRACTICE Knowledge of Order . This is knowledge to describe and explain the relationship of physical, biological, and social objects and events. This knowledge of order can be easily discovered and understood, such as the use of nursing process Knowledge of Disorder . This is knowledge to provide information to understand the events that pose a threat to well-being or survival of the individual or society, or which are deemed undesirable for sole other reasons. This is represented by awareness of events and disorders such as diseases, wars, earthquakes, among others, which threaten the well being or survival of people and society

35. THREE TYPES OF KNOWLEDGE REQUIRED FOR NURSING PRACTICE 3. Knowledge of Control . This is knowledge to facilitate a prescriptive course of action, which when implemented, changes the sequence of events in a preferred way and toward desired outcomes. Knowledge learned enables one to prescribe interventions that will ensure preferred client outcome such as to stop smoking to prevent lung cancer and hand washing to prevent infection

36. BARBARA CARPER’S FOUR PATTERNS OF NURSING KNOWLEDGE Empirics . This nursing knowledge describes, explains, and predicts the phenomenon specific to nursing, which can be organized by laws or theories. For the practicing nurse, empirical knowledge must always be interpreted within the contest of specific clinical situations. Aesthetics . This kind of nursing knowledge pertains to art of using empathy and creativity in designing and providing efficient nursing care Personal Knowledge . This refers to knowing oneself, accepting others and engaging in the process becoming a better person

37. BARBARA CARPER’S FOUR PATTERNS OF NURSING KNOWLEDGE Ethics . This refers to the moral component of human conduct and focuses on obligations, the moral codes, and responsibilities. Ethical knowing is knowledge of what is right or wrong and the commitment to act on the basis of correct knowledge

38. SCHULTZ AND MELEIS THREE TYPES OF NURSING PRACTICE KNOWLDEGE

39. SCHULTZ AND MELEIS THREE TYPES OF NURSING PRACTICE KNOWLDEGE

40. FOUR MAJOR STRATEGIES FOR THEORY DEVELOPMENT Theory-Practice-Theory Approach - Using this approach, the nurse can modify concepts and introduce new concepts that were not proposed in the original theory, but to accomplish these, the nurse would need to have: Basic knowledge of other theories and a working knowledge of the present theory to be modified, including its components, assumptions, concepts and propositions Redefine assumptions, concepts and hypotheses to reflect nursing care activities Reconstruct the theory using examples representing the refined concepts, assumptions and hypotheses

41. FOUR MAJOR STRATEGIES FOR THEORY DEVELOPMENT Research- Theory Approach - The researcher selects a phenomenon of interest to nursing and lists characteristics or variables surrounding such phenomenon. Then adopt a theory to explain such phenomenon. Theory-Research Approach - In this approach, the theorist will begin by defining a theory and determining hypotheses for testing. If carried through, the research findings may be used to further modify the existing theory or develop an original theory. Practice-Theory Approach - This is based on the premise that in a given situation, existing theories ar not useful in describing the phenomenon of interest, a theory is developed thereafter to explain the nursing situation being observed or talked about.

42. II. METAPARADIGM OF NURSING The components of nursing are described in a metaparadigm Metaparadigm is a global perspective of a discipline that identifies the primary phenomenon that are of interest to nursing profession and explains how nursing practice deals with those phenomenon in a unique manner It assists in the articulation and refinement of the nursing phenomenon being explored Nursing’s metaparadigm directs the activity of the nursing profession

43. METAPARADIGM OF NURSING Nursing theories describe the relationships among the concepts of interest to the profession There are four concepts important to nursing activities such as person, health , environment or situation and nursing . However, each theorist may define the concepts and the relationships among the concepts in very different ways differences will become evident when the various nursing theories are discussed Other nursing theorists, however, explains that the following are the important domains in nursing. To name a fe theorists, they are:

44. DOMAINS OF NURSING KNOWLEDGE THEORIST DOMAINS OF NURSING KNOWLEDGE Meleis Nursing client, transitions, interaction, nursing process, environment, nursing therapeutics and health Parse Self-care adaptation, interpersonal relations, goal attainment, caring, energy fields, human becoming and others Cody Respect for human dignity, uniqueness of each client

