Chapter 3 Framework of Practice The Theoretical Foundation of Nursing Nursing theory provides the theoretical foundation of the profession.

Theory defines what nursing is, what it does, and the goals or outcomes of nursing care. Nursing is the synthesis of many theories. Components of the Theoretical Foundation A theory is a set of concepts and propositions that provides an orderly way to view phenomena. Concepts and propositions are the structural elements of a theoretical foundation. Concepts Building blocks of a theory Labels or names for phenomena/observable facts Assist us in formulating a mental image about an object or situation Concepts Theories are formed by linking concepts together. A conceptual framework links global concepts together. Conceptual Model The symbolic representation of empiric experience in words, pictorial, or graphic diagram, mathematical notations or physical material. Propositions A proposition is a statement that proposes a relationship between concepts. Propositional statements in a theory represent the theorists view of which concepts fit together. Theories A theory helps us to organize our thoughts and ideas.

In science, the purpose of a theory is to guide research, support existing knowledge, or generate new knowledge. The term theory is not restricted to the scientific world. Importance of Nursing Theories Framework for thought in which to examine situations Structure for organization, analysis, and decision making Structure for communicating with other nurses and other health team members Importance of Nursing Theories Assist the nursing discipline in clarifying beliefs, values, and goals. Help to define the unique contribution of nursing in the care of clients. Standards of clinical practice are developed out of nursing theories. Process of Knowledge Development Scope of Theories Grand Theories Middle-Range Theories Grand Theory Provides an overall framework for structuring broad, abstract ideas. Composed of concepts representing global and extremely complex phenomena. Middle-Range Theory Provides a perspective from which to view complex situations and a direction for interventions in three levels of abstractness. High middle-range Middle middle-range Low middle-range

Florence Nightingales Influence on Knowledge Development in Nursing Described nursing as both an art and a science. Stressed the importance of caring for the ill person rather than the illness.

Viewed a persons health as the direct result of environmental influences (cleanliness, light, pure air, pure water, efficient drainage). Florence Nightingales Influence on Knowledge Development in Nursing The turn of the 20th century marked the beginning of hospital-based schools of nursing. Nightingales principles were incorporated into modern nursing theory. The Evolution of Nursing Theory Since the early 1950s, many nursing theories have been systematically developed to help describe, explain, and predict the phenomena of concern to nursing. Knowledge Development in Nursing Paradigm A particular viewpoint or perspective A worldview about the phenomena of concern in a discipline (Kuhn, 1970)

Metaparadigm The major concepts in a discipline that names the phenomena of concern

Knowledge Development in Nursing Metaparadigm of Nursing Person: Individual, family or group Health: Continuum of wellness to terminal illness Environment: Place or community where care is provided Nursing: Actions; interactions of the nurse with the person Knowledge Development in Nursing

Two individuals with different paradigmatic views can look at the same phenomenon and view the phenomenon differently.

Knowledge Development in Nursing The prevailing paradigm in a discipline represents the dominant view of particular concepts. A paradigm revolution is the turmoil and conflict that occur in a discipline when a competing paradigm gains acceptance over the dominant paradigm. Knowledge Development in Nursing A paradigm shift refers to the acceptance of the competing paradigm over the prevailing paradigm or a shifting away from one worldview toward another worldview. Members of a discipline cannot subscribe to two competing paradigms at the same time. Knowledge Development in Nursing Four Levels of Knowing Empirical Aesthetic Personal Ethical

Early Nursing Theorists Hildegard Peplau Defined concepts of stages of nurse-client relationships.

Virginia Henderson Defined basic human needs as the unique focus of nursing practice. Maslows Hierarchy of Needs

Early Nursing Theorists Faye Abdellah Identified 21 nursing problems that became the foundation of nursing diagnoses.

Joyce Travelbee, Josephine Paterson and Loretta Zderad

Emphasized the humanistic and existential basis of nursing practice to understanding the uniqueness of patients.

Contemporary Nursing Theorists The work of contemporary theorists form the theoretical basis for many interventions in current nursing practice. Myra Levine Dorothea Orem Sister Callista Roy

Contemporary Nursing Theorists Myra Levines Conservation Theory (1969) Four universal principles of conservation designed to apply concepts of nursing practice in different environments

Dorothea Orem Self-Care Deficit Theory of Nursing Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing Systems

Roy Adaptation Model Developed by Sister Callista Roy, 1976. Combined general systems theory with adaptation theory. Goal of nursing is promotion of adaptation in each of four modes of adaptation. Applicable to the home setting. Roy Adaptation Model The goal of nursing is the promotion of adaptation in each of four adaptive modes. Physiologic Self-concept Role function

Interdependence

Theories for the New Worldview of Nursing Describe, explain, and predict the phenomena of concern to nursing from a more holistic perspective. Jean Watson Martha Rogers Rosemarie Parse

The Theory of Human Caring Developed by Jean Watson in the 1980s. Conceptualizes human-to-human transactions that occur daily in nursing practice. Ten carative factors are classified as nursing actions or caring processes. The Science of Unitary Human Beings Developed by Martha Rogers in 1990. The person is characterized as a human energy field that unites all aspects of the person into a unified whole. Nursing aims to repattern the rhythm and organization of these energy fields to heighten the integrity of the person.

Gordons Functional Health Patterns Influenced by Maslows Hierarchy of Basic Human Needs and Von Bartlaffnys general systems theory. Offer a holistic approach to the development of nursing diagnoses and client care. Provides an appropriate method for organization of textbook topics. Continuing Evolution of Nursing Theory Nursing is always in a state of change. Nursing knowledge continues to expand in a multiplicity of ways.

New theories will come from a global perspective and international nursing leaders in the 21st century.