45. METAPARADIGM OF NURSING HAS FOUR MAJOR CONCEPTS Nursing - Theorists discuss nursing as a science, art and practice discipline. They identify the goals of nursing which include caring of the well and the sick, assisting with self-care activities, helping individuals attain their human potential and discovering the laws of health Person - This refers to the recipient of care and may be an individual, family group, or community. The term patient or client or client is frequently used to designate the person. This concept is viewe as being central to the profession and may be considered as the most important. The person varies from one nursing situation to another, requiring the nurse to be versatile, knowledgeable, and adept at critical thinking

46. METAPARADIGM OF NURSING HAS FOUR MAJOR CONCEPTS Health - This is the goal of nursing, the return to health or maintenance of health. The American Nurses Association (ANA. 1980) defines health as a “dynamic state of being in which the developmental and behavioural potential of an individual is realized to the fullest extent possible.” Thus, health can change drastically throughout life and may vary from day today. It is more than and different from the absence of disease and may labelled as diseases. A person may be diagnosed with a disease but may be considered healthy.

47. METAPARADIGM OF NURSING HAS FOUR MAJOR CONCEPTS Environment - This refers to all the conditions and circumstances affecting the person and is the setting in which nursing care activities occur. The environment surround each individual, and there is constant interaction between the person and the environment . This concept was first emphasized by Florence Nightingale and it is receiving renewed interest today. It is essential for the nurse to consider the ramification of environmental factors on health

48. III. CATEGORIES OF NURSING THEORIES Although theories address relatively specific and concrte phenomena they vary in scope. Scope refers to the relative level and specific substance of a theory and the concreteness of its concepts and propositions

49. CATEGORIES OF NURSING THEORIES Grand Theory - They are systematic constructs of the nature of nursing, the mission of nursing, and the goals of nursing care. Grand theories are complex in nature and are constructed from synthesis of experiences, observations, insights, and research findings. They reflect the broadest of scope and provide relationships between a large number of abstract concepts. They are incapable of empirical testing and lack direction for specific nursing interventions. Early theorization in nursing are considered grand theories

50. CATEGORIES OF NURSING THEORIES - Examples of Grand theories are: > Roger’s theory of “Unitary Human Beings Energy Field” > Dorothy Orem’s “Self Care Deficit Theory of Nursing” among others Middle-range Theory - They are more limited in scope, less abstraction, address specific phenomenon or concepts, and reflect the essence of nursing practice such as administrative, clinical or teaching. The phenomenon or concepts tend to cross different nursing fields and reflect a wide variety of nursing care situations.

51. CATEGORIES OF NURSING THEORIES Middle range theories lend themselves to empirical testing because the concepts are more specific and can be readily operationalized - Middle-range theory addresses more concrete and more narrowly defined phenomenon intended to answer questions about nursing situations, yet they do not cover the full range of the phenomenon of concern to the nursing discipline. It provides perspective from which to view complex situations and direction for nursing interventions

52. CATEGORIES OF NURSING THEORIES - Examples of middle range theories are: > Leininger’s “Culture Care Diversity and Universality” > Pender’s “Health Promotion Model” > Peplau’s “Theory of Interpersonal Relations” among others Micro-range They or Practice Theory - The theory that is most concrete and most narrow in scope. It explains a specific phenomenon of concern to nursing and provide concrete data to justify the basis of the theory - Examples of practice theory are: > Nightingale’s “Environmental Theory,” > Abdellah”s “Patient- Centered Approach to Nursing” among others

53. CATEGORIES OF NURSING THEORIES Partial Theory - It is a theory which is still in the development stage. Its concepts and some relationships between them have been identified but the theory is not complete. The phenomenon have been totally studied and completely explained. Hence, further research of the phenomenon is necessary. - Examples oft hese theories are grief, social support, quality of life and community empowerment

54. CATEGORIES ACCORDING TO LEVELS Factor-isolating theories - These are theories that describe, observe and name concepts, properties and dimensions. They identify and describe the major concepts of a phenomenon but do not explain how or why the concepts are related. They are also known as descriptive theories . They are generated and tested by descriptive research as case studies and surveys. - Factor-isolating theory or descriptive theory is the lowest level of theory construction but also the most basic. Nursing diagnosis is an example of this theory. Each level of theory construction presupposes that the lower level has been

55. CATEGORIES ACCORDING TO LEVELS d eveloped. Not all theories would describe and name a theory unless a relationship between the concepts are shown Factor –relating theories - These theories that relate concepts to one another. It describes the interrelationships among concepts. They are also known as ‘ explanatory theories ’ - Examples are pain and comfort, environment and health and illness continuum

56. CATEGORIES ACCORDING TO LEVELS Situation-relating theories - These are theories which are achieved when situations show relationships of concepts, and these relationships of concepts consistently describe future outcomes. They move to predict precise relationships between concepts. They are generated and tested by experimental research to establish causal relationship and effect. - Situation-relating theory explains the interrelationships and interconnectedness among concepts or propositions. Once such explanations been formulated, predictive statements or hypothesis may be deduced. The hypothesis may produce causation or correlation. For example, Mercer’s model of maternal role attainment (1985). The model was developed through a

57. CATEGORIES ACCORDING TO LEVELS longitudinal study using both quantitative and qualitative data on three groups of new mother to determine the extent of their mothering capability. They are also called as Correlational theories Situation-producing theories - They are theories that prescribe activities necessary to reach defined goals. They are also known as predictive theories . In nursing discipline, they address nursing therapeutics and consequences of interventions. Situation-producing theory provides prescriptions, the consequences, the type of client and conditions in a given period

58. CATEGORIES ACCORDING TO EMPHASIS While the middle range theories remain, he conceptual models and grand theories were categorized based on: Human need theories Interactive Theories Unitary Process Theories

59. CATEGORIES OF MIDDLE RANGE THEORIES HUMAN NEEDS THEORIES INTERACTIVE THEORIES UNITARY PROCESS THEORIES Abdellah Henderson Johnson Nightingale Neuman Orem Erikson, Tomline & Swain King Levine Roper, Logan & Tierney Roy Watson Newman Parse Rogers

60. SIGNIFICANCE OF NURSING THEORIES The significance of a theory is criticized or evaluated based on its clarity, simplicity, generality, empirical precision and derivable consequences. Clarity - The words and meanings used in the theory are clearly identified and structured. The meanings are concrete, practical and easily understood. The interrelationship of concepts are marked and tested well through hypothesis. Simplicity - A theory provides the greatest sense of understanding. Words used are simple and meaningful to every cases or situations.

61. SIGNIFICANCE OF NURSING THEORIES Generality - The applicability of the theory is not limited and too narrow that it can be used as source of knowledge. The broader the theory the better is its applications in various fields of nursing practice. Empirical Precision - This refers to the testability and ultimate use of theory in nursing practice to the extent that the defined concepts are grounded in observable reality.

62. SIGNIFICANCE OF NURSING THEORIES Empirical Derivability - Theory must guide nurses in their professional endeavour in order for theory to be sensible and useful. Knowledge derived from theory must help explain the occurrence of a nursing phenomenon. But for theory description, analysis and evaluation of middle range and practice theories.

63. RELATIONSHIP BETWEEN THEORY DESCRIPTION, ANALYSIS AND EVALUATION THEORY DESCRIPTION THEORY ANALYSIS THEORY EVALUATION Purpose of theory, scope or level of theory Origins of theory, major concepts, major theoretical propositions, major assumptions, context of theory Theoretical and operational definition of concepts and statements Explicit linkages, logical organization of theory, model/diagram Consistent use of concepts, statements, and assumptions, predicted outcomes or consequences Congruence of theory with current nursing standards, interventions of therapeutics Empirical testing of theory, research-based, accurate, valid Used by nursing educators, researchers, administrators Social relevance, cross-cultural relevance, contribution to the nursing discipline, implications for nursing related to the implementation of the theory

64. CATEGORY ACCORDING TO CHRONOLOGY AND THEMES 1859-prior to 1950 Environmental view of nursing Nursing as an art Curriculum era 1950’s Biomedical model Problem & needs of patients Functional roles of nurses Nursing as a science Research era 1960’s Relationship between nurse & patient Nursing as a process Conservation principles of nursing Nursing theory defined

65. CATEGORY ACCORDING TO CHRONOLOGY AND THEMES 1960’s Goals for theory development Modern definition of Nursing Graduate education era 1970’s Theoretical basis of nursing Clinical nursing Newman’s Total person approach to patient problems Betty Neuman Health-Care Systems Model Roy’s Adaptation Model Humanistic Nursing Newman’s Theory development in nursing Watson’s philosophy & science of caring

66. CATEGORY ACCORDING TO CHRONOLOGY AND THEMES 1980’s Johnson’s Behavioral System Model Leininger’s concept of caring, transcultural care diversity & Universality Parse’s Man-living-health Erickson’s modelling and role modelling Theory era 1990’s Revision and evolution of theories